text:
Structure of Obsessive-Compulsive Symptoms in Pediatric OCD
ERIC Educational Resources Information Center
The investigation of the structure of obsessive-compulsive disorder (OCD) symptoms observed in adults is similar to those observed in children is presented. This investigation indicates the structure of OCD symptoms is the same across the entire lifespan as compared to pediatric OCD and adulthood OCD.
Mataix-Cols, David; Nakatani, Eriko; Micali, Nadia; Heyman, Isobel
Testing a conceptual model of patient and family predictors of obsessive compulsive disorder (OCD) symptoms.
Path analysis was used to test a model linking family member's attributions, criticism, hostility, emotional overinvolvement (EOI) that focused on intrusiveness, and family accommodation to severity of obsessive compulsive symptoms. This study draws upon previous expressed emotion (EE) research by including separate components of EE assessed in relatives and patients, as well as family accommodation measures to build a model of family influences on OCD symptoms. Measures of patient- and relative-perceived criticism, family accommodation, EOI intrusiveness and OCD symptom severity were collected on a single occasion from 50 patients and 50 relatives whom the patient had daily contact with. Novel self-report scales for the three EE components of criticism, hostility and EOI derived from existing instruments showed good to excellent internal consistency. Confirmatory path analyses were used to demonstrate that the data provided an adequate fit to the hypothesized path model. The patient-rated data suggested that patients who perceived their relatives as either critical or hostile were likely to have more severe OCD symptoms. For relative-rated EE, hostility proved to be a better determinant than criticism in the path model. Implications of this model for interventions and for future research are discussed. The measures employed may prove to be a cost-effective alternative to the labor intensive Camberwell Family Interview. PMID:19026405
Van Noppen, Barbara; Steketee, Gail
The relationships between obsessive-compulsive symptom dimensions and cognitions in obsessive-compulsive disorder.
Several studies have linked obsessive-compulsive symptoms to specific obsessive-compulsive cognitions, however methodologies have varied, and no study has determined obsessive-compulsive symptoms using the most widely used clinician rating scale, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Considering that almost all studies that used factor analysis to ascertain OCD symptom dimensions were based on the Y-BOCS and that self-report instruments assessing obsessive-compulsive symptoms correlate poorly with the Y-BOCS, there is a need to use the Y-BOCS to examine the relationship between obsessive-compulsive cognitions and obsessive-compulsive symptom dimensions. This study examined the relationship between five Y-BOCS-derived obsessive-compulsive symptom dimensions and the three obsessive-compulsive cognitive domains identified by the obsessive-beliefs questionnaire (OBQ). The symmetry/ordering symptom dimension was associated with increased perfectionism/intolerance of uncertainty, the unacceptable/taboo thoughts symptom dimension was associated with increased importance/control of thoughts and the doubt/checking symptom dimension was associated with increased responsibility/threat estimation. There was no statistical evidence of an association between any OBQ belief sub-scale and the hoarding symptom dimension nor the contamination/cleaning symptom dimension. The findings encourage symptom-based approaches to cognitive-behavioural therapy for some OCD symptoms and call for further research on cognitions associated with contamination/cleaning symptoms and hoarding. PMID:24142072
Brakoulias, Vlasios; Starcevic, Vladan; Berle, David; Milicevic, Denise; Hannan, Anthony; Martin, Andrew
Testing a conceptual model of patient and family predictors of obsessive compulsive disorder (OCD) symptoms
Path analysis was used to test a model linking family member's attributions, criticism, hostility, emotional overinvolvement (EOI) that focused on intrusiveness, and family accommodation to severity of obsessive compulsive symptoms. This study draws upon previous expressed emotion (EE) research by including separate components of EE assessed in relatives and patients, as well as family accommodation measures to build a model
Barbara Van Noppen; Gail Steketee
Cognitive event-related potentials differentiate schizophrenia with obsessive-compulsive disorder (schizo-OCD) from OCD and schizophrenia without OC symptoms.
Clinical and neurobiological evidence suggests that concurrent presentation of schizophrenia and obsessive-compulsive (schizo-OCD) symptoms represents a distinct clinical entity. Given that obsessive-compulsive disorder (OCD) and schizophrenia have been modeled as having different neurofunctional profiles, the overlap between them represents a heuristic challenge for cognitive and endophenotype research. Event-related potentials (ERPs) may be used to probe neurophysiological correlates of the cognitive, emotional and behavioral disturbances found in neuropsychiatric entities such as schizo-OCD. Here we measure ERPs during a discriminative response task (DRT) in patients presenting with the DSM-IV criteria for both schizophrenia and OCD. We also performed these measurements in patients with OCD without psychotic features, as well as in patients with schizophrenia without OC symptoms. Schizo-OCD patients showed a distinct ERP pattern, with abnormally increased target activation (akin to OCD patients, but unlike the pattern observed in schizophrenic patients) and reduced P300 amplitudes (akin to schizophrenic patients, but unlike OCD patients). Similar to the control subjects, schizo-OCD patients showed larger amplitudes in the non-target condition than in the target condition. These results suggest that schizo-OCD may not only be a distinct clinical entity from pure OCD and schizophrenia, but it may also be characterized by a distinguishable neurophysiologic pattern. Neurobiological underpinnings deserve further considerations and might drive to a definition of a distinctive endophenotype for schizo-OCD in the de-construction of the schizophrenia endophenotype. PMID:19800695
Pallanti, Stefano; Castellini, Giovanni; Chamberlain, Samuel R; Quercioli, Leonardo; Zaccara, Gaetano; Fineberg, Naomi A
Sleep and obsessive-compulsive disorder (OCD).
Obsessive-compulsive disorder (OCD) is a chronic mental illness that can have a debilitating effect on daily functioning. A body of research reveals altered sleep behaviour in OCD sufferers; however, findings are inconsistent and there is no consensus on the nature of this relationship. Understanding sleep disturbance in OCD is of critical importance given the known negative consequences of disturbed sleep for mood and emotional wellbeing. A systematic literature search was conducted of five databases for studies assessing sleep in adults diagnosed with OCD. Fourteen studies met inclusion criteria and qualitative data analysis methods were used to identify common themes. There was some evidence of reduced total sleep time and sleep efficiency in OCD patients. Many of the sleep disturbances noted were characteristic of depression. However, some OCD sufferers displayed delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder (DSPD). Severe OCD symptoms were consistently associated with greater sleep disturbance. While the sleep of OCD patients has not been a major focus to date, the existing literature suggests that addressing sleep disturbance in OCD patients may ensure a holistic approach to treatment, enhance treatment efficacy, mitigate relapse and protect against the onset of co-morbid psychiatric illnesses. PMID:23499210
Paterson, Jessica L; Reynolds, Amy C; Ferguson, Sally A; Dawson, Drew
Characteristics of obsessive-compulsive symptoms in Tourette's syndrome, obsessive-compulsive disorder, and Parkinson's disease.
A high incidence of obsessions and compulsions is documented in basal ganglia disorders, especially in patients with Tourette's syndrome (TS). A comparison of patients with obsessive-compulsive disorder (OCD), TS, and Parkinson's disease (PD) revealed significantly higher total scores in both OCD and TS patients than in a healthy control group on the Maudsley obsessive-compulsive inventory (MOCI) and the Hamburg obsessive-compulsive inventory (HZI-K), two self-report measures of obsessive-compulsive symptoms. On most subscales (especially Checking, Ordering, and Counting/touching), TS patients scored higher than controls. Patients with Parkinson's disease merely scored higher on the subscale 'Ordering' of the HZI-K. Differences between OCD patients and TS patients were evident on the MOCI subscales 'Checking' and 'Slowness/Repetition' as well as on the MOCI total score and on the HZI subscales 'Cleaning' and 'Obsessive Thoughts'. On these scales, TS patients reported fewer symptoms than OCD patients. Stepwise discriminant analysis with preselected single items as variables was used to look for specific symptom patterns of OCD and TS. Seventy-eight percent of the patients could be correctly classified with respect to their diagnoses on the basis of only two items of the HZI-K. One item asks for fearful obsessive thoughts, which was found in 90% of the OCD patients; the second item represented echo phenomena, found in 56% of the TS patients. It is concluded that considering specific patterns of obsessive-compulsive psychopathology may contribute to a more reliable differential diagnosis in OCD and TS and help to avoid misdiagnosis of OCD in TS patients. PMID:9194204
M�ller, N; Putz, A; Kathmann, N; Lehle, R; G�nther, W; Straube, A
The Chinese version of the Obsessive-Compulsive Inventory-Revised scale: Replication and extension to non-clinical and clinical individuals with OCD symptoms
Background The Obsessive-Compulsive Inventory-Revised (OCI-R) was designed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical samples. The aim of the study was to evaluate the psychometric properties of a Chinese version of this scale. Methods The Chinese version of the OCI-R was administered to both a non-clinical sample (209 undergraduate students) and a clinical sample (56 obsessive-compulsive disorder (OCD) patients). Confirmatory factor analysis was conducted to examine the construct validity of the OCI-R in the non-clinical sample. The internal consistency at baseline and test-retest reliabilities at 4-week interval was examined in both the non-clinical and clinical samples. Results The confirmatory factor analysis of the non-clinical sample confirmed a 6-factor model suggested by the original authors of the instrument (df = 120, RMSEA = 0.068, CFI = 0.88, NNFI = 0.85, GFI = 0.89). The internal consistency and test-retest reliability were at an acceptable range for both the non-clinical and clinical samples. The OCI-R also showed good clinical discrimination for patients with OCD from healthy controls. Conclusions The Chinese version of the OCI-R is a valid and reliable instrument for measuring OCD symptoms in the Chinese context.
Obsessive-compulsive symptoms in eating disorders.
Obsessive-compulsive symptoms were measured in a consecutive series of new referrals with anorexia nervosa (n = 29) and bulimia nervosa (n = 77). In contrast with previous reports, there was no significant difference on MOCI scores between eating disorder groups and normal controls. A consecutive series of 38 patients with bulimia nervosa then entered a structured treatment programme. Poor outcome cases had a higher score on the MOCI-doubting sub-scale. However, there was no significant difference in obsessive-compulsive scores between those who were binge-free and those who were bingeing daily at the end of treatment and there was no significant in outcome between high and low-scorers on the MOCI. This study fails to support the view that the eating disorders are a subtype of OCD. Previous conflicting results are attributed to selection bias and the effects of low body weight. PMID:2021372
Fahy, T A
Obsessive compulsive symptoms in patients with Schizophrenia on Clozapine and with Obsessive Compulsive disorder: a comparison study.
Obsessive compulsive symptoms are commonly reported in those with schizophrenia. Clozapine has previously been reported to induce, aggravate and alleviate these symptoms. It is unclear if these are similar to the symptoms experienced by those with obsessive compulsive disorder. This study describes the obsessive compulsive symptom profile of a population of patients with schizophrenia treated with clozapine (n = 62) and compares this with patients with Obsessive Compulsive Disorder (n = 35). All participants were attending an outpatient community mental health service. The Obsessive Compulsive Inventory (which measures the frequency and associated distress of a range of "behavioural" and "cognitive" symptoms), the Hospital Anxiety and Depression Scale and a demographic questionnaire were completed. In addition the schizophrenia group treated with clozapine completed the Brief Psychiatric Rating Scale. The OCD group reported significantly more symptoms for all OCI subscales compared to the clozapine group. Overall fourteen (22%) of the schizophrenia treated with clozapine group had clinically significant total OCI scores. Two (3%) had documented OCS pre clozapine. De novo OCS was reported in twelve (19%) cases. Nine (11%) had documented OC symptoms pre-clozapine while only two (3%) had symptoms after clozapine was initiated. In terms of OC symptom profile, the clozapine group scored highest on the Doubting scale, a cognitive symptom whereas the OCD group scored highest on Washing, a behavioural symptom. Both groups reported greater distress with cognitive rather than behavioural symptoms. Medication including clozapine dose was not correlated with symptom severity. Anxiety correlated highly with obsessive compulsive symptoms in the Clozapine group but not the OCD group. Within the Clozapine group, Obsessing correlated highly with Unusual Thought Content. Findings suggest that obsessive compulsive symptoms in the Clozapine group may reflect a subtype of 'schizo-obsessive' disorder. PMID:24209980
Doyle, Mairead; Chorcorain, Aoife Ni; Griffith, Eleanor; Trimble, Tim; O'Callaghan, Eadbard
Screening for Obsessive and Compulsive Symptoms: Validation of the Clark-Beck Obsessive-Compulsive Inventory
ERIC Educational Resources Information Center
The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American�
Clark, David A.; Antony, Martin M.; Beck, Aaron T.; Swinson, Richard P.; Steer, Robert A.
Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome
Objective: A significant number of patients with obsessive- compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. Method: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. Results: The
M. Rufer; S. Fricke; S. Moritz; M. Kloss; I. Hand
Measuring obsessive-compulsive symptoms: Padua Inventory-Revised vs. Yale-Brown Obsessive Compulsive Scale.
Although the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory-Revised (PI-R) are the most widely used instruments for assessing presence and severity of symptoms in obsessive-compulsive disorder (OCD), the correlation between the two instruments is surprisingly low. The aim of the present investigation was to test two possible explanations for the discrepancy between these instruments by comparing both scales in 120 OCD patients. The tested hypotheses included: (1) differences in the way the measures are administered, i.e. observer-rated vs. self-rated; and (2) differences in the way severity is calculated, i.e. the PI-R measures severity by aggregating symptoms, while the Y-BOCS measures severity unrelated to the number of symptoms. Results indicated that neither hypothesis satisfactorily explains the differences between the measures. The investigation concludes that the Y-BOCS and PI-R measure relatively unrelated features of OCD, and the combined use of multiple measures is recommended to assess the complexity of OCD phenomena. PMID:19443176
Anholt, Gideon E; van Oppen, Patricia; Emmelkamp, Paul M G; Cath, Danielle C; Smit, Johannes H; van Dyck, Richard; van Balkom, Anton J L M
Interpretation of Ambiguity in Individuals with Obsessive-Compulsive Symptoms
In two experiments we examined the psychometric properties of a new measure of interpretation bias in individuals with obsessive-compulsive symptoms (OCs). In Experiment 1, 38 individuals high in OC symptoms, 34 individuals high in anxiety and dysphoric symptoms, and 31 asymptomatic individuals completed the measure. Results revealed that the Word Sentence Association Test for OCD (WSAO) can differentiate those with OC symptoms from both a matched anxious/dysphoric group and a non-anxious/non-dysphoric group. In a second experiment, we tested the predictive validity of the WSAO using a performance-based behavioral approach test of contamination fears, and found that the WSAO was a better predictor of avoidance than an established measure of OC washing symptoms (Obsessive Compulsive Inventory-Revised, washing subscale). Our results provide preliminary evidence for the reliability and validity of the WSAO as well as its usefulness in predicting response to behavioral challenge above and beyond OC symptoms, depression, and anxiety.
Kuckertz, Jennie M.; Amir, Nader; Tobin, Anastacia C.; Najmi, Sadia
Obsessive-compulsive disorder and obsessive-compulsive symptoms in Japanese inpatients with chronic schizophrenia - a possible schizophrenic subtype.
