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The Yale-Brown Obsessive-Compulsive Scale was administered to 180 undergraduates and 50 medical clinic patients to obtain normative data for this widely used instrument. These data should prove useful to clinicians who assess obsessive-compulsive symptomatology.
75 women and 64 men responded to the Coopersmith Self-esteem Inventory, the Manifest Anxiety Scale, and the Maudsley Obsessional-compulsive Inventory in addition to responding to a questionnaire on personal habits. The results indicated that more frequent hair-pullers and nervous twitchers scored lower on self-esteem and higher on anxiety. People who giggled and those who bit their fingernails more often scored higher on obsessive-compulsiveness. Self-reported gigglers were higher on manifest anxiety. If the criterion of self-assessed seriousness of the behavior problem was used, people who bit their nails, picked their noses, pulled their hair, chewed on objects, giggled, ground their teeth, twitched nervously, and picked at scabs scored lower on self-esteem. Higher manifest-anxiety scores were found among the people who regarded their nail-biting, hair-pulling, object-chewing, nervous twitching, or giggling as serious problems. Finally, people who regarded their nail-biting as more serious tended to have higher obsessive-compulsive scores. The results in general suggest that the frequency of several of these behaviors is anxiety-related and that it is the person's assessments of these behaviors as problems rather than simply their frequency that is related to higher anxiety and lower self-esteem.
American (n = 132) and Kuwaiti (n = 204) undergraduates responded to the Arabic Obsessive-Compulsive Scale in English and Arabic languages, respectively. Students in Kuwait scored as more obsessive-compulsive than their American counterparts.
The Arabic Obsessive-Compulsive Scale and the Maudsley Obsessional-Compulsive Inventory were administered to 159 Kuwaiti (Arabic version) and 72 American college students (English version). Pearson correlations for total score on the two scales were .68 and .64 for Kuwaiti and Americans, respectively, denoting a good convergent validity of the new Arabic Obsessive-Compulsive Scale against scores on the Maudsley Obsessional-Compulsive Inventory in the two different national groups.
The Arabic Obsessive-Compulsive Scale and the Maudsley Obsessional Compulsive Inventory were administered to 87 Kuwaiti (Arabic version) and 73 American college students (English form). Pearson correlations for the total score on the Arabic scale and the four subscores of the Maudsley scale: Checking, Cleaning, Slowness, and Doubting were .72, .48, .50, and .61 for the Kuwaitis and .52, .40, .51, and .52 for the Americans. The loadings of the total score of the Arabic scale onto a factor of obsession and compulsion were .83 and .79 for Kuwaiti and American students, respectively, denoting a good factorial validity of the Arabic scale.
To estimate the correlation between scores on obsession-compulsion and both age and sex, two studies were carried out with Kuwaiti (n1=87, n2=460), and American (n1=73, n2=273) undergraduates. The Arabic Obsessive-Compulsive Scale was used in both studies. Significant correlations were found for the Kuwaiti sample; however, these correlations were of low magnitude and have no practical value.
Freud (1909/1955) hypothesized a conflict between love and hate in obsessive neurosis. To test this relationship, we compared a Thematic Apperception Test-based measure of aggressive fantasies in college men who scored either high or low on the Obsessive-Compulsive Inventory-Revised. 64 undergraduate men from beginning classes in psychology participated. Their mean age was 19.4 yr. (SD= 1.7). 16 men with high scores had significantly higher scores on a TAT-based measure of aggressive fantasies toward parents, partners, and others than 15 men with low scores, which is consistent with Freud's hypothesis.
In this case series we report four cases of patients with Down syndrome with symptoms consistent with obsessive compulsive disorder. Each patient experienced substantial reduction in compulsive behaviors with pharmacotherapy of an SSRI alone or with the addition of risperidone to SSRI therapy. None of the patients experienced significant side effects. This small case series supports the use of these medications in the treatment of co-morbid obsessive compulsive disorder in patients with Down syndrome.
Behaviouristic theories of obsessive-compulsive neurosis are reviewed and their relationship indicated to the introduction of ritual prevention as a form of treatment for this condition. Studies investigating aspects of ritual prevention are summarised. The treatment of six obsessive-compulsive patients in a psychiatric ward of a general hospital is described and the difficulties encountered outlined. The authors' impression was that the response of patients shown was more marked and immediate than with any other treatment apart from leucotomy.
The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of obsessive-compulsive disorder were as follows: for those patients who have no significant personality disorder, either short-term dynamic psychotherapy or cognitive behaviour therapy is indicated if the illness has lasted less than a year or if obsessions are the predominant symptoms. When compulsions predominate, particularly when they have been present for more than a year, response prevention is the treatment of choice. Tricyclic antidepressants and cingulo-tractomy are also worthy of consideration in patients with persisting symptoms. Psychotherapy or cognitive behaviour therapy are the approaches recommended for compulsive personality disorder.
This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.
