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PubMed1985

Epidemiology of phobic and obsessive-compulsive disorders among adults.

Phobic and obsessive-compulsive disorders have long been believed to be infrequent in the general population and among persons in treatment. The most recent large-scale multicentered epidemiological study sponsored by NIMH shows startingly different results. Obsessive-compulsive disorders have a life prevalence of 1.9 to 3 percent and a six-month prevalence rate of 1.3 to 2 percent, rates admittedly low but higher than previously thought. Phobic disorders, however, have a life prevalence rate of 7.8 to 23.3 percent and a prevalence rate of 5.4 to 13.4 percent, placing them as the first leading diagnosis. This article also reviews what is known about risk factors and associated pathology.

Cross-Sectional Studies↗
PubMed1986

On the diagnosis of obsessive-compulsive disorder.

This article deals with the diagnostic criteria of obsessive-compulsive neurosis. Attention is given to the diagnostic problems related to patients presenting with symptoms similar to those that accompany obsessive-compulsive neurosis.

Anxiety Disorders↗
PubMed1997

Short-term psychoanalytic psychotherapy with obsessive preadolescents.

The phenomenological and psychodynamic differences between obsessive preadolescents and obsessive adults are pointed out. Case material shows how an effective therapeutic alliance on psychoanalytic lines can be established quite early with preadolescents. The therapy can be shortened mainly by opening up sexual subjects connected with the onset of puberty, and by working through the guilt engendered by the ambivalent relations this age group has with its parents.

Adolescent↗
PubMed2003

Behavioral avoidance test for childhood obsessive-compulsive disorder: a home-based observation.

Obsessive-compulsive disorder (OCD) is one of the most debilitating of the anxiety disorders. As our knowledge about this childhood condition continues to grow, there is a need for controlled treatment-outcome trials with precise assessments that are sensitive to treatment change, to guide the development of effective interventions. To evaluate the efficacy of a treatment protocol, it is necessary to have reliable and sensitive measures of OCD symptoms, including measures of obsessions, compulsions, and related levels of distress and avoidance. Whilst structured diagnostic interviews, semistructured clinical interviews, and self-report measures have been widely used in the assessment of childhood OCD, related levels of behavioral distress and avoidance have not been measured in treatment-outcome trials. This study investigated the sensitivity of a behavioral avoidance test (BAT), conducted in the home environment, in assessing treatment-outcome effects for children and adolescents with OCD following a 14-week cognitive-behavioral therapy (CBT) family intervention, in comparison to children in an 8-week "waitlist" control group. The results of the current study strongly support the sensitivity of a standardized BAT in assessing treatment-related changes in children and adolescents with OCD. Implications and future directions for research are discussed.

Adolescent↗
PubMed1989

Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive-compulsive disorder.

This article is intended to elucidate some of the neuropathogenetic mechanisms possibly operative in obsessive-compulsive disorder (OCD). Relevant literature is reviewed, with attention to psychologic, and pathologic considerations. Anatomy, neurochemistry, and known functional associations with neuropathological and behavioral abnormalities of implicated brain regions are discussed. The authors propose that dysfunction of neuronal circuits interconnecting the orbitofrontal cortex, basal ganglia/limbic striatum, and thalamus serves a critical role in the pathogenesis of OCD and that obsessive-compulsive symptoms occur when an aberrant positive feedback loop develops in the reciprocally excitatory frontothalamic neuronal interchange, which is inadequately integrated or inhibited by the ventromedial (limbic) portions of the striatum; the ventromedial striatum may serve to modulate activity in the frontothalamic circuit through a negative feedback loop.

Antidepressive Agents, Tricyclic↗
PubMed2003

The frontal lobe neuropsychological tests in patients with schizophrenia and/or obsessive-compulsive disorder.

This study compared the performances of matched schizophrenia patients with or without obsessive-compulsive (OC) symptoms, patients with obsessive-compulsive disorder (OCD), and control subjects on selected frontal lobe tests. Schizophrenic patients without OC were the most impaired; and OCD patients were the least, while schizophrenic patients with OC scored between these two groups.

Adult↗
PubMed2004

A possible association of recurrent streptococcal infections and acute onset of obsessive-compulsive disorder.