To investigate the prevalence of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) and their association with demographic and clinical factors, 92 inpatients with chronic schizophrenia participated in this study. Demographic factors, severity of psychiatric symptoms as determined by Brief Psychiatric Rating Scale and OCS by Yale-Brown Obsessive Compulsive Scale, general functioning, extrapyramidal symptoms, and dose of antipsychotics were compared between patients with and without OCD or OCS. The Mini-International Neuropsychiatric Interview was employed for diagnosis of OCD and OCS. OCD and OCS were observed in 14.1% and 51.1% of inpatients with schizophrenia, respectively. Schizophrenic patients with OCS exhibited significantly earlier onset of schizophrenia, lower socioeconomic status, and more severe psychiatric symptoms than those without OCS. Earlier hospitalization of schizophrenia, family history of psychosis, and more severe schizophrenic symptoms were associated with comorbidity of OCS, as determined by logistic regression analysis, and younger age was associated with more severe OCS. However, negative symptoms were associated with comorbidity of OCD in chronic schizophrenia. Our findings suggest there is a subtype of schizophrenia with OCS, which is related to earlier onset and more severe psychotic symptoms. PMID:20483470
Owashi, Toshimi; Ota, Arimitsu; Otsubo, Tempei; Susa, Yuko; Kamijima, Kunitoshi
Dissociation and symptom dimensions of obsessive�compulsive disorder
Background��Obsessive�compulsive disorder (OCD) is a phenotypically very heterogeneous disease with high rates of comorbid psychiatric\\u000a pathology. Previous studies have indicated that OCD is associated with higher levels of dissociation. The aims of the present\\u000a study were to replicate and extend previous findings of a significant link between certain OCD symptom dimensions and dissociation.\\u000a \\u000a \\u000a \\u000a Methods��The study sample comprised 50 patients with
Michael Rufer; Susanne Fricke; Dada Held; Julia Cremer; Iver Hand
Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study.
Objectives: To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender. Methods: Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring ? 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version - K-SADS-PL). Results: The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3�3.8) and symmetry (85.3%; 5.9�3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006). Conclusions: OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD. PMID:24165685
Vivan, Analise de Souza; Rodrigues, Lidiane; Wendt, Guilherme; Bicca, M�nica Giaretton; Braga, Daniela Tusi; Cordioli, Aristides Volpato
Obsessive-Compulsive Disorder. [Revised.
ERIC Educational Resources Information Center
This booklet provides an overview of the causes, symptoms, and incidence of obsessive-compulsive disorder (OCD) and addresses the key features of OCD, including obsessions, compulsions, realizations of senselessness, resistance, and shame and secrecy. Research findings into the causes of OCD are reviewed which indicate that the brains of�
Strock, Margaret
Obsessive-compulsive symptoms in Parkinson's disease
To systematically investigate obsessive-compulsive traits in Parkinson's disease, patients were administered the Maudsley obsessional-compulsive inventory (MOCI) and a modification of the Leyton obsessional inventory (LOI) to a sample of non-demented and non-depressed patients with Parkinson's disease. Patients with severe Parkinson's disease showed more obsessive traits than normal controls in MOCI and LOI total scores, and in the "checking", "doubting", and "cleaning" subscales of the MOCI. By contrast, patients with mild disease did not differ from controls. A significant correlation was found between severity and duration of illness and MOCI total score. These results support the involvement of basal ganglia in obsessive-compulsive symptomatology. As patients with mild Parkinson's disease did not differ from controls, obsessive-compulsive disorder does not seem to be directly related to the initial nigrostriatal dopaminergic deficiency which causes clinical Parkinson's disease symptomatology. The appearance of obsessive symptoms could be related to the subset of neurochemical changes taking place at the level of the basal ganglia circuitry as disease progresses.??
Alegret, M; Junque, C; Valldeoriola, F; Vendrell, P; Marti, M; Tolosa, E
Obsessive-compulsive symptoms in Parkinson's disease.
To systematically investigate obsessive-compulsive traits in Parkinson's disease, patients were administered the Maudsley obsessional-compulsive inventory (MOCI) and a modification of the Leyton obsessional inventory (LOI) to a sample of non-demented and non-depressed patients with Parkinson's disease. Patients with severe Parkinson's disease showed more obsessive traits than normal controls in MOCI and LOI total scores, and in the "checking", "doubting", and "cleaning" subscales of the MOCI. By contrast, patients with mild disease did not differ from controls. A significant correlation was found between severity and duration of illness and MOCI total score. These results support the involvement of basal ganglia in obsessive-compulsive symptomatology. As patients with mild Parkinson's disease did not differ from controls, obsessive-compulsive disorder does not seem to be directly related to the initial nigrostriatal dopaminergic deficiency which causes clinical Parkinson's disease symptomatology. The appearance of obsessive symptoms could be related to the subset of neurochemical changes taking place at the level of the basal ganglia circuitry as disease progresses. PMID:11181867
Alegret, M; Junqu�, C; Valldeoriola, F; Vendrell, P; Mart�, M J; Tolosa, E
Peer Victimization in Children with Obsessive-Compulsive Disorder: Relations with Symptoms of Psychopathology
ERIC Educational Resources Information Center
This study examined the frequency of peer victimization and psychological symptom correlates among youth with obsessive-compulsive disorder (OCD). The Schwartz Peer Victimization Scale, Children's Depression Inventory, and Asher Loneliness Scale were administered to 52 children and adolescents diagnosed with OCD. The child's parent or guardian�
Storch, Eric A.; Ledley, Deborah Roth; Lewin, Adam B.; Murphy, Tanya K.; Johns, Natalie B.; Goodman, Wayne K.; Geffken, Gary R.
Symptom Presentation and Outcome of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder
Previous researchers have classified obsessive-compulsive disorder (OCD) patients by the themes of their obsessions and compulsions (e.g., washing, checking); however, mental compulsions have not been adequately assessed in these studies. The authors conducted 2 studies using a large sample of OCD patients (N = 132). In the 1st study, they categorized patients on the basis of symptom presentation, giving adequate
Jonathan S. Abramowitz; Martin E. Franklin; Stefanie A. Schwartz; Jami M. Furr
General and Maladaptive Personality Dimensions in Pediatric Obsessive-Compulsive Symptoms
ERIC Educational Resources Information Center
Obsessive-compulsive disorder (OCD) is a chronic and impairing clinical disorder in childhood, often characterized by a heterogeneous symptomatic profile and high co-occurrence with other disorders. The present study introduces a new perspective on the description of OCD symptoms in youth, and empirically examines the value of a personality�
Aelterman, Nathalie; De Clercq, Barbara; De Bolle, Marleen; De Fruyt, Filip
Four-Factor Structure of Obsessive-Compulsive Disorder Symptoms in Children, Adolescents, and Adults
ERIC Educational Resources Information Center
A study was conducted to establish the efficacy of four-factor obsessive-compulsive disorder (OCD) symptom structure for use in child, adolescent and adult groups. Results indicated that the four-factor OCD structure is inadequate for use in children, adolescent and adult age groups.
Stewart, S. Evelyn; Rosario, Maria C.; Baer, Lee; Carter, Alice S.; Brown, Timothy A.; Scharf, Jeremiah M.; Illmann, Cornelia; Leckman, James F.; Sukhodolsky, Denis; Katsovich, Lilya; Rasmussen, Steven; Goodman, Wayne; Delorme, Richard; Leboyer, Marion; Chabane, Nadia; Jenike, Michael A.; Geller, Daniel A.; Pauls, David L.
Obsessive-compulsive symptoms among patients with Sydenham chorea
Background: Among patients with tic disorders, a distinctive clinical profile of obsessive-compulsive symptomatology has been described. The present investigation was designed to document the phenomenology of obsessive-compulsive symptoms (OCS) among patients with Sydenham chorea (SC), the neurologic variant of rheumatic fever. We hypothesized that OCS occurring in association with SC would be similar to those among patients with tic disorders.
Fernando R. Asbahr; Marjorie A. Garvey; Lisa A. Snider; Dirce M. Zanetta; Helio Elkis; Susan E. Swedo
Case series: increased vulnerability to obsessive-compulsive symptoms with repeated episodes of Sydenham chorea.
The association between obsessive-compulsive symptoms (OCS) and Sydenham chorea (SC) supports the hypothesis of a common neuroimmunological dysfunction in basal ganglia associated with group A beta-hemolytic streptococcal infection underlying both conditions. Four children with 2 distinct SC episodes were evaluated to assess the course of OCS. All patients developed OCS during their second episodes (3 met criteria for obsessive-compulsive disorder [OCD]), but not in their first episodes (2 developed OCS and met criteria for OCD). These data suggest that the recurrence of SC episodes may result in a cumulative effect, thus increasing the risk of appearance and intensification of OCS. PMID:10596252
Asbahr, F R; Ramos, R T; Negr�o, A B; Gentil, V
The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study.
Cognitive models of obsessive-compulsive disorder (OCD) posit that specific kinds of dysfunctional beliefs (e.g., pertaining to responsibility and the significance of intrusive thoughts) underlie the development of this disorder. The present study was designed to prospectively evaluate whether dysfunctional beliefs thought to underlie OCD act as a specific vulnerability factor in the pathogenesis of obsessive-compulsive symptomatology. Eighty-five individuals were prospectively followed over a period of time thought to be associated with an increased onset of OCD symptoms -- childbirth and the postpartum. The majority of these new mothers and fathers experienced intrusive infant-related thoughts and performed neutralizing behaviors similar to, but less severe than, those observed in OCD. Scores on a measure of dysfunctional beliefs thought to underlie OCD predicted the development of obsessive-compulsive symptoms after controlling for pre-existing OCD symptoms, anxiety, and depression. Dysfunctional beliefs also predicted the severity of checking, washing, and obsessional OCD symptom dimensions, but not neutralizing, ordering, or hoarding symptom dimensions. These data provide evidence for specific dysfunctional beliefs as risk factors in the development of some types of OCD symptoms. PMID:16352291
Abramowitz, Jonathan S; Khandker, Maheruh; Nelson, Christy A; Deacon, Brett J; Rygwall, Rebecca
Perceived parental rearing style in obsessive-compulsive disorder: relation to symptom dimensions.
Obsessive-compulsive disorder (OCD) runs in families, but the specific contribution of genetic and environmental factors to its development is not well understood. The aim of this study was to assess whether there are differences in perceived parental child-rearing practices between OCD patients and healthy controls, and whether any relationship exists between parental characteristics, depressive symptoms and the expression of particular OCD symptom dimensions. A group of 40 OCD outpatients and 40 matched healthy controls received the EMBU (Own Memories of Parental Rearing Experiences in Childhood), a self-report measure of perceived parental child-rearing style. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HDRS) were used to assess the severity of obsessive-compulsive and depressive symptoms. The Y-BOCS Symptom Checklist was used to assess the nature of obsessive-compulsive symptoms, considering the following five symptom dimensions: contamination/cleaning, aggressive/checking, symmetry/ordering, sexual/religious and hoarding. Logistic and multiple linear regression analyses were conducted to study the relationship between parental style of upbringing, depressive symptoms and OCD symptom dimensions. Severe OCD (Y-BOCS: 27.0+/-7.4) and mild to moderate depressive symptoms (HDRS: 14.0+/-5.4) were detected in our sample. Compared with healthy controls, OCD patients perceived higher levels of rejection from their fathers. No differences between the groups with respect to perceived levels of overprotection were detected. The seventy of depressive symptoms could not be predicted by scores on any perceived parental characteristics. Hoarding was the only OCD symptom dimension that could be partially predicted by parental traits, specifically low parental emotional warmth. Social/cultural variables such as parental child-rearing patterns, in interaction with biological and genetic factors, may contribute to the expression of the OCD phenotype. PMID:15296826
Alonso, Pino; Mench�n, Jos� M; Mataix-Cols, David; Pifarr�, Josep; Urretavizcaya, Mikel; Crespo, Jos� M; Jim�nez, Susana; Vallejo, Gema; Vallejo, Julio
Mediators and moderators of functional impairment in adults with obsessive-compulsive disorder.
The current study examined correlates, moderators, and mediators of functional impairment in 98 treatment-seeking adults with obsessive-compulsive disorder (OCD). Participants completed or were administered measures assessing obsessive-compulsive symptom severity, functional impairment, resistance against symptoms, interference due to obsessive-compulsive symptoms, depressive symptoms, insight, and anxiety sensitivity. Results indicated that all factors, except insight into symptoms, were significantly correlated with functional impairment. The relationship between obsessive-compulsive symptom severity and functional impairment was not moderated by patient insight, resistance against obsessive-compulsive symptoms, or anxiety sensitivity. Mediational analyses indicated that obsessive-compulsive symptom severity mediated the relationship between anxiety sensitivity and obsessive-compulsive related impairment. Indeed, anxiety sensitivity may play an important contributory role in exacerbating impairment through increases in obsessive-compulsive symptom severity. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and obsessive-compulsive related impairment. Implications for assessment and treatment are discussed. PMID:24342055
Storch, Eric A; Wu, Monica S; Small, Brent J; Crawford, Erika A; Lewin, Adam B; Horng, Betty; Murphy, Tanya K
Relationship between severity of obsessive-compulsive symptoms and schizotypy in obsessive-compulsive disorder
Purpose Obsessive-compulsive disorder (OCD) patients exhibit a noninhibition response pattern very similar to that observed in schizotypy patients in cognitive tasks. It has been suggested that the reduced cognitive inhibition observed in both schizotypy and OCD may result in the frequent entry into awareness of unacceptable urges and intrusive thoughts. The aim of this study was to investigate the relationship between the severity of obsession or compulsion and schizotypy in OCD. Patients and methods Sixty subjects (25 males and 35 females) who were OCD outpatients in the University Hospital at the Kyoto Prefectural University of Medicine during the period 2008�2010 were enrolled in the study. Assessments of these patients were made using the Yale�Brown Obsessive Compulsive Scale (Y-BOCS), the Schizotypal Personality Questionnaire (SPQ), the Hamilton Depression Rating Scale (HAM-D), and the Hamilton Anxiety Rating Scale (HAM-A). The Pearson correlation coefficients between Y-BOCS and SPQ scores were calculated. Furthermore, hierarchical multiple linear regression analyses were conducted to assess whether schizotypy predicted the severity of obsession and compulsion. Results By calculating the Pearson correlation coefficient, it was found that the Y-BOCS obsession score, not the Y-BOCS compulsion score, was correlated with the SPQ total score. Results of the hierarchical multiple linear regression analysis showed that SPQ total score was a significant predictor of the Y-BOCS obsession score, after accounting for control variables (ie, HAM-D and HAM-A). Conclusion Results of this study showed that the Y-BOCS obsession score, not the Y-BOCS compulsion score, was correlated with the SPQ total score. This finding suggests that OCD patients with an elevated SPQ total score experience a reduction of cognitive inhibition, resulting in the frequent entry into obsession. Future longitudinal studies are recommended to clarify the effect of schizotypy on the clinical course of OCD.
Yamamoto, Haruka; Tsuchida, Hideto; Nakamae, Takashi; Nishida, Seiji; Sakai, Yuki; Fujimori, Akihito; Narumoto, Jin; Wada, Yoshihisa; Yoshida, Takafumi; Taga, Chiaki; Fukui, Kenji
Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder.
