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PubMed1995

Personality disorders and psychiatric symptoms in psoriasis.

Two groups of psoriatic outpatients (ns = 192 and 119) were given, respectively, the Million Clinical Multiaxial Inventory-II and Foulds' Delusions-Symptoms-States Inventory. They were compared with dental (n = 192) and with general surgical (n = 190) patients. The psoriatic group presented clearly higher mean scores and frequencies on most of the personality disorder scales. On Foulds' inventory, psoriatic patients showed higher frequencies of neurotic and psychotic class allocations. A cluster analysis of personality scores provided evidence for 4 different personality clusters of patients with psoriasis: (a) Avoidant, Dependent, Schizoid, and Self-defeating (32.2%), (b) Compulsive, Narcissistic, and Aggressive (30.7%), (c) no personality disorder (18.2%), (d) Borderline, Paranoid, and Schizotypal, etc. (18.8%).

Adolescent↗
PubMed1995

Obsessive-compulsive disorder in children and adolescents. A 6-22 year follow-up study of social outcome.

Twenty-eight adult males and 19 females with childhood obsessive-compulsive disorder (OCD) were followed-up in young adulthood, six to 22 years after their first referral, and their social outcome was described. The overall, social outcome was illustrated with The Global Assessment Scale (GAS). Ten patients (21.2%) had a poor outcome with GAS-scores under 50; 19 patients (40.4%) had a GAS-score between 50 and 70; and 18 (38.3%) of the patients had a good prognosis with GAS-scores over 70. Childhood OCD-patients were more socially isolated in adulthood than a non-OCD psychiatric comparison group and an age and sex standardised group from the normal population: more still lived with their parents, and fewer had partnerships. Seventeen percent had been granted disability pension, which was significantly different from the normal population, but not from that of the psychiatric comparison group. Age of onset of OCD, social background factors, and symptomatology in childhood did not seem to predict the social outcome. OCD at follow-up was strongly associated with a poor outcome.

Activities of Daily Living↗
PubMed2006

[Functional neuroimaging in psychotherapy research].

Only recently has functional neuroimaging been used increasingly in the context of psychotherapy research. Based on a literature survey, procedures, methodological underpinnings and paradigms relevant for psychotherapy research are explored regarding functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Current studies on changes of brain functions and potential mechanisms are presented based on obsessive-compulsive disorders, depression, phobia, panic and borderline personality disorders. Findings and implications are discussed regarding the use of functional neuroimaging in psychotherapy research. Systematic changes of brain activation were demonstrated following successful psychotherapy, partially resembling and partially differing from those induced by psychopharmacological treatments. Thus the traditional split between pharmacological procedures "acting on the brain" and psychological procedures making the patient "feel better" has been rendered obsolete. Procedures of functional neuroimaging have been developed to such an extent that they can be used to study issues of great relevance for psychotherapy, e. g. biological underpinnings of psychiatric disorders, plasticity of neural networks, mechanisms of change and prognostic factors of psychotherapy, etc.

Biomedical Research↗
PubMed1996

AIDS-related obsessive compulsive disorder: deconditioning based on fluoxetine-induced inhibition of anxiety.

Abel's (1993) review of treatments for obsessive compulsive disorder (OCD) indicated that both behavioral treatment (exposure with response prevention, and biological treatment (specific serotonin reuptake inhibiting drugs) are effective. It was recognized that having both available for patients is preferable because there would be situations where one treatment is more appropriate than the other. One indication for using drugs would be where situational constraints do not allow for effective exposure treatment. We present a case study of a microbiology technician with AIDS-related OCD who had an excellent response to the administration of fluoxetine without relapse when the drug was discontinued.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD.

Predictors of improvement in obsessive-compulsive symptoms (Y-BOCS) in a randomized clinical trial with adult obsessive-compulsive disorder outpatients were examined. Results of multiple regression analyses revealed that a positive helping alliance was significantly predictive of posttreatment Y-BOCS. Treatment expectancy and high motivation to change were not significantly related to posttreatment outcome. None of the predictors were significantly related to Y-BOCS levels at 12-month follow-up, but positive alliance showed a trend to significance.

Adult↗
PubMed2007

Evaluation of exposure with response-prevention for obsessive compulsive disorder in childhood and adolescence.

The present study was undertaken to estimate the effect of exposure plus response-prevention (E/RP), delivered alone intensively over 5-weeks and without concomitant pharmacotherapy, for children and adolescents with OCD. Twenty children and adolescents with OCD, not receiving medication for this condition, were randomized to E/RP or a wait-list condition. Statistically and clinically significant symptomatic improvement was found in the E/RP group compared with controls, with improvement maintained at follow-up an average of 14 weeks later. Effect size in the main intention-to-treat analysis was 1.23 and in the secondary per protocol analysis was 1.64. This study lends further support to the view that E/RP is an effective treatment for childhood OCD.

