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PubMed1996

Obsessive-compulsive disorder associated with brain lesions: clinical phenomenology, cognitive function, and anatomic correlates.

We studied the behavioral, cognitive, and neuroimaging characteristics of obsessive-compulsive disorder (OCD) in 13 patients with focal brain lesions (acquired OCD) and compared their clinical features and the severity of obsessive and compulsive (OC) symptoms with patients with idiopathic OCD. Both OCD groups were further compared with matched normal controls on a series of neuropsychological tests. Patients with acquired OCD had a negative familial history and later age at onset of OCD symptoms than patients with idiopathic OCD. The two OCD groups showed relatively similar clinical phenomenology, severity of OC symptoms, and profile of neuropsychological deficits. Compared with normal control subjects, both OCD groups showed cognitive deficits affecting attention, intellectual function, memory, word retrieval, and motor and executive functions. Eight of the 13 patients with acquired OCD had abnormal neurologic examinations, whereas only 3 of the 13 patients with idiopathic OCD had abnormal neurologic examinations. Neuroimaging in the acquired OCD group disclosed a variety of lesions involving exclusively the cerebral cortex (frontal, temporal, or cingulate regions), the basal ganglia, or both. These results suggest that acquired and idiopathic OCDs may share a common pathophysiologic mechanism, and that structural damage to specific frontal-limbic-subcortical circuits plays an important role in the pathogenesis of acquired OCD.

Adult↗
PubMed2004

The role of venlafaxine in the treatment of obsessive-compulsive disorder.

OBJECTIVE: To evaluate the published literature regarding the use of venlafaxine in the treatment of obsessive-compulsive disorder (OCD). DATA SOURCES: MEDLINE (1996-March 2004) and International Pharmaceutical Abstracts (1970-March 2004) were searched using the terms venlafaxine and obsessive-compulsive disorder. A bibliographic search was conducted as well. DATA SYNTHESIS: Successful treatment of OCD with venlafaxine has been reported in case reports, open trials, and blinded trials versus active comparators. The only placebo-controlled trial did not find statistically significant improvement with venlafaxine treatment; however, methodologic limitations may have influenced those results. Venlafaxine appears to be as efficacious as clomipramine, but is preferable to this agent in terms of safety and tolerability. Venlafaxine seems to be similar to paroxetine with respect to both therapeutic effects and adverse effects, but may be inferior to paroxetine when used for nonresponders to previous serotonin-reuptake inhibitor therapy. CONCLUSIONS: Although the relative scarcity of data precludes definitive conclusions, available evidence suggests that venlafaxine is effective and well tolerated in the treatment of OCD. Unfortunately, it has not shown any unique advantages relative to currently available medications.

Clinical Trials as Topic↗
PubMed2005

Twin studies on obsessive-compulsive disorder: a review.

Genetic factors have historically been thought of as important in the development of obsessive-compulsive disorder (OCD). For the estimation of the relative importance of genetic and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a long history, starting in 1929. In this review, over 70 years of twin research of OCD is presented, using four different approaches that represent the steps in the twin research of OCD from past to present. These steps include (1) case-studies of twins with OCD from the old literature; (2) twin studies of OCD using Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria; (3) twin studies of OCD using a dimensional approach, comparing resemblances in monozygotic and dizygotic twins; and (4) twin studies of OCD using a dimensional approach, analyzing the data with Structural Equation Modeling. It is concluded that only the studies using the last method have convincingly shown that, in children, obsessive-compulsive (OC) symptoms are heritable, with genetic influences in the range of 45% to 65%. In adults, studies are suggestive for a genetic influence on OC symptoms, ranging from 27% to 47%, but a large twin study using a biometrical approach with continuous data is still needed to provide conclusive evidence. Strategies for future twin studies of OCD are discussed.

Adult↗
PubMed2003

Current and potential pharmacological treatments for obsessive-compulsive disorder.