The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and "compulsive" buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups. PMID:23298952
Torresan, Ricardo C; Ramos-Cerqueira, Ana Teresa A; Shavitt, Roseli G; do Ros�rio, Maria Concei��o; de Mathis, Maria Alice; Miguel, Euripedes C; Torres, Albina R
Rates for tic disorders and obsessive compulsive symptomatology in families of children and adolescents with Gilles de la Tourette syndrome
The aim of this study was to assess rates for tic disorders and obsessive compulsive psychopathology in families of children and adolescents with Gilles de la Tourette syndrome (TS). Diagnoses were based on the DSM III-R criteria. Obsessive compulsive psychopathology, that did not fulfill the criteria for obsessive compulsive disorder (OCD) was additionally assessed and termed obsessive compulsive symptoms (OCS).
Johannes Hebebrand; Birgit Klug; Rolf Fimmers; Susanne A. Seuchter; Roswitha Wettke-Sch�fer; Felicitas Deget; Astrid Camps; Sonja Lisch; Kathrin Hebebrand; Alexander Von Gontard; Gerd Lehmkuhl; Fritz Poustka; Martin Schmidt; Max P. Baur; Helmut Remschmidt
Prevalence and clinical characteristics of obsessive-compulsive disorder and obsessive compulsive symptoms in Afrikaner schizophrenia and schizoaffective disorder patients.
Objective: There is evidence of variation in the prevalence of co-morbid obsessive-compulsive disorder in schizophrenia amongst ethnic groups. This study evaluated the lifetime prevalence and clinical characteristics of obsessive-compulsive disorder (OCD)/ obsessive-compulsive symptoms (OCS) in Afrikaner schizophrenic and schizoaffective disorder patients. Method: An ongoing genetic study of schizophrenia is currently being conducted on the Afrikaner founder population. In this cohort of 400 subjects from the original genetic study, we identified 53 subjects with schizophrenia or schizoaffective disorder and co-morbid OCD/OCS (study group). They were matched for gender and age of onset of illness with 59 subjects who do not have OCD/OCS (control group). The diagnostic instrument used in this cohort is the Diagnostic Interview for Genetic Studies (DIGS) version 2, which has been translated into Afrikaans. In addition to the DIGS, information for the relevant clinical characteristics reported in this study was also drawn from a detailed narrative chronological summary report and clinical files. A checklist was completed. Results: The prevalence of co-morbid OCD/OCS amongst 400 subjects with schizophrenia or schizoaffective disorder was 13.2% [n=53] of which 40 were male and 13 female patients. The prevalence of OCD was 10.7% and OCS was 2.5%. Contamination obsessions [n=17] were the most common type of obsession reported, followed by religious obsessions [n=8]. The most prevalent compulsions were repetitive rituals [n=32] followed by checking behaviour [n=22]. Onset of psychotic symptoms was found to be insidious in 86.8% of the study group compared to 24.6% of the control group (p<0.0001). Second-generation antipsychotic use was found to be statistically more prevalent in the study group (77.4%), compared to the control group (45.8%) (p=0.0008). 73% of the study group experienced depressive symptoms compared to 50.8% of the control group. Both groups were found to have a similar incidence of suicidal thoughts and suicide attempts. Substance abuse amongst the control group was significantly higher (35.9%) compared to the study group (19.2%) (p <0.05). Cannabis was most commonly abused in both groups, followed by alcohol. Conclusion: The prevalence rate of 13.2% of co-morbid OCD/OCS in Afrikaner schizophrenia and schizoaffective disorder patients differs from findings in other ethnic groups, suggesting the possible role of genetic and cultural factors in the prevalence of co-morbid OCD/OCS. Second-generation antipsychotic use amongst schizophrenia and schizoaffective disorder patients with co-morbid OCD/OCS was found to be significantly higher than in those without co-morbid OCD/OCS. Clinical characteristics of Afrikaner schizophrenics and schizoaffective disorder patients with and without co-morbid OCD/OCS are the same, both groups were associated with significant psychopathology and a poor prognosis. PMID:19588030
Seedat, F; Roos, J L; Pretorius, H W; Karayiorgou, M; Nel, B
Obsessive-Compulsive Spectrum Disorder Symptoms in College Students
ERIC Educational Resources Information Center
Objective: This study investigated the occurrence of obsessive-compulsive spectrum disorders (OCSDs) and associated symptomology in college students. Participants: Participants included 358 undergraduate students. Results: Results suggest that clinically significant levels of OCSD symptoms are relatively common. Additionally, OCSD symptoms�
Sulkowski, Michael L.; Mariaskin, Amy; Storch, Eric A.
Prevalence rates of obsessive-compulsive symptoms and psychiatric comorbidity among adolescents in Iran.
Recent epidemiological studies show that obsessive-compulsive disorder (OCD) and its comorbidity with psychiatric problems is more prevalent among children and adolescents than was previously believed. The primary aim of the current study is to investigate the point-prevalence rate of obsessive compulsive symptoms in a sample of adolescent high school student in Iran. A two-stage epidemiological study was carried out through a clustered random sampling method. All participants went through a two-stage assessment procedure, in the first screening phase, the Maudsley Obsessive-Compulsive Inventory (MOCI) was administered to 909 randomly selected students (in the age range 14-18 years). Participants were considered possible sub-clinical or clinical OCD cases, if they obtained a score of MOCI?15. In the second stage, the Symptoms Checklist -90-revised (SCL-90-R) was administered to student who fulfilled the screening criteria. The prevalence of OC symptoms was found to be 11.2 percent for the total sample. The most prevalent comorbid conditions were depression and anxiety with prevalence rates of 91.2 and 78.4 percent respectively. Gender, age, birth-order, parent's education and family income had no statistically significant association with OC symptoms. Further research in this area is warranted in order to establish a set of comprehensive global assessment and measurement tools, which would allow cross-cultural studies in the field of OCD. PMID:22071645
Shams, Giti; Foroughi, Elham; Esmaili, Yaghoob; Amini, Homayoon; Ebrahimkhani, Narges
Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive-compulsive symptoms.
The Obsessive Beliefs Questionnaire-44 (OBQ-44) was developed by the Obsessive Compulsive Cognitions Working Group to measure beliefs considered important in the development and maintenance of obsessive-compulsive disorder (OCD). In this study an exploratory factor analysis of the questionnaire was conducted with a student population (n=238). Results indicated four factors: (1) perfectionism and intolerance of uncertainty, (2) importance and control of thoughts, (3) responsibility, and (4) overestimation of threat. All four factors were positively associated with obsessive-compulsive symptoms and worry. A series of regression analyses was run to test the relative contributions of cognitive and metacognitive factors. In doing so, we controlled for worry and general threat. The metacognitive dimension of importance and control of thoughts emerged as a consistent unique predictor of overall obsessive-compulsive symptoms. Exploratory analyses of predictors of obsessive-compulsive symptom subtypes showed that metacognition and perfectionism contributed to different symptom domains. The data suggests that particular beliefs may be important in OCD. PMID:17481852
Myers, Samuel G; Fisher, Peter L; Wells, Adrian
Error-related negativity in individuals with obsessive-compulsive symptoms: Toward an understanding of hoarding behaviors
The error-related negativity (ERN), an event-related potential component elicited by error responses in cognitive tasks, has been shown to be abnormal in most, but not all, studies of obsessive�compulsive disorder or obsessive�compulsive symptoms (OCD/S); these inconsistencies may be due to task selection, symptom subtype, or both. We used meta-analysis to further characterize the ERN in OCD/S, and pooled data across studies to examine the ERN in OCD/S with hoarding. We found an enhanced ERN in OCD/S relative to controls, as well as heterogeneity across tasks. When stratified, OCD/S showed a significantly enhanced ERN only in response conflict tasks. However, OCD/S + hoarding showed a marginally larger ERN than OCD/S�hoarding, but only for probabilistic learning tasks. These results suggest that abnormal ERN in OCD/S is task-dependent, and that OCD/S + hoarding show different ERN activity from OCD/S - hoarding perhaps suggesting different pathophysiological mechanisms of error monitoring.
Mathews, Carol A.; Perez, Veronica B.; Delucchi, Kevin L.; Mathalon, Daniel H.
Role of magical thinking in obsessive-compulsive symptoms in an undergraduate sample.
Thought action fusion (TAF) is an important presenting feature of many individuals with obsessive-compulsive disorder (OCD). "Magical thinking" is a similar construct (developed within the literature on schizotypy) that may provide a more accurate depiction of difficulties encountered by individuals with OCD. This study seeks to examine relationships between components of magical thinking, TAF, and superstitiousness; establish the extent to which these constructs are independently related to OCD proneness; and establish the extent to which these biased reasoning styles are related to each of the major OCD symptom clusters (e.g., washing, checking). The Padua Inventory (PI), the Maudsley Obsessional-Compulsive Inventory (MOCI), the Magical Ideation Scale (MI), the Lucky Behaviours (Lbeh) and Lucky Beliefs (Lbel) Scales, and the Thought Action Fusion-Revised scale (TAF-R) were given to a cohort of 86 undergraduate students. Of all the measures, the MI scale was found to be the most strongly related to obsessive-compulsive symptoms. Large and significant relationships between MI scores and the two measures of OCD (i.e., MOCI and PI) were obtained even when alternative mediators (i.e., Lbeh, Lbel, TAF-R) were held constant. No other variable remained significantly related to the MOCI or PI when magical ideation scores were held constant. The findings suggest that a general magical thinking tendency may underpin previous observed links between superstitiousness, thought action fusion, and OCD severity. PMID:15129419
Einstein, Danielle A; Menzies, Ross G
Electroconvulsive Therapy on Severe Obsessive-Compulsive Disorder Comorbid Depressive Symptoms
Electroconvulsive therapy (ECT) is not currently used as a first-line treatment for obsessive-compulsive disorder (OCD). However, several related case reports have demonstrated that ECT seems to be effective for severe OCD, especially when first-line therapies have failed. In this study, we describe the courses, detailed parameters, effects, and follow-up information relating to three patients with severe OCD who were treated by modified bifrontal ECT after their first-line anti-OCD treatments pharmacotherapy, behavioral therapy, and cognitive behavioral therapy failed. The number of ECT procedures administered in each case is as follows: Case 1, eight; Case 2, three; and Case 3, four. In all three cases, the patients' depressive symptoms improved considerably after the ECT procedures. In addition, the condition of all three patients' OCD significantly improved and remained stable at regular follow-ups. ECT may play an effective role in treating severe OCD.
Liu, Xiaohui; Cui, Hong; Wei, Qiang; Wang, Ying; Wang, Keyong; Wang, Chen; Zhu, Chunyan
Rearing practices and impulsivity/hyperactivity symptoms in relation to inflated responsibility and obsessive-compulsive symptoms.
Sm�ri, J., R�rik Martinsson, D., & Einarsson, H. (2010). Rearing practices and impulsivity/hyperactivity symptoms in relation to inflated responsibility and obsessive-compulsive symptoms. Scandinavian Journal of Psychology. The aim of the study was to investigate potential precursors of inflated responsibility (responsibility attitudes) and obsessive-compulsive (OCD) symptoms. It was argued that both parental overprotection and impulsivity, separately and in interaction with each other, contribute to inflated responsibility and OCD symptoms. In a large sample of young adults (N = 570), self-report measures of OCD symptoms (OCI-R), responsibility attitudes (RAS), anxiety/depression (HADS), rearing practices (EMBU), present and past impulsivity/hyperactivity symptoms (IMP/HY) were administered. Overprotection as well as IMP/HY were found to predict OCD symptoms as well as inflated responsibility. Finally, a significant interaction was found between IMP/HY and overprotection with regard to both OCD symptoms and inflated responsibility. This effect reflected that IMP/HY was more strongly related to OCD symptoms and responsibility in people who had not been overprotected than in people who had been. Conversely overprotection was related to OCD symptoms and responsibility in people low but not in people high in IMP/HY. The results seem to indicate that the inadequacy between offer and need for parental control may play a role in the development of OCD symptoms. PMID:20584153
Sm�ri, Jakob; Martinsson, Dav�� R�rik; Einarsson, Hjalti
Subtyping obsessive compulsive patients by depressive symptoms: a retrospective pilot study.
Depression is a frequent comorbid condition in obsessive compulsive disorder (OCD) patients and may impact upon treatment prognosis. Identification of OCD "subtypes" might ultimately aid in treatment decision-making as it has in other psychiatric disorders. A retrospective pilot study was performed examining depressive and OCD symptomatology by analyzing the relation between factor scores on the Beck Depression Inventory (BDI) and the Maudsley Inventory (MOCI) in 41 OCD patients. Total BDI score was significantly correlated with total MOCI score (r = .36, p < .02). Checking was correlated with Retarded depression (r = .30, p < .05). Doubting correlated with both Guilty depression (r = .48, p < .002) and Retarded depression (r = .37, p < .02). None of the canonical correlations were significant. At p < .08, the first canonical correlation approached significance. The data were interpreted cautiously as suggesting that some OCD patients may exhibit symptoms of Doubting together with Guilty depression and Retarded depression symptoms. These data need replication in a larger, prospective study design. PMID:9924732
Tynes, L L; Winstead, D K
Symptom Dimensions in Two Samples of Africans Americans with Obsessive-Compulsive Disorder.
Obsessive-compulsive disorder (OCD) is a leading cause of disability worldwide, however, there is a lack of research that includes African Americans, thus it is unclear whether findings about symptom dimensions can be generalized to this population. A sample of adult African Americans with OCD (N=74) was recruited at the University of Pennsylvania (Penn) and administered the Yale Brown Obsessive-Compulsive checklist (YBOCS) to better understand the phenomenology of OCD in African Americans. Frequencies of symptoms are reported and compared to findings from the National Survey of American Life (NSAL; N=54). A principal components analysis of YBOCS categories and items was performed on the Penn sample. A six-component solution was found, that included Contamination & Washing, Hoarding, Sexual Obsessions & Reassurance, Aggression & Mental Compulsions, Symmetry & Perfectionism, and Doubt & Checking, explaining 59.1% of the variance. Factors identified were similar to those of previous studies in primarily white samples. African Americans with OCD reported more contamination symptoms and were twice as likely to report excessive concerns with animals as European Americans with OCD. The results indicate the presence of cultural differences, which is consistent with findings among non-clinical samples. Implications of these findings are discussed. PMID:22708117
Williams, M T; Elstein, J; Buckner, E; Abelson, J; Himle, J
An examination of obsessive-compulsive symptoms and dimensions using profile analysis via multidimensional scaling (PAMS).
