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PubMedDate not supplied

Phenomenology of obsessive-compulsive disorder: a transcultural study.

Ninety patients suffering from obsessive-compulsive disorder (OCD) and diagnosed according to International Classification of Diseases (10th edition [ICD-10]) criteria attending the outpatient clinic of the Institute of Psychiatry in Cairo in 1991-1992 were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for symptomatology and severity of symptoms. Sixty-nine percent of the patients were males, and 32% were females. The mean age of the sample was 23.7 years, with a mean duration of OCD of 3.2 years. Twenty percent of patients had a positive family history for OCD. Forty percent of patients presented with a mixture of obsessions and compulsions, whereas 29% presented with obsessions and 31% with compulsions. The most commonly occurring obsessions were religious and contamination obsessions (60%) and somatic obsessions (49%), and the most commonly occurring compulsions were repeating rituals (68%), cleaning and washing compulsions (63%), and checking compulsions (58%). Seventy-one percent of patients were rated severe on the Y-BOCS, and all of them had impaired insight; 9% were insightless. The age of patients was found to correlate positively with the total compulsive score and the total Yale BOCS score, but it correlated negatively with the total obsessive score. One third of patients had a comorbid depressive disorder. Regarding premorbid personality disorders, 14% had obsessive personality disorder, 34% had paranoid, anxious, or emotionally labile personality disorder, and 52% had no premorbid personality disorder. The role of religious upbringing has been evident in the phenomenology of OCD in Egypt, which is similar to the outcomes of studies in Jerusalem and different from results in India and Britain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Frequency of obsessive compulsive symptoms and disorder in patients with schizophrenia: importence for prognosis].

OBJECTIVE: The objective is to study the comorbidity rate of obsessive compulsive disorder and obsessive compulsive symptoms in patients with schizophrenia and their relation with the course of this illness. DESIGN: 73 out-patients from Istanbul Medical Faculty Department of Psychiatry and 4th Unit of Bakirköy Mental Hospital who met the DSM III-R criteria for schizophrenia were recruited for this study. Other inclusion criteria were being out of acute exacerbation phase of schizophrenia. Yale-Brown Obsessive-Compulsive Scale, Yale Brown Obsessive Compulsive Symptom Screening Inventory were applied to patients. RESULTS: Comorbidity rate of obsessive-compulsive disorder in patients with schizophrenia was 9.6%, and also obsessive compulsive symptoms were detected 31% of patients. Aggressive obsessions were seen most frequently. These symptoms were also reported more frequently in the patients whose Global Assessment of Functionality score was higher than 45 points. Suicide attempts in psychiatric history were significantly higher for patients with obsessive-compulsive symptoms. CONCLUSION: Our findings indicate that obsessive-compulsive symptoms are seen more frequently than previously reported, and have no major effect upon the course of schizophrenia.

Adolescent↗
PubMed2006

[Obsessive-compulsive disorder and schizophrenia. A critical review].

Co-occurrence of psychotic and obsessive-compulsive symptoms has been recognized for decades. This paper reviews published reports from five perspectives: schizophrenia with obsessive-compulsive symptoms, obsessive-compulsive disorder (OCD) with psychotic symptoms, schizophrenia-spectrum-personality disorder with obsessive-compulsive symptoms, obsessive-compulsive symptoms induced by atypical antipsychotics and similarities of functional neural circuits theory in OCD and schizophrenia. A MEDLINE search was conducted to identify relevant articles from 1960 until 2004. Only a few systematic data that explore the nature and significance of such occurrence have been published. More recent studies using systematic diagnostic criteria suggest that the rate of occurrence may not be rare at all. In schizophrenia, a similar dorsolateral prefrontal cortex circuit shares anatomic substrates similar to those of the OCD orbitofrontal circuit. Exploring the interface of schizophrenic and obsessive-compulsive symptoms is important for diagnostic clarity and could have important implications for treatment and long-term prognosis. The review emphasizes the different origins and natural course of co-occurrence of schizophrenic and obsessive-compulsive symptoms and their various outcome under atypical antipsychotics and selective serotonin reuptake inhibitors (SSRI). Further double-blind, randomized, placebo-controlled investigations in larger cohorts of schizophrenic and OCD patients are needed in order to identify a schizo-obsessive schizophrenia and a schizotypal subtype of obsessive compulsive disorder and to substantiate the algorithm for treatment.

