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PubMed1993

Obsessions, responsibility and guilt.

Introduction of the concept of "inflated responsibility" into the so-called anatomy of obsessions gives rise to an elaborated analysis of obsessions, responsibility and guilt. The analysis touches on a range of phenomena including anger and guilt, control of thoughts, the fusion of thoughts and action, resistance to additional responsibility, procrastination and unfinished tasks, hypochondriasis, brief holidays. Some clinical implications are deduced from the analysis.

Anger↗
PubMed2001

Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory.

In 1995 the Obsessive Compulsive Cognitions Working Group initiated a collective process to develop two measures of cognition relevant to current cognitive-behavioural models of OCD. An earlier report (Behav. Res. Therapy, 35 (1997) 667) describes the original process of defining relevant domains. This article describes the subsequent steps of the development and validation process: item generation, scale reduction, and initial examination of reliability and validity. Two scales were developed. The Obsessive Beliefs Questionnaire consists of 87 items representing dysfunctional assumptions covering six domains: overestimation of threat, tolerance of uncertainty, importance of thoughts, control of thoughts, responsibility, and perfectionism. The Interpretation of Intrusions Inventory consists of 31 items that refer to interpretations of intrusions that have occurred recently. Three of the above domains are represented: importance of thoughts, control of thoughts, and responsibility. The item reduction and validation analyses were conducted on clinical and non-clinical samples from multiple sites. Initial examination of reliability and validity indicates excellent internal consistency and stability and encouraging evidence of validity. However, high correlations indicating overlap between some of the scales, particularly importance of thoughts, control of thoughts, and responsibility will need to be addressed in subsequent empirical and theoretical investigations.

Adolescent↗
PubMed1999

The stress of caring for people with obsessive compulsive disorders.

This paper presents a survey of stress of key carers of 46 consecutive cases of chronic obsessive-compulsive disorders who were receiving combined drug and cognitive-behavioral therapy in an out-patient clinic. A reliable semi-structured interview was used to estimate the overall stresses in various aspects of life. The effects of the disorder were most commonly expressed by carers in their marital relationship and in home management. Twenty-eight percent were severely burdened by their carer role, and 35% were extremely distressed at the prospect of ongoing care provision. Caregivers require support, and may be considered to be consumers of mental health services themselves.

Adolescent↗
PubMed1997

The phenomenology of ritualized and repeated behaviors in nonclinical populations in the United States.

The question of whether ritualized and repeated behaviors might be part of a person's "normal" repertoire, providing them with feelings of self-efficacy, is explored in a phenomenological study in which nonclinical subjects who engage in ritualized and repeated behaviors describe their behaviors, and reflect on their feelings before, during, and after engaging in these rituals. Results seem to support the hypothesis that engaging in these behaviors is perceived as reducing feelings of anxiety, fear, and discomfort, and increasing feelings of control and security. Subjects also report that they would feel anxiety and lack of control if confronted with the possibility of interference with rituals. Results contribute to the conceptualization of ritualized and repeated behaviors as coping strategies in an individualized society, which function to alleviate anxiety and promote self-efficacy. It is suggested that this paradigm be used to explore obsessive-compulsive disorder in clinically diagnosed populations of ritualizers, in terms of etiology and for purposes of treatment.

Adaptation, Psychological↗
PubMed2006

Obsessive-compulsive disorder and executive deficits in two patients with primary dystonia.

In spite of the high prevalence of behavioral and cognitive disturbances found in most basal ganglia disorders and attributed to fronto-striatal dysfunction, the existence of psychiatric and cognitive symptoms in patients with primary dystonia remains controversial. We present a 42-year-old female with primary writer's cramp and obsessive-compulsive disorder (OCD) and a 59-year-old male with Meigs syndrome, idiopathic torticollis and OCD. Both patients had mild executive dysfunction. The coexistence of psychiatric, cognitive and motor symptoms of different intensity may be explained by variable dysfunction on different frontal-striatal loops, as proposed by the open interconnected model of fronto-striatal circuits.

Adult↗
PubMed1999

A Case Series of Women With Postpartum-Onset Obsessive-Compulsive Disorder.

