[What psychotherapy to offer to anxious patients?].
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Anxiety Disorders↗
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[Tics and Tourette's syndrome].
This article is reviewing current knowledge of Tourette's syndrome (TS) including its clinical picture, pathophysiology, genetics and treatment. The semiology of TS is characterized with various types of motor and vocal tics and associated pathological behaviors as attention deficit hyperactivity disorder and obsessive-compulsive disorder. Recent pathophysiological and genetic data confirm organic character of the condition. Treatment strategies are proposed with regard to prevailing type of symptoms.
Diagnosis, Differential↗
Obsessive-compulsive disorder: the hidden epidemic.
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Adolescent↗
Investigating the structure of craving using structural equation modeling in analysis of the obsessive-compulsive drinking scale: a multinational study.
BACKGROUND: Currently, there is no agreement among researchers on the definition of craving and its underlying theoretical model. The Obsessive-Compulsive Drinking Scale (OCDS) seems to measure certain aspects of craving, but its theoretical basis remains unclear. The aim of this study was to investigate the structure of alcohol craving, using OCDS data. METHODS: OCDS data from four studies were pooled to obtain a large and heterogeneous sample of 505 participants. All participants were treatment-seeking alcoholics meeting DSM-IV criteria for alcohol dependence. The factor structures of the OCDS previously found were evaluated using confirmatory factor analyses. The goodness of fit of these solutions was compared with those of alternative causal models: an obsessive-compulsive disorder model, an inhibition model, and a cognitive-behavioral model. These alternative models were based on modern theories about craving and were tested in the OCDS data, using structural equation modeling. In this way, the current study replaced simple correlational analysis by a more sophisticated causal way of analyzing the underlying structure of the OCDS items. The best fitting model was selected by comparing the mean discrepancy between the implied and observed matrices of the models. RESULTS: The data showed that the previously reported factor structures had to be rejected. Also, the inhibition model and obsessive-compulsive disorder model did not fit the data. The cognitive-behavioral model showed encouraging fit. Optimizing strategies were applied to further improve the fit of this model, which resulted in a model with close fit to the data. CONCLUSIONS: The causal cognitive-behavioral model proved to be superior. It showed that the OCDS contains many items that do not represent the core concept of craving but instead are indicators for the consequences of craving. From this model, it seems that craving, in a narrow sense, can be reliably assessed with only five items of the OCDS.
Adult↗
Habituation to fear stimuli in a case of obsessive compulsive disorder: examining the generalization process.
The purpose of this investigation was to determine if habituation of anxiety to a visual form of the number 13 would generalize to other forms (auditory, behavioral and cognitive) of the number 13 in a 20-year-old male with obsessive compulsive disorder. Treatment included exposure and response prevention. A multiple baseline design across fear stimulus forms was used. Habituation to the visual form began generalizing to other forms of the number 13 before prolonged exposures to these three stimulus forms were instituted. Results suggest that exposure to a single stimulus form may result in sufficient generalization of treatment effects in cases involving seemingly independent fear responses to several forms of a stimulus.
Adult↗
Obsessive compulsive disorder treatment in patients with Down syndrome: a case series.
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.
Adult↗
Peer victimization and the development of obsessive-compulsive disorder in adolescence.
We describe an adolescent boy's experience of peer victimization and its relation with his development of obsessive-compulsive disorder (OCD). Subsequent to being peer victimized, this boy was seen for 20 sessions of cognitive-behavioral therapy over the course of 4 weeks that followed the protocol outlined by March and Mulle in 1998. Standardized post-treatment assessment indicated significant reductions in OCD, depressive, and anxious symptomatology as compared to baseline. This case illustrates how negative peer experiences may be related to the development and maintenance of OCD.
Adolescent↗
Obsessive-compulsive disorder in dermatologic practice.
