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PubMed2002

A dialogical approach to obsessions.

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

Cognitive Behavioral Therapy↗
PubMed2002

Working with children with obsessive compulsive disorder.

1. Children with OCD are a special challenge for nursing staff. 2. Children with OCD often are unable to comply with preexisting behavior management programs at child psychiatric units. 3. Each child who enters an inpatient unit must be viewed as an individual, separate from his or her diagnosis, and what works for one patient with a particular diagnosis may not work for another patient with the same diagnosis. 4. A special plan devised with input from the entire nursing team is the best way to ensure that continuity of care is carried out among all staff on the unit.

Behavior Therapy↗
PubMed1988

Bulimia: a comparison of psychological adjustment and familial characteristics in a nonclinical sample.

This study examined the relation of eating attitudes and behaviors to family dynamics and psychological adjustment in a nonclinical group of female university freshmen. Family dynamics variables, which were measured by the Family Environment Scale (FES), included Control, Cohesion, Conflict, Organization, Expressiveness, Independence, Achievement-Orientation, Intellectual-Cultural Orientation, Active-Recreational Orientation, and Moral Religious Emphasis. Psychological adjustment was measured by the Hopkins Symptom Checklist (HSC). Variables on this scale included Anxiety, Depression, Somatization, Obsessive-Compulsive, and Interpersonal Sensitivity. Eating attitudes and behaviors were measured by the Bulimia Test (BULIT), a 32-item self-report inventory. Multivariate analysis of variance indicated that bulimics, subclinical bulimics, and normals could be differentiated on the Hopkins Symptom Checklist. Univariate analyses revealed differences between the groups on all of the HSC measures and the Organization scale of the FES. The results suggest that conclusions about the causal relationships between maladaptive family patterns and bulimia presented in previous research should be viewed with caution.

Adaptation, Psychological↗
PubMed1997

A cross-cultural comparison of behavior disturbance and suicidal behavior among psychiatrically hospitalized adolescents in Israel and the United States.

American adolescent psychiatric patients had significantly higher levels of suicidal behavior (49% vs. 19%) and a higher percentage of depression diagnoses (78% vs. 24%) than Israeli psychiatric inpatients. After controlling for the diagnosis of depression, American male patients obtained significantly higher scores on the Obsessive-Compulsive, Aggression, and Hyperactive subscales of the Child Behavior Checklist (CBCL) than the Israeli males. American females scored higher on the Depression subscale than Israeli females. Differences may be attributed to less tolerance or differing perceptions of deviant behavior in America, clinical practice, and/or the CBCL's greater applicability to American inpatient samples.

Adolescent↗
PubMed1999

Anxiety in a transgenic mouse model of cortical-limbic neuro-potentiated compulsive behavior.

Anxiety and amygdalar stimulation may induce or exacerbate compulsions triggered by cortical-limbic hyperactivity, as in human obsessive-compulsive disorder (OCD). We previously created transgenic mice that exhibit OCD-like biting, movement and behavioral perseverance abnormalities. These behaviors are caused by expression of a neuro-potentiating cholera toxin (CT) transgene in dopamine D1 receptor-expressing (D1+) neurons within the amygdalar intercalated nucleus (ICN) and within cortical areas that project to orbitofrontal cortex and striatum. Here we tested whether anxiety and increased amygdalar stimulation may play a role in eliciting or exacerbating such behaviors. D1CT mice exhibited increased thigmotaxis (tendency of mice to remain along the perimeter of open areas) in the open field assay, and increased latency to first transit and reduced transit number in the light-dark assay. These studies indicate that the D1CT mice exhibit a significant increase in behavioral indicators of anxiety. Furthermore, yohimbine, a drug that induces both amygdalar stimulation and behavioral indicators of anxiety, exacerbated abnormal leaping in D1CT mice but failed to exacerbate their abnormal behavioral perseverance. These data suggest that chronic potentiation of D1+ neurons in the amygdalar ICN increases anxiety and facilitates particular compulsive behaviors.

Amygdala↗
PubMed1998

Summary of the practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. American Academy of Child and Adolescent Psychiatry.

This summary provides an overview of the assessment, differential diagnosis, and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents With Obsessive-Compulsive Disorder. OCD is a disorder of heterogeneous origin characterized by intrusive thoughts or compulsive urges or behaviors that are distressing, time-consuming, or functionally impairing. In children and adolescents, the disorder often is accompanied by a wide range of comorbidity. Two modalities have been systematically assessed and empirically shown to ameliorate the core symptoms of OCD: cognitive-behavioral therapy (primarily exposure/response prevention) and serotonin reuptake inhibitor medication. Additional individual and family psychotherapeutic, pharmacological, and educational interventions often are necessary.

Adolescent↗
PubMed2002

Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children.

