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PubMed2001

Brain-behavior relationships in obsessive-compulsive disorder.

Advances in neuroimaging have led to a greater understanding of brain-behavior relationships in obsessive-compulsive disorder (OCD). This article provides an updated review and analysis of the structural and functional neuroimaging studies in OCD published to date and discusses how evidence from various types of neuroimaging studies has been synthesized to generate and test hypotheses regarding these relationships. We also review the basic science literature on the functional neuroanatomy of cortico-basal ganglia-thalamo-cortical circuits and integrate this information with neuroimaging data in OCD, to present a theoretical model of brain mediation of OCD symptoms and response to treatment. Taken together, neuroimaging studies indicate that OCD symptoms are mediated by hyperactivity in orbitofrontal-subcortical circuits, which may be attributable to an imbalance of tone between direct and indirect striato-pallidal pathways. Serotonergic drugs may ameliorate OCD symptoms by changing the relative balance of tone through the indirect versus direct orbitofrontal-subcortical pathways, thereby decreasing activity in the overall circuit that exists in the symptomatic state.

Brain↗
PubMed2001

Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder.

Discusses the cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder (OCD). Over the past 15 years, cognitive-behavioral psychotherapy has emerged as the psychosocial treatment of choice for OCD across lifespan. Unlike other psychotherapies that have been applied usually unsuccessfully to OCD, cognitive-behavioral treatment (CBT) presents a logically consistent and compelling relationship between the disorder, the treatment, and the specified outcome. Nevertheless, despite a consensus that CBT is usually helpful, clinicians routinely complain that patients will not comply with behavioral treatments and parents routinely complain that clinicians are poorly trained in CBT, with the result that many if not most children and adolescents are denied access to effective psychosocial treatment. This unfortunate situation may be avoidable, given an increased understanding regarding the implementation of CBT in children and adolescents with OCD. To this end, we review the principles and the practical aspects of the cognitive-behavioral treatment of OCD in youth, move on to discuss empirical studies supporting the use of CBT in the pediatric age group, and conclude by discussing directions for future research.

Adolescent↗
PubMed2002

Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control.

BACKGROUND: The demand for effective behavior therapy for obsessive-compulsive disorder (OCD) by exposure and ritual prevention exceeds its supply by trained therapists. A computer-guided behavior therapy self-help system (BT STEPS) was created that patients access by telephone from home via interactive voice response technology. This study compared the value of computer-guided behavior therapy value with that of clinician-guided behavior therapy and systematic relaxation as a control treatment. METHOD: After screening by a clinician, 218 patients with DSM-IV OCD at 8 North American sites were randomly assigned to 10 weeks of behavior therapy treatment guided by (1) a computer accessed by telephone and a user workbook (N = 74) or (2) a behavior therapist (N = 69) or (3) systematic relaxation guided by an audiotape and manual (N = 75). RESULTS: By week 10, in an intent-to-treat analysis, mean change in score on the Yale-Brown Obsessive Compulsive Scale was significantly greater in clinician-guided behavior therapy (8.0) than in computer-guided (5.6), and changes in scores with both clinician-guided and computer-guided behavior therapy were significantly greater than with relaxation (1.7), which was ineffective. Similarly, the percentage of responders on the Clinical Global Impressions scale was significantly (p < .05) greater with clinician-guided (60%) than computer-guided behavior therapy (38%), and both were significantly greater than with relaxation (14%). Clinician-guided was superior to computer-guided behavior therapy overall, but not when patients completed at least 1 self-exposure session (N = 36 [65%]). At endpoint, patients were more satisfied with either behavior therapy group than with relaxation. Patients assigned to computer-guided behavior therapy improved more the longer they spent telephoning the computer (mostly outside usual office hours) and doing self-exposure. They improved slightly further by week 26 follow-up, unlike the other 2 groups. CONCLUSION: For OCD, computer-guided behavior therapy was effective, although clinician-guided behavior therapy was even more effective. Systematic relaxation was ineffective. Computer-guided behavior therapy can be a helpful first step in treating patients with OCD when clinician-guided behavior therapy is unavailable.

Adolescent↗
PubMed2003

Cognitive-behavioral treatment of obsessive-compulsive disorder in a child with Asperger syndrome: a case report.

This case report outlines the cognitive-behavioral treatment of obsessive-compulsive disorder in a 7-year-old female with Asperger syndrome. Interventions were based upon the work of March and Mulle and were adapted in light of the patient's cognitive, social, and linguistic characteristics. Obsessive-compulsive symptoms improved markedly after approximately 6 months of treatment. Issues regarding symptom presentation, assessment, and treatment of a dually diagnosed patient are discussed.

Anxiety↗
PubMed1994

Behavioral group therapy with obsessive-compulsives: an overview.