Until recently, obsessive-compulsive disorder has been thought of as a rare illness with a poor prognosis. Epidemiologic studies have found that obsessive-compulsive disorder has a lifetime prevalence rate of 2% to 3%, double that of panic disorder or schizophrenia. Many patients with primary obsessive-compulsive disorder present initially to their medical specialist. Because of the frequency of nonspecific dermatitis in compulsive hand washers, as well as the number of patients presenting with somatic obsessions, dermatologists should be familiar with this disorder. The early recognition and diagnosis of obsessive-compulsive disorder has taken on increasing importance because of the development of effective pharmacologic and behavioral treatment strategies.
Adult↗
Normal and disordered compulsivity: evidence against a continuum.
Sixteen patients with obsessive compulsive disorder and 16 mentally healthy control subjects of comparable gender, age, and educational level underwent psychometric testing with the Obsessive-Compulsive subscale of the Comprehensive Psychiatric Rating Scale, the Maudsley Obsessive-Compulsive Inventory, and the Obsessive subscale of the Lazare-Klerman-Armor (LKA) Personality Inventory. An interviewer also rated each subject as positive or negative for each of the five DSM-III elements of compulsive personality disorder. Patients scored significantly higher than controls on all measures except the Obsessive subscale of the LKA Personality Inventory, on which the controls actually scored slightly higher. The authors suggest that the failure of this last instrument to differentiate the subject groups can be interpreted as evidence against a continuum between a certain type of supposed normal personality pattern (obsessive or compulsive) and a corresponding psychopathologic state (obsessive compulsive disorder).
Adult↗
Paradoxical instruction in the elimination of avoidance behavior in an agoraphobic girl.
The case is described of a 16-yr-old girl whose agoraphobia was of recent onset. In the light of a rapidly increasing pattern of escape and avoidance behavior associated with several phobic situations, treatment consisted of a paradoxical instruction to embellish subjective anxiety and elicit anticipated negative consequences during prolonged in vivo exposure. Treatment was associated with the elimination of avoidance behavior and a dramatic reduction in self-reported anxiety, and obsessive-compulsive complaints, as well as anxiety ratings during exposure. These improvements were maintained and enhanced at both 3- and 9-month follow-up. The implications of this approach with severe fears and the need for additional empirical evaluations are discussed.
Adolescent↗
Hair pulling and eating in captive rhesus monkey troops.
Hair pulling and eating has not yet received attention in the nonhuman primate literature. Hair pulling and eating was recorded 388 times in two heterogeneous troops of healthy rhesus monkeys that were kept according to modern management practices. The behavior in question consists of the following sequence: pulling with the fingers (1/3 of cases) or with the teeth (2/3 of cases) tufts of hair from one's own or from a partner's coat; chewing the hair and finally swallowing it; the undigested material is excreted in the feces. Hair pulling was almost exclusively (378/388) partner-directed. It was observed 364 times between animals whose dominance relationships were known; it was performed in 96% (349/364) of observations by a dominant but only in 4% (15/364) of observations by a subordinate monkey. The recipient of hair pulling showed typical fear and/or avoidance reactions. In both troops young animals (2-8 years of age) engaged in hair pulling and eating significantly more often than old animals (10-26 years of age). There was no evidence that nutritional, toxicological or climatic factors were responsible for the manifestation of this behavior. It was concluded that, similar to trichotillomania in man, wool pulling and eating in sheep and muskox, and feather picking in poultry, hair pulling and eating is an aggressive behavioral disorder in rhesus monkeys reflecting adjustment problems to a stressful environment.
Animals↗
The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence.
