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PubMed1993

The relationship between insight and control in obsessive-compulsive disorder: implications for the insanity defense.

In this paper the authors examine the relationship between insight and control in patients with obsessive-compulsive disorder (OCD) in an effort to better understand the concept of volitional control of behavior especially as it relates to changes in the insanity defense that were recommended by the American Psychiatric Association (APA), specifically that the volitional prong be dropped. Yale-Brown Obsessive Compulsive Scale ratings in 56 subjects with OCD were reviewed with specific attention to items measuring the patients' subjective sense of decreased volitional control over their compulsions and their insight into their behavior. No statistically significant correlation was found between the control over compulsions item and the insight item. The authors conclude that the experience of volitional control in patients with OCD is not significantly related to the level of insight they have into the irrationality of their behavior. The authors then review cognitive therapy literature and show that though cognition and volition may appear to be dissociated in some disorders, even in the absence of insight, a relatively gross measure of legally relevant cognitive disturbance, subtle cognitive changes can be identified in patients with seemingly purely volitional disorders such as OCD.

Adult↗
PubMed1985

Behavioral psychotherapy for anxiety disorders.

Behavioral psychotherapy is probably the treatment of choice for most phobic and obsessive-compulsive disorders and plays a lesser role in the management of panic disorder without agoraphobia, generalized anxiety disorder, and posttraumatic stress disorder. This article discusses treatment goals and strategies for each disorder.

Abreaction↗
PubMed1989

Psychoanalysis and general psychiatry: obsessive-compulsive disorder as paradigm.

To certain areas once dominated by psychoanalytic conceptualizations of psychopathology and pathogenesis, general psychiatry has in recent years made significant contributions. The obsessive-compulsive disorder is cited as an example, and illustrations of such contributions are described and discussed. Some implications for psychoanalytic theory and research are suggested.

Antidepressive Agents↗
PubMed2003

A review of pharmacologic treatments for obsessive-compulsive disorder.

OBJECTIVE: Obsessive-compulsive disorder is a chronic and often disabling disorder that affects 2 to 3 percent of the U.S. population. Optimal treatment involves a combination of pharmacologic and cognitive-behavioral therapies. Advances in psychopharmacology have led to safe and effective treatments for obsessive-compulsive disorder that provide clinically significant improvement in symptoms. In this article the authors review studies of pharmacologic treatments. METHODS: A MEDLINE search was conducted to identify relevant articles from 1991 to 2002. Double-blind, placebo-controlled studies as well as open-label studies and case reports were included. RESULTS AND DISCUSSION: The serotonin reuptake inhibitors (SRIs), including clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine, have been approved by the U.S. Food and Drug Administration for the treatment of adults with obsessive-compulsive disorder; three of these (clomipramine, fluvoxamine, and sertraline) have been approved for treatment of children and adolescents. Clomipramine and the selective serotonin reuptake inhibitors (SSRIs) are first-line agents. However, 40 to 60 percent of patients with obsessive-compulsive disorder do not respond to adequate treatment trials with SRIs, and agents that alter serotonin receptors and other neurotransmitter systems, such as dopamine, norepinephrine, and second-messenger systems, may play a role in treatment. Treatment options for patients who do not respond to SRIs include switching, augmentation, or novel-agent strategies. Up to two-thirds of patients with obsessive-compulsive disorder have comorbid psychiatric disorders, which may present a challenge in pharmacologic treatment. Major depressive disorder is the most common comorbid condition. Nonpharmacologic invasive techniques may play a role in refractory cases of obsessive-compulsive disorder, but further research is warranted.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

Prader-Willi Syndrome: clinical concerns for the orthopaedic surgeon.