BACKGROUND: There is emerging evidence that postpartum women are at risk for the development or worsening of obsessive-compulsive disorder. The purpose of this study was to provide data regarding the demographics, phenomenology, associated psychiatric comorbidity, family history, and response to open treatment with fluvoxamine in subjects with postpartum-onset obsessive-compulsive disorder. METHOD: Seven consecutive subjects were recruited from an outpatient obstetrical practice and by advertisement. Subjects completed the Structured Clinical Interview for DSM-IV, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview for family history, demographic data, and clinical features. Three of the 7 subjects participated in a 12-week, open-label trial of fluvoxamine treatment of postpartum-onset DSM-IV obsessive-compulsive disorder. RESULTS: The women described a mean age at onset of 28 years, and 4 subjects had a chronic course. Six subjects reported onset after the birth of their first child, and the mean time to onset was 3.7 weeks postpartum. All subjects experienced both obsessions and compulsions and reported aggressive obsessions that involved their children. None of the subjects acted on their obsessions to harm the children, but 5 reported dysfunctional mother-child behavior. All 7 subjects met criteria for at least 1 comorbid psychiatric disorder, with a mood disorder the most common. Family histories were notable for high rates of mood disorders and psychoactive substance use disorders in first-degree relatives. Two of the 3 subjects who entered the open-label trial of fluvoxamine experienced a positive response, defined as a 30% or greater decrease in the total score of the Yale-Brown Obsessive Compulsive Scale. CONCLUSION: Obsessive-compulsive disorder may present in the postpartum period and become chronic. Symptoms of the disorder may adversely affect the mother-child relationship, and it is important to assess for obsessions and compulsions in postpartum women who present with anxiety and/or depression. Fluvoxamine may be effective in reducing the symptoms of postpartum-onset obsessive-compulsive disorder. Controlled studies are needed to confirm these findings.

Journal Article↗
PubMed1991

Acute psychostimulant challenge in primary obsessive-compulsive disorder.

The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had a significantly greater antiobsessive-compulsive effect as measured by the Comprehensive Psychiatric Rating Scale--Obsessive-Compulsive Subscale, as compared with placebo. This effect appeared unrelated to their effect on depression although a differential effect of the two psychostimulants on anxiety was observed. Although both these stimulants affect serotonin, the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder.

Adult↗
PubMed1994

Obsessive intrusive thoughts in nonclinical subjects. Part II. Cognitive appraisal, emotional response and thought control strategies.

This second part of the study reports on the appraisal and thought control responses of 270 students to their most upsetting intrusive thought. Multiple regression analysis revealed that belief that one could act on the intrusive thought and perceived uncontrollability of the thought were the two most important predictors of the frequency, or persistence of the distressing intrusion. Intrusions rated as very difficult to control were also associated with increased belief that one could act on the intrusion, avoidance of situations that may trigger the intrusion, reduced success with one's most typical thought control strategy and higher thought frequency. Based on the Padua Inventory Total score, high and low obsessional Ss were selected. Highly obsessional individuals reported more unwanted obsessive intrusive thoughts and rated their thoughts as significantly more frequent and believable than low obsessive individuals. The type of thought control strategy typically used was not a factor in thought frequency and controllability, nor did it differentiate between high and low obsessional groups. The results are discussed in terms of Salkovskis' cognitive model of obsessions and intrusive thoughts.

Anxiety↗
PubMedDate not supplied

Tic-related vs. non-tic-related obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is a chronic condition characterized by an array of intrusive, upsetting thoughts and interfering, repetitive behaviors. Some forms of OCD may be etiologically related to Tourette's syndrome (TS). This cross-sectional study examines a range of obsessive compulsive (OC) symptoms which have been hypothesized to distinguish tic-related OCD from non-tic-related OCD. One hundred and seventy-seven patients with a primary DSM-IIIR diagnosis of OCD, aged 16 to 72, participated in the study. Patients with tic-related OCD (n = 56) reported more OC symptoms, including more aggressive, religious, and sexual obsessions as well as checking, counting, ordering, touching, and boarding compulsions than did patients with non-tic-related OCD (n = 121). Contrary to our expectation, these two groups of OCD patients did not differ with regard to the presence of "just right" phenomena or symptoms of psychasthenia. "Just right" phenomena and symptoms of psychasthenia, however, were both found to be associated with the current severity of OC symptoms.

Adult↗
PubMed1999

Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: main and incremental effects across settings.

