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Thought suppression and obsession-compulsion.

It was argued that obsession-compulsion might affect the consequences of thought suppression. A group of 35 female students who were first submitted to thought suppression and then to an expression instruction were compared with a group of 38 female students submitted twice to an expression instruction. The emotional character of a target story read by subjects was systematically varied between subjects, and obsession-compulsion was included as a third between-subjects factors. No evidence of rebound or of initial enhancement was found when reported story-related thoughts were compared across instructional conditions. There was an interaction between obsession-compulsion and initial instruction on attempts to avoid target thoughts during the first period. Contrary to expectations obsession-compulsion was related to fewer attempts at suppression in the suppression and more in the expression conditions. Similarly, there was a trend for obsession-compulsion to be related to more frequent target thoughts in the expression and less in the suppression conditions. These findings are discussed in relation to the role of perceived responsibility in obsession-compulsion for thought as a determinant of thought processes of obsessive-compulsive people.

Adult↗

Multimodal treatment of a case of obsessive-compulsive neurosis.

A severe incapacitating case of obsessive-compulsive neurosis was treated in hospital with an intense multimodal approach including individual, conjoint marital, and group psychotherapy, behavioral therapy, occupational and recreational therapy, milieu therapy, and medications. The separate treatments appeared to have a synergistic effect. The patient's symptoms decreased dramatically, and he resumed his normal occupational and family functions and responsibilities. At 2-year follow-up, the patient remained well.

Adult↗

Re-examining comorbidity of Obsessive Compulsive and Attention-Deficit Hyperactivity Disorder using an empirically derived taxonomy.

BACKGROUND: Using an empirically derived instrument to reduce the assessor bias inherent in structured diagnostic interviews, we sought to re-examine and validate the putative comorbidity between Obsessive Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. METHOD: We examined the correlation between Child Behavior Checklist (CBCL) syndrome, competence, and composite scores in children with: 1) OCD plus ADHD (OCD + ADHD), N = 47; 2) OCD without comorbid ADHD (OCD), N = 33; 3) ADHD without comorbid OCD (ADHD) N = 43; and 4) comparison controls recruited from general pediatric clinics,N = 32. RESULTS: CBCL findings in our ADHD children were similar to previous findings reported in ADHD youth, irrespective of the presence or absence of comorbid OCD. Comorbid youth generally had additive scores on the CBCL scales, reflecting the independent contribution of symptomatic and functional impairment from each disorder. CONCLUSION: These findings suggest that when ADHD-like symptoms are seen in OCD youth, they reflect a true comorbid state of OCD plus ADHD. The CBCL may provide a rapid assessment tool to identify comorbid ADHD in OCD youth.

Adolescent↗

Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies.

Increased interest in body dysmorphic disorder (BDD) has generated a wealth of recent research. This paper reviews the current literature regarding conceptualizations of the disorder, the development of assessment tools, and treatment outcome. Although BDD has been viewed as a variant of an eating disorder, obsessive compulsive disorder, or a somatoform disorder, it appears best conceptualized as a body image disorder with social, psychological, and possibly biological influences. Assessment instruments with acceptable psychometric properies have been developed to specifically assess BDD (e.g., the Body Dysmorphic Disorder Examination and the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder). Examination and the initial results from uncontrolled and controlled treatment research suggest that cognitive behavioral treatments for BDD may be as effective as those for possibly related disorders such as obsessive compulsive disorder and bulimia nervosa.

Body Image↗

Two cases of severe head-banging parasomnias in peripubertal males resulting from otitis media in toddlerhood.

The author presents two case reports of peripubertal boys with severe and chronic head-banging parasomnias, or rhythmic movement disorders (RMDs), which started de novo whilst they were suffering from recurrent and severe otitis media in toddlerhood. Treatment consisting of straightforward behaviour modification techniques and advice concerning healthy sleeping habits proved highly successful. It is proposed that these late-onset or 'acquired' forms of RMD might be distinct from those which continue from infancy which have a stronger developmental aetiology.

Behavior Therapy↗

[Choice of symptoms in neuroses. Hysterical and obsessive-phobic neuroses].

This publication is a first attempt to verify our hypothesis that symptom choice in the classical neuroses depends on a disequilibrium between assimilation and accommodation, in the Piagetian sense, of reflective thinking. Results of tests derived from classical paradoxes of Western thought, from genetic psychology and from a neuropsychological test of the habituation of the alpha-blocking response support the following hypothesis; the reflective thinking of hysterical patients appears dominated by a primacy of assimilation and that of obsessional patients by a primacy of accommodation.

Alpha Rhythm↗

m-Chlorophenylpiperazine in patients with obsessive-compulsive disorder: absence of symptom exacerbation.

Oral administration of the serotonin mixed agonist-antagonist meta-chlorophenylpiperazine (mCPP) at 0.5 mg/kg has been reported to exacerbate symptoms of obsessive-compulsive disorder (OCD). In an attempt to replicate these findings, double-blind behavioral and biochemical measures were obtained in 12 drug-free patients (9 men, 3 women) with OCD who received either oral mCPP (0.5 mg/kg), intravenous (IV) mCPP (0.1 mg/kg over 20 min), or placebo in random order on 3 separate test days. Neither oral nor IV mCPP had significant effects on the severity of OCD symptoms. The magnitude of the mCPP-induced plasma prolactin response and plasma mCPP levels were similar to those values obtained in other published studies in which mCPP exacerbated OCD symptoms. In contrast, both oral and IV mCPP were associated with significant increases in ratings of anxiety. These findings suggest that mCPP, whether administered by an oral or intravenous route (as a slow infusion), may not be a reliable probe for investigating obsessive-compulsive symptoms. It is possible, however, that more reproducible behavioral findings might be obtained by identifying susceptible subgroups of OCD or by including a behavioral exposure condition.