A micronutrient supplement containing a broad range of dietary minerals and vitamins is being examined for the treatment of mood lability in both adults and children (Kaplan et al. 2001; Popper 2001). During pilot work, two medication-free boys with mood lability and explosive rage were studied in an open-label treatment followed by reversal and retreatment. One child was an 8-year-old with atypical obsessive-compulsive disorder, and the other was a 12-year-old with pervasive developmental delay. Both boys were monitored using the mood and temper items from the Conners Parent Rating Scale, as well as the Child Behavior Checklist. In addition, the boy with atypical obsessive-compulsive disorder was monitored with the child version of the Yale-Brown Obsessive Compulsive Scale. Both boys benefited from the micronutrient supplement when examined in ABAB designs: mood, angry outbursts, and obsessional symptoms improved when initially treated, returned when not taking the supplement, and remitted when the micronutrient supplement was reintroduced. Both boys have been followed and are stable on the nutritional supplement for over 2 years. These cases suggest that mood lability and explosive rage can, in some cases, be managed with a mixture of biologically active minerals and vitamins, without using lithium or other traditional psychopharmacologic agents.

Child↗
PubMed1996

[Electroconvulsive therapy in compulsive syndromes. A case report].

We report on a case of successful ECT in serious drug-resistant and psychotherapy-resistant obsessive-compulsive disorder. The 44-year old male patient had already had symptoms of this disorder for 4 years, and they completely disappeared after seven ECTs (1 bi-, 6 unilateral). After remission of the obsessions the patient underwent a behaviour therapy to consolidate the success of the ECT treatment and to prepare the patient for returning to work. He remains free of obsessions 18 months later.

Adult↗
PubMed1995

Psychopharmacology of central serotonergic systems.

Serotonin neurons in the rostral and caudal brainstem raphe nuclear groups give rise to collateralized ascending and descending projections which provide modulatory input into most networks throughout the entire neuraxis. The rostral raphe system is interconnected with target forebrain areas through reciprocal limbic-midbrain loops, which suggests that serotonin has a role in the regulation of complex intelligent adaptive behavior. Serotonergic pathways sensitize brainstem and spinal cord central rhythmic pattern generators which organize repetitive autonomic and motor activities, e.g. oral-buccal and nutritive behaviors, facilitate tonically active motor neurons innervating antigravity muscles, and disfacilitate somatosensory information processing. Serotonin effects are mediated by multiple receptor subtypes with distinct pre- and postsynaptic localization and regional distribution pattern. They belong to the G protein superfamily, coupling to adenylate cyclase (5-HT1,4,5,6,7) or phospholipase C (5-HT2), and to the ligand-gated ion channel superfamily (5-HT3). Drugs acting at these receptors are known to modulate various aspects of cooperative social behavior and responding latency, i.e. impulsivity, in a variety of experimental models of anxiety and depression. The clinical efficacy of the so-called selective serotonin reuptake inhibitors (SSRIs) in disorders characterized by poor impulse control, e.g. bulimia nervosa, obsessive-compulsive disorder (OCD) and violent suicidal or homicidal behavior, may likewise be due to improved responding latency.

Brain↗
PubMed1989

Obsessive-compulsive disorder. How primary care physicians can help.

Obsessive-compulsive disorder is common but not always recognized and treated. Obsessions are recurrent undesirable thoughts or images; compulsions are recurrent undesirable actions. Behavior psychotherapy can be very helpful in controlling compulsions, whereas clomipramine (Anafranil) or fluoxetine (Prozac) therapy can relieve both obsessions and compulsions. Given an understanding of the disorder and its treatment, primary care physicians can, in most cases, effectively diagnose and manage this debilitating condition. Those who do not wish to initiate treatment should refer patients to a mental health professional, as should those who attempt treatment but meet with an unresponsive case.

Humans↗
PubMed1983

Impulsiveness in obsessive-compulsive patients.

Obsessive-compulsive patients with a history of poor impulse control were identified and compared with non-impulsive obsessive-compulsive patients. Although both groups reported comparable obsessive-compulsive symptoms, the impulsive group rated significantly higher on disturbances during childhood, which included learning problems, low frustration tolerance, poor interpersonal relationships and attention-seeking behaviour. The impulsive group also scored highly on the neuroticism scale of the Eysenck Personality Questionnaire and reported a higher incidence of somatic symptoms. It appears that poor impulse control was related to disturbances which had already manifested themselves during childhood, while the obsessive-compulsive disorder was superimposed at a later time.

Adult↗
PubMed1996

[Paul Girard and the left-handed].

Paul Girard's original theory of left handedness and of its relationship with stuttering, writer's cramp, and obsessive compulsive disorders is described and connected with its historical background.

Behavior↗