Humans↗
PubMed2005

Hierarchical structure of dysfunctional beliefs in obsessive-compulsive disorder.

The Obsessive Beliefs Questionnaire was developed as a comprehensive measure of dysfunctional beliefs, which cognitive models consider to be etiologically related to obsessive-compulsive disorder. Obsessive Beliefs Questionnaire subscales tend to be highly correlated, which raises the question of whether obsessive-compulsive-related beliefs are hierarchically structured, consisting of lower-order factors loading on 1 or more higher-order factors. To investigate the nature and relative importance of these factors, a hierarchical factor analysis was conducted (n = 202 obsessive-compulsive disorder patients), using a Schmid-Leiman transformation. Results indicated a higher-order (general factor) and 3 lower-order factors: (i) responsibility and overestimation of threat, (ii) perfectionism and intolerance of uncertainty and (iii) importance and control of thoughts. The high-order factor accounted for more variance in Obsessive Beliefs Questionnaire scores (22%) than did the lower-order factors (6-7%), thereby underscoring the importance of the higher-order factor. Despite the importance of the higher-order factor, the lower-order factors significantly predicted unique variance in measures of obsessive-compulsive symptoms, including severity ratings of compulsions. These finding suggest that cognitive models of obsessive-compulsive disorder should take into consideration the hierarchic structure of obsessive-compulsive-related beliefs.

Adult↗
PubMed2000

Beneficial effect of olanzapine in schizophrenic patients with obsessive-compulsive symptoms.

Some studies suggest that obsessive-compulsive symptoms may be common (7.8-46%) in schizophrenic patients and seem to be poorly responsive to drug therapy. Conventional neuroleptics are of limited value, but adjunctive anti-obsessive agents (clomipramine, fluvoxamine) may be an option. Although novel atypical antipsychotics (clozapine, risperidone) reportedly aggravate the obsessive-compulsive symptoms, a recent trial has shown that olanzapine did not induce new-onset obsessive-compulsive symptoms in schizophrenic patients. We report our experience with three schizophrenic patients with obsessive-compulsive symptoms who were unsuccessfully treated with various conventional neuroleptics in combination with anti-obsessive agents and subsequently showed resistance or intolerance to clozapine. All of them were switched to olanzapine (10-20 mg/ day). All patients demonstrated a significant improvement in both schizophrenic and obsessive-compulsive symptoms as measured by the Brief Psychiatric Rating Scale (BPRS) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Within 5-8 weeks of initiation of olanzapine, the BPRS scores of the three patient decreased by 53%, 51% and 48%, and the Y-BOCS scores by 68%, 73% and 85%. Olanzapine was well tolerated. These preliminary results suggest that olanzapine may be a therapeutic option in schizophrenic patients with obsessive-compulsive symptoms.

Adult↗
PubMed2005

A family genetic study of clinical subtypes of obsessive-compulsive disorder.

OBJECTIVE: The results of various family studies of obsessive-compulsive disorder have varied widely, possibly because of heterogeneity in the obsessive-compulsive disorder phenotype. The current study was conducted to determine familiality of checker and washer subtypes of obsessive-compulsive disorder compared with normal controls. METHODS: In this study, all available first-degree relatives of 25 checker, 34 washer and 40 psychiatrically normal control probands were interviewed directly, using structured interviews. RESULTS: The morbid risk of syndromal and subsyndromal obsessive-compulsive disorder was significantly greater among the relatives of checker probands (19.4%) than in the relatives of washer (8.7%) or control probands (5.4%), while the morbid risk for the relatives of washer and control probands was not significantly different. In all, 67% of the checker relatives with syndromal and subsyndromal obsessive-compulsive disorder were checkers, while 54% of the washer relatives with syndromal and subsyndromal obsessive-compulsive disorder were washers. CONCLUSIONS: Our study provides preliminary evidence of familiality of the checker subtype of obsessive-compulsive disorder. Future studies using patients subtyped on the basis of symptom dimensions, in larger obsessive-compulsive disorder samples, are needed, to further validate the genetic basis of obsessive-compulsive disorder.