Contemporary cognitive models of obsessive-compulsive disorder (OCD) emphasize the importance of various types of dysfunctional beliefs in contributing to OC symptoms, such as beliefs about excessive personal responsibility, perfectionism, and intolerance for uncertainty. The present study seeks to further our understanding of the role of these beliefs by identifying the common profiles of such beliefs, using profile analysis via multidimensional scaling (PAMS). In Study 1, a large student sample (N=4079) completed the 44-item obsessive beliefs questionnaire. One major profile, control of thoughts and perfectionism, was extracted. Study 2 examined profiles of the 87-item obsessive beliefs questionnaire in people with obsessive-compulsive disorder (OCD; n=398), other anxiety disorders (n=104), and a sample of undergraduate students (n=285). Inflated responsibility was a prominent subscale in the profiles of all three groups. Only control over thoughts was a unique subscale in the profile obtained for the OCD group, with this group having lower scores compared to the other groups. The results suggest that while inflated responsibility is a significant subscale in the profile of individuals with OCD, it is not a unique contributor; instead, control over thoughts is unique to OCD. The data, as well as recent research investigating obsessive beliefs, suggest the need to revise the contemporary cognitive model of OCD. PMID:24786360
McKay, Dean; Kim, Se-Kang; Taylor, Steven; Abramowitz, Jonathan S; Tolin, David; Coles, Meredith; Timpano, Kiara R; Olatunji, Bunmi
[Advantage of obsessive-compulsive symptoms from the aspect of individual selection and group selection: an evolutionary psychological approach to obsessive-compulsive disorder].
Psychiatric disorders are difficult to explain from an evolutionary aspect, since it is hard to reason how a characteristic carrying a reproductive disadvantage survives through natural selection. There are several evolution-based papers concerning obsessive-compulsive disorder (OCD), which aim at resolving this contradiction. Recent studies provided considerable evidence in support for the evolutionary theories of OCD. Research confirmed an important role for genetic factors in the background of OCD, and neuroanatomic studies supported that neuroanatomical structures playing a role in OCD are those areas which are activated during the processing of danger and threat. From the evolutionary aspect OCD can be explained both from the individual and group selection aspect. According to the theory of individual selection, OCD symptoms are based on such behaviors which are by themselves advantageous serving individual survival and reproduction and therefore carry on through natural selection. According to group selection theory, although OCD is disadvantageous for the individual, it is adaptive for the survival of the group. In our paper we review the individual and group selection theories of OCD, and we also outline the continuity and discontinuity theories which show a significant overlap with the evolutionary theories. We review characteristic age and gender differences related to OCD from this aspect. The evolutionary approach to OCD is important in understanding the background factors, development and symptoms of OCD, which mean new tools in the prevention and treatment of this disorder. PMID:19213201
Gonda, X�nia; Jekkel, Eva; Varga, Anna; Mikl�si, M�nika; Forintos, D�ra Perczel
Children�s Florida Obsessive Compulsive Inventory: Psychometric Properties and Feasibility of a Self-Report Measure of Obsessive�Compulsive Symptoms in Youth
This report describes the development and psychometric properties of the Children�s Florida Obsessive Compulsive Inventory\\u000a (C-FOCI). Designed specifically as a brief measure for assessing obsessive�compulsive symptoms, the C-FOCI was created for\\u000a use in both clinical and community settings. Study 1 included 82 children and adolescents diagnosed with primary Obsessive�Compulsive\\u000a Disorder, and their parents. The Children�s Yale-Brown Obsessive�Compulsive Scale (CY-BOCS) was
Eric A. Storch; Muniya Khanna; Lisa J. Merlo; Benjamin A. Loew; Martin Franklin; Jeannette M. Reid; Wayne K. Goodman; Tanya K. Murphy
Case Series: Transformation Obsession in Young People with Obsessive-Compulsive Disorder (OCD)
ERIC Educational Resources Information Center
This article presents a previously unreported symptom of obsessive-compulsive disorder. The young people reported describe a fear of turning into someone or something else or taking on unwanted characteristics. We have called this transformation obsession. The bizarre nature of this obsession had led to misdiagnosis and inappropriate treatments in�
Volz, Chloe; Heyman, Isobel
Children' Florida Obsessive Compulsive Inventory: Psychometric Properties and Feasibility of a Self-Report Measure of Obsessive-Compulsive Symptoms in Youth
ERIC Educational Resources Information Center
This report describes the development and psychometric properties of the Children's Florida Obsessive Compulsive Inventory (C-FOCI). Designed specifically as a brief measure for assessing obsessive-compulsive symptoms, the C-FOCI was created for use in both clinical and community settings. Study 1 included 82 children and adolescents diagnosed�
Storch, Eric A.; Khanna, Muniya; Merlo, Lisa J.; Loew, Benjamin A.; Franklin, Martin; Reid, Jeannette M.; Goodman, Wayne K.; Murphy, Tanya K.
Psychosis with obsessive-compulsive symptoms in tuberous sclerosis.
We present a case of tuberous sclerosis complex (TSC) diagnosed in adulthood in a man initially referred for specialist neuropsychiatric assessment with psychosis and obsessive-compulsive symptoms (OCS) on a background of epilepsy and intellectual disability. To our knowledge, this is the first reported patient with TSC featuring both psychosis and OCS. This patient highlights the importance of comprehensive re-evaluation of atypical presentations of intellectual disability, epilepsy and associated neuropsychiatric symptoms, even in adulthood. This is particularly relevant in the context of significant advances in genetics, neuroscience, imaging and treatments for heritable neurogenetic disorders. PMID:24211143
Hassan, Islam K; Looi, Jeffrey C L; Velakoulis, Dennis; Gaillard, Frank; Lui, Elaine H; O'Brien, Terence J; French, Chris; Le Heron, Campbell; Adams, Sophia J
Amygdala hyperactivation during symptom provocation in obsessive-compulsive disorder and its modulation by distraction
Anxiety disorders have been linked to a hyperactivated cortico-amygdalar circuitry. Recent findings highlight the amygdala's role in mediating elevated anxiety in obsessive�compulsive disorder (OCD). However, modulation of amygdala hyperactivation by attentional distraction � an effective emotion regulation strategy in healthy individuals � has not yet been examined. While undergoing functional magnetic resonance imaging twenty-one unmedicated OCD patients and 21 controls performed an evaluation and a distraction task during symptom provocation with individually tailored OCD-relevant pictures. To test the specificity of responses, additional aversive and neutral stimuli were included. Significant group-by-picture type interactions were observed within fronto�striato�limbic circuits including the amygdala. In these regions patients showed increased BOLD responses during processing of OCD triggers relative to healthy controls. Amygdala hyperactivation was present across OCD symptom dimensions indicating that it represents a common neural correlate. During distraction, we observed dampening of patients' amygdala hyperactivity to OCD-relevant stimuli. Augmented amygdala involvement in patients during symptom provocation, present across OCD symptom dimensions, might constitute a correlate of fear expression in OCD linking it to other anxiety disorders. Attentional distraction seemed to dampen emotional processing of disorder-relevant stimuli via amygdala downregulation. The clinical impact of this strategy to manage anxiety in OCD should be further elucidated.
Simon, Daniela; Adler, Nele; Kaufmann, Christian; Kathmann, Norbert
Associations between obsessive-compulsive symptoms, revenge, and the perception of interpersonal transgressions.
Anger and aggression have only recently gained center stage in research on obsessive-compulsive disorder (OCD). An investigation of obsessive-compulsive (OC) symptoms focusing on the outcome of unresolved anger (i.e., revenge), however, is absent from the literature. The objective of the present research was therefore to provide a first step towards filling this gap and, hence, to systematically examine the associations between OC symptoms and different aspects of revenge (i.e., attitudes, dispositions, motivations). In three independent studies with nonclinical participants (N=504), we tested the hypothesis that OC symptoms relate to greater revenge. Individuals high in OC symptoms reported more positive attitudes toward revenge (Study 1), scored higher on a measure of trait revenge (Study 2), and reported increased revenge motivation regarding a real-life transgressor (Study 3). Furthermore, Study 4 (N=175) demonstrated that individuals high in OC symptoms perceived interpersonal transgressions more frequently in their daily lives. OC symptoms were positively related to the number of transgressions that respondents disclosed. Our results suggest that revenge and interpersonal hurt play a significant role in OCD. PMID:24928759
Fatfouta, Ramzi; Merkl, Angela
Obsessive-compulsive symptoms in parents of Tourette syndrome probands and autism spectrum disorder probands.
Obsessive-compulsive symptoms (OCS) frequently occur in patients with Tourette syndrome (TS) and autism spectrum disorders (ASD). It has been suggested that genetic factors play a role in the transmission of both TS and ASD and that obsessive-compulsive disorder (OCD) may have some genetic relationship with these disorders. The objective of this study was to explore whether the OCS associated with TS and ASD were found in the parents of TS and ASD probands by comparing them with normal controls. The subjects were parents of 13 TS and 16 ASD probands. All parents underwent an examination for tic symptoms and OCD, and completed the Maudsley Obsessional Compulsive Inventory (MOCI) and State-Trait Anxiety Inventory (STAI). No significant differences were observed in the MOCI and STAI scores among all three groups. However, the MOCI total score was higher in fathers of ASD probands than in male normal controls with a marginal significance. There was a significant tendency for the mean cleaning score of MOCI in fathers of ASD probands to be higher than that in male normal controls, and the mean checking score in fathers of ASD probands was fourfold higher than that in male normal controls, although there was no significant difference. No significant relationship was observed between OCS in TS or ASD probands and OCS of their parents. Further studies on OCD and OCS including a dimensional approach within ASD families are needed. PMID:15298645
Kano, Yukiko; Ohta, Masataka; Nagai, Yoko; Pauls, David L; Leckman, James F
Case Series: Increased Vulnerability to Obsessive-Compulsive Symptoms With Repeated Episodes of Sydenham Chorea
The association between obsessive-compulsive symptoms (OCS) and Sydenham chorea (SC) supports the hypothesis of a common neuroimmunological dysfunction in basal ganglia associated with group A ?-hemolytic streptococcal infection underlying both conditions. Four children with 2 distinct SC episodes were evaluated to assess the course of OCS. All patients developed OCS during their second episodes (3 met criteria for obsessive-compulsive disorder
Disgust implicated in obsessive-compulsive disorder.
Psychiatric classificatory systems consider obsessions and compulsions as forms of anxiety disorder. However, the neurology of diseases associated with obsessive-compulsive symptoms suggests the involvement of fronto-striatal regions likely to be involved in the mediation of the emotion of disgust, suggesting that dysfunctions of disgust should be considered alongside anxiety in the pathogenesis of obsessive-compulsive behaviours. We therefore tested recognition of facial expressions of basic emotions (including disgust) by groups of participants with obsessive-compulsive disorder (OCD) and with Gilles de la Tourette's syndrome (GTS) with an without co-present obsessive-compulsive behaviours (GTS with OCB; GTS without OCB). A group of people suffering from panic disorder and generalized anxiety were also included in the study. Both groups with obsessive-compulsive symptoms (OCD; GTS with OCB) showed impaired recognition of facial expressions of disgust. Such problems were not evident in participants with panic disorder and generalized anxiety, or for participants with GTS without obsessions or compulsions, indicating that the deficit is closely related to the presence of obsessive-compulsive symptoms. Participants with OCD were able to assign words to emotion categories without difficulty, showing that their problem with disgust is linked to a failure to recognize this emotion in others and not a comprehension or response criterion effect. Impaired recognition of disgust is consistent with the neurology of OCD and with the idea that abnormal experience of disgust may be involved in the genesis of obsessions and compulsions.
Sprengelmeyer, R; Young, A W; Pundt, I; Sprengelmeyer, A; Calder, A J; Berrios, G; Winkel, R; Vollmoeller, W; Kuhn, W; Sartory, G; Przuntek, H
A Somatoform Variant of Obsessive-Compulsive Disorder: A Case Report of OCD Presenting With Persistent Vomiting
Acute nausea and vomiting are often self-limited or easily treated. Persistent vomiting, however, poses diagnostic and therapeutic challenges for the primary care physician. In addition to gastrointestinal, neurologic, and endocrine disorders, the differential diagnosis includes psychiatric illnesses, such as eating and factitious disorders. We present the case of a 52-year-old woman referred to the Tulane University Internal Medicine/Psychiatry clinic with persistent daily vomiting for 8 years despite repeated medical evaluations. The vomiting was of sufficient severity to require intensive care unit admission for hematemesis. A dually trained internal medicine-psychiatry house officer obtained further history and identified that the woman experienced an intrusive thought that urged her to vomit after each meal. Resisting the urge resulted in intolerable anxiety that was relieved only by vomiting. Obsessive-compulsive disorder (OCD) was diagnosed according to DSM-IV criteria. Initiation of escitalopram with titration to clinical response resulted in full symptom resolution and meaningful quality of life improvement. Pertinent literature was reviewed using 2 methods: (1) an English-language MEDLINE search (1966�February 2004) using the search terms vomiting and (chronic or psychogenic or psychiatric), and obsessive-compulsive disorder and (primary care or treatment); and (2) a direct search of reference lists of pertinent journal articles. A review of psychiatric etiologies of vomiting and primary care aspects of OCD is presented. Primary care clinicians are strongly encouraged to consider psychiatric etiologies, including OCD, when common symptoms persist or present in atypical ways. Such disorders can be debilitating but also responsive to treatment.
Kirkcaldy, Robert D.; Kim, Thomas J.; Carney, Caroline P.
Differential diagnosis of obsessive-compulsive symptoms from delusions in schizophrenia: A phenomenological approach
Several studies suggest increased prevalence-rates of obsessive-compulsive symptoms (OCS) and even of obsessive-compulsive disorder (OCD) in patients with schizophrenic disorders. Moreover, it has been recently proposed the existence of a distinct diagnostic sub-group of schizo-obsessive disorder. However, the further investigation of the OCS or OCD-schizophrenia diagnostic comorbidity presupposes the accurate clinical differential diagnosis of obsessions and compulsions from delusions and repetitive delusional behaviours, respectively. In turn, this could be facilitated by a careful comparative examination of the phenomenological features of typical obsessions/compulsions and delusions/repetitive delusional behaviours, respectively. This was precisely the primary aim of the present investigation. Our examination included seven features of obsessions/delusions (source of origin and sense of ownership of the thought, conviction, consistency with one�s belief-system, awareness of its inaccuracy, awareness of its symptomatic nature, resistance, and emotional impact) and five features of repetitive behaviours (aim of repetitive behaviours, awareness of their inappropriateness, awareness of their symptomatic nature, and their immediate effect on underlying thought, and their emotional impact). Several of these clinical features, if properly and empathically investigated, can help discriminate obsessions and compulsive rituals from delusions and delusional repetitive behaviours, respectively, in patients with schizophrenic disorders. We comment on the results of our examination as well as on those of another recent similar investigation. Moreover, we also address several still controversial issues, such as the nature of insight, the diagnostic status of poor insight in OCD, the conceptualization and differential diagnosis of compulsions from other categories of repetitive behaviours, as well as the diagnostic weight assigned to compulsions in contemporary psychiatric diagnostic systems. We stress the importance of the feature of mental reflexivity for understanding the nature of insight and the ambiguous diagnostic status of poor insight in OCD which may be either a marker of the chronicity of obsessions, or a marker of their delusionality. Furthermore, we criticize two major shortcomings of contemporary psychiatric diagnostic systems (DSM-IV, DSM-V, ICD-10) in their criteria or guidelines for the diagnosis of OCD or OCS: first, the diagnostic parity between obsessions and compulsions and, second, the inadequate conceptualization of compulsions. We argue that these shortcomings might artificially inflate the clinical prevalence of OC symptoms in the course of schizophrenic disorders. Still, contrary to a recent proposal, we do not exclude on purely a priori grounds the possibility of a concurrence of genuine obsessions along with delusions in patients with schizophrenia.