BACKGROUND: Prader-Willi Syndrome (PWS) is a chromosome 15 disorder characterized by hypotonia, hypogonadism, hyperphagia, and obesity. Musculoskeletal manifestations, including scoliosis, hip dysplasia, and lower limb alignment abnormalities, are well described in the orthopaedic literature. However, care of this patient population from the orthopaedic surgeon's perspective is complicated by other clinical manifestations of PWS. Osteopenia, psychiatric disorders, and diminished pain sensitivity are frequently noted in PWS but are not discussed in the orthopaedic literature. The authors present a clinical review of an 8-year experience of caring for 31 patients with PWS to highlight all clinical concerns that influence orthopaedic management. METHODS: Thirty-one institutionalized patients diagnosed with PWS were examined and all past medical records were reviewed. Patient demographics, genetic testing, musculoskeletal diagnoses, psychiatric diagnoses, and clinical behaviors were recorded. Radiological studies performed in the course of routine clinical care were evaluated. RESULTS: Twenty-three men and 8 women, with an average age of 22 years (range, 8-39 years), were studied. A chromosome 15q abnormality was confirmed in 18 patients. Scoliosis was clinically detected in 21 of 30 patients and confirmed by radiographs in 14 of these 24 patients (overall with scoliosis, 45%) with an average primary curve of 27 degrees; 3 were braced, and 2 underwent spinal fusion. Radiographs also revealed diminished cervical lordosis and increased cervicothoracic kyphosis in 16 patients, a previously undescribed finding. Hip radiographs of 26 patients revealed dysplasia in 2 patients (13%); no slipped capital femoral epiphysis were identified. Fourteen patients had sustained a total of 58 fractures, with 6 patients sustaining multiple fractures (range, 2-7). Six patients have undergone orthopaedic surgical procedures with one major complication (spinal infection). Fracture management was associated with frequent minor complications. Bone densitometry was performed on 14 patients; 8 patients had osteopenia, and 4 had osteoporosis based on lumbar spine z scores. Twenty-six patients had Axis I psychiatric diagnoses including impulse control disorder (7), organic personality disorder (6), oppositional defiant disorder (5), dysthymic disorder (4), depressive disorder not otherwise specified (3), attention-deficit/hyperactivity disorder (2), and obsessive-compulsive disorder (2). Nine patients exhibited self-mutilating behaviors. CONCLUSIONS: Osteopenia, poor impulse control and defiant behaviors, and diminished pain sensitivity are aspects of PWS that may complicate all facets of orthopaedic nonsurgical and surgical management in this patient population. The treating orthopaedic surgeon must plan carefully and proceed with caution when treating children and adults with PWS.

Adolescent↗
PubMed2003

Perceived responsibility in juvenile obsessive-compulsive disorder: an experimental manipulation.

Investigated the role of responsibility in obsessive-compulsive disorder (OCD) in juveniles with the disorder. This study experimentally manipulated perceived responsibility during a behavioral avoidance task (BAT) and examined the effects on levels of perceived probability and severity of harm, distress, ritualizing, and avoidance. Further, the association between OCD severity, anxiety, and depression with cognitive perceptions of threat was investigated. Finally, this study examined whether cognitive-behavioral treatment (CBT) would decrease ratings across all measures during a BAT. Results indicated that the manipulation successfully inflated responsibility, however this did not lead to increased ratings of distress or of probability or severity of harm. Anxiety was negatively correlated with responsibility; however, there were no significant correlations between depression and the cognitive variables. Following CBT, there were significant reductions across measures during the BAT.

Adolescent↗
PubMed2002

Thought suppression in obsessive-compulsive disorder.

Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.

Adolescent↗
PubMed1985

Patients who complain of social dysfunction as their main problem: II. Comparison with other outpatients seen for behavior therapy.

Forty socially dysfunctional patients (avoidant personality disorder, DSM-III) and 76 other patients also seen for behavioral psychotherapy rated 30 items from the Social Situations Questionnaire on dimensions of distress and frequency of involvement. A discriminant function analysis showed that socially dysfunctional patients formed a distinct group as compared with other patients on ratings of distress. The main characteristics were over initiating social contact and carrying on a conversation with people one does not know. The separation between groups on the rating of frequency of involvement was less clear cut with some degree of overlap. The differences were in interactions with relative strangers and making decisions affecting them. A subsequent classification of cases using the derived discriminant function validated the above findings.

Adult↗
PubMed2004

Symmetry, ordering and arranging compulsive behaviour.