Adolescent↗
PubMed1997

Disgust implicated in obsessive-compulsive disorder.

Psychiatric classificatory systems consider obsessions and compulsions as forms of anxiety disorder. However, the neurology of diseases associated with obsessive-compulsive symptoms suggests the involvement of fronto-striatal regions likely to be involved in the mediation of the emotion of disgust, suggesting that dysfunctions of disgust should be considered alongside anxiety in the pathogenesis of obsessive-compulsive behaviours. We therefore tested recognition of facial expressions of basic emotions (including disgust) by groups of participants with obsessive-compulsive disorder (OCD) and with Gilles de la Tourette's syndrome (GTS) with an without co-present obsessive-compulsive behaviours (GTS with OCB; GTS without OCB). A group of people suffering from panic disorder and generalized anxiety were also included in the study. Both groups with obsessive-compulsive symptoms (OCD; GTS with OCB) showed impaired recognition of facial expressions of disgust. Such problems were not evident in participants with panic disorder and generalized anxiety, or for participants with GTS without obsessions or compulsions, indicating that the deficit is closely related to the presence of obsessive-compulsive symptoms. Participants with OCD were able to assign words to emotion categories without difficulty, showing that their problem with disgust is linked to a failure to recognize this emotion in others and not a comprehension or response criterion effect. Impaired recognition of disgust is consistent with the neurology of OCD and with the idea that abnormal experience of disgust may be involved in the genesis of obsessions and compulsions.

Adult↗
PubMed2001

Psychopathology and personality characteristics in relation to blood serotonin in Tourette's syndrome and obsessive-compulsive disorder.

Family studies suggest an interrelationship between Gilles de la Tourette Syndrome (GTS) and some forms of obsessive-compulsive disorder (OCD). Some authors consider GTS to be part of a serotonergically mediated cluster of OCD spectrum disorders. The present study was undertaken to compare measures of psychopathology, personality and blood serotonin between GTS and OCD (without tics), and to investigate whether an OCD spectrum hypothesis is supported for GTS. Fifteen GTS without OCD subjects, 21 tic with (+) OCD subjects, 15 OCD without tic subjects and 26 controls (all without serotonergic medication) were evaluated with self-rated and clinician-rated measures of psychopathology and personality. Whole blood serotonin (5-HT) and platelet monoamine oxidase activity (MAO) was measured, and Spearman's correlations were calculated between whole blood 5-HT, MAO and rating scale scores within the entire sample and within subgroups. There were main effects of OCD on anxiety, obsessive-compulsive, neuroticism and extraversion scores. There were main effects of tics on depression, obsessive-compulsive, trait anxiety and neuroticism scores, and on platelet MAO. There were interaction effects on platelet MAO, 5-HT, Yale-Brown Obsessive-Compulsive Rating Scale severity, trait anxiety and Eysenck Personality Questionnaire neuroticism scores. Platelet MAO activity was elevated in tic-free OCD subjects when compared to tic + OCD, GTS without OCD and controls. Whole blood 5-HT was lowered in tic + OCD patients in comparison to GTS without OCD and tic-free OCD subjects. Whole blood 5-HT and obsessive-compulsive severity were negatively correlated within OCD without tic patients and MAO and Leyton Obsessive Inventory scores were negatively related within GTS without OCD patients. The biochemical data of this study suggest that in tic + OCD and in tic-free OCD patients, 5-HT dysregulations play a role, but not necessarily in pure GTS. Serotonergic dysregulations within tic + OCD and tic-free OCD patients are distinct, suggesting differences in underlying pathophysiology. The finding that obsessions and compulsions can be associated with either 5-HT hypofunctionality or hyperfunctionality reveals a major weakness in the OCD spectrum theory, i.e. that the associations between obsessive-compulsive behaviours and 5-HT abnormalities are less specific than suggested by the original obsessive-compulsive spectrum model.

Adult↗
PubMed1995

Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review.

BACKGROUND: A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach. METHOD: Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms. RESULTS: Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties. CONCLUSION: Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.