In the past 20 years, several effective treatments have been developed for obsessive-compulsive disorder. Despite this, it is a disorder that is often inadequately treated by available therapies. Recent advances in neuroimaging and neurophysiology have provided some clues to possible treatments that may be more effective in treating this disorder. Serotonin agents remain the cornerstone of pharmacological treatment for obsessive-compulsive disorder. The development of agents that target specific serotonin receptor subtypes may improve the effectiveness of drug treatment. Other possible future treatment approaches are also discussed.

Animals↗
PubMed1988

Precocious ego development and obsessive compulsive neurosis.

Precocious ego development is frequently mentioned in psychoanalytic theory as an important determinant of obsessive-compulsive neurosis. Writers such as Anna Freud suggest that an imbalance in the development of ego over drive may lead to obsessional neurosis. However, further examination of the psychoanalytic literature reveals that the nature of this supposed link is not clear. Explanations couched in economic language or in terms of an early hypersensitivity to stimulation are open to theoretical criticism or are unsatisfying. The author suggests that we focus on the effect of precocious ego development on developing object relations. It is suggested that precocity may lead to early disappointment in parental objects. The inter-relationships of disappointment with early identifications, premature sense of autonomy and anal problems are discussed. A case of an obsessive-compulsive adolescent girl is presented to illustrate the role of precocious ego development and superior intelligence in the formation of the symptoms.

Adolescent↗
PubMed2003

Assessment of DSM-IV personality disorders in obsessive-compulsive disorder: comparison of clinical diagnosis, self-report questionnaire, and semi-structured interview.

In patients with obsessive-compulsive disorder, personality disorders are not many times assessed according to DSM-IV criteria. The purpose of the present study is to examine the prevalence of personality disorders diagnosed according to the DSM-IV in a severely disordered OCD population (n=65) with three different methods of assessing personality disorders (structured interview, questionnaire, and clinical diagnoses). Furthermore, correspondence between these different methods was investigated and their construct validity was examined by relating the three methods to external variables. Each method resulted in a predominance of Cluster C personality disorders, and obsessive-compulsive personality disorder had the highest prevalence. However, there was generally low correspondence regarding which patient had which personality disorder. Results concerning the relation of external variables were the most promising for the structured clinical interview.

Adult↗
PubMed2001

Obsessive-compulsive symptomatology: a goal-directed response to anticipated traumatization?

Through the use of case material, this article traces the evolution of one individual's potentially adaptive response to traumatic stressors into obsessive-compulsive illness. The following discussion offers a conceptualization of trauma-induced obsessive-compulsive symptomatology that presents the phenomena as a predictable pattern of traumatic antecedents, anticipatory arousal, and a subsequent goal-directed motivational state to prevent anticipated traumatization. However, this hypothesis depends upon an expansion of our diagnostic understanding of traumatization to include interpersonal threat and how it might be symbolized by the individual seeking relief.

Adaptation, Psychological↗
PubMed2001

Obsessive-compulsive scale of the child behavior checklist: specificity, sensitivity, and predictive power.

OBJECTIVE: To create an obsessive-compulsive disorder subscale (OCS) of the Child Behavior Checklist (CBCL) and to determine its internal consistency, sensitivity, specificity, and positive and negative predictive power to identify obsessive-compulsive disorder (OCD) in children and adolescents. METHODS: Three samples of equal size (n = 73) of children and adolescents, matched for age, gender, and race, were selected for these analyses: 1) a clinically ascertained OCD group, 2) a psychiatrically treated group whose records revealed no evidence of OCD, and 3) a general population control group. An OCS was created by applying factor analysis to 11 CBCL items. Examinations of internal consistency, sensitivity, specificity, and positive and negative predictive value were undertaken. RESULTS: Of 11 items hypothesized to predict OCD, 8 items were retained after factor analyses (smallest factor loading: 0.49) and used to calculate OCS scores. The retained items displayed excellent internal consistency (Cronbach's alpha coefficient = 0.84). OCD participants had significantly higher OCS scores than either psychiatrically treated or general population control groups. With the use of the 2 cutoff scores closest to the true rate of OCD in the overall sample, sensitivity was 75.3% to 84.9%, specificity was 82.2% to 92.5%, positive predictive value was 70.5% to 83.3%, and negative predictive value was 88.2% to 91.6%. CONCLUSION: The performance of the proposed CBCL OCS compares favorably with that of the only previously studied screening instrument for OCD, the Leyton Obsessional Inventory-Child Version. Unlike the Leyton Obsessional Inventory-Child Version, the CBCL is already in widespread use as a screen for most other forms of psychopathology. As the performance of the CBCL OCS will need to be replicated in other sample populations, data with various cutoff levels are provided to enable investigators and clinicians to tailor its use to specific study populations.

