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PubMed1988

Paradoxical intention and anti-exposure in a non-compliant, obsessive-compulsive ritualiser.

A woman with persistent obsessive-compulsive rituals showed limited improvement with exposure therapy, because of her refusal to comply fully with treatment and a lack of homework practice. She was negativistic towards therapists. Following a relapse, she was asked to try anti-exposure and to increase rituals. Paradoxically, this led to marked self exposure to the feared situation, and self-imposed response prevention, with resultant improvement, whereas anti-exposure instructions are generally anti-therapeutic in obsessive-compulsive disorder.

Adult↗
PubMed1989

A follow-up of adolescents with obsessive-compulsive disorder.

Twenty-six patients seen at a regional adolescent psychiatry unit between 1974 and 1979 with a discharge diagnosis of obsessive-compulsive disorder were followed up after an average of ten years. Of 24 subjects traced, outcome information was obtained from 20. At the point of follow-up, ten patients remained psychiatrically ill, six having persisting obsessive-compulsive symptoms. Poor outcome was associated with a family history of psychiatric illness and lack of response to therapy at initial contact. All patients who were asymptomatic at discharge had remained well.

Adolescent↗
PubMed1989

Obsessive-compulsive disorder in a mentally retarded woman.

Obsessive-compulsive disorder is extremely rare among mentally retarded people. We report here a case of a mildly mentally retarded woman who exhibits contamination obsessions, compulsive hand-washing rituals, and avoidance.

Behavior Therapy↗
PubMed1990

A comparative study of family-based and patient-based behavioural management in obsessive-compulsive disorder.

Thirty obsessive-compulsive patients were randomly allocated to two treatment conditions. In group A a significant family member was trained to act as cotherapist at home, whereas in group B, only the patient was seen and given home assignments. All 30 patients received a similar treatment regime of systematic desensitisation, exposure, and response prevention. The family-based approach resulted in greater improvement in anxiety, depression, obsessive symptoms, and in social adjustment in occupational and household responsibilities. The personality pattern of the family members also appeared to influence outcome.

Adolescent↗
PubMed1990

Unwanted erections in obsessive-compulsive disorder.

The presentation of inappropriate penile erections calls for great caution in making a diagnosis. Two patients who had unwanted erections also had obsessive-compulsive disorder--a previously unreported association. Obsessive-compulsive disorder is not inconsistent with unwanted erections and should be considered in assessment.

Adult↗
PubMed1994

Functional anatomy of obsessive-compulsive phenomena.

Regional cerebral blood flow was measured with H2 15O positron emission tomography in four patients with obsessive-compulsive disorder. Patients were scanned on 12 occasions in the same session, with each scan paired with brief exposure to one of a hierarchy of contaminants that elicited increasingly intense urges to ritualise. The relationship between symptom intensity and regional cerebral blood flow (rCBF; an index of neural activity) was subsequently examined in the group and in individual patients. The group showed significant positive correlations between symptom intensity and blood flow in the right inferior frontal gyrus, caudate nucleus, putamen, globus pallidus and thalamus, and the left hippocampus and posterior cingulate gyrus. Negative correlations were evident in the right superior prefrontal cortex, and the temporoparietal junction, particularly on the right side. The pattern in single subjects was broadly similar, although individual differences in neural response were also observed. A graded relationship between symptom intensity and regional brain activity can thus be identified in obsessive-compulsive disorder. It is hypothesised that the increases in rCBF in the orbitofrontal cortex, neostriatum, global pallidus and thalamus were related to urges to perform compulsive movements, while those in the hippocampus and posterior cingulate cortex corresponded to the anxiety that accompanied them.

Adult↗
PubMed1995

[18F]FDG PET study in obsessive-compulsive disorder. A clinical/metabolic correlation study after treatment.

BACKGROUND: We used [18F]FDG and PET in patients with obsessive-compulsive disorder (OCD) to evaluate cerebral metabolic involvement before and after treatment with serotonin-specific reuptake inhibitors. METHOD: In 11 untreated, drug-free adults, regional cerebral metabolic rate for glucose (rCMRglu) was compared with that of 15 age-matched normal controls. RESULTS: rCMRglu values were significantly increased in the cingulate cortex, thalamus and pallidum/putamen complex. After treatment a significant improvement in obsessive-compulsive symptoms on the Y-BOC scale (t = 3.59, P < 0.01) was associated with a significant bilateral decrease of metabolism in the whole cingulate cortex (P < 0.001). Clinical and metabolic data were significantly intercorrelated (Kendall's tau = 0.65; P < 0.01). CONCLUSIONS: These findings indicate that OCD is associated with functional hyperactivity of a selected neuronal network and that treatment to reduce symptoms may have a selective neuromodulatory effect on cingulate cortex.

Adolescent↗
PubMed1995

Neuropsychological slowness in obsessive-compulsive patients. Is it confined to tests involving the fronto-subcortical systems?