OBJECTIVE: Although the combination of methylphenidate (MPH) and behavior modification (BMOD) has been advocated to enhance clinical outcome for children with attention-deficit hyperactivity disorder (ADHD) and comorbid disruptive disorders, few group studies have been conducted. This study evaluates the separate and incremental effects of these modalities on rating scale and observational measures in multiple settings. METHOD: Sixteen of 22 children with ADHD and comorbid disruptive disorder completed a randomized, placebo-controlled study examining the separate and incremental effects of 2 doses of MPH and BMOD during a partial hospitalization program. Of the 6 who did not complete the study, 2 children developed significant side effects. For the 16 who did complete the study, effects were examined on measures of symptom ratings, behavioral frequencies, and stimulant side effects across program activities. RESULTS: Based on alpha-adjusted analyses of variance, there were several main effects of MPH and BMOD on ADHD symptoms, oppositional behavior, and positive social behavior, with certain effects unique to each intervention and setting. One incremental effect each was found for MPH (positive mood/behavior) and BMOD (negative behavior). MPH and BMOD were associated with few side effects. Effect sizes for each intervention showed considerable variability in clinical response. CONCLUSIONS: That MPH and BMOD had certain unique main and incremental effects extends findings supporting their combination and suggests that integrated studies evaluate multiple dimensions of functioning and in novel settings (e.g., home, school). The incorporation of other intervention components in combined treatments may be warranted to enhance clinical efficacy.

Adolescent↗
PubMed2000

Cognitive-behavioral therapy for anxiety disorders: why and how it works.

Cognitive-behavioral therapy (CBT) has been found to be effective in the treatment of anxiety disorders such as obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). There is a gap, however, between reports of controlled clinical trials and actual clinical use of the methods of CBT in general medical and psychiatric settings. While psychiatric medications are commonly the first line of treatment, pharmacotherapy may not completely eradicate symptomatology or may have a delayed effectiveness, during which time patients continue to suffer. Cognitive and behavioral interventions can complement, if not replace, pharmacotherapy for relief of symptoms of OCD and PTSD. This article explains how CBT works in the treatment of OCD and PTSD. Basic instructions for implementing these treatment methods are provided.

Adult↗
PubMed2005

Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity.

The goals of this study were to examine relationships among symptom categories in obsessive-compulsive disorder (OCD), to establish OCD symptom dimensions by factor- and cluster-analytic analyses, and to explore associations between OCD symptom dimensions and comorbid neuropsychiatric conditions. A total of 317 OCD participants underwent a systematic diagnostic interview using the Structured Clinical Interview for DSM-IV. OCD symptoms assessed by the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (N=169) and by the Thoughts and Behaviors Inventory (N=275) were subjected to factor and cluster analyses. An identical four-factor solution emerged in two different data sets from overlapping samples, in agreement with most smaller factor-analytic studies employing the YBOCS checklist alone. The cluster analysis confirmed the four-factor solution and provided additional information on the similarity among OCD symptom categories at five different levels. OCD symptom dimensions showed specific relationships to comorbid psychiatric disorders: Factor I (aggressive, sexual, religious and somatic obsessions, and checking compulsions) was broadly associated with comorbid anxiety disorders and depression; Factor II (obsessions of symmetry, and repeating, counting and ordering/arranging compulsions) with bipolar disorders and panic disorder/agoraphobia; and Factor III (contamination obsessions and cleaning compulsions) with eating disorders. Factors I and II were associated with early onset OCD. This study encourages the use of cluster analyses as a supplementary method to factor analyses to establish psychiatric symptom dimensions. The frequent co-occurrence of OCD with other psychiatric disorders and the relatively specific association patterns between OCD symptom dimensions and comorbid disorders support the importance of OCD subtyping for treatment, genetic, and other research studies of this heterogeneous disorder.

Anxiety Disorders↗
PubMed2005

[Novel brain stimulation techniques: therapeutic perspectives in psychiatry].

Recent advances have allowed the development of new physical techniques in neurology and psychiatry, such as Transcranial Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS), and Deep Brain Stimulation (DBS). These techniques are already recognized as therapeutic approaches in several late stage refractory neurological disorders (Parkinson's disease, tremor, epilepsy), and currently investigated in psychiatric conditions, refractory to medical treatment (obsessive-compulsive disorder, resistant major depression). In Paralell, these new techniques offer a new window to understand the neurobiology of human behavior.

Deep Brain Stimulation↗
PubMed1989

Serotonin and treatment in obsessive-compulsive disorder.

Recognized since the Middle Ages, and clearly described for more than 100 years, obsessive-compulsive disorder (OCD) continues to intrigue and challenge mental health professionals. Recent evidence has implicated dysfunctional serotonergic neurotransmission in OCD. This review summarizes the evidence favoring a serotonergic hypothesis for OCD followed by a more detailed discussion of the implications the hypothesis holds for treatment.

Behavior Therapy↗