This study was conducted to investigate the association between psychiatric disorders and high-risk sexual behavior among adolescent primary care patients. Interviews assessing anxiety, conduct, depressive, eating, substance use, and personality disorders (PDs), as well as histories of sexual behavior were administered to 119 male and 284 female adolescent primary care patients. Results indicated that, after co-occurring psychiatric disorders were controlled statistically, adolescents with elevated PD symptom levels were more likely than adolescents without elevated PD symptom levels to report a high number of sexual partners during the past year and during their lifetime. Adolescents with a history of conduct disorder were more likely than adolescents without such a history to report a high number of lifetime unsafe sexual partners. Elevated antisocial, dependent, and paranoid PD symptom levels were associated with high-risk sexual behavior after co-occurring psychiatric disorders were controlled. Further, certain specific antisocial, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, and schizotypal PD symptoms were independently associated with high-risk sexual behavior after co-occurring psychiatric disorders and overall PD symptom levels were controlled. The association between overall PD symptom levels and the number of sexual partners was significantly stronger among the females than among the males in the sample. Increased recognition and treatment of PDs, coupled with increased recognition of high-risk sexual behavior may facilitate the prevention of sexually transmitted diseases and teenage pregnancy among adolescents.
Adolescent↗
Childhood obsessive compulsive disorder.
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Adolescent↗
Depersonalization disorder and self-injurious behavior.
Depersonalization is a subjective sense of unreality regarding various aspects of the self, experienced as disconnectedness from one's own body, mentations, feelings, or actions. When episodes of depersonalization are recurrent or persistent and lead to distress or dysfunction, the diagnosis of depersonalization disorder is made. Certain similarities in phenomenology, comorbidity, neurochemistry, and treatment response suggest a relationship to the obsessive-compulsive spectrum. However, depersonalization is a very poorly studied condition, and any conclusions must be viewed tentatively. Self-injurious behaviors are defined as intentionally self-inflicted bodily injuries without lethal intent. Basic categories are briefly described. Subsequently, the phenomenology and biology of both impulsive and compulsive self-injurious behaviors, and their relationship to the obsessive-compulsive spectrum, are discussed.
Adolescent↗
[Psychotherapy of compulsive disorder in children and adolescents--an overview].
The literature on evaluated methods of psychotherapy for the treatment of obsessive-compulsive disorders (OCD) in children and adolescents is reviewed and the following cognitive-behavioral treatment modules are described: psychoeducation, exposure with response prevention, family-based interventions, and cognitive as well as meta-cognitive techniques. Behavior therapy, especially exposure with response prevention, has been shown to be an effective treatment. Severe cases require a combined therapy with serotonin-reuptake inhibitors, while "thought stopping" cannot be recommended as an effective therapy for obsessions. New cognitive and meta-cognitive approaches should be evaluated to determine whether they might advance treatment. Controlled therapy studies are needed in order to evaluate the different effects and underlying efficacy factors of, as well as the indications and contraindications for different strategies of treatment for obsessive-compulsive disorder in childhood and adolescence.
Adolescent↗
Obsessive-compulsiveness in obese weight-loss patients and normal weight adults.
It recently has been suggested that obsessive-compulsive personality characteristics may predispose people to become obese. In addition, it has been suggested that dieting may increase the frequency of thoughts about food and its consumption. The present study compared a group of 50 obese weight-loss patients to 50 normal weight adults on personality-related O-C characteristics and food and eating-related cognitions. Results supported the notion that obese weight-loss patients tend to be obsessed with food. There was no evidence that traditional O-C personality measures are related to obesity. These results suggest that effortful inhibition of appetitive behaviors may have adverse cognitive consequences.
Adult↗
Passive and participant modelling in exposure treatment of obsessive-compulsive neurotics.
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Adult↗
Compulsive sexual behaviors.
CSBs constitute a wide range of complex sexual behaviors that clinicians are increasingly encountering. This article has set forth four models of CSBs: compulsive, affective, addictive, and impulsive. Some of the CSBs appear to fit rather neatly into one of the models, whereas others have features of two or more of them. The identification of these various features has important treatment implications. Although a scientific demarcation of these sexually compulsive disorders awaits further research, clinicians should be aware of the growing number of assessment and treatment approaches for these disorders, as well as of the specialists in the field who can be turned to for consultation and referral depending upon the complexities and dangerousness of the case.
Adult↗