BACKGROUND: Although it is acknowledged that obsessive-compulsive (OC) patients may be slower than healthy controls in performing neuropsychological tests, speed has usually been treated as a confounding variable. It is possible, however, that the slower performance of OC patients is itself the result of a dysfunction of specific neural circuits (in particular of fronto-subcortical systems). METHOD: A neuropsychological battery including tests sensitive to fronto- and temporo-subcortical dysfunction was administered to a group of OC patients and a group of healthy controls. Each test provided independent indices of accuracy and speed. RESULTS: OC patients were significantly slower than controls only when performing tasks involving the fronto-subcortical systems, whereas they did not differ from controls with respect to accuracy indices. CONCLUSION: It may be that neuropsychological slowness of OC patients is not merely an epiphenomenon of meticulous concern for correct test execution or intrusion of obsessive thoughts, but reflects the dysfunction of fronto-subcortical systems.

Adolescent↗
PubMed1996

Obsessive-compulsive disorder, tattooing and bizarre sexual practices.

BACKGROUND: A case is presented describing an association between obsessive-compulsive disorder, tattooing and unusual sexual practices. METHOD: A single case report. CONCLUSIONS: Tattooing and unusual sexual practices are compulsive behaviours associated with the subject's obsessive-compulsive disorder. Such associations have not previously been described in the literature.

Adult↗
PubMed1997

Controlled trial of exposure and response prevention in obsessive-compulsive disorder.

BACKGROUND: Exposure and response prevention is considered a treatment of choice for obsessive-compulsive disorder (OCD). Yet there have been very few randomised controlled trials employing credible placebo conditions. This study compares exposure and response prevention with a general anxiety management intervention. METHOD: Eighteen patients meeting DSM-IV criteria for OCD were randomly assigned to either exposure and response prevention or anxiety management. Both treatments involved approximately 15 hours of therapy over a three-week period. RESULTS: There was a significant reduction in obsessive-compulsive symptoms following treatment with exposure and response prevention, while no change occurred in the control group. This was found to be statistically significant using a composite measure of OCD symptom severity, patient ratings of interference and therapist ratings of symptom severity. CONCLUSIONS: These findings suggest that the symptom reductions associated with behaviour therapy for OCD are a result of the specific techniques of exposure and response prevention, rather than non-specific aspects of the therapy process. General anxiety management techniques are not effective in the treatment of OCD.

Adult↗
PubMed1998

Home self-assessment of obsessive-compulsive disorder. Use of a manual and a computer-conducted telephone interview: two UK-US studies.

BACKGROUND: Two studies tested whether subjects with obsessive-compulsive disorder could successfully use BT STEPS, a computer-aided system, to perform self-assessment for self-treatment of obsessive-compulsive disorder by exposure and ritual prevention. METHOD: Subjects were given a self-guiding manual and could use a touch-tone telephone to access computer-controlled Interactive Voice Response interviews at their convenience from home. Using the BT STEPS system, patients rated themselves and worked out a plan for individually tailored self-exposure therapy. RESULTS: Outcomes were similar in the two studies. Of the 63 subjects who used BT STEPS, 84% completed the self-assessment module. Most calls were made outside usual office hours. As expected, subjects did not improve merely by completing self-assessment. However, completion of self-assessment predicted later improvement with self-exposure therapy. CONCLUSIONS: Most subjects successfully completed self-assessment using BT STEPS from their homes. DECLARATION OF INTEREST: BT STEPS is a trademark of Pfizer, Inc. I.M.M., L.B. and J.H.G. have a financial interest in BT STEPS.

Adult↗
PubMed2000

Obsessive-compulsive disorder and delusions revisited.

BACKGROUND: The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive-compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management. AIMS: To present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD. METHOD: The cases of five subjects with delusions in the course of obsessive-compulsive disorder are presented to illustrate 'delusional' OCD. The management and outcome of these cases are discussed. RESULTS: Fixity and bizarreness of beliefs in OCD occur on a continuum from 'none' to 'delusional intensity' and may fluctuate within subjects. CONCLUSIONS: The idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriate behavioural and/or pharmacological strategies used in OCD.

Adolescent↗
PubMed2000

Personality disorders and normal personality dimensions in obsessive-compulsive disorder.

BACKGROUND: Little is known about personality disorders and normal personality dimensions in relatives of patients with obsessive-compulsive disorder (OCD). AIMS: To determine whether specific personality characteristics are part of a familial spectrum of OCD. METHOD: Clinicians evaluated personality disorders in 72 OCD case and 72 control probands and 198 case and 207 control first-degree relatives. The selfcompleted Revised NEO Personality Inventory was used for assessment of normal personality dimensions. The prevalence of personality disorders and scores on normal personality dimensions were compared between case and control probands and between case and control relatives. RESULTS: Case probands and case relatives had a high prevalence of obsessive-compulsive personality disorder (OCPD) and high neuroticism scores. Neuroticism was associated with OCPD in case but not control relatives. CONCLUSIONS: Neuroticism and OCPD may share a common familial aetiology with OCD.