1-Naphthylamine↗
PubMed2002

Sociodemographic and clinical characteristics of Turkish children and adolescents with obsessive-compulsive disorder.

AIM: To assess clinical and demographic characteristics of Turkish children and adolescents with obsessive-compulsive disorder. METHOD: The study comprised 47 children and adolescents (31 boys and 15 girls) aged between 9 and 15 years, who were diagnosed with obsessive-compulsive disorder according to Diagnostic and Statistical Manual of Mental Disorders-IV. At the first interview, sociodemographic data of patients were recorded and Maudsley Obsession Compulsive Questionnaire (MOCQ), Child Depression Inventory (CDI), and State and Trait Anxiety Inventory for Children (STAI-C) were administered concurrently. Afterwards, the comorbid diagnosis and clinical characteristics of obsessive-compulsive disorder were investigated in detail during a psychiatric interview. RESULTS: The obsessive-compulsive disorder prevalence among 1,739 outpatients seen for the first time at our clinics between January 1998 and April 1999 was 2.7% (n=47). Initial complaints with a content of obsession or compulsion were observed in only 14.9% (n=7) of the patients. Contamination (48.9%) and cleaning (68.1%) were the most common symptoms. Thirty-one patients (65.9%) had at least one comorbid disorder with obsessive-compulsive disorder, the most common being major depression (29.8%). There were no significant differences between the patients with and those without comorbid disorder in terms of MOCQ and subscales scores. Children under age of 13 had higher scores on cleanliness subscale on MOCQ, whereas children with migration history had higher state anxiety scores. There were no differences in STAI-C and CDI scores between boy and girls, children (<13 years) and adolescents (13 years), and firstborn and other children in a family. CONCLUSION: Obsessive-compulsive disorder is a serious clinical problem in childhood and practitioners, pediatricians, and psychiatrists should explicitly ask about the presence of symptoms characteristic to obsessive-compulsive disorder. Given the high rates of various comorbid states, such as anxiety, mood and tic disorders, comorbidities should also be taken into account during psychiatric evaluation of a child patient.

Adolescent↗
PubMed1992

The epidemiology and differential diagnosis of obsessive compulsive disorder.

Obsessive compulsive disorder is now recognized as a common psychiatric disorder. The lifetime prevalence of 2% to 3% found in the United States has also been found in epidemiologic studies in several other countries with diverse cultures. This disorder has previously been underestimated due to a number of factors that include patients' reluctance to spontaneously admit to obsessions and compulsions and the omission of screening questions about obsessive compulsive disorder on routine mental status examinations. Depression and other anxiety disorders frequently co-occur with obsessive compulsive disorder, which may contribute to misdiagnosis. Patients with eating disorders, Gilles de la Tourette's syndrome, and schizophrenia have a greater comorbid risk compared with the general population. Differential diagnosis of obsessive compulsive disorder includes generalized anxiety disorder, panic disorder, phobias, compulsive personality disorder, and hypochondriasis. While many of these syndromes are characterized by intrusive thoughts, few have associated rituals. The complex tics seen in some patients with Tourette's syndrome may be difficult to distinguish from the compulsions seen in obsessive compulsive disorder, and, in fact, there is significant overlap in symptoms between the two disorders. Currently, the impulse control disorders, such as compulsive gambling and the paraphilias, are not considered to be part of obsessive compulsive disorder. Although the phenomenology of obsessive compulsive disorder appears to be quite diverse, with many distinct kinds of obsessions and compulsions, there are three important core features: abnormal risk assessment, pathologic doubt, and incompleteness. These features cut across phenomenological subtypes and may be useful in defining homogeneous subgroups with distinct treatment outcomes.

Anxiety Disorders↗
PubMedDate not supplied

[Obsessive-compulsive disorders caused by basal ganglia diseases].

