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PubMed2005

Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.

OBJECTIVE: The purpose of the study was to test the relative and combined efficacy of clomipramine and exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) in adults. Serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy by exposure and ritual prevention are both established treatments for OCD, yet their relative and combined efficacy have not been demonstrated conclusively. METHOD: A double-blind, randomized, placebo-controlled trial comparing exposure and ritual prevention, clomipramine, their combination (exposure and ritual prevention plus clomipramine), and pill placebo was conducted at one center expert in pharmacotherapy, another with expertise in exposure and ritual prevention, and a third with expertise in both modalities. Participants were adult outpatients (N=122 entrants) with OCD. Interventions included intensive exposure and ritual prevention for 4 weeks, followed by eight weekly maintenance sessions, and/or clomipramine administered for 12 weeks, with a maximum dose of 250 mg/day. The main outcome measures were the Yale-Brown Obsessive Compulsive Scale total score and response rates determined by the Clinical Global Impression improvement scale. RESULTS: At week 12, the effects of all active treatments were superior to placebo. The effect of exposure and ritual prevention did not differ from that of exposure and ritual prevention plus clomipramine, and both were superior to clomipramine only. Treated and completer response rates were, respectively, 62% and 86% for exposure and ritual prevention, 42% and 48% for clomipramine, 70% and 79% for exposure and ritual prevention plus clomipramine, and 8% and 10% for placebo. CONCLUSIONS: Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and, by implication, to monotherapy with the other SRIs.

Adolescent↗
PubMed1996

[Obsessive-compulsive disorder in children and adolescents. Etiology and treatment--a literature review].

The available literature on etiological aspects and treatment of childhood and adolescent obsessive-compulsive disorder is reviewed. Reports regarding the etiological background are still inconsistent, but there is increasing evidence of a biological background with involvement of serotonin neurotransmitter systems. It seems that a combination of medication and behavioral therapy is most effective in the treatment of OCD. Only a few controlled trials of medication in the treatment of OCD in children and adolescents have been published. Such studies, including a considerable number of patients over a considerable period of time, are still needed.

Adolescent↗
PubMed1986

Clinical characteristics and family history in DSM-III obsessive-compulsive disorder.

The authors present the clinical characteristics, demographic features, and family history of a clinical sample of 44 patients who met DSM-III criteria for obsessive-compulsive disorder. Their findings are consistent with those of previous epidemiologic studies completed before the introduction of DSM-III with regard to phenomenology, course, and demographic characteristics. Most of the 44 patients had concomitant or lifetime histories of a major depressive disorder or another anxiety disorder. A number of first-degree relatives of these patients had probable obsessive-compulsive disorder or obsessive traits. The findings of this study should prove useful in further epidemiologic, biologic, and behavioral studies.

Adolescent↗
PubMed1983

Assessing the impact of cognitive differences in the treatment of obsessive-compulsives.

Demonstrated a set of research techniques that combine multidimensional scaling, a quantitative cognitive procedure, and cost outcome analysis. The multidimensional scaling results supported Reed's (1969) notion that obsessive-compulsive clients are underinclusive and did not support Foa and Steketee's (1979) contention that they are overinclusive. Significant differences in extent of follow-up therapy were found between obsessive compulsives (N = 12) with the underinclusive cognitive style and those with a normal cognitive style.

Adult↗
PubMed1985

[Compulsion in neurosis, psychosis and psychosomatic disease].

Obsessive-compulsive phenomena are ubiquitous. Therefore onesided nosological categorization, e.g. viewing obsessive compulsive phenomena as variants of psychosis, seems inappropriate. After discussing these problems of definition, the clinical presentation and relative importance of obsessive-compulsive phenomena in neurosis, psychosis and psychosomatic disorders will be investigated. It will be shown, that the respective obsessive-compulsive syndromes share in common an auto-protective "function", i.e. obsessive-compulsive phenomena can be regarded as a counterregulative attempt of the individual to stabilize unstable structures. That the obsessive-compulsive phenomena tend themselves to have a highly pathological quality, is the reverse of this coping behavior.