Adolescent↗
PubMed2002

Eye-hand preference dissociation in obsessive-compulsive disorder and dyslexia.

Dyslexia may be a development disturbance in which there are alterations in visual-spatial and visual-motor processing, while obsessive-compulsive disorder (OCD) is a psychiatric disease in which there are alterations in memory, executive function, and visual-spatial processing. Our hypothesis is that these disturbances may be, at least partially, the result of a crossed eye and hand preference. In the present study 16 controls, 20 OCD (DSM-IV criteria) and 13 dyslexic adults (Brazilian Dyslexia Association criteria) were included. All had a neurological examination, the Yale-Brown scale for obsessive-compulsive symptoms application and the Zazzó evaluation for laterality, abridged by Granjon. Results showed a right hand preference for 100% of controls, 84.6% of dyslexics, and 75% of OCD patients and a right eye preference for 73.3% of controls, 69.2% of dyslexics, and 35% of OCD patients. The left eye preference was significantly higher in OCD when compared with the two other groups (p = 0.01) and the left hand preference of OCD patients (25%) was also significant when compared to Brazilian population (4%) or British population (4.5%). It is possible that this crossed preference may be partially the reason for visual-spatial and constructive disturbances observed in OCD.

Adult↗
PubMed2003

Basal ganglia hemorrhagic ablation associated with temporary suppression of obsessive-compulsive symptoms.

Currently, basal ganglia (BG) are considered regulators of motor and emotional activity. It's operationality encompass Obsessive Compulsive Disorder (OCD). The case of a patient suffering with severe OCD is described of note, his symptoms disappeared following a hemorrhage of the left BG. However, once the hemorrhage was reabsorbed his symptoms returned. It is possible that lesions affecting cerebral OCD association circuits may influence the evolution of obsessive-compulsive symptoms.

Adult↗
PubMed2003

Obsessive compulsive disorder in a fishermen community.

OBJECTIVE: To find the prevalence of obsessive compulsive disorder(OCD). DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Two years at the local community of Manora, Karachi. SUBJECTS AND METHODS: An initial survey was conducted in a fishermen community at Salehabad which is located in Manora. A questionnaire inquiring about the demographic details of the patients and using the ICD-10 diagnostic research criteria along with Yale-Brown OC scale on a population of 5,000 for a period of 2 years was applied. About 150 positive cases were identified whose details were subjected to analysis. RESULTS: Out of a total population of 5,000, 3% were found to be suffering from OCD. Among these 56% (n=150) were females, 60% were married and 50% of the cases were under the age of 25. Among the obsessions contamination, pathological doubt and need for symmetry were the most common. Regarding the compulsions, checking, washing and counting were the most common. CONCLUSION: It was concluded that 3% of the population of given community was suffering from OCD, which is a significant finding. More community based studies are needed to assess the real magnitude of this illness.

Adolescent↗
PubMed1986

Drug treatment of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is an uncommon but difficult to manage problem. Behaviour therapy is the treatment of choice, with clomipramine as an adjunct in patients with coexisting depression. However, the incidence of side effects with the doses required (up to 200 mg daily, or occasionally higher) is high, and the side effects may be intolerable to some patients. Benzodiazepines have no effect on the core symptoms of OCD, and their usefulness as long term anxiolytics is outweighed by the risks of physical and psychological dependence. There is no place for antipsychotic drugs in managing obsessive-compulsive disorder.