Oulis, Panagiotis; Konstantakopoulos, George; Lykouras, Lefteris; Michalopoulou, Panayiota G
Symptom dimensions in obsessive�compulsive disorder: From normal cognitive intrusions to clinical obsessions
Cognitive behavioral models of obsessive�compulsive disorder (OCD) assume continuity between normal obsessional intrusive thoughts (OITs) and obsessions. However, this assumption has recently been criticized. This article examines this issue using a new instrument (the Obsessional Intrusive Thoughts Inventory, INPIOS) specifically designed to assess the frequency and content of 48 OITs, which was completed by 734 community subjects and 55 OCD
Gemma Garc�a-Soriano; Amparo Belloch; Carmen Morillo; David A. Clark
Obsessive-compulsive symptoms and characteristics in individuals with delayed sleep phase disorder.
Research has demonstrated a relationship between circadian disruption and severe obsessive-compulsive disorder (OCD). Misalignment of sleep timing/endogenous biological rhythms with the 24-hour light/dark cycle may result in difficulty dismissing intrusive thoughts, thus increasing vulnerability to disorders characterized by intrusive thoughts, such as OCD. Deficits in inhibition of intrusive thoughts are posited to play a role in OCD. The current study investigated whether individuals with delayed sleep phase disorder (DSPD) report elevated symptoms of OCD and have greater difficulty inhibiting intrusive thoughts than do individuals without DSPD. Community participants with and without DSPD completed questionnaires and performed behavioral tasks designed to elicit intrusive thoughts. The participants with DSPD (n = 27) had elevated OCD symptoms and greater rates of disorders characterized by intrusive thoughts on a structured interview, as compared with the participants without DSPD (n = 19). These results support a link between the timing of sleep and symptoms of OCD. Implications and future directions are discussed. PMID:24080675
Schubert, Jessica R; Coles, Meredith E
The familial phenotype of obsessive-compulsive disorder in relation to tic disorders: the Hopkins OCD family study
Background: Obsessive-compulsive disorder (OCD) and tic disorders have phenomenological and familial-genetic overlaps. An OCD family study sample that excludes Tourette�s syndrome in probands is used to examine whether tic disorders are part of the familial phenotype of OCD.Methods: Eighty case and 73 control probands and their first-degree relatives were examined by experienced clinicians using the Schedule for Affective Disorders and
Marco A Grados; Mark A Riddle; Jack F Samuels; Kung-Yee Liang; Rudolf Hoehn-Saric; O. Joseph Bienvenu; John T Walkup; DongHo Song; Gerald Nestadt
Autism and ADHD Symptoms in Patients with OCD: Are They Associated with Specific OC Symptom Dimensions or OC Symptom Severity?
In obsessive-compulsive disorder (OCD), the relationship between autism spectrum disorders (ASD), attention-deficit\\/hyperactivity\\u000a disorder (ADHD) symptom, and obsessive-compulsive (OC) symptom dimensions and severity has scarcely been studied. Therefore,\\u000a 109 adult outpatients with primary OCD were compared to 87 healthy controls on OC, ADHD and ASD symptoms. OCD patients showed\\u000a increased ADHD and autism symptom frequencies, OCD�+�ADHD patients reporting more autism symptoms
Gideon E. Anholt; Danielle C. Cath; Patricia van Oppen; Merijn Eikelenboom; Johannes H. Smit; Harold van Megen
The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study.
Contemporary cognitive models of obsessive-compulsive disorder (OCD) posit that OC symptoms arise from negative interpretations of intrusive thoughts, which are derived from trait-like dysfunctional assumptions ("obsessive beliefs;" e.g., concerning overestimates of responsibility). Although correlational studies suggest that obsessive beliefs, negative interpretations of intrusions, and OC symptoms are interrelated, prospective studies evaluating the directional hypotheses implied in the cognitive model are lacking. In the present longitudinal study, 76 first time expecting parents were followed through the postpartum. Results indicated that the tendency to negatively interpret the presence and meaning of unwanted intrusive infant-related thoughts early in the postpartum period (3-4 weeks) mediated the relationship between pre-childbirth obsessive-beliefs and late postpartum (12 weeks) OC symptoms. Results are discussed in terms of their theoretical and treatment implications. PMID:16806800
Abramowitz, Jonathan S; Nelson, Christy A; Rygwall, Rebecca; Khandker, Maheruh
Clozapine-Induced Obsessive-Compulsive Symptoms in Schizophrenia: A Critical Review
Obsessive-compulsive disorder (OCD) is rarely associated with schizophrenia, whereas 20 to 30% of schizophrenic patients, suffer from comorbid obsessive-compulsive symptoms (OCS). So far no single pathogenetic theory convincingly explained this fact suggesting heterogeneous subgroups. Based on long-term case observations, one hypothesis assumes that second-onset OCS in the course of schizophrenia might be a side effect of second generation antipsychotics (SGA), most importantly clozapine (CLZ). This review summarizes the supporting epidemiological and pharmacological evidence: Estimations on prevalence of OCS increase in more recent cross-sectional studies and in later disease stages. Longitudinal observations report the de novo-onset of OCS under clozapine treatment. This association has not been reported with first generation antipsychotics (FGA) or SGAs with mainly dopaminergic mode of action. Finally, significant correlations of OCS-severity with duration of treatment, dose and serum levels suggest clozapine-induced OCS. However, supposed causal interactions need further verifications. It is also unclear, which neurobiological mechanisms might underlie the pathogenetic process. Detailed genotypic and phenotypic characterizations of schizophrenics with comorbid OCS regarding neurocognitive functioning and activation in sensitive tasks of functional magnetic imaging are needed. Multimodal large-scaled prospective studies are necessary to define patients at risk for second-onset OCS and to improve early detection and therapeutic interventions.
Schirmbeck, Frederike; Zink, Mathias
Basal Ganglia MR Relaxometry in Obsessive-Compulsive Disorder: T2 Depends Upon Age of Symptom Onset
Dysfunction in circuits linking frontal cortex and basal ganglia (BG) is strongly implicated in obsessive-compulsive disorder (OCD). On MRI studies, neuropsychiatric disorders with known BG pathology have abnormally short T2 relaxation values (a putative biomarker of elevated iron) in this region. We asked if BG T2 values are abnormal in OCD. We measured volume and T2 and T1 relaxation rates in BG of 32 adults with OCD and 33 matched controls. There were no group differences in volume or T1 values in caudate, putamen, or globus pallidus (GP). The OCD group had lower T2 values (suggesting higher iron content) in the right GP, with a trend in the same direction for the left GP. This effect was driven by patients whose OCD symptoms began from around adolescence to early adulthood. The results suggest a possible relationship between age of OCD onset and iron deposition in the basal ganglia.
Hubbard, Emily; Hassenstab, Jason; Yip, Agustin; Vymazal, Josef; Herynek, Vit; Giedd, Jay; Murphy, Dennis L.; Greenberg, Benjamin D.
Insight in adults with obsessive-compulsive disorder.
The present study examined the clinical correlates of insight among adults with obsessive-compulsive disorder (OCD). One hundred and thirty treatment-seeking adults with a primary diagnosis of OCD, aged 18 to 68 years (mean 31.4 years) participated. Measures of clinical severity, obsessive-compulsive symptom dimensions, anxiety symptoms, depressive symptoms, and ability to resist and control OCD symptoms were obtained. Results indicated that poor insight was positively related to greater OCD symptom severity and poorer ability to resist and control OCD symptoms; this pattern of associations held when insight was examined continuously and categorically (i.e., high versus low insight). Insight was generally not associated with other clinical characteristics, except for a relationship with mental neutralizing behaviors. Insight did not mediate the relationship between the ability to resist and control OCD symptoms and obsessive-compulsive symptom severity. Overall, this study provides further information into the nature and role of insight in adults with OCD. PMID:24445116
Jacob, Marni L; Larson, Michael J; Storch, Eric A
Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder
BACKGROUND: The new technique of functional magnetic resonance imaging was used to investigate the mediating neuroanatomy of obsessive-compulsive disorder symptoms. METHODS: Ten patients with obsessive-compulsive disorder and 5 normal subjects were studied via functional magnetic resonance imaging during control and provoked conditions. Data analysis entailed parametric and nonparametric statistical mapping. RESULTS: Statistical maps (nonparametric; P < 10(-3)) showed activation for
H. C. Breiter; S. L. Rauch; K. K. Kwong; J. R. Baker; R. M. Weisskoff; D. N. Kennedy; A. D. Kendrick; T. L. Davis; A. Jiang; M. S. Cohen; C. E. Stern; J. W. Belliveau; L. Baer; R. L. O'Sullivan; C. R. Savage; M. A. Jenike; B. R. Rosen
Diffusion tensor imaging (DTI) studies in patients with obsessive-compulsive disorder (OCD): a review.
This review presents an overview of studies investigating white-matter integrity in patients with obsessive-compulsive disorder (OCD) using diffusion tensor imaging (DTI). There is increasing evidence for white matter alterations in OCD. In adult patients the majority of all studies reported abnormalities in terms of decreased fractional anisotropy (FA) compared to healthy volunteers. Although findings are heterogeneous, the cingulate bundle, the corpus callosum and the anterior limb of the internal capsule are most commonly affected by decreased white matter integrity in adult OCD patients. In pediatric and adolescent patients initial evidence points more towards increased white matter connectivity. Thus, current results suggest alterations in various white matter regions in both pediatric and adult OCD patients. They indicate that alterations may vary as a function of clinical characteristics and may be amenable to pharmacologic treatment. Although the findings have important implications for the neurobiology of OCD they also raise a number of important questions that are discussed in this review and need to be taken into consideration in future studies. PMID:24694669
Koch, Kathrin; Reess, Tim J; Rus, O Georgiana; Zimmer, Claus; Zaudig, Michael
White matter structure and symptom dimensions in obsessive-compulsive disorder.
There is evidence that the different symptom dimensions in obsessive-compulsive disorder (OCD) may be mediated by partially distinct neural systems. This DTI study investigated the relationship between symptom dimensions and white matter microstructure. Fractional anisotropy (FA), axial and radial diffusivity was analyzed in relation to the main OCD symptom dimensions. Symptom severity on the obsessing dimension was negatively correlated with FA in the corpus callosum and the cingulate bundle. Severity on the ordering dimension was negatively correlated with FA in, amongst others, the right inferior fronto-occipital fasciculus and the right optic radiation. All correlations were ascribable to alterations in radial diffusivity while there was no association between symptoms and axial diffusivity. Present results illustrate an association between alterations in visual processing tracts and ordering symptoms which are characterized by altered visual processing and increased attention towards irrelevant detail. They also indicate an association between obsessive thoughts and alterations in structures known to be relevant for cognitive control and inhibition. Hence, different symptom dimensions must be taken into account in order to disentangle the neurobiological underpinnings of OCD. PMID:22099866
Koch, Kathrin; Wagner, Gerd; Schachtzabel, Claudia; Schultz, C Christoph; Straube, Thomas; G�llmar, Daniel; Reichenbach, J�rgen R; Peikert, Gregor; Sauer, Heinrich; Schl�sser, Ralf G M
The Impact of Personality Traits on Ratings of Obsessive-Compulsive Symptoms
Objective The goal of this study was to evaluate consistencies and discrepancies between clinician-administered and self-report versions of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and to examine relationships between these scales and personality traits. Methods A total of 106 patients with obsessive-compulsive disorder (OCD) participated in this study. All participants were assessed with both clinician-administered and self-report versions of the Y-BOCS. The Structured Clinical Interview for DSM-IV Axis II Disorders Personality Questionnaire (SCID-II-PQ) was used to evaluate relationships between personality traits and scores on the Y-BOCS. Results Scores on the clinician-administered Y-BOCS and its obsession subscale were significantly higher than were those on the self-report version. However, we found no significant differences in compulsion subscale scores. We also found that the discrepancies in the scores on the two versions of the Y-BOCS and its compulsion subscale were significantly positively correlated with scores for narcissistic personality traits on the SCID-II-PQ. Additionally, narcissistic personality traits had a significant effect on the discrepancy in the scores on the two versions of the Y-BOCS and its compulsion subscale in the multiple linear regression analysis. Conclusion This is the first study to elucidate relationships between personality traits and discrepancies between scores on the two versions of the Y-BOCS. Although clinicians tend to rate obsessive symptoms as being more severe than do patients, clinicians may underestimate the degree to which individuals with narcissistic personality traits suffer more from subjective discomfort due to compulsive symptoms. Therefore, the effect of personality traits on symptom severity should be considered in the treatment of OCD.
Huh, Min Jung; Shim, Geumsook; Byun, Min Soo; Kim, Sung Nyun; Kim, Euitae; Jang, Joon Hwan; Shin, Min-Sup
Visual, tactile, and auditory "not just right" experiences: associations with obsessive-compulsive symptoms and perfectionism.
"Not just right" experiences (NJREs), or uncomfortable sensations associated with the immediate environment not feeling "right," are thought to contribute to obsessive-compulsive disorder (OCD) symptomatology. The literature suggests that NJREs are experienced across sensory modalities; however, existing in vivo measures have been restricted to visual inductions (e.g., viewing and/or rearranging a cluttered table). The present study used a large undergraduate sample (N=284) to examine 4 in vivo tasks designed to elicit and assess NJREs across separate sensory modalities (i.e., visual, tactile, and auditory). Task ratings (discomfort evoked, and urge to counteract task-specific stimuli) were uniquely associated with self-report measures of NJREs, OC symptoms (ordering/arranging, checking, and washing), and certain maladaptive domains of perfectionism (doubts about actions, and organization). Findings have implications for experimental research and clinical work targeting NJREs specific to particular senses. PMID:25022778
Summers, Berta J; Fitch, Kristin E; Cougle, Jesse R
Defining clinical severity in pediatric obsessive-compulsive disorder.
Despite extensive use of the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997), the lack of normative data impedes interpretation of individual CYBOCS scores. Consequently, psychometrics on CYBOCS severity scores from 815 treatment-seeking youth with obsessive-compulsive disorder (OCD) are presented, across age and sex, so that normative comparisons of obsessive, compulsive, and combined obsessive-compulsive severity could be calculated. Our findings suggest no evidence for marked age or sex differences. Further, obsessive-compulsive symptom severity scores (measured via the CYBOCS) appear consistent with global OCD syndrome severity (measured via the Clinician Global Impression-Severity scale [CGI-S; Guy, 1976]; r = .58). This study contributes the 1st empirically based guidelines for interpreting obsessive-compulsive symptom severity scores. After a diagnosis of OCD is determined, the CYBOCS can be used to determine severity of illness (however, categories of severity proposed by this article should not be used in the screening of OCD symptoms). Findings can facilitate clinicians' and investigators' ability to draw comparisons across obsessive-compulsive severity scores. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24320764
Lewin, Adam B; Piacentini, John; De Nadai, Alessandro S; Jones, Anna M; Peris, Tara S; Geffken, Gary R; Geller, Daniel A; Nadeau, Joshua M; Murphy, Tanya K; Storch, Eric A
Differential neural network of checking versus washing symptoms in obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The aim of this study was to investigate differential neural responses to a symptom provocation task in drug-free patients who have predominantly aggression/checking symptoms (Checkers) and patients with contamination/washing symptoms (Washers). We compared the Checkers (n=10) and the Washers (n=12) separately to normal controls during the symptom provocation tasks using fMRI (functional magnetic resonance imaging). Moreover, we performed correlative analysis in each OCD group between brain activation and symptom severity. The Checkers showed hypoactivation in the left caudate and left anterior cingulate cortex (ACC) compared to the normal controls and a positive correlation between activated brain areas and symptom severity in the left ACC. The Washers showed hyperactivation in several bilateral cortico-cerebellar regions and a positive correlation between symptom severity and the bilateral fronto-temporal gyrus. We suggest that the caudate and ACC are associated with checking rituals and that large cortical brain regions are related to washing rituals. PMID:22996045
Murayama, Keitaro; Nakao, Tomohiro; Sanematsu, Hirokuni; Okada, Kayo; Yoshiura, Takashi; Tomita, Mayumi; Masuda, Yusuke; Isomura, Kayoko; Nakagawa, Akiko; Kanba, Shigenobu
Relationship between two aspects of perfectionism and obsessive-compulsive symptoms.