Adolescent↗
PubMed2001

On becoming neutral: effects of experimental neutralizing reconsidered.

Behaviour Research and Therapy 34 (1996) 889-898 found that writing out a negative thought produced anxiety and an urge to neutralize the thought, that instructing participants to neutralize the thought reduced anxiety/neutralization urge in the short run (i.e. within 2 min), but that in the control group 20 min without instruction was attended by the same reduction in anxiety/urge to neutralize ("natural decay"). The observations were made with pariticipants who scored high on "thought action fusion" and the experiment was set up as exerimental model of obsessions. We repeated the study with participants that were not selected on thought action fusion. All the findings reported by Behaviour Research and Therapy 34 (1996) 889-898 were replicated. Correlational analysis indicated that the strength of the effect was not related to scores on scales measuring "thought action fusion". Behaviour Research and Therapy 34 (1996) 889-898 did not assess whether non-neutralizing was followed by immediate reductions in distress. We did assess this and found that the larger part of the immediate reduction of distress after neutralization also occurs when no neutralization instruction is given. The effects of neutralization instructions in the present type of experiment are considerably less powerful than suggested earlier.

Adolescent↗
PubMed1997

Characteristics of obsessive-compulsive symptoms in Tourette's syndrome, obsessive-compulsive disorder, and Parkinson's disease.

A high incidence of obsessions and compulsions is documented in basal ganglia disorders, especially in patients with Tourette's syndrome (TS). A comparison of patients with obsessive-compulsive disorder (OCD), TS, and Parkinson's disease (PD) revealed significantly higher total scores in both OCD and TS patients than in a healthy control group on the Maudsley obsessive-compulsive inventory (MOCI) and the Hamburg obsessive-compulsive inventory (HZI-K), two self-report measures of obsessive-compulsive symptoms. On most subscales (especially Checking, Ordering, and Counting/touching), TS patients scored higher than controls. Patients with Parkinson's disease merely scored higher on the subscale 'Ordering' of the HZI-K. Differences between OCD patients and TS patients were evident on the MOCI subscales 'Checking' and 'Slowness/Repetition' as well as on the MOCI total score and on the HZI subscales 'Cleaning' and 'Obsessive Thoughts'. On these scales, TS patients reported fewer symptoms than OCD patients. Stepwise discriminant analysis with preselected single items as variables was used to look for specific symptom patterns of OCD and TS. Seventy-eight percent of the patients could be correctly classified with respect to their diagnoses on the basis of only two items of the HZI-K. One item asks for fearful obsessive thoughts, which was found in 90% of the OCD patients; the second item represented echo phenomena, found in 56% of the TS patients. It is concluded that considering specific patterns of obsessive-compulsive psychopathology may contribute to a more reliable differential diagnosis in OCD and TS and help to avoid misdiagnosis of OCD in TS patients.

Adult↗
PubMedDate not supplied

Implicit and explicit memory in obsessive-compulsive disorder.

We examined implicit and explicit memory in obsessive-compulsive disorder (OCD) patients an in non-patients. Implicit memory was measured by the effect of prior presentation on ratings of noise volume. Explicit memory was examined via a recognition task. We also investigated participants' confidence in the accuracy of their recognition. OCD patients rated noise accompanying contamination and neutral sentences as louder than did non-patients. Both groups rated noise accompanying contamination sentences as louder than noise accompanying neutral sentences. Also, both groups were less confident in their recognition of new contamination sentences compared to new neutral sentences, but this difference was less pronounced in the OCD group. The findings are discussed in light of previous research on memory in anxiety disordered individuals.

Adult↗
PubMed2002

Long-term adjustment in burn victims: a matched-control study.

BACKGROUND: To date, there is little information about how severely burned patients compare to unburned healthy individuals in terms of psychological profile and quality of life. As part of a larger study on the sensory consequences of burns, we assessed psychological functioning and quality of life in burned patients and unburned healthy control subjects. We also examined whether burn patients experiencing pain and/or paresthetic sensations (i.e. symptomatic patients) present a profile that is different from those who are asymptomatic. METHODS: Forty-nine burned patients (% total body surface area = 34 59 % +/- 13.40; 82% males/18% females) were evaluated 63 59 +/- 28.1 months post-burn. They were matched with 49 unburned healthy volunteers on age, sex, and education level. All subjects were administered the Symptom Checklist 90-Revised (SCL-90-R) to assess psychological functioning and the 36-item Short-Form Health Survey (SF-36) to assess quality of life. RESULTS: Approximately 25% of the burn patients presented clinically-significant psychological disturbances compared to 12% in the control group. Burn patients enjoyed a quality of life comparable to that of the control subjects, although they perceived some deterioration in their general health. More symptomatic than asymptomatic patients suffered from clinically-relevant somatization and obsessive-compulsive disturbances. CONCLUSIONS: Severely burned patients adjust relatively well, although some develop clinically-significant psychological disturbances such as somatization and phobic anxiety. Burn patients experiencing abnormal sensations in their healed wounds (i.e. symptomatic patients) do not suffer from maladjustment to a greater extent than their asymptomatic counterparts, although more symptomatic patients experience somatization and obsessive-compulsive behaviours.

