BEHAVIOR DISORDERS OF INTEREST TO DERMATOLOGISTS.
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Adolescent↗
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Testing the prenatal hormone hypothesis of tic-related disorders: gender identity and gender role behavior.
The hypothesis that prenatal masculinization of the brain increases risk of tic disorders in postnatal life was tested by measuring gender and gender role behavior in 89 children and adults with a clinical diagnosis of Tourette syndrome or obsessive compulsive disorder and 67 healthy, unaffected children and adults. Consistent with this hypothesis, a tic disorder in females was associated with more gender dysphoria, increased masculine play preferences, and a more typically "masculine" pattern of performance on two sex-typed spatial tasks. Males with tic disorders reported increased masculine play preferences, and the strength of these preferences was positively associated with the severity of tic symptoms. In addition, unlike their female counterparts, males with tic disorders showed a relative impairment in mental rotation ability. These behavioral profiles are consistent with those of children who have verifiable elevations in prenatal androgen levels. These findings therefore support the hypothesis that an altered androgen-dependent process of sexual differentiation during prenatal life may contribute to the development of tic-related disorders.
Adolescent↗
Behavioral and biofeedback therapy for a functionally impaired musician: a case report.
A performing musician with severe occupational palsy accompanied by obsessions and compulsions was treated by an in vivo temperature biofeedback exercise. The treatment appeared highly successful in removing both the palsy and the obsessions, with improvement seen after six 1/2-day sessions and persisting for 4 years after the termination of treatment. This is the second reported case of functional palsy in a performing musician successfully treated by applying feedback apparatus directly to the affected part of the body. Occupational palsy, traditionally thought to be highly resistant to treatment, seems surprisingly amenable to in vivo biofeedback.
Adult↗
[Verbal interaction and heart rate in the course of the therapeutic process in a neurotic patient. A psychobiologic pilot project].
Whereas measurements of physiologic variables are widely used in investigations of psychosomatic illnesses, this proceeding is not an established strategy when dealing with the therapeutic process of neuroses which lack coarse bodily symptoms. Therefore, we investigate the heart rate response pattern and the verbal dialog during therapeutic sessions of a patient with an impulsive neurosis. Recordings are made before and after the obsessive symptoms improve. Changes are found in the heart rate response as well as in the verbal interaction between patient and therapist. While symptoms persist the patient's behavior alternates between patient and therapist. While symptoms persist the patient's behavior alternates between gross defense and a panic like disturbance. Concurrently the heart rate response shows an inconspicuous pattern interrupted by sudden heart rate increases. After the obsessive symptoms had ceased the patient has been better controlled in his behavior but is more tense. Compared to the previous state this is accompanied by more frequent and longer lasting periods of reduced heart rate variability and only moderate increases.
Adult↗
m-Chlorophenylpiperazine challenge in borderline personality disorder: relationship of neuroendocrine response, behavioral response, and clinical measures.
We have previously found that a subgroup of patients with impulsive personality disorders respond to m-chlorophenylpiperazine (m-CPP) administration with a distinctive spacy/high behavioral reaction and with increased cortisol responses. In this report we analyzed the relationship between behavioral and neuroendocrine responses to m-CPP in an enlarged sample of patients with borderline personality disorder (BPD). We also assessed the association of behavioral and neuroendocrine responses with clinical symptoms and with m-CPP blood levels. We found that in BPD patients the presence of a spacy/high behavioral response was significantly associated with increased prolactin and cortisol responses to m-CPP. In BPD patients increased m-CPP levels were significantly associated with neuroendocrine hypersensitivity and with a spacy/high behavioral response, while in controls increased m-CPP levels were not significantly associated with neuroendocrine hypersensitivity but were significantly associated with dysphoric behavioral responses. Taken together with previous work on m-CPP in obsessive-compulsive disorder, these results are partially consistent with the hypothesis that compulsive and impulsive symptoms fall at opposite ends of a phenomenologic and neurobiologic spectrum.
Adult↗
Management of obsessive compulsive disorder.
The treatment of obsessive compulsive disorder was characterised by therapeutic pessimism until 25 years ago when effective treatments using behaviour therapy and the serotonin reuptake inhibitors were developed. At present the best available treatment is a combination of behaviour therapy and pharmacotherapy with a serotonin reuptake inhibitor. Psychosurgery is only indicated for patients who fail to respond to pharmacologic and behavioural treatments and who suffer from disabling symptoms.