Adult↗
PubMed2005

Incidence of anti-brain antibodies in children with obsessive-compulsive disorder.

BACKGROUND: Obsessions and compulsions may occur in the post-streptococcal disorders Sydenham's chorea and paediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). The proposed mediators are anti-basal ganglia antibodies (ABGA). AIMS: We tested the hypothesis that post-streptococcal autoimmunity may have a role in'idiopathic'obsessive-compulsive disorder (OCD). METHOD: We examined 50 children with OCD for ABGA using enzyme-linked immunosorbent assay (ELISA) and western immunoblotting. The findings were compared with paediatric autoimmune (n=50), neurological (n=100) and streptococcal (n=40) controls. RESULTS: The mean ABGA binding on ABGA binding on ELISA was elevated in the patient cohort compared with all control groups (P<0.005 in all comparisons). Western immunoblotting revealed positive antibody binding (as seen in Sydenham's chorea) in 42% of the patient cohort compared with 2-10% of control groups (P<0.001 in all comparisons). CONCLUSIONS: Our findings support the hypothesis that central nervous system autoimmunity may have a role in a significant subgroup of cases of OCD. Further study is required to examine whether the antibodies concerned are pathogenic.

Adolescent↗
PubMed2001

Pharmacological treatment of childhood obsessive-compulsive disorder: from theory to practice.

Discusses pharmacological treatment of childhood obsessive-compulsive disorder (OCD), chronic and underrecognized psychiatric condition that affects up to 2% to 3% of children and adolescents. Research in OCD in children, including neuropharmacology, brain imaging, genetics, and clinical phenomenology, informs current views of OCD pathophysiology. Contemporary research supports the notion of a dysregulation in serotonin subsystems in the central nervous system, with target areas of dysfunction including basal ganglia and orbitofrontal cortex. Pharmacotherapy, along with cognitive-behavioral approaches, constitutes the indicated treatment for childhood OCD. Pharmacological treatment is best guided by a phenomenological understanding of the type of obsessions and compulsions, the intensity and frequency of their presentation with attention to behavioral reinforcements, and psychosocial factors that affect the course of the disease. Serotonin-enhancing agents, such as fluoxetine, fluvoxamine, paroxetine, and sertraline and citalopram (SSRIs) are first-line pharmacological agents, whereas refractory symptoms can be treated by augmentation with neuroleptics or other agents. Clomipramine is as effective as the SSRIs but its use may be accompanied by increased side effects. Genetic factors probably influence susceptibility to OCD as well as response to treatment, and the elucidation of these and other risk factors will be important elements in the future understanding and treatment of this disorder.

Antipsychotic Agents↗
PubMed2006

Peer victimization in children with obsessive-compulsive disorder: relations with symptoms of psychopathology.

This study examined the frequency of peer victimization and psychological symptom correlates among youth with obsessive-compulsive disorder (OCD). The Schwartz Peer Victimization Scale, Children's Depression Inventory, and Asher Loneliness Scale were administered to 52 children and adolescents diagnosed with OCD. The child's parent or guardian completed the Child Behavior Checklist, and a trained clinician administered the Children's Yale-Brown Obsessive-Compulsive Scale (CY- BOCS). Fifty-two healthy controls and 52 children with Type 1 diabetes (T1D) who were administered the Schwartz Peer Victimization Scale as part of another study were included for comparison purposes. Greater rates of peer victimization were reported in youth with OCD relative to healthy controls and children with Type 1 diabetes (T1D). Peer victimization in the OCD sample was positively related to loneliness, child-reported depression, parent-reported internalizing and externalizing symptoms, and clinician-rated OCD severity. Peer victimization fully mediated the relation between OCD severity and both depression and parent reports of child externalizing behaviors and partially mediated the relation between OCD severity and loneliness. Recognition of the magnitude of the problem and contribution problematic peer relations may play in comorbid psychological conditions is important for clinicians who see children with OCD.

Adolescent↗
PubMed1991

An open-label trial of fluoxetine for obsessive-compulsive disorder in Gilles de la Tourette's syndrome.

Obsessive-compulsive disorder (OCD) occurs commonly in association with Gilles de la Tourette's syndrome (GTS) and can be a major source of disability. Fluoxetine, a new antidepressant, has been effective for psychiatric patients with OCD. We conducted an open-label trial of fluoxetine (20 to 40 mg/d) for 32 GTS patients with OCD. After 1 week of treatment, six patients (16%) withdrew from the trial due to perceived lack of benefit. Data were analyzed for 26 patients (13 children and 13 adults) who were treated by a neurologist for 3 to 8 months. Following treatment, there was a significant reduction in scores on the Leyton Obsessional Inventory for both the adult and child groups, and 81% of patients reported a subjective improvement in obsessions and compulsions. Since fluoxetine was well tolerated, our findings indicate that the drug may be an effective agent for the treatment of OCD in GTS patients.

Adolescent↗