Adaptation, Psychological↗
PubMed1995

Family accommodation in obsessive-compulsive disorder.

OBJECTIVE: Family accommodation of patients with obsessive-compulsive disorder, i.e., participation in symptoms and modification of personal and family routines, was assessed in relation to family stress, functioning, and attitudes toward the patient. METHOD: Primary caretakers for 34 patients with obsessive-compulsive disorder were interviewed to assess the nature and frequency of accommodating behaviors. The caretakers also completed several measures of family functioning. RESULTS: Of the 34 spouses or parents, 30 (88.2%) reported accommodating the patient. Family accommodation correlated with poor family functioning, rejecting attitudes toward the patient, and several types of family stress. CONCLUSIONS: Family accommodation of patients with obsessive-compulsive disorder was associated with global family dysfunction and stress. This study suggests that families' efforts to accommodate patients may be intended to reduce patient anxiety or anger directed at relatives.

Adult↗
PubMed2006

Obsessive-compulsive disorder as a disturbance of security motivation: constraints on comorbidity.

Patients with OCD often meet criteria for additional psychiatric disorders, with the incidence of comorbidity being as high as 75% in some studies. Here we examine the theoretical plausibility that in OCD much of the domain of co-morbid presentations encompasses related perturbations of the security motivation system. According to a recent proposal, the security motivation system represents a biologically primitive special motivation that is activated by potential (as opposed to imminent) danger to self or intimate others and engages a set of specialized species-typical behaviors (such as checking and washing) to handle potential danger. Because the task of security motivation is open ended, in the sense that no consummatory stimuli can exist in the real world to indicate the absence of potential danger, the shutdown of security motivation is produced by a self-generated feeling of knowing, a satiety signal termed yedasentience. In this schema, OCD results from a failure to generate or respond to the yedasentience signal: without this negative feedback the patient persists abnormally long in a strong motivational state having to do with primal, basic threats to existence, a condition that leads to prolonged engagement in security-related behaviors, such as the checking and washing, characteristic of OCD compulsions and obsessions. Considering the proposed neuronatomy of security motivation system and OCD, we discuss the likelihood that the phenomenon of "spread of allied reflexes" can produce other security-related psychiatric conditions, as well as the possibility that disturbances along different pathways of the security motivation system can lead to apparently different disorders.

Anxiety↗
PubMedDate not supplied

Recognizing and treating body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD) is a relatively common and often-disabling obsessive compulsive spectrum disorder that often goes unrecognized in clinical practice. METHODS: The present review examines the clinical features of BDD, its relationship to other disorders, and what is known about effective treatment. RESULTS: BDD consists of a distressing and impairing preoccupation with imagined or slight defects in appearance that can focus on any body area. Insight is usually poor or absent; nearly half of patients are delusional. Typical associated behaviors include skin picking, mirror checking, excessive grooming, and camouflaging. It appears that higher doses of serotonin reuptake inhibitors and longer treatment trials than those used for many other psychiatric disorders, including depression, are often needed to effectively treat BDD. Cognitive-behavioral therapy also appears efficacious and is currently considered the psychotherapy of choice for BDD. Core techniques are cognitive restructuring, behavioral experiments, response (ritual) prevention, and exposure. CONCLUSIONS: Further research is needed to minimize the underrecognition of BDD and to improve proper treatment. Because of the high rates of comorbidity in patients with BDD, treatment studies need to include subjects with co-occurring disorders and thereby attempt to understand how these other disorders affect treatment response. Finally, more research needs to address the pathophysiology of BDD (for example, by incorporating imaging and genetics).

Cognitive Behavioral Therapy↗
PubMedDate not supplied

[Anorexia nervosa in a young man: a case report].

The paper describes a case of a young man with anorexia nervosa. We try to explain our difficulties in diagnosis and treatment of this patient. Most of them were connected with comorbidity of anorexia nervosa (depression, anxiety and obsessive-compulsive behaviour).

Adolescent↗