Administration, Oral↗

Obsessive-compulsive disorders: a review of the literature.

The authors reviewed the studies on obsessive-compulsive disorders published from 1953 to 1978. They report on various theories of the etiology of the disorders and provide an overview of the studies based on these theories. The treatment modalities covered include behavioral modification, drug therapy psychotherapy, surgery, and experimental therapies. the authors conclude that, although the obsessive-compulsive disorders are widely present, there is a paucity of new data concerning their treatment. The evidence to date, however, suggests that psychotherapy is an essential ingredient in the treatment process. They recommended that further clinical studies be done to elucidate the etiology and treatment of these disorders.

Anti-Anxiety Agents↗

Mental play in Gilles de la Tourette's syndrome and obsessive-compulsive disorder.

A new phenomenon, found only in Gilles de la Tourette (GTS) patients, and which we have called 'mental play', is described. It was compared with the phenomenon of counting, which occurred in both GTS and obsessive-compulsive patients. In the GTS patients both mental play and counting were best characterised as playful impulsions. In contrast to the GTS patients, the counting of the obsessive-compulsive patients was in line with their obsessive-compulsive behaviour. These findings suggest that repetitive symptoms in GTS patients, even when they share superficial similarities with obsessive-compulsive symptoms, should not be diagnosed automatically as obsessive-compulsive.

Adolescent↗

Comorbidity in compulsive hoarding: a case report.

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.

Attention Deficit Disorder with Hyperactivity↗

A phenomenological analysis of symptoms in obsessive-compulsive neurosis.

Eighty-two obsessional neurotics were studied from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to ascertain the frequency with which the different forms and content occur and their effect on the final outcome of the disorder. Five types of obsessions were identified: doubts, obsessive thinking, fears, impulses, and images, in order of frequency of their occurrence. Compulsive acts could be classified in two types, depending on whether they yielded to or diverted the underlying obsession. One-fourth of the patients displayed no compulsions. The content of obsession could be classified in five broad categories as relating to: dirt and contamination, aggression, inanimate-impersonal themes, religion, and sexual matters, in order of the frequency of their occurrence. The paper, while offering an interpretation of these findings, emphasizes the part played by socio-cultural factors in the character of an obsession's thought content. The absence of compulsions was found to be associated with good prognosis. A downward gradient was noted in the final outcome of patients without compulsions, those with controlling compulsions alone, those with both varieties of compulsions, and those displaying yielding compulsions alone, in that order. Based on this observation the paper suggests a prognosis-related hierarchical continuum of the severity of obsessional disorder.

Adult↗

Clinical and neuropsychological correlates in two brothers with pantothenate kinase-associated neurodegeneration.

Adult-onset focal dystonia was the presenting sign of pantothenate kinase-associated neurodegeneration (PKAN) in a patient with a novel homozygous missense mutation (C856T). His brother shared the same mutation and showed similar, albeit minor, motor signs, but a different behavioral profile. Both brothers had an atypical form of PKAN. The neuropsychological assessment showed that, despite a normal Mini-Mental State Examination, both patients presented a deficit of executive functions and of attention. The profile of cognitive impairment in these cases was typically that of a subcortical dementia. Both patients fulfilled Diagnostic and Statistical Manual for Mental Disorders criteria for obsessive-compulsive disorder; however, paranoia was associated with depression and aggressive behavior in Patient 1, whereas Patient 2 had hyperactivity, disinhibition, and euphoria. Our findings suggest that these two brothers had a different pattern of involvement of motor and nonmotor basal ganglia-thalamocortical circuits.

Adult↗

Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions.

This article describes a broad-spectrum, computer-aided self-help clinic that raised the throughput of anxious/depressed patients per clinician and lowered per-patient time with a clinician without impairing effectiveness. Many sufferers improved by using one of four computer-aided systems of cognitive behavior therapy (CBT) self-help for phobia/panic, depression, obsessive-compulsive disorder, and general anxiety. The systems are accessible at home, two by phone and two by the Web. Initial brief screening by a clinician can be done by phone, and if patients get stuck they can obtain brief live advice from a therapist on a phone helpline. Such clinician-extender systems offer hope for enhancing the convenience and confidentiality of guided self-help, reducing the per-patient cost of CBT, and lessening stigma. The case examples illustrate the clinical process and outcomes of the computer-aided system.

Adult↗

A decision model in the treatment of obsessive-compulsive neuroses.

The treatment of obsessive-compulsive disorders with a behavioural therapeutic program consisting of response prevention has proved to be rather successful. A prospective study of the potentialities of predicting the outcome of such a treatment program is described. The results of this research could possibly lead to the development of a decision model for use in the treatment of obsessive-compulsive neurosis.

Ambulatory Care↗