Behavior Therapy↗
Presence of muscle dysmorphia symptomology among male weightlifters.
Limited research exists on muscle dysmorphia (MD) in men and in nonclinical populations. The current study evaluated types of body image disturbance among 237 male weightlifters. Latent class analysis of 8 measures of body image disturbance revealed 5 independent types of respondents: Dysmorphic, Muscle Concerned, Fat Concerned, Normal Behavioral, and Normal. One-way analysis of variance of independent measures of body image disturbance and associated psychopathology confirmed significant differences between groups. The Dysmorphic group reported a pattern of body image disturbance consistent with MD by displaying a high overall level of body image disturbance, symptoms of associated psychopathology, steroid use, and appearance-controlling behavior. Findings generally supported classifying MD as a subtype of body dysmorphic disorder and an obsessive-compulsive spectrum disorder. Implications for studying body image disturbance in male weightlifters, and further evaluation of the MD diagnostic criteria are discussed.
Adolescent↗
[Relationship between obsessive and depressive syndromes; therapeutic implications].
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Adjustment Disorders↗
Combined therapies in OCD.
1. A supportive and therapeutic approach, including implementing "combined" therapies, has been important in achieving recovery of obsessive-compulsive disorder in a community setting. 2. Helping the patient maintain independence after professional community support has been discontinued was a primary objective of the initial treatment plan. 3. The combination of behavioral, cognitive, and pharmacological therapies has been successful in achieving ongoing maintenance of independence and desensitization to the anxiety and phobias within the patient's home environment and community and has prevented further hospitalizations.
Activities of Daily Living↗
Treatment of chronic obsessive-compulsive neurosis by in-vivo exposure. A two-year follow-up and issues in treatment.
Twenty patients with chronic obsessive-compulsive rituals were treated in a partially controlled design by in-vivo (real life) exposure with self-imposed response prevention. Treatment included 4-12 weeks as in-patients, and lasted a mean of 23 sessions. All patients were followed-up for at least two years. No patients dropped out during the trial, though one refused domiciliary treatment after discharge. Significant improvement in compulsions was found after three weeks of real-life exposure, and continued during follow-up. At two years follow-up 14 patients were much improved, one improved and 5 unchanged; in a third year of follow-up the improved patient became symptom-free after further exposure treatment. Improvement after three weeks exposure predicted good outcome at 6 and 12 months follow-up. Muscular relaxation treatment had no significant effect on rituals. Modelling of exposure conferred no advantage over exposure alone for the group as a whole, though it may help selected patients. The role of response prevention is unknown. Patients' commitment to treatment facilitates exposure. Domiciliary treatment with involvement of family members in therapy seems crucial in some cases. Pilot group treatment of patients and families together suggests that this may be a useful adjuvant to individual treatment by increasing motivation and aiding follow-up. Compulsive slowness presents special treatment problems but can be improved by a prompting and pacing approach. The course of rituals was often independent of that of agoraphobia, marital problems and depression where these had initially coexisted with rituals. Depressive episodes were common before, during and after treatment, and required tricyclic medication. The trial sample was predominantly female but was otherwise typical of patients with compulsive rituals. Of the 125 obsessive-compulsives seen in the first author's unit over four years 96 per cent were offered behavioural or anti-depressant treatment. One quarter refused behavioural treatment after it was offered. Real-life exposure with self-imposed response prevention is usually an effective procedure for lasting reduction of chronic compulsive rituals in well motivated patients.
Adult↗
The relationship between disgust sensitivity and avoidant behavior: studies of clinical and nonclinical samples.
Researchers have reported links between specific phobias (of small animals and blood/ injection/injury (BII)) and disgust sensitivity. Avoidance is one route by which disgust sensitivity may play a role in the etiology or maintenance of pathological fear. This paper discusses a series of three studies to examine behavior associated with disgust sensitivity. Study I examined disgust sensitivity and avoidance of disgust-evoking tasks among spider fearful and nonfearful participants. Study 2 reanalyzed previously published data on the relationship between disgust sensitivity and visual avoidance of BII stimuli and spiders. Study 3 examined disgust sensitivity in obsessive-compulsive disorder (OCD). Results indicate the trait of disgust sensitivity is a poor predictor of avoidance behavior in specific situations, but state disgust more consistently predicts avoidance, suggesting future research in specific phobia should shift emphasis toward examining the role of state disgust.