Rheumatic fever is an immunologically mediated disease that follows infection by group A beta-hemolytic Streptococcus (GABHS). In rheumatic fever, antibodies generated against GABHS cross-react with the heart, joints, skin, and other sites, inducing an inflammatory, multisystem disease. Brain tissue-specific antibodies have been demonstrated in a subset of children with Sydenham chorea (a component of the Jones criteria for the diagnosis of rheumatic fever), and most Sydenham chorea patients manifest obsessive-compulsive symptoms very similar to those in traditional obsessive-compulsive disorder. The parallels drawn from the paradigm of Sydenham's chorea to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is an area of active controversy. Newly emerging information on the role of GABHS superantigens in the pathogenesis of rheumatic fever is of particular interest. In this article, we review the microbial characteristics of GABHS and the subsequent immune responses to GABHS as a possible etiology of PANDAS.

Antibodies, Monoclonal↗
PubMed2004

Volumetric investigation of the frontal-subcortical circuitry in patients with obsessive-compulsive disorder.

The pathophysiology of obsessive-compulsive disorder (OCD) is thought to involve disturbance of the frontal-subcortical circuitry. To investigate the morphological characteristics of this circuitry, we examined the volume of the orbitofrontal cortex, anterior cingulate, thalamus, caudate, and the putamen in 36 age- and sex-matched OCD patients and normal control subjects using three-dimensional magnetic resonance (MR) brain imaging. The left orbitofrontal volumes were found to be significantly smaller in the OCD patients and showed significant negative correlations with obsessive-compulsive symptom severity. These findings suggest that a structural abnormality of this brain region is implicated in the pathophysiology of OCD.

Adult↗
PubMed1990

Brain-mapping abnormalities in a family with three obsessive compulsive children.

Brain electrical activity mapping (BEAM) and personality disorder assessment (Millon Clinical Multiaxial Inventory-II) were performed on a married couple and their four children. Three of the children had previously been identified as having obsessive compulsive disorder (OCD). Temporal lobe abnormalities were found in all four children but in neither parent. If there is a neurophysiologic basis for this subtype of OCD, brain electrical abnormalities may be necessary, but not sufficient, to produce the clinical syndrome. Delineation of specific electrophysiological and personality characteristics may help define subtypes of obsessive compulsive disorder.

Adult↗
PubMed1992

Open trial of intravenous clomipramine in five treatment-refractory patients with obsessive-compulsive disorder.

In a preliminary trial, five oral-clomipramine-refractory patients with obsessive-compulsive disorder (OCD) were treated openly with 14 intravenous clomipramine infusions each. Using standardized assessments, three patients were rated as much improved, one as unchanged, and one as minimally improved. Statistically significant improvements were noted on both the Yale-Brown Obsessive Compulsive Scale and the NIMH Global OCD scores. No patient discontinued treatment because of side effects. Although the results are provocative in that three of five patients were much improved at the end of the protocol, conclusions about preferential efficacy for the intravenous route must await a placebo-controlled trial.

Administration, Oral↗
PubMed1995

Increased cerebral blood flow during m-CPP exacerbation of obsessive-compulsive disorder.

The partial serotonin agonist m-chlorophenyl-piperazine (m-CPP) has been reported to increase obsessive-compulsive symptoms in some patients with obsessive-compulsive disorder (OCD). The authors investigated the underlying physiological mechanisms of this variable exacerbation by imaging regional cerebral blood flow with the planar xenon-133 method after administration of oral m-CPP (0.5 mg/kg). Seven patients who responded to m-CPP with symptomatic exacerbation had a marked increase in global cortical perfusion (18.1%), in contrast to the remaining 7 nonresponders to m-CPP, who showed no change. These results suggest that m-CPP exacerbation of OCD symptoms is associated with increased cortical blood flow.

Administration, Oral↗
PubMed1996

Anatomy and function of the orbital frontal cortex, I: anatomy, neurocircuitry; and obsessive-compulsive disorder.

