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PubMed1996

Obsessive compulsive disorder and depression--first results of a prospective study on 74 patients.

1. Seventy-four patients who met DSM-III-R criteria for Obsessive Compulsive Disorder received a serotonin reuptake inhibitor and cognitive behavior therapy for 6 months (baseline to follow-up I). 2. In order to maximize therapeutic effects, different kinds of treatment were applied between follow-up I and follow-up II (12 months). 3. Patients were followed-up twice with respect to long-term outcome of obsessive compulsive disorder and depression. Forty % of the sample showed marked improvement at follow-up. No specific variant of treatment could be identified to be significantly more effective. 4. Cross-sectional investigations showed significant correlations between extent of depressive and obsessive compulsive symptomatology (admission, follow-up I and II).

Adolescent↗
PubMed1993

Obsessive-compulsive disorder: efficacy of specific treatments as assessed by controlled trials.

There is overwhelming evidence that specific pharmacologic agents are effective in lessening symptoms of OCD in many patients. In addition, considerable evidence indicates that the behavioral techniques of exposure and response prevention are effective. Although complete cure occurs infrequently, the combination of both pharmacotherapy and behavioral treatment optimizes the individual patient's potential for recovery and the majority of patients can now expect to lead relatively normal lives, to work, and to function well in families and in social situations. There is no controlled, and almost no anecdotal evidence, to suggest that traditional psychodynamic psychotherapy or psychoanalysis are effective in treating the symptoms of OCD. However, wise clinicians frequently use psychotherapy as an adjunct to more specific treatments to help deal with other problems that the patient might have. Even though many patients became vigorously opposed to psychodynamic treatments and psychoanalysis after experiencing such treatments for years without any improvement in their obsessions and compulsions, they are now realizing that psychotherapy may have a place in the treatment plan for many patients who, after responding to medication and behavior therapy, need to explore the deeply rooted thought patterns that developed in response to obsessive-compulsive behaviors and to work to free themselves from these patterns. For example, it may no longer be adaptive for the patient to attempt to control others, or to set up a restricted or extremely regimented environment. Even trying to distinguish a "normal" thought or worry from an obsession may require the help of a therapist. There may well be a place for psychodynamic therapies for some patients (often with onset of OCD in childhood) who are left with developmental scars after their OCD is well-treated. Although controlled evidence is lacking, there may well be a role for neurosurgical procedures in the management of very severely-ill OCD patients who have failed to respond to more conventional treatments. With the development of new technologies, controlled trials may now be feasible.

Clinical Trials as Topic↗
PubMed2005

A tale of two foxes--case reports: 1. Radial nerve paralysis treated with acupuncture in a wild fox. 2. Acupuncture in a fox with aggressive and obsessive behaviour.

Case 1. This is believed to be the first report of acupuncture treatment for traumatic radial nerve paralysis in a wild fox. From the first treatment, improvement in the range of mobility and sensation of the limb was evident. Additionally, the attitude of this wild animal changed from fear and aggression to complete cooperation: he lay peacefully during every treatment in a calm, drowsy state. Case 2. This reports the calming effects of acupuncture on a fox which had been showing aggressive behaviour and obsessive circling following toxoplasma infection.

Acupuncture Therapy↗
PubMedDate not supplied

Self-treatment for obsessive compulsive disorder using a manual and a computerized telephone interview: a U.S.-U.K. study.

Bt steps is a patient-centered behavioral therapy program that uses a manual and a computer-driven interactive voice response system to assess and treat obsessive compulsive disorder. This nine-step program contains a self-assessment module and a self-treatment module that provides teaching on exposure and ritual prevention. The patient reads about the steps in a manual and then uses a touch-tone telephone to contact the program, in which a recorded voice conducts the interview. Of 40 patients in an open 12-week trial in the United States and London, 35 completed the self-assessment module, and 17 completed at least two sessions of exposure and ritual prevention. The system produced statistically significant improvements on measures of obsessive compulsive disorder.

Adult↗
PubMed2001

Combining ondansetron and naltrexone reduces craving among biologically predisposed alcoholics: preliminary clinical evidence.