Antipsychotic Agents↗
PubMed1992

Current concepts in the pharmacological treatment of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a chronic and often disabling disease. OCD is characterised by intrusive, unwanted and persistently recurring mental events (obsessions) that usually evoke discomfort or anxiety, and/or repetitive ritualistic behaviours (compulsions) that are aimed at reducing discomfort and anxiety. However, the compulsions succeed only in achieving transient relief, followed by a growing sense of pressure. 10 years ago, OCD was considered a rare and treatment-refractory disorder. Recent well designed studies document a lifetime prevalence rate for OCD of more than 2% in the general population. The outlook for patients with OCD has changed in the last decade, with many well controlled studies showing that OCD patients respond to specific behavioural and pharmacological treatments. The specific form of behavioural therapy is in vivo exposure coupled with response prevention. Only serotonin reuptake inhibitors, such as clomipramine, fluoxetine and fluvoxamine, are effective in the treatment of both depressed and not depressed OCD patients. Fluoxetine and fluvoxamine lack the anticholinergic side effects of clomipramine and, thus, provide an alternative treatment for patients who cannot tolerate clomipramine. Other nonserotonergic antidepressants (tricyclics and monoamine oxidase inhibitors) and anxiolytic agents have not been found to be consistently effective in this disorder. Insufficient data on the efficacy of neuroleptics and their potentially irreversible side effects limit their use in OCD patients. Behavioural and the pharmacological treatment are complementary, and a combination of the 2 therapies is apparently more effective than either modality alone.

Clomipramine↗
PubMed2004

Citalopram concentrations and response in obsessive-compulsive disorder. Preliminary results.

OBJECTIVE: Citalopram, a highly potent SSRI, is effective in the treatment of depressive disorders and obsessive-compulsive disorder (OCD); however, very few studies have reported concentration-effect relationships for SSRIs. The aim of this study was to investigate the relationship between citalopram concentrations and clinical response in patients with OCD. METHODS AND STUDY DESIGN: Fifteen patients (aged 18-65 years) with a DSM-IV diagnosis of OCD were included in this open-label, single-blind study. Citalopram was started at a dosage of 20 mg/day; the dosage was increased to a maximum of 60 mg/day by the third week, on the basis of clinical need and tolerability. The dosage then remained unchanged until the end of the 10-week study. Clinical assessments were made at baseline, weekly for the first four weeks and then at weeks 6, 8 and 10. The assessment scales used were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Clinical Global Impression Scale (CGI) and the Hamilton Depression Rating Scale (HDRS). Plasma citalopram concentrations were determined using a high performance liquid chromatography method after solid phase extraction. RESULTS: One patient was withdrawn from the study because of poor compliance. Of the 14 patients who completed the study, nine did not meet the treatment response criterion of an improvement of >25% from the baseline total Y-BOCS score and a score of < or =3 for the global improvement item of the CGI (these patients were termed non-responders), while five did (responders). There were no differences in the main demographic and baseline clinical variables between responders and non-responders. Steady-state citalopram concentrations were similar in the two groups, suggesting that the anti-obsessional effects of citalopram were not related to pharmacokinetic differences between responders and non-responders. There was no linear relationship between steady-state citalopram concentrations and response. The citalopram concentrations and Y-BOCS scores of individual responders obtained at baseline and various study timepoints showed a sigmoid relationship when analysed using the E(max) (maximum change in Y-BOCS score) model, with a mean EC(50) value (drug concentration that elicits 50% of the E(max)) of 152 microg/L, whereas a similar analysis of the non-responders generated a flat line. CONCLUSION: The results of this preliminary study suggest that plasma citalopram concentrations may be related to the clinical response in responders, but do not seem to account for the lack of clinical effect in non-responders. These data, as well as the usefulness of the model in relating plasma concentrations to response, even after repeated administration, need to be validated by further investigations.

Adolescent↗
PubMed2001

Obsessive-compulsive disorder and immunocompetence.