OBJECTIVE: To describe the characteristics of a series of children and adolescents with obsessive-compulsive disorder (OCD) and evaluate the outcome of treatment. METHOD: Type of symptoms, severity before and after treatment and factors associated with outcome were examined in a large group (n = 82) of consecutive OCD cases referred for treatment. RESULTS: Most children (95%) had both obsessions and compulsions. Symptoms had been present for 2 years on average. Seventy-one per cent (n = 57) of all eligible patients completed a combined behavioural and pharmacological protocol. Among these, there was a 68% remission rate and a 60% decrease of symptoms at 4 weeks. Comorbidity with oppositional defiant disorder and high aggression scores were associated with poor outcome. CONCLUSIONS: Juvenile OCD can be treated effectively in a standard clinical setting. Treatment programs of the kind described are accepted by young people. It remains to be seen whether in this age group a combined treatment produces better results than medication alone or cognitive-behaviour therapy alone.
OBJECTIVE: This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). METHOD: Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology. RESULTS: In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1-3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores. CONCLUSIONS: The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.
The aim of this study was to investigate the clinical efficacy of yogic techniques in the treatment of eight adults with obsessive-compulsive disorder (OCD). A specific yogic breathing pattern has been prescribed for the treatment of OCD, as well as others for treating generalized anxiety. A one year course of therapy was followed. Subjects improved on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) comparing baseline with three, six, nine, & 12 month results (one-way ANOVA for repeated measures, F(4,12) = 3.343, p < or = .046). Five patients completed the study (Y-BOCS results were 83%, 79%, 65%, 61% improvement, and one at-18%), group mean improvement of +54%. The Symptoms Checklist-90-R showed significant improvement comparing baseline and 12 months using two-tailed T-tests for OCD (t = 13.856, p < .001), anxiety (t = 3.167, p < .051), and global severity indexes (t = 7.314, p = .005). Perceived Stress Scale scores showed significant improvement for the five test periods (one-way ANOVA for repeated measures, F(4,12) = 9.114, p < or = .001). Five patients were well stabilized on fluoxetine prior to the study, three stopped medication after seven months or less, and two significantly reduced it, one by 25% and the other by 50%. These techniques, merit further study under controlled conditions and could help lead to new approaches for the treatment of OCD and perhaps other impulse control and anxiety-related disorders.
Psychoanalytic observation has launched a long tradition in medical literature that links constipation with obsessive-compulsive traits. This association, however, has never been tested empirically. The current investigation sought to test this hypothesized association empirically using a large, randomly sampled population database. Data from the Epidemiologic Catchment Area project collected with the Diagnostic Interview Schedule were analyzed to determine the association, if any, of complaint of medically unexplained constipation (ascertained from the somatization disorder section of the interview) with a DIS diagnosis of obsessive compulsive disorder (OCD). Reported history of constipation was significantly associated with a lifetime diagnosis of OCD in women (not men), even when controlling for symptom-reporting biases using number of other positive somatoform symptoms. This association was specific to constipation and OCD and did not apply to other functional bowel symptoms including diarrhea, bloating (gas), and abdominal pain. Other psychiatric disorders commonly implicated with functional bowel complaints--major depression and panic disorder--were not significantly associated with constipation controlling for effects of other somatoform symptoms. The lack of association of constipation with OCD in men in a general population sample fails to support psychoanalytic concepts that historically have linked these two phenomena, but a special relationship of OCD with constipation was present in women.
This review discusses augmentation strategies for patients with obsessive-compulsive disorder who fail to respond to treatment. A patient's failure to respond to treatment may be due to any of a number of factors, such as noncompliance with a behavioral program, concurrent severe depression or personality disorder, certain ritualistic behaviors, inaccurate diagnosis, and inadequate treatment. It is particularly important that comorbid psychiatric disorders be diagnosed and treated. A review of the literature and my experience with the use of augmenting agents such as lithium, buspirone, clonidine, fenfluramine, antidepressants, anxiolytic agents, and neuroleptics in treatment-resistant obsessive-compulsive disorder are presented. Existing evidence suggests that some of these approaches are useful for some patients. However, many questions remain, and much research remains to be done on this topic.
OBJECTIVE: The authors sought to determine the long-term outcome of patients with severe and refractory obsessive-compulsive disorder spectrum (OCDS) following neurosurgery. METHOD: Five patients who underwent neurosurgery as a last-resort treatment for refractory OCDS were evaluated. On all patients, posttest data was obtained from the Yale-Brown Obsessive-Compulsive Scale, The Overvalued Ideas Scale, the Beck Depression Inventory and the Beck Anxiety Inventory. Pretest scores were available on three patients as well. RESULTS: All patients failed to maintain initial improvements after surgery and relapsed. In addition, they became depressed with suicidal ideation or attempt. CONCLUSION: Complications of neurosurgery are discussed, notably relapse and depression.
In this report, recommendations for the pharmacological treatment of anxiety and obsessive-compulsive disorders are presented, based on available randomized, placebo- or comparator-controlled clinical studies. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for panic disorder. Tri2-cyclic antidepressants (TCAs) are equally effective, but they are less well tolerated than the SSRIs. In treatment-resistant cases, benzodiazepines like alprazolam may be used when the patient does not have a history of dependency and tolerance. Due to possible serious side effects and interactions with other drugs and food components, the irreversible monamine oxidase inhibitor (MAOI) phenelzine should be used only when first-line drugs have failed. In generalised anxiety disorder, venlafaxine and SSRIs can be recommended, while buspirone and imipramine may be alternatives. For social phobia, SSRIs are recommended for the first line, and MAOIs, moclobemide and benzodiazepines as second line. Obsessive-compulsive disorder is best treated with SSRIs or clomipramine.