RATIONALE: Previously, we have reported that the combination of ondansetron (a 5-HT3 antagonist) and naltrexone (a mu opioid antagonist) appears to act synergistically at improving the drinking outcomes of early onset alcoholics (EOA). a subtype of alcoholic characterized by developing problem-drinking earlier, antisocial behaviors, high familial loading, and biological disease predisposition. Presumably, this medication combination counteracts the interaction between activated central 5-HT3 receptors and the endogenous opioid system during the mediation of alcohol-induced reward. We now hypothesize further that an important mechanism by which the combination diminishes alcohol consumption is through a reduction in craving. OBJECTIVE: To determine whether the combination of naltrexone and ondansetron is superior to a placebo at reducing craving among EOA, and the relationship between craving and drinking behavior in both treatment groups. METHODS: We conducted an 8-week double-blind placebo-controlled clinical trial in which 10 EOA were randomized to receive ondansetron (4 microg/kg b.i.d.) + naltrexone (25 mg b.i.d.) and 10 EOA had a placebo (total n=20) as an adjunct to weekly standardized group cognitive behavioral therapy. Craving was measured by using the obsessive compulsive drinking scale (OCDS). RESULTS: Craving ratings were scored on four subscales which where derived empirically by principal component structure analysis of the OCDS. EOA who received the medication combination, compared with the placebo, had significantly lower scores on "automaticity of drinking" and "alcohol consumption ". Reduction in automaticity of drinking was correlated with self-reported drinking for only the medication combination group. CONCLUSIONS: By reducing automaticity of drinking, the medication combination presumably decreased drinking salience and intensity. Larger scale studies testing these medications, both alone and together, among alcoholic subtypes are needed to establish and extend these promising findings.

Adult↗
PubMed1996

New developments in behaviour therapy for obsessive-compulsive disorder.

Effective behaviour therapy techniques of exposure and response (or ritual) prevention for obsessive-compulsive disorder (OCD) are based on the principle of habituation. This is a common-sense approach that is simple in conception but not easy to implement and maintain. Controlled trials have proven the short- and long-term effectiveness of behaviour therapies in OCD and meta-analyses suggest that behaviour therapy is at least as effective as potent serotonin reuptake inhibitors (SRIs). A combination of these behavioural and psychopharmacological modalities might represent the optimal treatment for OCD. Here I review behaviour therapy techniques for OCD, the studies supporting its effectiveness and acceptability and problems limiting its wider dissemination. The preliminary results of a computer-administered behaviour therapy programme for OCD, BT STEPS, are also presented.

Behavior Therapy↗
PubMed2004

Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon.

AIM: To propose a diagnostic proceeding and to try to verify the prevalence of orthorexia nervosa (ON), an eating disorder defined as "a maniacal obsession for healthy foods". MATERIALS AND METHODS: 404 subjects were enrolled. Diagnosis of ON was based on both the presence of a disorder with obsessive-compulsive personality features and an exaggerated healthy eating behaviour pattern. RESULTS: Of the 404 subjects examined, 28 were found to suffer from ON (prevalence of 6.9%). The analysis of the physiological characteristics, the social-cultural and the psychological behaviour that characterises subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education. The orthorexic subjects attribute characteristics that show their specific "feelings" towards food ("dangerous" to describe a conserved product, "artificial" for industrially produced products, "healthy" for biological produce) and demonstrate a strong or uncontrollable desire to eat when feeling nervous, excited, happy or guilty.

Adult↗
PubMed1998

Neuroanatomical aspects of cognitive-behavioural therapy response in obsessive-compulsive disorder. An evolving perspective on brain and behaviour.

BACKGROUND: Recent research has demonstrated that cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) can systematically modify cerebral metabolic activity in a manner which is significantly related to clinical outcome. METHOD: A substantial body of research is reviewed which supports an involvement of neural circuitry connecting the orbitofrontal cortex, cingulate gyrus and basal ganglia in the expression of the symptoms of OCD. RESULTS: Data are presented which expand upon previous work demonstrating effects of CBT on functional interactions between limbic cortex and the basal ganglia. CONCLUSIONS: The relevance of these effects of CBT on brain function is discussed in the context of recent advances in our knowledge of cortical-basal ganglia physiology. The clinical importance of these data is best appreciated when they are seen to reflect the interactive nature of the relationships between cognitive choice, behavioural output and brain activity.