CT scan and magnetic resonance imaging in patients with bilateral lesions of the lenticular nuclei, especially the pallidum, have demonstrated a relationship between these lesions and obsessive-compulsive behaviours. Typical behaviour may satisfy the DSM III criteria for obsessive-compulsive disorders, but in some patients signs are limited to elementary stereotyped movements or thoughts, either together or separately. The same patient may exhibit several kinds of behaviour. The range of disorders suggests that circuits running through the striatum and pallidum participate in regulatory and unification processes of sensori-motor and mental systems. Neuropsychological and metabolic tests suggest that frontal circuits involving the pallidum are especially important in this process. Similar disorders may be observed in patients with frontal or bilateral lesions of the caudate. Obsessive-compulsive behaviour is often associated with a loss of psychic self-activation, but there are exceptions. This evidence suggests a similarity between obsessions related to demonstrated lesions of the basal ganglia and other diseases displaying obsessive-compulsive behaviour, including Gilles de la Tourette disease and the former obsessive neurosis, currently termed obsessive-compulsive trouble. As after von Economo encephalitis, these pathological and clinical features should be considered in the current interpretation of the mechanisms of obsession-compulsion. It appears to be easier to apply Charcot's intuitions about neuroses to obsessive-compulsive behaviour than to hysteria.

Basal Ganglia Diseases↗
PubMed2005

Autogenous/reactive obsessions and their relationship with OCD symptoms and schizotypal personality features.

This study was conducted to examine the autogenous-reactive model of obsessions [Behav. Res. Ther. 41 (2003) 11-29]. A large number of college students (n=932) were administered a questionnaire battery assessing obsessional intrusions, schizotypal personality features, depressive symptoms, general anxiety and OCD symptoms. Hierarchical regression analyses revealed that autogenous obsessions were more strongly associated with schizotypal personality features than with OCD symptoms, general anxiety, or depression, whereas the relationship between reactive obsessions and schizotypal personality features was negligible. Moreover, autogenous obsessions were more strongly associated with covert OCD symptoms, whereas reactive obsessions were more strongly associated with overt OCD symptoms. These findings suggest that autogenous obsessions are more strongly associated with cognitive features (e.g., anomalous perception, obsessing), whereas reactive obsessions are more strongly associated with overt behavioral features (e.g., checking, washing, ordering). Theoretical and clinical implications are discussed.

Adult↗
PubMed1999

[Dependence and obsession].

Alcoholism, especially the urge to drink and relapse from abstinence, is deeply associated with obsession. And also alcoholics on abstinent 10 years or more are still higher on the obsessive-compulsive symptom dimension more than the depression and interpersonal sensitivity. Obsession was introduced by Kraepelin in 1915 and has been studied extensively since. When a person with obsession becomes exhausted with chronic rumination accompanied suspicion, he or she is driven to impulsive acts like alcoholics, and develops a personality disorder that displays persistent abnormal activities. Impulsive-compulsive spectrum characterizes by dimensions of risk-aversive/risk-seeking and harm-avoidant/harm- minimizing behaviors. Disorders on the compulsive end of the spectrum include obsessive-compulsive disorder, hypochondriasis, body dysmorphic disorder, anorexia nervosa an depersonalization. Mixed compulsive and impulsive disorders include Tourette's disorder, trichotillomania, pathologic gambling, sexual compulsions and alcoholism. Disorders on the impulsive end of the spectrum include borderline personality disorder and antisocial personality disorder. Using 123I-IMP SPECT, regional cerebral blood flow significantly decreased in alcoholics without Korsakoff sign (WAIS FIQ 90 or over) than alcoholics with Korsakoff signs (WAIS FIQ 89 or under) and control on the frontal lobe and thalamus. Recent model of obsessive-compulsive pathophysiology demonstrating that cortical regions have different effects on the direct and indirect pathways, indicates that the the different effects of serotonergic agents in the cortex alone could result in a change in balance between the direct versus indirect basal ganglia pathway. This article reviews alcoholism and obsession, ego dystonic and ego syntonic, approach-avoidance conflict, a recent biological approach to alcoholics and a spectrum for obsession.

Alcoholism↗
PubMed1989

The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability.

The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.

Adult↗
PubMed1989

The Yale-Brown Obsessive Compulsive Scale. II. Validity.

