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The assessment and coordination of treatment of children and adolescents with OCD.

This article discusses assessment, differential diagnosis, and treatment planning for children and adolescents with obsessions and compulsions. Such children require a detailed assessment of their obsessions and compulsions, comorbid difficulties, and overall developmental and adaptive functioning. Although cognitive behavioral therapy and psychopharmacology are the main forms of treatment for the core symptoms of OCD, comprehensive treatment planning and coordination require attention to the child's overall clinical picture.

Adolescent↗

Strategies used with intrusive thoughts: a comparison of OCD patients with anxious and community controls.

Models of intrusive thoughts attribute a key role to strategies used by people to cope with their unwanted cognitions. In an extension of previous work, the authors conducted structured interviews with 38 people with obsessive-compulsive disorder, 38 people with another anxiety disorder, and 19 healthy volunteers. The interview identified the repertoire of strategies used with the participant's most troubling thought. The 2 clinical groups reported significantly more strategies than the nonclinical group. The clinical groups also reported significantly greater intensity of the thought and their emotional response and lower efficacy for the strategies. People with OCD reported a significantly higher proportion of strategies that were specifically linked to the thought content (as distinct from nonspecific strategies that were only linked sequentially in time). The results identify both common and differential characteristics of intrusive cognition in anxiety disorders.

Adult↗

Investigation into the relationship between personality traits and OCD.

In the light of recent research suggesting that obsessive-compulsive disorder is more likely to be associated with constellations of personality traits other than obsessive-compulsive personality traits, the present study was undertaken to explore this relationship further and to remove the possibly confounding effects of general pathology, anxiety and depression. By using a non-clinical sample and partialling out the effects of anxiety and depression, it was found, contrary to recent research, that specific obsessional symptoms were only related to the traits of obsessive-compulsive personality disorder.

Adolescent↗

Timing of neuroendocrine responses and effect of m-CPP and fenfluramine plasma levels in OCD.

The present study assesses the timing of and relationship between neuroendocrine response and metabolite blood levels following the partial serotonin (5-HT) agonist m-CPP and the 5-HT releaser/reuptake blocker fenfluramine. Cortisol levels peaked significantly earlier than did prolactin, m-CPP, fenfluramine, or norfenfluramine blood levels by time-to-peak analysis. This earlier cortisol response to both 5-HT agents raises the possibility that peripheral mechanisms may play a role in cortisol release. Since peak m-CPP level correlated even more closely to peak prolactin rise than did peak fenfluramine, this suggests that prolactin response to oral m-CPP challenge is useful in assessing 5-HT function.

Adult↗

SERT and DAT availabilities under citalopram treatment in obsessive-compulsive disorder (OCD).

Serotonin and dopamine transporter (SERT, DAT) availabilities have prospectively been investigated using [123I]beta-CIT and single photon emission computed tomography in subjects with obsessive-compulsive disorder under treatment with the selective serotonin reuptake inhibitor citalopram. SERT availability decreased by a mean 36.5%, whereas DAT availability increased by about 40%. The data point at a citalopram induced modulation of both serotonergic and dopaminergic activity and support the notion of functional interactions of monoaminergic systems in the human brain.

Brain↗

Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD.

Predictors of improvement in obsessive-compulsive symptoms (Y-BOCS) in a randomized clinical trial with adult obsessive-compulsive disorder outpatients were examined. Results of multiple regression analyses revealed that a positive helping alliance was significantly predictive of posttreatment Y-BOCS. Treatment expectancy and high motivation to change were not significantly related to posttreatment outcome. None of the predictors were significantly related to Y-BOCS levels at 12-month follow-up, but positive alliance showed a trend to significance.

Adult↗

Using mental imagery with subclinical OCD to 'freeze' contamination in its place: evidence for looming vulnerability theory.

The present research examines the possibility that 'freezing' or slowing-down the rate at which threats can advance and thereby blocking a sense of looming vulnerability can reduce fears of contamination and avoidance behavior among individuals with obsessional symptoms. Mental imagery was used to reduce the rate at which threat can advance by means of instructions to imagine that contamination was 'frozen' in place and unable to move. Measures included self-reports of anxiety and worry, and indirect assessments of fear and avoidance behavior. A parallel mental imagery condition was used to examine the possibility that accentuating the spread or contamination, or its 'looming', would in turn accentuate fear and avoidance. The results, particularly of the more unobtrusive measures, indicated that freeze imagery reduced fear and avoidance for the relatively obsessional participants. In addition, support was found that it reduced fear for participants with relatively higher levels of imagination. However, the freeze imagery paradoxically seemed to sensitize the non-obsessional participants to possibilities of contamination they had not previously considered, and thus increased their fear. The results provide support for the looming vulnerability model of anxiety and suggest applications to treatment.

Adolescent↗

Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension.

In a follow-up study to [J. Anxiety Disord., in press] examination of inflated perception of responsibility for harm among individuals with obsessive compulsive disorder (OCs), 22 OC checkers, 24 OC non-checkers, and 25 non-anxious controls (NACs) completed the Obsessive Compulsive Responsibility Scale (OCRS), which consisted of written descriptions of Low-Risk (LR), Moderate-Risk (MR), and High-Risk (HR) scenarios. In LR and MR scenarios, OC checkers reported greater perception of responsibility for harm and greater relief upon rectifying the situation, than did NACs. OC checkers also reported greater urges to rectify LR situations than did NACs. OC non-checkers did not differ from NACs on any of the scales. No group differences emerged for HR scenarios. The results suggest that, compared to OC non-checkers and to NACs, OC checkers have an inflated perception of responsibility for harm; and that this perception leads to a need to rectify potentially harmful situations.

Analysis of Variance↗

Osteoarticular grafts in the treatment of OCD of the talus: mosaicplasty versus autologous chondrocyte transplantation.

Further advancements in articular cartilage transplantation require an understanding of the anatomy, physiology, biomaterials, biology, and cartilage engineering that are fundamental for better results in joint arthroplasty and cartilage repair. Currently, efforts to induce healing and regeneration of cartilage are being directed toward enhancing the natural potential of cartilage to replace the damaged tissue with cells that can generate cartilage. Mosaicplasty and ACT are carried out in the same way, have similar therapeutic indications, and have been demonstrated capable of reconstructing hyaline cartilage with similar clinical results. ACT is the most recent technique and, in the authors' opinion, is preferable in that it is less invasive at the donor site and gives better histologic results because of the reconstruction of a continuous cartilage sheath compared with that achieved by mosaicplasty. Furthermore, with this technique, it is possible to forecast the possibility of improvement owing to further technical and biologic advancements. The authors are currently experimenting with the use of adhesive patches with substitution of the periosteum, resulting in less morbidity. The use of growth factors and new tissue engineering techniques in the future would simplify the methodology, rendering it less invasive and more effective.

Animals↗