Behavior Therapy↗
PubMed1992

Paraphilias: a double-blind crossover comparison of clomipramine versus desipramine.

A relationship has been suggested between clinical presentation of paraphilias and obsessive-compulsive disorder (OCD) with respect to the unwanted repetitive nature and insight into the irrationality of the paraphiliac behavior. This has led to speculation that paraphiliac disorders might belong to an "obsessive compulsive spectrum." To address this issue, and because of the striking selective benefit of serotonin reuptake blocking antidepressants (such as clomipramine) in the treatment of OCD, 15 paraphiliacs entered a double-blind crossover comparison of clomipramine vs. desipramine preceded by a 2-week single-blind placebo period. Four subjects responded to placebo and were dropped from the study. Three others failed to complete the study. Although the study is limited by the small number of patients and the heterogeneity of the paraphilias, the observed benefit from both tricyclics (over the initial placebo) encourages further study. For the 8 subjects completing the protocol, there was no preferential response to the more specific serotonin reuptake inhibitor suggesting a difference in underlying pathophysiology between paraphilia and OCD.

Adult↗
PubMed2001

[The psychopathology of severe obsessive-compulsive disorder: Zwangskrankheit and primary obsessional slowness].

In investigation obsessive-compulsive phenomena, it is important to not only regard them as a kind of symptomatology extending across a variety of diagnostic categories on the basis of faint similarities of symptoms from the cross-sectional point of view, but also to take into account how the psychopathology of a nuclear form of severe obsessive-compulsive disorder (OCD) is different from a neurotic form from the vertical-sectional point of view. In this paper, the psychopathological features of 3 cases of Zwangskrankheit and primary obsessional slowness, which are considered to be nuclear forms of severe OCD, are reported. We suggest that 'obsessive-compulsive pseudophobia' lies behind Zwangskrankheit, and 'obsessive-compulsive depersonalization' lies behind primary obsessional slowness. In both disorders, a peculiar form of avoidance behavior, called 'pathological access to safety signal' was observed in which dangerous situations were avoided by taking no other action other than a determined one. Thus never making a mistake was stressed in their actions which is a feature of adherence to extra-orderliness. Therefore, a patient with Zwangskrankheit lives a restricted life according to strict rules characteristic of ritualization of one's whole life, while a patient with primary obsessional slowness acts according to the principle of miticulousness. Thus we considered that this kind of avoidance behavior is the result of a loss of safety signal not by the existence of a danger signal. In a neurotic form of OCD, patients may attempt to superficially restore the safety signal by avoiding the danger signal. In comparing the psychopathology of OCD with agoraphobia, avoidance behavior involves space in the latter, while it is an act in the former. Obsessive-compulsive pseudophobia and obsessive-compulsive depersonalization are hypothesized to be the background of symptoms of a neurotic form of OCD, but since the patients do not experience them as phenomena and so cannot take them into the field of consciousness, then they are likely to feel them, literally 'obsessive-compulsive.'

Adult↗
PubMed2006

The effects of temporary inactivation of the orbital cortex in the signal attenuation rat model of obsessive compulsive disorder.

Rats undergoing extinction of lever pressing after an external feedback for this behavior was attenuated by extinguishing its Pavlovian association with the reward (signal attenuation) exhibit compulsive lever pressing. The present study tested the effects of temporary inactivation of the orbital cortex in rats undergoing extinction of lever pressing that was or was not preceded by signal attenuation (post-training signal attenuation and regular extinction, respectively). Orbital inactivation led to a nonspecific decrease in lever pressing in rats undergoing post-training signal attenuation and to the emergence of compulsive-like behavior in rats undergoing regular extinction. These results suggest that orbital inactivation and extinguishing a Pavlovian stimulus-reinforcer contingency have a similar effect on lever pressing and are in line with previous findings implicating the orbital cortex in mediating the effects of previously acquired stimulus-reinforcer associations on operant behavior.

Analysis of Variance↗
PubMed2002

[Predicting factors of eating disorders and general psychological symptoms in female college students].