In this study was investigated the relationship between two aspects of perfectionism (Concern over Mistakes and Personal Standards) and obsessive-compulsive symptoms. College students (57 men and 193 women: M age = 19.5 yr., SD = 1.9) majoring in psychology were from introductory psychology classes and a psychological assessment practice class. They completed the Padua Inventory, which assesses obsessive-compulsive symptoms, and the subscales of Concern over Mistakes and Personal Standards of the Frost Multidimensional Perfectionism Scale, which assess the tendency to be concerned about making mistakes and the tendency to set excessively high standards, respectively. Multiple regression analysis indicated that only the Concern over Mistakes scores predicted significantly all Padua Inventory subscale scores. Perhaps only being concerned over making mistakes may be associated with obsessive-compulsive symptoms. The tendency to set high standards was not strongly correlated with obsessive-compulsive symptoms. Further, the relationship between setting high standards and having obsessive-compulsive symptoms reported in previous studies may be spurious. Further work is required to untangle these associations. PMID:15941102
Suzuki, T
Development and Psychometric Evaluation of the Yale-Brown Obsessive-Compulsive Scale--Second Edition
ERIC Educational Resources Information Center
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989) is acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. A number of areas where the Y-BOCS may benefit from revision have emerged in past psychometric studies of the Severity Scale and Symptom�
Storch, Eric A.; Rasmussen, Steven A.; Price, Lawrence H.; Larson, Michael J.; Murphy, Tanya K.; Goodman, Wayne K.
Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors
A large subgroup of around 25% of schizophrenia patients suffers from obsessive-compulsive symptoms (OCS) and about 12% fulfill the diagnostic criteria of an obsessive-compulsive disorder (OCD). The additional occurrence of OCS is associated with high subjective burden of disease, additional neurocognitive impairment, poorer social and vocational functioning, greater service utilization and high levels of anxiety and depression. Comorbid patients can be assigned to heterogeneous subgroups. One hypothesis assumes that second generation antipsychotics (SGAs), most importantly clozapine, might aggravate or even induce second-onset OCS. Several arguments support this assumption, most importantly the observed chronological order of first psychotic manifestation, start of treatment with clozapine and onset of OCS. In addition, correlations between OCS-severity and dose and serum levels and duration of clozapine treatment hint toward a dose-dependent side effect. It has been hypothesized that genetic risk-factors dispose patients with schizophrenia to develop OCS. One study in a South Korean sample reported associations with polymorphisms in the gene SLC1A1 (solute carrier family 1A1) and SGA-induced OCS. However, this finding could not be replicated in European patients. Preliminary results also suggest an involvement of polymorphisms in the BDNF gene (brain-derived neurotrophic factor) and an interaction between markers of SLC1A1 and the gene DLGAP3 (disc large associated protein 3) as well as GRIN2B (N-methyl-D-aspartate receptor subunit 2B). Further research of well-defined samples, in particular studies investigating possible interactions of genetic risk-constellations and pharmacodynamic properties, are needed to clarify the assumed development of SGA-induced OCS. Results might improve pathogenic concepts and facilitate the definition of at risk populations, early detection and monitoring of OCS as well as multimodal therapeutic interventions.
Schirmbeck, Frederike; Zink, Mathias
Executive Control of Attention in Individuals with Contamination-Related Obsessive-Compulsive Symptoms
Background In the present study, we examined executive control of attention in individuals with contamination-related obsessive-compulsive (OC) symptoms using a modified version of the Eriksen flanker task. The task indexes one�s ability to resolve attentional conflict between different responses and to ignore task distracters. Methods For the present study, we modified the original flanker task using affective words to examine the effect of threat-relevant stimuli on executive control of attention. Consistent with research on information processing biases in individuals with OC symptoms, we hypothesized that the flanker interference effect (i.e., difference in response latencies between incongruent and congruent flanker trials) will be greater for threat-related flankers in individuals with OC symptoms (n = 32), relative to a control group (n = 36). Results Results of our study were consistent with our hypothesis: The interference effect for threat flankers was greater in individuals with OC symptoms than in those low in symptoms. Moreover, there was no differential interference effect in the low and high symptom groups for neutral flankers. Conclusions These findings suggest that the presence of threat-relevant distracters disrupts executive control of attention in individuals with contamination-related OC symptoms. These results are consistent with extant research on attentional biases in individuals with clinical and sub-clinical symptoms of OCD.
Najmi, Sadia; Hindash, Alexandra Cowden; Amir, Nader
Disordered Eating Behavior and Obsessive Compulsive Symptoms in College Students: Cognitive and Affective Similarities
Few studies have examined the psychological similarities between disordered eating behavior and obsessive-compulsive (OC) symptoms. The present study examined relationships among disordered eating, OC symptoms, and three cognitive and affective variables (perfectionism, obsessive beliefs, and negative affect). The cognitive and affective variables were significantly associated with disordered eating and with OC symptoms in a sample of 160 college women. Results
Joy D. Humphreys; James R. Clopton; Darcy A. Reich
Revision of the Padua Inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions.
The Padua Inventory (PI), a self-report measure of obsessive and compulsive symptoms, is increasingly used in obsessive compulsive disorder (OCD) research. Freeston, Ladouceur, Rheaume, Letarte, Gagnon and Thibodeau (1994) [Behaviour Research and Therapy, 32, 29-36], however, recently showed that the PI measures worry in addition to obsessions. In an attempt to solve this measurement problem, this study used a content distinction between obsessions and worry to revise the PI. The revision was constructed to measure five content dimensions relevant to OCD i.e. (1) obsessional thoughts about harm to oneself or others; (2) obsessional impulses to harm oneself or others; (3) contamination obsessions and washing compulsions; (4) checking compulsions; and (5) dressing/grooming compulsions. A total of 5010 individuals participated in the study, 2970 individuals completing the PI and the Penn State Worry Questionnaire (PSWQ) and an additional 2040 individuals completing only the PI. The results provided support for the reliability and validity of the revision. In addition, the revision of the PI was more independent of worry, as measured by the PSWQ, than the original PI. Support was thus found for the validity of the content distinction between obsessions and worry. The importance of this content distinction is also discussed for the evaluation of other hypothesized distinctions between obsessions and worry. PMID:8741724
Burns, G L; Keortge, S G; Formea, G M; Sternberger, L G
Understanding Obsessive�Compulsive Disorder: Focus on Decision Making
Current approaches to obsessive-compulsive disorder (OCD) have suggested that neurobiological abnormalities play a crucial role in the etiology and course of this psychiatric illness. In particular, a fronto-subcortical circuit, including the orbitofrontal cortex, basal ganglia and thalamus appears to be involved in the expression of OCD symptoms. Neuropsychological studies have also shown that patients with OCD show deficits in cognitive
Paolo Cavedini; Alessandra Gorini; Laura Bellodi
Task-related dissociation in ERN amplitude as a function of obsessive-compulsive symptoms
Hyperactive cortico-striatal circuits including the Anterior Cingulate Cortex (ACC) have been implicated to underlie obtrusive thoughts and repetitive behaviors in Obsessive-Compulsive Disorder (OCD). Larger Error-Related Negativities (ERNs) in OCD patients during simple flanker tasks have been proposed to reflect an amplified error signal in these hyperactive circuits. Such amplified error signals typically are associated with an adaptive change in response, yet in OCD these same repetitive responses persist to the point of distress and impairment. In contrast to this repetitive character of OC behavior, larger ERN amplitudes have been linked to better avoidance learning in reinforcement learning tasks. Study I thus investigated if OC symptomatology in non-patients predicted an enhanced ERN after suboptimal choices in a probabilistic learning task. Absent any behavioral differences, higher OC symptoms predicted smaller ERNs. Study II replicated this effect in an independent sample while also replicating findings of a larger ERN in a flanker task. There were no relevant behavioral differences in reinforcement learning or error monitoring as a function of symptom score. These findings implicate different, yet overlapping neural mechanisms underlying the negative deflection in the ERP following the execution of an erroneous motor response and the one following a suboptimal choice in a reinforcement learning paradigm. OC symptomatology may be dissociated in these neural systems, with hypoactivity in a system that enables learning to avoid maladaptive choices, and hyperactivity in another system that enables the same behavior to be repeated when it was assessed as not quite good enough the first time.
Grundler, Theo O.J.; Cavanagh, James F.; Figueroa, Christina M.; Frank, Michael J.; Allen, John J.B.
Obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a common heterogeneous psychiatric disorder manifesting with obsessions and compulsions. Obsessions are intrusive, recurrent, and persistent unwanted thoughts. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to the obsessions. The heterogeneity of OCD includes themes of obsessions, types of rituals, presence or absence of tics, etiology, genetics, and response to pharmacotherapy. Complications of OCD include interpersonal difficulties, unemployment, substance abuse, criminal justice issues, and physical injuries. Areas of the brain involved in the pathophysiology include the orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia. Overall, OCD may be due to a malfunction in the cortico-striato-thalamo-cortical circuit in the brain. Neurotransmitters implicated in OCD include serotonin, dopamine, and glutamate. Numerous drugs such as atypical antipsychotics and dopaminergic agents can cause or exacerbate OCD symptoms. The etiology includes genetics and neurological insults. Treatment of OCD includes psychotherapy, pharmacotherapy, electroconvulsive therapy, transcranial magnetic simulation, and in extreme cases surgery. Exposure and response prevention is the most effective form of psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy. Higher doses than listed in the package insert and a longer trial are often needed for SSRIs than compared to other psychiatric disorders. Alternatives to SSRIs include clomipramine and serotonin/norepinephrine reuptake inhibitors. Treatment of resistant cases includes augmentation with atypical antipsychotics, pindolol, buspirone, and glutamate-blocking agents. PMID:24576790
Bokor, Gyula; Anderson, Peter D
Exploring the role of metacognition in obsessive�compulsive and anxiety symptoms
This study tests three hypotheses, predicting first that metacognition is highly correlated with anxiety and obsessive�compulsive (O�C) symptoms, second that it mediates the relationship between O�C symptoms and anxiety, and third that the meta-cognitive predictors of anxiety are different from the meta-cognitive predictors of O�C symptoms. The sample of the present study was 850 students selected from various universities in
Metehan Irak; Ahmet Tosun
Altered Cingulate Sub-Region Activation Accounts for Task-Related Dissociation in ERN Amplitude as a Function of Obsessive-Compulsive Symptoms
ERIC Educational Resources Information Center
Larger error-related negativities (ERNs) have been consistently found in obsessive-compulsive disorder (OCD) patients, and are thought to reflect the activities of a hyperactive cortico-striatal circuit during action monitoring. We previously observed that obsessive-compulsive (OC) symptomatic students (non-patients) have larger ERNs during errors�
Cavanagh, James F.; Grundler, Theo O. J.; Frank, Michael J.; Allen, John J. B.
Genetic and environmental covariations among obsessive-compulsive symptoms, neuroticism, and extraversion in South Korean adolescent and young adult twins.
A growing literature suggests that personality traits may be endophenotype markers for psychiatric illnesses. Although the phenotypic relationships between obsessive-compulsive disorder (OCD) and high neuroticism and low extraversion have been well documented, underlying genetic and environmental contributions to these associations have not been explored previously. Five hundred and twenty-four monozygoitc (MZ) and 228 dizygotic (DZ) pairs of adolescent and young adult twins (aged 13-24 years) drawn from the South Korean Twin Registry completed the Maudsley Obsessive Compulsive Inventory (MOCI) and the Neuroticism and Extraversion scale of the Eysenck Personality Scale by mail. The total score of MOCI (MOCIT) was significantly and positively correlated with Neuroticism (r = .44), but only weakly and negatively related to Extraversion (r = -.10). A trivariate Cholesky model was applied to the data. The additive genetic correlations in the best-fitting model were .51 between Neuroticism and MOCIT and -.17 between Extraversion and MOCIT, suggesting that additive genetic factors that lead to high neuroticism and low extraversion overlap with those genetic factors influencing high OC symptoms. These findings add to the cumulative evidence of the shared genetic etiology for the associations between a personality profile of high neuroticism and low extraversion and mental illnesses. PMID:19335184
Hur, Yoon-Mi
Religiousness and obsessive�compulsive cognitions and symptoms in an Italian population
Fifty-four individuals with a high degree of religiosity, 47 with a medium degree of religiosity and 64 with low religiosity completed anonymously the Italian versions of well-established measures of obsessive�compulsive (OC) cognitions and symptoms, depression and anxiety. After controlling for anxiety and depression, religious groups scored higher than individuals with a low degree of religiosity on measures of obsessionality, overimportance
Claudio Sica; Caterina Novara; Ezio Sanavio
Streptococcal upper respiratory tract infections and psychosocial stress predict future tic and obsessive-compulsive symptom severity in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder
Background: One goal of this prospective longitudinal study was to identify new group A beta hemolytic streptococcal (GABHS) infections in children and adolescents with Tourette syndrome (TS) and/or obsessive-compulsive disorder (OCD) compared to healthy control subjects. We then examined the power of GABHS infections and measures of psychosocial stress to predict future tic, obsessive-compulsive (OC), and depressive symptom severity. Methods: Consecutive ratings of tic, OC and depressive symptom severity were obtained for 45 cases and 41 matched control subjects over a two-year period. Clinical raters were blinded to the results of laboratory tests. Laboratory personnel were blinded to case or control status and clinical ratings. Structural equation modeling for unbalanced repeated measures was used to assess the sequence of new GABHS infections and psychosocial stress and their impact on future symptom severity. Results: Increases in tic and OC symptom severity did not occur after every new GABHS infection. However, the structural equation model found that these newly diagnosed infections were predictive of modest increases in future tic and OC symptom severity, but did not predict future depressive symptom severity. In addition, the inclusion of new infections in the model greatly enhanced, by a factor of three, the power of psychosocial stress in predicting future tic and OC symptom severity. Conclusions: Our data suggest that a minority of children with TS and early-onset OCD were sensitive to antecedent GABHS infections. These infections also enhanced the predictive power of current psychosocial stress on future tic and OC symptom severity.
Lin, Haiqun; Williams, Kyle A.; Katsovich, Liliya; Findley, Diane B.; Grantz, Heidi; Lombroso, Paul J.; King, Robert A.; Bessen, Debra E.; Johnson, Dwight; Kaplan, Edward L.; Landeros-Weisenberger, Angeli; Zhang, Heping; Leckman, James F.