Adaptation, Psychological↗
PubMed2007

[Phenomenology and co-morbidity of childhood onset obsessive compulsive disorder].

OBJECTIVES: The goal of the study was to investigate the contents and comorbidity features of obsessive-compulsive disorder in children and adolescents. METHOD: 55 patients (29 males, 26 females), mainly inpatients selected from university clinics for child and adolescent psychiatry (95%), were investigated. Structured diagnostic interviews were used to interview patients and their parents. RESULTS: The mean age of onset for obsessive-compulsive disorders was 11.3 years. In males the onset was slightly earlier than among females, but this difference was not significantly significant. Compulsions mostly referred to washing and cleaning, checking, repeating, ordering, and counting. Most frequently, obsessions included thought about contamination, catastrophes, sexuality, and aggression. According to parental reports, the rate of comorbidity was high (lifetime diagnosis: 69%, current diagnosis: 53%), with anxiety, depressive, hyperkinetic, conduct, and eating disorders being the most frequent co-morbid conditions. Obsessive-compulsive symptoms were more intense in those patients who had a greater number of lifetime diagnoses of other psychiatric disorders. Comparing the rates found when structured interviews were carried out according to the study protocol to those for clinicians, clinicians were found to have diagnosed mixed obsessional thoughts and acts (presenting obsessional thoughts, as well as compulsive acts) less frequently. CONCLUSIONS: The results of this investigation are well in line with those of international studies on obsessive-compulsive disorders. The rates of disorders found were dependent on the diagnostic methods used. A potentially promising approach for further investigation is the sub-typing of patients according to symptom dimensions.

Adolescent↗
PubMed1993

Sexual history and quality of current relationships in patients with obsessive compulsive disorder: a comparison with two other psychiatric samples.

It has been hypothesized that sexual conflict is a causal factor in the development of obsessive compulsive disorder. This study investigated the relationship between obsessive compulsive disorder and variables related to the individual's sexual history, present life, sexual satisfaction, and marital adjustment. Of inpatient admissions, 363 who met criteria for obsessive compulsive disorder, panic disorder, and depressive disorder completed a standard history questionnaire and the Marital Adjustment Test. Findings showed that obsessive compulsive individuals cannot be distinguished from either depressive or panic disordered groups by a particular sexual history. Future studies should use measures that do not rely on patient self-report.

Adolescent↗
PubMed1992

Child panic revisited.

Childhood panic attacks and panic disorder were assessed retrospectively in adult anxiety clinic patients (N = 343) and their adult relatives (N = 560). Only nine (1%) of the 903 subjects were judged to have experienced spontaneous panic attacks before age 13 by clinically trained interviewers. The narrative summaries of these cases were reviewed, and only three of nine provided convincing descriptions of spontaneous panic attacks in childhood. The authors conclude that prepubertal spontaneous panic attacks are rare, and that retrospective assessments of panic phenomena are difficult, even among adequately trained mental health professionals.

Adolescent↗
PubMed1998

Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder.

The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder (OCD) versus the sequential combination with fluvoxamine. Patients with OCD (N = 117) were randomized to one of the following five conditions: a) cognitive therapy for weeks 1 to 16, b) exposure in vivo with response prevention for weeks 1 to 16, c) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16, d) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16, or e) waiting list control condition for weeks 1 to 8 only. Assessments took place before treatment (pretest) and after 8 (midtest), and 16 weeks (posttest). In the first 8 weeks, six treatment sessions were delivered. During weeks 9 to 16, another 10 sessions were given. Thirty-one patients dropped out. Outcome was assessed by patient-, therapist- and assessor-ratings of the Anxiety Discomfort Scale, the Yale-Brown Obsessive Compulsive Scale, and the Padua Inventory-Revised. In contrast with the four treatments, after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms. After 16 weeks of treatment, all four treatment packages were effective on these OCD ratings, but they did not differ among each other in effectiveness. In OCD, the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone.

Adult↗