The development design and reliability of the Yale-Brown Obsessive Compulsive Scale have been described elsewhere. We focused on the validity of the Yale-Brown Scale and its sensitivity to change. Convergent and discriminant validity were examined in baseline ratings from three cohorts of patients with obsessive-compulsive disorder (N = 81). The total Yale-Brown Scale score was significantly correlated with two of three independent measures of obsessive-compulsive disorder and weakly correlated with measures of depression and of anxiety in patients with obsessive-compulsive disorder with minimal secondary depressive symptoms. Results from a previously reported placebo-controlled trial of fluvoxamine in 42 patients with obsessive-compulsive disorder showed that the Yale-Brown Scale was sensitive to drug-induced changes and that reductions in Yale-Brown Scale scores specifically reflected improvement in obsessive-compulsive disorder symptoms. Together, these studies indicate that the 10-item Yale-Brown Scale is a reliable and valid instrument for assessing obsessive-compulsive disorder symptom severity and that it is suitable as an outcome measure in drug trials of obsessive-compulsive disorder.

Adult↗
PubMed1990

Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Behavioral and biological results.

Treatment with fluoxetine hydrochloride was compared with treatment with clomipramine hydrochloride in two groups of patients with obsessive-compulsive disorder using two different experimental designs. In the first group of 11 patients with obsessive-compulsive disorder studied using a randomized, double-blind, crossover design, treatment with fluoxetine for 10 weeks was found to produce therapeutic effects similar to treatment with clomipramine for 10 weeks. There were significantly fewer total side effects reported during fluoxetine than clomipramine treatment. Drug tapering and placebo substitution in the 4-week crossover interval phase led to substantial relapses in obsessive-compulsive disorder symptoms and depression. Furthermore, responses to the second drug took as long to occur as responses to the first drug, although both drugs are thought to act by a common mechanism, serotonin uptake inhibition. A second group of 21 patients with obsessive-compulsive disorder that had been previously stabilized on clomipramine treatment with at least partial benefit were crossed over to fluoxetine treatment in a double-blind fashion. After 10 weeks of fluoxetine administration, most patients manifested behavioral rating scores of obsessive-compulsive disorder and depressive symptoms that were comparable with precrossover ratings completed during clomipramine treatment. A significant exacerbation in obsessive-compulsive disorder and depression ratings as well as a similar lag in therapeutic efficacy were also noted in this second cohort of patients with obsessive-compulsive disorder. Platelet 5-HT concentrations were reduced 95% during both clomipramine and fluoxetine treatment periods. These results suggest that fluoxetine may represent a viable alternative to clomipramine in the treatment of obsessive-compulsive disorder, although further studies with larger sample sizes are needed.

Adult↗
PubMed2007

Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder.

BACKGROUND: We aimed to investigate the correlates of major depressive disorder (MDD) occurring after the onset of obsessive-compulsive disorder (OCD). METHODS: Forty-three OCD patients who developed MDD after the onset of OCD (OCD-MDD group) and 67 OCD patients without MDD (non-MDD, NMDD group) were compared with regard to sociodemographic characteristics, clinical history, symptom severity, types of obsessions and compulsions, insight degree, comorbid axis I and axis II diagnosis and quality-of-life level. RESULTS: The OCD-MDD group scored significantly higher on measures of obsessions, compulsions and depression severity than did the NMDD. Significantly more aggressive obsessions were identified in the OCD-MDD group than in the NMDD group. The OCD-MDD group was also significantly more likely than the NMDD group to have generalized anxiety disorder (GAD). There was no significant difference in the rate of personality disorders between the groups. The OCD-MDD group reported significantly lower levels of quality of life (QOL) in the domains of physical health, psychological health and social relationships. Depression severity was associated with obsession but not with compulsion severity. In a logistic regression model, obsession severity, presence of GAD and aggressive obsessions emerged as the factors associated with the occurrence of MDD. LIMITATIONS: To exclude ineligible patients, we gathered the information about past mood episodes cross-sectionally. CONCLUSIONS: These results suggest that psychopathological processes mediated by specific obsessions as well as excessive anxiety and worries may render the neurocircuities more vulnerable to the development of MDD. The occurrence of MDD in OCD cannot sufficiently be explained as a secondary complication to the disability of OCD.

Adult↗