OBJECTIVE: A postinfectious, autoimmune response may be associated with the development of pediatric obsessive-compulsive disorder (OCD). According to this model, antistreptococcal antibodies cross-react with basal ganglia neurons following streptococcus infection. This autoimmune reaction disrupts a basal ganglia-thalamocortical circuit and generates obsessive-compulsive symptoms. One implication of this model is that prolonged immunologic stress may be a risk factor for OCD. That is, immunologic stress may compromise the blood-brain barrier and permit the influx of antistriatal antibodies into the central nervous system. This article explores one part of this putative relationship by investigating whether adult OCD patients, compared to members of other psychiatric groups, demonstrate a higher incidence of recurrent infections and other conditions suggestive of compromised immune function. METHOD: To test this hypothesis, we conducted a medical records review of 100 consecutive patients evaluated at a private psychiatric clinic specializing in the treatment of anxiety disorders. Sixty-five patients met diagnostic criteria for an Axis-I syndrome. Primary diagnoses included OCD, posttraumatic stress disorder, social anxiety disorder, generalized anxiety disorder, panic disorder with agoraphobia, and dysthymic disorder. Each medical record was reviewed for the presence of target syndromes or presenting symptoms suggestive of compromised immune function. RESULTS: Chart review revealed an increased rate of immune-related symptoms and syndromes among OCD patients in comparison to other anxiety and mood disorder groups. Groups did not differ significantly in the incidence of non-immune symptoms and syndromes. CONCLUSION: Adult OCD patients appear to have an increased rate of immune-related diseases above and beyond that seen in other psychiatric disorders.

Adult↗
PubMed2002

Clinical features and outcome in dogs and cats with obsessive-compulsive disorder: 126 cases (1989-2000).

OBJECTIVE: To determine clinical features and outcome in dogs and cats with obsessive-compulsive disorder (OCD). DESIGN: Retrospective study. ANIMALS: 103 dogs and 23 cats. PROCEDURES: Records of patients with OCD were analyzed for clinical features, medication used, extent of behavior modification, and outcome. RESULTS: Most dogs affected with OCD had been obtained from breeders. Male dogs significantly outnumbered females (2:1). Female cats outnumbered male cats by 2:1 in a small sample. Most affected dogs lived in households with 2 or more humans and other dogs or cats, and had some formal training. Client compliance with behavior modification was high. A combination of behavior modification and medication resulted in a large decrease in intensity and frequency of OCD in most animals. Clomipramine was significantly more efficacious for treatment in dogs than was amitriptyline. Only 1 dog and 1 cat were euthanatized because of OCD during the study. CONCLUSIONS AND CLINICAL RELEVANCE: OCD in dogs does not appear to be associated with lack of training, lack of household stimulation, or social confinement. In cats, OCD may be associated with environmental and social stress. Obsessive-compulsive disorder appears at the time of social maturity and may have sporadic and heritable forms. With appropriate treatment (consistent behavior modification and treatment with clomipramine), frequency and intensity of clinical signs in most dogs and cats may decrease by > 50%. Success appears to depend on client understanding and compliance and the reasonable expectation that OCD cannot be cured, but can be well controlled.

Age of Onset↗
PubMed2004

Death anxiety and death obsession in Spanish students.

This study examined the dimensional structure of Templer's Death Anxiety Scale and Abdel-Khalek's Death Obsession Scale. The responses of 289 Spanish students to the Spanish forms of both scales were evaluated by means of a principal components analysis with varimax rotation. Three significant factors were identified: Death Obsession, Cognitive-Affective, and Death Anxiety. The distribution of the factor loadings for the items of both scales on Factors 1 and 3 supported the discriminant validity of the constructs specific to each of the scales, while Factor 2 showed a common component in both scales characterized by cognitive and affective aspects in relation to the idea of death.

Adolescent↗
PubMed1992

A dimensional analysis of the Yale-Brown Obsessive Compulsive Scale.

A principal axis factor analysis with a Promax rotation was performed on the Yale-Brown Obsessive Compulsive Scale. Although the scale has separate obsession and compulsion indices, only one factor was extracted. The psychometric implications of this finding are discussed.

Adult↗