Obsessive-compulsive disorder and immunology: a review.
Interest in the possibility of an immune-mediated pathophysiology of obsessive-compulsive disorder and related disorders has increased. In the late 1980s, the National Institute of Mental Health reported an increase in obsessive-compulsive symptoms (OCS) in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCS but no chorea led to the coining of PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). This association has furthered interest in biological measures for immune and genetic susceptibility in non-PANDAS obsessive-compulsive disorder patients (OCD). Furthermore, some studies are trying to demonstrate alterations of immune parameters in OCD patients, with few positive results. In this narrative review, our objective was to describe the immunologic findings in OCD, PANDAS, and their association with SC. PMID:18262706
da Rocha, Felipe Filardi; Correa, Humberto; Teixeira, Antonio Lucio
Turning order into chaos through repetition and addition of elementary acts in obsessive-compulsive disorder (OCD).
A concept and methodology derived from an animal model provided the framework for a study of rituals in obsessive compulsive disorder (OCD) patients and yielded objective and observable criteria applicable for compulsive rituals across patients. The employed ethological approach should be able to reveal and identify a common structure underlying OCD rituals, pointing to shared psychopathology. Eleven OCD rituals performed by patients in their own home were videotaped and compared with the behaviour of healthy individuals instructed to perform the same rituals. The videotaped rituals were deconstructed into visits to specific locations or objects (ritual space), and to the acts performed at each location/object (ritual basic components). Quantitative analyses revealed that compulsiveness emanates from the expansion of repeats for some acts and visits, and from the addition of superfluous act types. Best discrimination between OCD and control rituals (90.9% success) was provided by the parameter "maximum of act repeats in a ritual" (R(2)=0.77). It is suggested that the identified properties of compulsive behaviour are consistent with a recent hypothesis that ritualized behaviour shifts the individual's attention from a normal focus on structured actions to a pathological attraction onto the processing of basic acts, a shift that invariably overtaxes memory. Characteristics and mechanisms of compulsive rituals may prove useful in objective assessment of psychiatric disorders, behavioural therapy, and OCD nosology. PMID:17853263
Zor, Rama; Hermesh, Haggai; Szechtman, Henry; Eilam, David
Disordered eating behavior and obsessive compulsive symptoms in college students: cognitive and affective similarities.
Few studies have examined the psychological similarities between disordered eating behavior and obsessive-compulsive (OC) symptoms. The present study examined relationships among disordered eating, OC symptoms, and three cognitive and affective variables (perfectionism, obsessive beliefs, and negative affect). The cognitive and affective variables were significantly associated with disordered eating and with OC symptoms in a sample of 160 college women. Results also indicated that perfectionism is an important link between disordered eating behavior and OC symptoms, although the nature of perfectionism differs somewhat for the two types of behavior. Implications of the current results and directions for future research are discussed. PMID:17520456
Humphreys, Joy D; Clopton, James R; Reich, Darcy A
Family Accommodation in Pediatric Obsessive�Compulsive Disorder
Despite the importance of the family in the treatment of pediatric obsessive�compulsive disorder (OCD), relatively little empirical attention has been directed to family accommodation of symptoms. This study examined the relations among family accommodation, OCD symptom severity, functional impairment, and internalizing and externalizing behavior problems in a sample of 57 clinic-referred youth 7 to 17 years old (M�=�12.99���2.54) with OCD.
Eric A. Storch; Gary R. Geffken; Lisa J. Merlo; Marni L. Jacob; Tanya K. Murphy; Wayne K. Goodman; Michael J. Larson; Melanie Fernandez; Kristen Grabill
The future of pharmacotherapy for obsessive-compulsive disorder may lie in a better understanding of its heterogeneity.
Pharmacological treatments currently available to treat obsessive-compulsive disorder (OCD) rarely produce remission. This Editorial aims to encourage more targeted research based on the specific OCD symptoms patients primarily present with. Specific OCD symptoms have been associated with distinct clinical characteristics, aetiological hypotheses and treatment responses. Treatment studies should use these findings to develop more targeted pharmacotherapy for patients with OCD. PMID:24866422
Brakoulias, Vlasios
Introduction Obsessions or compulsions that cause personal distress or social dysfunction affect about 1% of adult men and 1.5% of adult women. About half of adults with obsessive compulsive disorder (OCD) have an episodic course, whereas the other half have continuous problems. Prevalence in children and adolescents is 2.7%. The disorder persists in about 40% of children and adolescents at mean follow-up of 5.7 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of initial treatments for obsessive compulsive disorder in adults? What are the effects of initial treatments for obsessive compulsive disorder in children and adolescents? What are the effects of maintenance treatment for obsessive compulsive disorder in adults? What are the effects of maintenance treatment for obsessive compulsive disorder in children and adolescents? What are the effects of treatments for obsessive compulsive disorder in adults who have not responded to initial treatment with serotonin reuptake inhibitors (SRIs)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 43 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: addition of antipsychotics to serotonin reuptake inhibitors, behavioural therapy alone or with serotonin reuptake inhibitors, cognitive therapy or cognitive behavioural therapy (CBT) (alone or with serotonin reuptake inhibitors), electroconvulsive therapy, optimum duration of maintenance treatment, psychosurgery, serotonin reuptake inhibitors (citalopram, clomipramine, fluoxetine, fluvoxamine, paroxetine, or sertraline), and transcranial magnetic stimulation.
Non-Clinical Obsessive Compulsive Symptoms and Executive Functions in Schizophrenia
The impact of non-clinical obsessive compulsive symptoms (OCS) on neuropsychological functioning in schizophrenia has received little investigation. We evaluated whether severity and subtype of OCS are associated with executive functioning in schizophrenia. Twenty-nine patients with schizophrenia and 32 healthy subjects completed questionnaire and performance-based measures of executive functioning Overall OCS severity in patients was associated with poorer monitoring and cognitive flexibility per a questionnaire. Obsessing, hoarding, and checking were related to poorer executive functioning in daily life. Performance-based scores showed few correlations with OCS. Findings indicate that severity of non-clinical OCS subtypes contribute to the heterogeneity of executive functions in schizophrenia.
Kumbhani, Sheba R.; Roth, Robert M.; Kruck, Carrie L.; Psych, M.; Flashman, Laura A.; McAllister, Thomas W.
Neurotrophic factors in obsessive-compulsive disorder.
In this cross-sectional study, we assessed the levels of neurotrophins (NF) of patients with obsessive-compulsive disorder (OCD) in different stages of treatment and their relationship with OCD clinical features. Forty patients with OCD and 40 healthy controls had Brain-Derived Neurotrophic Factor (BDNF), Nerve Growth Factor (NGF), and Glial Cell-Derived Neurotrophic Factor (GNDF) plasma levels measured by enzyme-linked immunosorbent assay (ELISA). Patients with OCD were further examined with the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Sheehan Disability Scale (SDS). Patients with OCD exhibited significantly lower levels of BDNF and significantly increased levels of NGF as compared to healthy controls. In OCD, statistically significant negative correlations between BDNF levels and number of working days lost per week were found. Additional analyses revealed a statistically significant positive correlation between both NGF and GDNF and severity of washing symptoms. Plasma levels of NF were not affected by age, age at OCD onset, gender, major depressive disorder, the relative dose of serotonin-reuptake inhibitors being prescribed, or the use of antipsychotics. Our findings suggest that patients with OCD may exhibit a particular NF profile, with functional impairment correlating with BDNF levels and severity of washing symptoms correlating with NGF and GDNF levels. PMID:22494702
Fontenelle, Leonardo F; Barbosa, Izabela Guimar�es; Luna, Juliano Victor; Rocha, Natalia Pessoa; Silva Miranda, Aline; Teixeira, Antonio Lucio
[Treatment-refractory OCD from the viewpoint of obsessive-compulsive spectrum disorders: impact of comorbid child and adolescent psychiatric disorders].
More than a half of patients with OCD are classified as early-onset. Early-onset OCD has been indicated to be associated with a greater OCD global severity and more frequently comorbid with tic disorders and other obsessive-compulsive (OC) spectrum disorders, compared with late-onset OCD. Early-onset OCD patients with severe impairment caused by both OC symptoms and comorbid OC spectrum disorders may be identified as being refractory. Tic disorders and autism spectrum disorder (ASD) are child and adolescent psychiatric disorders included in OC spectrum disorders. OCD comorbid with chronic tic disorders including Tourette syndrome (TS) is specified as tic-related OCD. Tic-related OCD is characterized by the high prevalence of early-onset and sensory phenomena including "just right" feeling. Self-injurious behaviors (SIB) such as head banging and body punching often occur in patients with TS. The patients' concern about SIB is likely to trigger them, suggesting that an impulse-control problem is a feature of TS. More than a half of patients with TS have OC symptoms. When OC symptoms in patients with TS were assessed with a dimensional approach, symmetry dimension symptoms were found most frequently over the lifetime. On the other hand, the severity of aggression dimension symptoms was the most stable during the course among all dimensions. Aggression dimension symptoms also exhibited a close relationship with impairment of global functioning and sensory phenomena. This tendency may be characteristic of tic-related OCD. It is sometimes difficult to differentiate between OC symptoms and restricted, repetitive behaviors which are core symptoms of ASD. Recently, ego-dystonia and insight are considered non-essential to diagnose OCD, whereas high-functioning and/or atypical ASD is recognized as being more prevalent than previously estimated. In this situation, attention to comorbidity of OCD and ASD is increasing, and the prevalence of OCD in children and adolescents with ASD was reported to be about 20%. One study on the impact of comorbid ASD in adults with OCD indicated that comorbid patients had higher scores for the Autism Questionnaire (AQ) subscales of attention switching and imagination but showed little difference in OC symptoms except for the predominance of compulsion compared to patients with pure OCD. "Just right" feeling and impulse-control problems were evident in OC patients comorbid with both ASD and TS. Out of five adults with TS who underwent deep brain stimulation (DBS) because of refractory tics, four had impulse-control problems including SIB, leading to very severe physical injuries in two patients. After DBS, tics and SIB improved in all patients; however, one patient experienced their re-aggravation. To improve understanding of and treatment/support for refractory OCD, OC spectrum disorders should also be considered. PMID:24228477
Kano, Yukiko
Aberrant error processing in relation to symptom severity in obsessive-compulsive disorder: A multimodal neuroimaging study
Background Obsessive�compulsive disorder (OCD) is characterized by maladaptive repetitive behaviors that persist despite feedback. Using multimodal neuroimaging, we tested the hypothesis that this behavioral rigidity reflects impaired use of behavioral outcomes (here, errors) to adaptively adjust responses. We measured both neural responses to errors and adjustments in the subsequent trial to determine whether abnormalities correlate with symptom severity. Since error processing depends on communication between the anterior and the posterior cingulate cortex, we also examined the integrity of the cingulum bundle with diffusion tensor imaging. Methods Participants performed the same antisaccade task during functional MRI and electroencephalography sessions. We measured error-related activation of the anterior cingulate cortex (ACC) and the error-related negativity (ERN). We also examined post-error adjustments, indexed by changes in activation of the default network in trials surrounding errors. Results OCD patients showed intact error-related ACC activation and ERN, but abnormal adjustments in the post- vs. pre-error trial. Relative to controls, who responded to errors by deactivating the default network, OCD patients showed increased default network activation including in the rostral ACC (rACC). Greater rACC activation in the post-error trial correlated with more severe compulsions. Patients also showed increased fractional anisotropy (FA) in the white matter underlying rACC. Conclusions Impaired use of behavioral outcomes to adaptively adjust neural responses may contribute to symptoms in OCD. The rACC locus of abnormal adjustment and relations with symptoms suggests difficulty suppressing emotional responses to aversive, unexpected events (e.g., errors). Increased structural connectivity of this paralimbic default network region may contribute to this impairment.
Agam, Yigal; Greenberg, Jennifer L.; Isom, Marlisa; Falkenstein, Martha J.; Jenike, Eric; Wilhelm, Sabine; Manoach, Dara S.
Differential effects of antipsychotic agents on obsessive-compulsive symptoms in schizophrenia: a longitudinal study.
Indirect evidence supports the assumption that antiserotonergic second-generation antipsychotics (SGA) induce and aggravate obsessive-compulsive symptoms (OCS) in schizophrenia. However, multimodal studies assessing the long-term interaction of pharmacotherapy and psychopathology are missing. Over 12 months, we followed-up 75 schizophrenia patients who were classified into two groups according to antipsychotic treatment: clozapine or olanzapine (group I) versus aripiprazole or amisulpride (group II). We applied the Yale Brown Obsessive Compulsive Scale (YBOCS) and investigated between-group changes over time as the primary endpoint. Group I showed markedly higher YBOCS scores at both time points. Repeated measure analyses of variance (ANOVAs) revealed significant interaction effects of group and time (per protocol sample (PP): p=0.006). This was due to persistently high OCS severity within group I, and decreasing YBOCS scores within group II. OCS severity correlated significantly with the negative and general psychopathology subscales of the Positive and Negative Syndrome Scale (PANSS), as well as with depressive symptoms. The progressive differences in OCS severity between our groups support the assumption of differential pharmacodynamic effects on comorbid OCS in schizophrenia. Further studies should address the pathogenetic mechanism, define patients at risk and facilitate early detection as well as therapeutic interventions. PMID:23095245
Schirmbeck, Frederike; Rausch, Franziska; Englisch, Susanne; Eifler, Sarah; Esslinger, Christine; Meyer-Lindenberg, Andreas; Zink, Mathias
The Validation of a New Obsessive-Compulsive Disorder Scale: The Obsessive-Compulsive Inventory.
ERIC Educational Resources Information Center
The Obsessive-Compulsive Inventory (OCI), a new self-report measure for determining the diagnosis and severity of obsessive- compulsive disorder (OCD), was validated with 141 patients with OCD, 58 with social phobia, 44 with posttraumatic stress disorder, and 194 nonpatients. The OCI exhibited satisfactory reliability and validity with all four�
Foa, Edna B.; Kozak, Michael J.; Salkovskis, Paul M.; Coles, Meredith E.; Amir, Nader
Modulation of affective symptoms and resting state activity by brain stimulation in a treatment-resistant case of obsessive-compulsive disorder.
The effect of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) on psychopathological symptoms and resting state brain activity was assessed in a patient with obsessive-compulsive disorder (OCD). tDCS and rTMS had no effect on OC symptoms. tDCS, however, improved depression and anxiety. Functional magnetic resonance imaging at baseline showed an interhemispheric asymmetry with hyperactivation of the left and hypoactivation of the right anterior neural circuits. A reduction of interhemispheric imbalance was detected after tDCS but not after rTMS. tDCS seems to be more effective than rTMS in restoring interhemispheric imbalance and improving anxiety and depression in OCD. PMID:22554168
Volpato, C; Piccione, F; Cavinato, M; Duzzi, D; Schiff, S; Foscolo, L; Venneri, A
Autism and ADHD symptoms in patients with OCD: are they associated with specific OC symptom dimensions or OC symptom severity?