During the last two decades, effective psychotherapeutic interventions have been developed and proven successful in treating patients with Obsessive-Compulsive Disorder (OCD). Behavior therapy, using exposure to anxiety-evoking stimuli and response prevention directed toward rituals, provides lasting benefit for most patients who engage in and comply with treatment. A recent study indicated that, for certain OCD patients, these interventions could be applied successfully in a group therapy context. This article describes the general procedures used in this study to treat obsessive-compulsives with exposure and response prevention in a group context.

Behavior Therapy↗
PubMedDate not supplied

[Eating behaviors, attitudes and obsessive-compulsive traits in adolescents of Buenos Aires City].

OBJECTIVE: Eating disorders are psychiatric illnesses of important prevalence in Argentina. Some typical characteristics of adolescence, such as body image fragility, media influence and social pressure lead partly into the development of eating disorders at that age. The objective of our study was to explore the eating behaviors, attitudes and obsessive-compulsive traits of the adolescents of Buenos Aires City. METHODS: A questionnaire survey was administered to 380 students of 5 Buenos Aires high schools (mean age:16,8 years old) and their answers were analyzed. RESULTS: Almost 50% of the adolescents were not satisfied with their weight, 43% of them has been on a diet at least once (the majority because of aesthetic reasons). A percentage of 23,5 had bulimic behaviors, 34,5% had a high number of obsessive-compulsive traits. Women were significantly more dissatisfied with their weight, had been on more diets and had more bulimic behaviors and obsessive-compulsive traits. CONCLUSIONS: Weight dissatisfaction and bulimic behaviors are frequent in adolescents of Buenos Aires City, specially among women. Preventive measures against eating disorders should be done on this population.

Adolescent↗
PubMed1999

Validity of the Obsessive Compulsive Drinking Scale (OCDS): does craving predict drinking behavior?

OBJECTIVE: The Obsessive Compulsive Drinking Scale (OCDS), a 14-item, self-report questionnaire, was developed to measure alcohol-related craving. The OCDS may provide a measure of the state of illness among alcohol-dependent individuals and may have value in predicting subsequent drinking behavior. The present study was conducted to evaluate the factor structure and the concurrent, construct, and predictive validity of the OCDS. METHODS: Data on desire to drink and on drinking behavior were obtained from 127 alcohol-dependent subjects who participated in a 12-week outpatient pharmacotherapy trial and a 3-month posttreatment follow-up. RESULTS: Principal components analysis of the OCDS indicated that three factors best described its structure: obsessions, drinking control and consequences, and alcohol consumption. Data also supported the concurrent and discriminant validity of the OCDS. However, the OCDS total score showed limited validity in predicting drinking during a posttreatment follow-up period. Furthermore, the only empirically derived factor that predicted drinking during this period was the alcohol consumption factor. CONCLUSIONS: As might be expected, the OCDS questions on drinking behavior predict subsequent drinking behavior. However, the instrument does not appear to provide a general measure of alcohol-related illness. The utility of the OCDS in studies of alcoholism treatment outcome requires clearer definition.

Adolescent↗
PubMed2003

Tourette's syndrome in Taiwan: an epidemiological study of tic disorders in an elementary school at Taipei County.

We have done an epidemiological study in an elementary school with 2000 Taiwanese children aged from 6 to 12 years, and found 11 of them with Tourette's syndrome. The prevalence rate of Tourette's syndrome was around 0.56%. The ratio of male to female was 9 to 2. The comorbid rate of attention-deficit/hyperactivity disorder was 36%, self-injurious behaviors 27%, and obsessive-compulsive behaviors 18%. The familial rate of Tourette's syndrome was 27%. We also found that another 98 children had transient tic disorders. For 73% of patients with mild tics, understanding and acceptance from family, teachers, and friends are the most important things. When tics are so severe that medication is necessary, haloperidol is no longer the first or only choice. We tried clonidine, atypical neuroleptics such as risperidone or olanzapine, or pergolide. The first support group was established in 1999 for children with tics in Taiwan and transformed to Taiwan Tourette Family association in June 2001 to provide further service for Tourette's syndrome.

Antipsychotic Agents↗
PubMed2006

Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder.

Because little is known about sexual obsessions in individuals with obsessive-compulsive disorder (OCD), we examined rates and clinical correlates of sexual obsessions in 293 consecutive subjects with primary lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, OCD (54.6% females; mean age, 40.5 +/- 12.9 years). Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Comorbidity, treatment response, insight, depression symptoms, quality of life, and social functioning were also assessed. All variables were compared in subjects who have OCD with and without sexual obsessions. Of the 293 subjects with primary OCD, 73 (24.9%) reported a history of sexual obsessions, and 39 (13.3%) of the subjects with OCD reported current sexual obsessions. Women were as likely as men to report sexual obsessions. As compared to those without these symptoms, subjects with current sexual obsessions were significantly more likely to report current aggressive (P < .001) and religious (P = .001) obsessions. Subjects with sexual obsessions also reported an earlier age of onset of OCD than subjects without these symptoms. Severity of OCD, comorbidity, treatment response, insight, depressive symptoms, quality of life, and social functioning did not differ between those with and without sexual obsessions. These preliminary results suggest that sexual obsessions are fairly common among individuals with OCD and may be associated with important clinical characteristics.