OBJECTIVE: To compare and determine the relative effects of six of the variables (family functioning, self-esteem, obsessive-compulsive symptoms, depressive symptoms, locus of control and Body Mass Index-BMI) related to the etiology of eating disorders in predicting eating disorder symptoms and the general symptom index. METHOD: Two hundred and ninety-two female college students completed the Rosenberg Self-Esteem Scale (RSES), the Family Assessment Device (FAD), the Eating Attitude Test (EAT), the Symptom Check List (SCL-90-R), Rotter's Internal-External Locus of Control Scale (RIELCS), and the Beck Depression Inventory (BDI). Multiple regression analysis was employed, and scores of the obsessive-compulsive subscale of SCL-90-R, BMI, RSES, FAD, BDI and RIELCS were used as predictors of EAT total scores. The second multiple regression analysis was employed with the same independent variables as predictors of the General Symptom Index (GSI) of SCL-90-R. RESULTS: Obsessive-compulsive symptoms were the best predictor of the total score of EAT, and the second was the BMI scores. Depressive symptoms and self-esteem scores were significantly correlated with EAT scores but these variables were not chosen for inclusion in the regression equation. There was a strong relation between scores on BMI and scores on EAT. BMI scores were correlated nonsignificantly with the scores of the other variables. RIELCS and FAD scores were not significantly correlated with EAT scores. Obsessive-compulsive symptoms were also the best predictor of GSI of SCL-90-R and the second best predictor was the RSES. FAD was significantly correlated with SCL-90-R GSI scores, depression and obsessive compulsive scores. CONCLUSION: It appears that obsessive-compulsive symptoms were the best predictor of pathologic eating behavior. BMI was the second predictor of EAT scores. Locus of control and family functioning were not correlated with eating pathology. Family functioning scores were significantly correlated with the GSI scores, and depressive and obsessive-compulsive symptoms. Obsessive-compulsive symptoms were also the best predictor of the GSI scores.

English Abstract↗
PubMed2000

Obsessions: the impact and treatment of obsessive-compulsive disorder in children and adolescents.

In the development of the majority of children, ritualistic behaviour may be seen as a normal phenomenon. In some children and adolescents, however, these rituals become time-consuming, interfering, irritating and annoying. The most common obsessions in both children and adults with obsessive-compulsive disorder (OCD) are related to a fear of dirt and contamination, fear of some terrible happening, and the fear of harming a loved one. The most common compulsions are washing fixations, checking behaviour and rituals (including mental rituals). Prevalence studies show that OCD in children and adolescents is far more common than previously thought. It is estimated that up to 2% of this population have symptoms fulfilling OCD criteria. The impact of early OCD onset can be profound, with long-term studies indicating that approximately 50% of these patients will also suffer from OCD in early adulthood. These patients tend to remain socially isolated, to have fewer relationships than their non-OCD peers, and have a tendency to remain within the family home during early adulthood. In addition, childhood OCD is associated with comorbid psychiatric disorders, in particular depression, anxiety and panic disorders, Tourette's syndrome and eating disorders. Treatment strategies for childhood OCD reflect those used in adult psychiatry. The most effective psychotherapeutic approach is based on cognitive-behavioural therapy with exposure and prevention. In contrast to pharmacotherapeutic agents without serotonin activity, the serotonin-specific antidepressants appear to be effective and well-tolerated in the treatment of OCD in children.

Adolescent↗
PubMed1989

Obsessive-compulsive disorder in mentally retarded patients.

Of 283 mildly to profoundly retarded patients, 10 (3.5%) presented with compulsive behavior that significantly interfered with their daily functioning. Compulsions occurred in the context of obvious cerebral dysfunction and in the absence of anxiety or "ego-dystonic" qualities. The interrater reliability of the differential diagnosis between compulsions, stereotypies, and other repetitive behaviors was good (kappa = .82). A severity rating scale for the compulsive behavior yielded total scores with good interrater reliability (intraclass correlation coefficient = .82). Single items that described observable behaviors had good reliability, while inner resistance and subjective distress were not reliably assessed and contributed little to the total score. The authors suggest that the DSM-III-R diagnosis of obsessive-compulsive disorder be considered in mentally retarded patients, despite the absence of recognizable ego dystonic characteristics. Emphasis should be on the behavioral, externally observable components of the disorder, rather than on inner conflicts and anxiety. Such a diagnostic approach may also benefit nonretarded compulsive patients.

Adolescent↗