Animals↗
How to treat OCD in patients with Tourette syndrome.
Obsessive-compulsive disorder (OCD) constitutes an etiologically heterogeneous set of conditions, including a subtype that seems etiologically related to Tourette syndrome (TS). In order to treat OCD patients optimally, the clinician needs to integrate educational, psychological and pharmacological approaches. The most effective psychological intervention is cognitive-behavior therapy (CBT). Drug treatment includes clomipramine and all selective serotonin reuptake inhibitors (SSRIs). A subgroup of OCD patients, however, shows no significant improvement. Few studies suggest that the presence of tics is associated to a worse treatment response to SSRIs and that such patients benefit from combined therapy of serotonin-reuptake inhibitors plus neuroleptics. Independently of the presence of tics, there are several different augmentation strategies for resistant cases with drugs that interfere in the dopamine, serotonin, opioid and gonadal hormone systems. In addition, new therapies are now being tested against presumed postinfectious autoimmune processes. Finally, new developments are promising in neural circuit-based therapies, including neurosurgery for refractory patients.
Behavior Therapy↗
Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect.
BACKGROUND: The goal of this study was to investigate the co-occurrence of depressive disorders in obsessive-compulsive disorder (OCD) and the effect of these disorders on combined pharmacologic and behavioral treatment for OCD. METHOD: A retrospective chart analysis was performed on baseline ratings of 120 OCD patients and posttreatment ratings of 72 of these patients. For depressive symptoms, the Montgomery-Asberg Depression Rating Scale and the Self-Rating Depression Scale were applied; for obsessive-compulsive symptoms, the Yale-Brown Obsessive Compulsive Scale and the Maudsley Obsessive Compulsive Inventory were used; and for general anxiety symptoms, the Self-Rating Anxiety Scale, the Clinical Anxiety Scale, and the State-Trait Anxiety Inventory were given. RESULTS: One third of the OCD patients in our sample were found to be depressed. Symptom severity on OCD symptoms at baseline did not differ between depressed and nondepressed OCD patients; on general anxiety symptoms, the comorbid group was more severely affected. Both depressed and nondepressed OCD patients responded well to treatment, as reflected in assessments for depressive, obsessive-compulsive, and general anxiety symptoms. However, comorbid depression had a negative effect on treatment: depressed OCD patients showed less improvement than nondepressed OCD patients on most scales. CONCLUSION: Depression frequently accompanies OCD and appears to affect treatment outcome negatively. While both groups of patients improved with combination treatment, the OCD-alone group had more improvement than the group that had comorbid depression.
Adult↗
Fluoxetine has no marked effect on tic symptoms in patients with Tourette's syndrome: a double-blind placebo-controlled study.
To evaluate the efficacy of fluoxetine in the treatment of tics and obsessive-compulsive symptoms in patients with Tourette's syndrome (TS), 14 subjects (8-33 years old) with TS participated in a 20-week, fixed-dose (20 mg daily), double-blind, placebo-controlled crossover trial of fluoxetine monotherapy. Five subjects met criteria for obsessive-compulsive disorder (OCD), 6 additional subjects had obsessive-compulsive features, and 3 subjects had TS without obsessive-compulsive symptoms. There was no improvement in tics after 8 weeks of treatment with fluoxetine (p = 0.58). In contrast, fluoxetine treatment was associated with a significant reduction in obsessive-compulsive symptoms for the group of 6 subjects initially randomized to fluoxetine (p = 0.04). Crossover analysis showed that fluoxetine had no marked effect on tics (n = 10, p = 0.30, but produced a modest decrease in obsessive-compulsive symptoms (n = 8, p = 0.06). Order effects and carry-over effects were not significant. Withdrawal to placebo was associated with a 55% increase in obsessive-compulsive symptoms (p = 0.05), but there was no effect on tics. The most common side effect was transient behavioral activation, which occurred in about half of the subjects and was more common in children. Fluoxetine may be useful for the treatment of obsessive-compulsive symptoms in some patients with TS, but does not appear to be effective for tics.
Adolescent↗
Repetition, repetition, and repetition: compulsive and punding behaviors in Parkinson's disease.
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Humans↗
Therapist-controlled exposure in vivo versus self-controlled exposure in vivo a comparison with obsessive-compulsive patients.
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Adult↗
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↗