Many neuroimaging studies have implicated the orbital frontal cortex (OFC) in the pathophysiology of obsessive-compulsive disorder. In recent years there have been significant advances in elucidating the anatomical characteristics of the OFC in nonhuman primates. The authors review literature on the cytoarchitecture and afferent and efferent connections of the OFC, giving particular attention to the OFC's relationship to limbic and paralimbic regions, the mediodorsal thalamus, the basal ganglia, and sensory association cortices. These cytoarchitectural divisions and connections are discussed in terms of how they may influence thinking about the OFC's contribution to obsessive-compulsive disorder.

Amygdala↗
PubMed1997

Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning.

Positron emission tomography was employed to contrast the brain activation pattern in patients with obsessive-compulsive disorder (OCD) to that of matched control subjects while they performed an implicit learning task. Although patients and control subjects evidenced comparable learning, imaging data from control subjects indicated bilateral inferior striatal activation, whereas OCD patients did not activate right or left inferior striatum and instead showed bilateral medial temporal activation. The findings further implicate corticostriatal dysfunction in obsessive-compulsive disorder. Furthermore, when OCD patients are confronted with stimuli that call for recruitment of corticostriatal systems, they instead appear to access brain regions normally associated with explicit (conscious) information processing.

Adult↗
PubMed1999

Quality-of-life changes among patients with obsessive-compulsive disorder in a partial hospitalization program.

Thirty treatment-resistant patients with a primary DSA-IV diagnosis of obsessive-compulsive disorder were assessed at admission to and discharge from a partial hospitalization program to determine whether improvement in symptoms of the disorder was associated with improvements in patients' quality of life. Symptom severity was measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS). Quality of life was measured using Lehman's Quality of Life (QOL) scale, which includes several objective and subjective indexes. YBOCS scores significantly improved with treatment, as did scores on the majority of the QOL subjective indexes and on the objective social, health, and activity indexes. No significant association between changes in YBOCS scores and QOL scores was found.

Adult↗
PubMed1988

Social adjustment in obsessive compulsive disorder.

The Social Adjustment Scale-Self Report was administered to 32 subjects with Obsessive Compulsive Disorder and age-sex matched controls. The patients had global impairment, especially during leisure, which correlated with severity of the disorder. The improvement of this impairment with therapy is highlighted. It is stressed that social adjustment in Obsessive Compulsive Disorder subjects should be considered during their therapy.

Adult↗
PubMed1988

Life events and onset of obsessive compulsive disorder.

Life events were evaluated for a period of one year prior to onset of obsessive compulsive disorder in 32 subjects with a maximum duration of illness of two years and compared with a matched healthy volunteer group. There was a significant excess of life events in the six months prior to the onset of the illness. Undesirable, uncontrolled life events in the area of health and bereavement occurred more commonly in obsessive compulsive disorder.

Adult↗
PubMed2002

Home-based cognitive-behavioral treatment of chronic, refractory obsessive-compulsive disorder can be effective. Single case analysis of four patients.

Four patients with obsessive-compulsive disorder (OCD) were referred for home-based cognitive-behavioral therapy. All patients had failed extensive trials of behavioral and cognitive therapy and pharmacotherapy in a variety of settings (e.g., outpatient, inpatient, and day program) and were generally considered chronic and refractory to treatment. Generalization from treatment sites to natural settings in which they lived did not occur. They were evaluated at baseline, after treatment, and at an 18-month follow-up using the Yale-Brown Obsessive Compulsive Scale. Conducting end-state functioning and reliable change assessment according to the methods specified by Jacobson and Truax, the authors found that 3 patients achieved clinically significant gains after treatment and 2 patients maintained those gains at the 18-month follow-up. Data suggested better overall adjustment for 3 of the patients at follow-up. This study demonstrates the effectiveness of home-based cognitive-behavioral therapy for chronic, refractory OCD; implications for further, controlled trials are discussed.

Adult↗
PubMed1989

Clinical social work and obsessive compulsive disorder. A single-subject investigation.

Clinical research on the purely obsessional patient is considerably less developed than that for compulsive ritualizers or obsessive compulsives with mixed features. A single case investigation of exposure therapy in the treatment of obsessive ruminations is presented. Treatment involved exposing the patient to a variety of stimuli related to obsessional thoughts including reading, writing, and listening to such content. The patient's immediate response to treatment was favorable, with improvements being maintained at two-year follow-up.

Behavior Therapy↗