Adult↗
PubMedDate not supplied

[Treatment of a case of chronic obsessive troubles through combined behavioral therapy (author's transl)].

Behavior therapy of a young man, suffering from grave obsessive and compulsive troubles is the first example of combined therapy, with individual therapy, family therapy as group therapy. Two steps are find in the cure. There are benefits--trust and hope--due to psychiatric hospitalization and generous and constant affection of the sponse. The sponse was the key of reciprocal inhibition necessary to the control of anxieties due to the treatment. The aim reached was the control of obsessions and compulsions lasting for more than sixteen years.

Adult↗
PubMed1989

Hypothesis: homozygosity in Tourette syndrome.

We review evidence suggesting that many individuals with Tourette syndrome (TS) may be homozygous for a "Tourette syndrome" gene. This is based on experience with pedigrees on 1,200 TS families, comparison of the occurrence of tics or associated behaviors such as obsessive-compulsive behavior, panic attacks, attention deficit hyperactivity disorder, and/or severe alcohol or drug abuse, on both the maternal and paternal side in 170 TS families compared to control families, biochemical studies of blood serotonin and tryptophan levels, and other evidence. These observations suggest the inheritance in TS may be best described as semi-dominant, semi-recessive. Some of the implications of this proposal are discussed.

Adult↗
PubMed2003

Depression and suicidal behavior in adolescent inpatients with obsessive compulsive disorder.

BACKGROUND: To investigate the prevalence and correlations of suicidal behavior in obsessive compulsive disorder (OCD) among adolescent psychiatric inpatients. METHODS: A total of 348 adolescents, representing consecutive admissions to an adolescent inpatient unit, were assessed. Of these, 40 patients had OCD, 118 had schizophrenia, 59 had an affective disorder, 81 had a conduct disorder and 50 had an eating disorder. In addition, 87 normal community controls were assessed. All subjects were assessed for suicidal behavior by the Childhood Suicide Potential Scale (CSPS), for depression by the Beck Depression Inventory, for impulsiveness by the Impulse Control Scale, for anxiety by the State-Trait Anxiety Scale and for aggression by the Yudowsky Overt Aggression Scale. RESULTS: All the psychiatrically ill subjects, including those with OCD, had high levels of depression, anxiety and impulsiveness, which were far higher than those of the controls. The rate of attempted suicide was, however, much lower in the OCD subjects. In addition, there was a significant inverse correlation between suicidal behavior levels on the CSPS and depression in the OCD subjects, while all other subjects showed the expected significant positive correlation between level of suicidal behavior and depression. LIMITATIONS: This study looked at a referred population and generalization to outpatient and community samples cannot be made. Distinguishing between the primary and the comorbid diagnosis is difficult and some findings are based on small sample size and therefore may be vulnerable to type I error. CONCLUSIONS: Although suicidal ideation and depressive symptoms are common in OCD adolescent inpatients, they seem to be protected against suicide attempts. The inverse relationship between suicidal behavior and depression may mean that suicidal behavior is, in some ways, qualitatively different from that seen in other psychiatrically ill adolescents.

Adolescent↗
PubMed2002

Exploratory factor analysis of obsessive-compulsive patients and association with 5-HTTLPR polymorphism.

The determination of a genetic basis for obsessive-compulsive disorder (OCD) depends on how phenotypic boundaries are defined. Although a hypothesis for serotonin dysfunction in OCD has been advanced, no genes specifically responsible for serotonin regulation have as yet been definitively related to the etiology of OCD. The phenotypic variability of OCD could be at the basis of the failure of molecular biology investigations to find any genes involved in the liability to the disorder. Obsessive and compulsive contents can aggregate in OCD patients differently; multifactorial description may therefore be able to account for OCD phenotypic variance. Using principal component analysis, we derived five factors from 13 main contents of the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and considered them as quantitative phenotypes to evaluate their possible association with an insertion/deletion polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR). A trend toward positive association between the fifth factor, including counting and repeating rituals, and 5-HTTLPR was found. However, only considering the subgroup of patients with tic codiagnosis, we found a significantly higher score for the fifth factor for patients with L/L genotype with respect to L/S and S/S genotypes.

Adolescent↗