Compulsive ordering and arranging, and a preoccupation with symmetry are features of obsessive-compulsive disorder (OCD) that have not been examined experimentally. Three connected studies were conducted to examine this phenomenon: a self-report measure of this behaviour was developed and validated, participants were asked to engage in tasks designed to assess preferences for order, and to assess the interference of disorderly surroundings in the completion of a stressful activity. The self-report measure has sound psychometric properties and validity. Participants with a strong preference for order were made more anxious by having to complete a difficult task in a disorganized environment. Participants without this preference did not show this effect. The results are discussed in terms of the phenomenology of compulsive ordering and arranging, and its relationships with both OCD and normal human behaviour. It is suggested that compulsive ordering and a drive for symmetry are extreme manifestations of the common preference for order and symmetry.

Adult↗
PubMed1993

Behavioral frequency and psychological commitment: necessary concepts in the study of excessive exercising.

Efforts to understand the associations among exercising, personality factors, and disordered eating have been the focus of much debate. However, research has been plagued by inconsistent findings, and there is evidence that classification and measurement differences are fundamental to these problems. To date, there are no studies which have defined exercise as a multifaceted construct. The purposes of this study were to establish the factor structure of a questionnaire developed to assess the core features believed to characterize excessive exercisers and to assess relationships between exercise (operationally defined as a function of behaviors and attitudes) and a number of putative risk factors. Results indicated that exercise was strongly related to weight preoccupation among women and men and that, among men, obsessive-compulsiveness was also positively related--findings which support claims that exercising and dieting tend to coexist, and they are associated with an obsessive-compulsive personality profile.

Adolescent↗
PubMedDate not supplied

[Anxiety disorders in children suffering from anorexia nervosa].

AIM: The basic aim of the study was the estimation of comorbidity of anxiety disorders (including obsessive-compulsive disorders) and anorexia nervosa. The next aim was to make out whether and what kind of influence is exerted on them by environmental (especially the family's) and children's own conditioning. A group of 30 children (the average age - 13.5 years), 27 girls and 3 boys treated for the first episode of anorexia nervosa was considered. METHOD: Structured interview from patients as well as their parents, clinical observation, psychiatric and psychological investigation with the use of The Depression Rating Scale for Children (Elva o. Poznansky and comp.), The Hamilton Depression Rating Scale and The Children's Yale-Brown Obsessive-Compulsive Scale. Results were worked out with the help of statistical methods. RESULTS: The comorbidity of anxiety disorders, OCD and anorexia nervosa in the considered group was frequently observed. Anxiety disorders were observed in the group of 16.7% patients in which 6.7% suffered from generalized anxiety disorders and 10% - from social phobia. According to the anamnesis - 40% of the investigated children, suffered from separation anxiety in the past, 13% - manifested social phobia and 10% - experienced generalized anxiety disorders. Together, during the whole life of those studied, anxiety disorders were observed in 40% of the children. Statistically, in the examined group, depression was significantly frequent amongst children suffering from anxiety disorders and anorexia nervosa (p<0.01). The comorbidity of OCD and anorexia nervosa appeared in 13.3% of the cases. As for intensity--in one case it was extremely severe, in another one--moderate and in two other cases--mild. In the investigated group of children OCD appeared in the restricting subtype of anorexia nervosa. All children with OCD and anorexia nervosa suffered from severe depression syndromes. CONCLUSIONS: In the considered group of children suffering from anorexia nervosa the number of biological as well as psychological events which could predispose to anxiety disorders (including OCD) was found.

Adolescent↗
PubMed1992

An integrated approach to treatment of obsessive compulsive disorder.

Except for rarely performed psychosurgery, obsessive compulsive disorder seldom improved with reversible treatments before 1966. In that year, Victor Meyer reported successful treatment of OCD with behavior therapy, and clomipramine was first released. For the past 25 years, controlled research has demonstrated specific efficacy of exposure for obsessional anxiety and ritual or response prevention for reducing ritual time, interference, and associated distress. Over the same time span, clomipramine has been conclusively shown to be an effective treatment for obsessive compulsive disorder in double-blind controlled trials against placebo and other nonpotent serotonin uptake inhibitor antidepressants. Fluvoxamine, fluoxetine, and sertraline, all potent serotonin uptake inhibitors, have also demonstrated efficacy in obsessive compulsive disorder; fluvoxamine is the best studied of these three compounds. The combination of behavior therapy and a potent serotonin uptake inhibitor is currently the best treatment for most patients. Psychosurgery still has a part to play in the treatment of a small proportion of severely disabled and distressed obsessive compulsive patients unresponsive to other effective treatments.

Behavior Therapy↗