In obsessive-compulsive disorder (OCD), the relationship between autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) symptom, and obsessive-compulsive (OC) symptom dimensions and severity has scarcely been studied. Therefore, 109 adult outpatients with primary OCD were compared to 87 healthy controls on OC, ADHD and ASD symptoms. OCD patients showed increased ADHD and autism symptom frequencies, OCD + ADHD patients reporting more autism symptoms (particularly attention switching and social skills problems) than OCD - ADHD patients. Attention switching problems were most significant predictors of OC symptom dimensions (except hoarding) and of symptom severity. Hoarding was not associated with elevated autism scale scores, but with inattention. In conclusion, attention switching problems may reflect both symptom overlap and a common etiological factor underlying ASD, ADHD and OCD. PMID:20039111
Anholt, Gideon E; Cath, Danielle C; van Oppen, Patricia; Eikelenboom, Merijn; Smit, Johannes H; van Megen, Harold; van Balkom, Anton J L M
Sex differences in genetic and environmental influences on obsessive-compulsive symptoms in South Korean adolescent and young adult twins.
Recent molecular genetic studies provide suggestive evidence for sexual dimorphism in genetics of obsessive-compulsive disorder. However, only a few twin studies have addressed the question of sex differences in genetic and environmental contributions to variation of obsessive-compulsive symptoms. The aim of the present study was to estimate genetic and environmental influences on obsessive-compulsive symptoms in South Korean twins, with a special emphasis on sex difference. In total, 751 adolescent and young adult twin pairs (ages: 13-23 years) completed a Korean version of the 30 items of the Maudsley Obsessional - Compulsive Inventory (MOCI) through a mail survey. A sum of the answers for the 30 items was calculated to represent a total score for obsessive-compulsive symptoms (hereafter, the MOCIT). Males had significantly higher variance of the MOCIT than did females. In males, monozygotic (MZ) twin correlation was significantly higher than dizygotic (DZ) twin correlations (.56 vs. .24), whereas in females, MZ and DZ twin correlations were not significantly different from each other (.39 vs. .36). The general sex-limitation model was applied to the twin data. The results of model-fitting analyses indicated that the unstandardized genetic variance as well as heritability estimate (53% vs. 41%) for the MOCIT was higher in males than in females. However, shared environmental influences did not attain statistical significance perhaps due to insufficient statistical power. PMID:18498209
Hur, Yoon-Mi; Jeong, Hoe-Uk
[Perinatal obsessive-compulsive disorder].
A perinatal obsessive-compulsive disorder (OCD) is defined as an illness exhibiting first symptoms in the context of pregnancy and the postpartal period. There are no valid data up to date concerning the incidence of OCD, which might be of multifactorial origin, in this period in which females are highly vulnerable for psychiatric diseases. From a clinical point of view, obsessions and compulsions are mainly related to the well-being of the foetus or newborn baby. Differential diagnosis of perinatal OCD including pregnancy psychosis and post-partum depression is often difficult. Concerning treatment, non-pharmacological approaches should be preferred. Administration of SSRIs should be strongly restricted. However, there are no controlled therapy studies in patients with perinatal OCD. Furthermore, current knowledge about these patients is still limited. The aim of this review article is the presentation of phenomenology, pathogenesis, differential diagnosis and treatment of perinatal OCD. The mental situation of the female patients can be improved and stabilised if early diagnosis of a perinatal OCD leads to early initiation of an adequate therapy. This will then enable a good and stable mother-child relationship to develop. PMID:21830184
Mavrogiorgou, P; Illes, F; Juckel, G
Specificity of Fear and Disgust Experienced During Traumatic Interpersonal Victimization in Predicting Posttraumatic Stress and Contamination-Based Obsessive-Compulsive Symptoms
Emerging evidence has documented comorbidity between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) among individuals with a history of traumatic events. There is growing recognition of the importance of disgust in each of these conditions independently. No study, however, has examined the potential role of disgust in these conditions following traumatic event exposure. The current study examined the unique role of peritraumatic fear, self-focused disgust, and other-focused disgust in predicting posttraumatic stress symptoms and contamination-based OC symptoms among 49 adult women (Mage = 28.37, SD = 13.86) with a history of traumatic interpersonal victimization. Results demonstrated that intensity of peritraumatic self-focused disgust was significantly related to contamination-based OC symptoms while peritraumatic fear and other-focused disgust were related to posttraumatic stress symptoms. These results highlight the need for future research aimed at elucidating the nature of the association between disgust experienced during traumatic events and subsequent psychopathology.
Badour, Christal L.; Bown, Stephanie; Adams, Thomas G.; Bunaciu, Liviu; Feldner, Matthew T.
Safety, Tolerability, and Efficacy of Psilocybin in 9 Patients With Obsessive-Compulsive Disorder
Background: Anecdotal reports suggest that psychedelic agents may relieve symptoms of obsessive-compulsive disorder (OCD). This modi- fied double-blind study investigated the safety, tol- erability, and clinical effects of psilocybin, a potent 5-HT1A and 5-HT2A\\/2C agonist, in patients with OCD.
Francisco A. Moreno; Christopher B. Wiegand; E. Keolani Taitano; Pedro L. Delgado
Temper Outbursts in Paediatric Obsessive-Compulsive Disorder and Their Association with Depressed Mood and Treatment Outcome
ERIC Educational Resources Information Center
Background: Temper outbursts in youth with obsessive-compulsive disorder (OCD) are a common source of concern, but remain poorly understood. This study examined a set of hypotheses related to: (a) the prevalence of temper outbursts in paediatric OCD, (b) the associations of temper outbursts with OCD severity and depressive symptoms; and (c) the�
Krebs, Georgina; Bolhuis, Koen; Heyman, Isobel; Mataix-Cols, David; Turner, Cynthia; Stringaris, Argyris
Correlates of Insight Level in Obsessive-Compulsive Disorder with Dimensions of Symptomology
Background Cross-sectional studies have associated poor insight in patients with obsessive-compulsive disorder (OCD) with increased OCD symptom severity, earlier age of comorbid depression, and treatment response. The goal of this current study was to examine the relationship between dimensions of OCD symp tomatology and insight in a large clinical cohort of Brazilian patients with OCD. We expect poor insight to be associated with total symptom severity as well as with hoarding symptoms severity. Methods 824 outpatients underwent a detailed clinical assessment for OCD, including the Yale�Brown Obsessive�Compulsive Scale (Y-BOCS), the Dimensional Yale�Brown Obsessive�Compulsive Scale (D-YBOCS), the Brown Assessment of Beliefs Scale (BABS), a socio-demographic questionnaire, and the Stuctured Clinical Interview for axis I DSM-IV disorders (SCID-P). Tobit regression models were used to examine the association between level of insight and clinical variables of interest. Results Increased severity of current and worst-ever hoarding symptoms was associated with poor insight in OCD after controlling for current OCD severity, age and gender. Poor insight was also correlated with increased current OCD symptom severity. Conclusion Hoarding and overall OCD severity explained were significantly but weakly associated with level of insight in OCD patients. Further studies should examine insight as a moderator and mediator of treatment response in OCD in both behavioral therapy and pharmacological trials. Behavioral techniques aimed at enhancing insight may be potentially beneficial in OCD, especially among patients with hoarding.
Jakubovski, Ewgeni; Pittenger, Christopher; Torres, Albina Rodrigues; Fontenelle, Leonardo Franklin; do Rosario, Maria Conceicao; Ferrao, Ygor Arzeno; de Mathis, Maria Alice; Miguel, Euripedes Constantino; Bloch, Michael H.
Rapid, illegible handwriting as a symptom of obsessive-compulsive disorder.
This is a case report of a 13 year male child who had co-morbid OCD and trichotillomania. On evaluation, he had rapid, illegible handwriting as a symptom of OCD, which has hitherto not been reported. PMID:24891714
Bavle, Amar; Andrade, Chittaranjan; Vidhyavathi, M
Temperament features in adolescents with ego-syntonic or ego-dystonic obsessive-compulsive symptoms.
The present study evaluated whether different patterns of temperament may predict a different threshold of acceptability of obsessive-compulsive (OC) symptoms in adolescents. OC symptomatology was detected with the Leyton Obsessional Inventory-Child Version (LOI-CV) and temperament was assessed using the tridimensional personality questionnaire in 2,775 high-school students. According to the LOI-CV scores, the adolescents were classified as high interference (interfering, ego-dystonic symptoms) (HI), supernormal (noninterfering, ego-syntonic symptoms) (Sn) and controls (C) HI were 119 (4.3%), Sn 85 (3.1%) and C 2,571 (92.6%). The best predictor of belonging to HI or Sn groups was the temperament configuration of high Harm Avoidance (HA) and high Persistence (P). The feature that mainly distinguishes the two symptomatic groups were Novelty Seeking (NS) levels. Our data suggest that people characterized by pessimistic worry in anticipation of future problems, passive avoidant behaviour, rapid fatigability (high HA) and irresoluteness, ambitiousness, perseverance, perfectionism, enduring feelings of frustration (high P) might develop OC symptoms. Whether OC symptoms become ego-syntonic or ego-dystonic seems to mainly depend on NS levels: low NS might protect people (with the prevention of "exploratory and active behaviours" that may elicit loss of control on symptoms) from the development of interfering OC symptoms. PMID:18427866
Marchesi, Carlo; Ampollini, Paolo; DePanfilis, Chiara; Maggini, Carlo
The Effect of Attention Training on a Behavioral Test of Contamination Fears in Individuals with Subclinical Obsessive-Compulsive Symptoms
In the current study, we evaluated the effectiveness of attention training in individuals with subclinical obsessive-compulsive symptoms. We hypothesized that after completing attention training, participants would be more likely to complete steps in a hierarchy approaching their feared contaminant compared to participants in the control condition. Participants completed a probe detection task by identifying letters replacing one member of a pair of words (neutral or contamination-related). We trained attention by building a contingency between the location of the contamination-related word in the active condition and not in the control condition. Participants in the active group showed a significant reduction in attention bias for threat and completed significantly more steps approaching their feared objects compared to participants in the control group. Our results suggest that attention disengagement training may facilitate approaching feared objects in individuals with obsessive-compulsive symptoms.
Najmi, Sadia; Amir, Nader
Family Accommodation in Pediatric Obsessive Compulsive Disorder
Objective Family accommodation refers to ways in which family members assist the proband in the performance of rituals, avoidance of anxiety provoking situations, or modification of daily routines to assist a relative with obsessive-compulsive disorder. The purpose of this review was to analyze and integrate the available data on the role of family accommodation in pediatric obsessive compulsive disorder including its prevalence and its relationship the course of the disorder. Method A search of available peer reviewed English language papers was conducted through PubMed and PsycINFO cross-referencing the keyword OCD, with accommodation, family relations, and parents. Resulting papers were individually evaluated for relevance to the scope of the review. Results Accommodation is common in pediatric OCD and is strongly associated with symptom severity. Levels of accommodation have been also associated with treatment outcomes for both cognitive behavioral and pharmacological treatment. Significant improvement with treatment in OCD is often associated with reductions in family accommodation.. Conclusion Family accommodation represents important clinical data that is worth measuring, monitoring and tracking in clinical care. Therapies targeting family accommodation may be successful in improving treatment outcomes in pediatric OCD.
Lebowitz, Eli R.; Bloch, Michael
Sex determines which section of the SLC6A4 gene is linked to obsessive-compulsive symptoms in normal Chinese college students.
Previous case-control and family-based association studies have implicated the SLC6A4 gene in obsessive-compulsive disorder (OCD). Little research, however, has examined this gene's role in obsessive-compulsive symptoms (OCS) in community samples. The present study genotyped seven tag SNPs and two common functional tandem repeat polymorphisms (5-HTTLPR and STin2), which together cover the whole SLC6A4 gene, and investigated their associations with OCS in normal Chinese college students (N�=�572). The results revealed a significant gender main effect and gender-specific genetic effects of the SLC6A4 gene on OCS. Males scored significantly higher on total OCS and its three dimensions than did females (ps�<�.01). The 5-HTTLPR in the promoter region showed a female-specific genetic effect, with the l/l and l/s genotypes linked to higher OCS scores than the s/s genotype (ps�<�.05). In contrast, a conserved haplotype polymorphism (rs1042173| rs4325622| rs3794808| rs140701| rs4583306| rs2020942) covering from intron 3 to the 3' UTR of the SLC6A4 gene showed male-specific genetic effects, with the CGAAGG/CGAAGG genotype associated with lower OCS scores than the other genotypes (ps�<�.05). These effects remained significant after controlling for OCS-related factors including participants' depressive and anxiety symptoms as well as stressful life events, and correction for multiple tests. These results are discussed in terms of their implications for our understanding of the sex-specific role of the different sections of the SLC6A4 gene in OCD. PMID:22727904
Lei, Xuemei; Chen, Chuansheng; He, Qinghua; Chen, Chunhui; Moyzis, Robert K; Xue, Gui; Chen, Xiongying; Cao, Zhongyu; Li, Jin; Li, He; Zhu, Bi; Chun Hsu, Anna Shan; Li, Sufang; Li, Jun; Dong, Qi
Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder.
Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ? 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome. PMID:21600563
Pinto, Anthony; Liebowitz, Michael R; Foa, Edna B; Simpson, H Blair
Clinical correlates and genetic linkage of social and communication difficulties in families with obsessive-compulsive disorder: Results from the OCD Collaborative Genetics Study.
Some individuals with obsessive-compulsive disorder (OCD) have autistic-like traits, including deficits in social and communication behaviors (pragmatics). The objective of this study was to determine if pragmatic impairment aggregates in OCD families and discriminates a clinically and genetically distinct subtype of OCD. We conducted clinical examinations on, and collected DNA samples from, 706 individuals with OCD in 221 multiply affected OCD families. Using the Pragmatic Rating Scale (PRS), we compared the prevalence of pragmatic impairment in OCD-affected relatives of probands with and without pragmatic impairment. We also compared clinical features of OCD-affected individuals in families having at least one, versus no, individual with pragmatic impairment, and assessed for linkage to OCD in the two groups of families. The odds of pragmatic impairment were substantially greater in OCD-affected relatives of probands with pragmatic impairment. Individuals in high-PRS families had greater odds of separation anxiety disorder and social phobia, and a greater number of schizotypal personality traits. In high-PRS families, there was suggestive linkage to OCD on chromosome 12 at marker D12S1064 and on chromosome X at marker DXS7132 whereas, in low-PRS families, there was suggestive linkage to chromosome 3 at marker D3S2398. Pragmatic impairment aggregates in OCD families. Separation anxiety disorder, social phobia, and schizotypal personality traits are part of a clinical spectrum associated with pragmatic impairment in these families. Specific regions of chromosomes 12 and X are linked to OCD in high-PRS families. Thus, pragmatic impairment may distinguish a clinically and genetically homogeneous subtype of OCD. � 2014 Wiley Periodicals, Inc. PMID:24798771
Samuels, Jack; Shugart, Yin Yao; Wang, Ying; Grados, Marco A; Bienvenu, O Joseph; Pinto, Anthony; Rauch, Scott L; Greenberg, Benjamin D; Knowles, James A; Fyer, Abby J; Piacentini, John; Pauls, David L; Cullen, Bernadette; Rasmussen, Steven A; Stewart, S Evelyn; Geller, Dan A; Maher, Brion S; Goes, Fernando S; Murphy, Dennis L; McCracken, James T; Riddle, Mark A; Nestadt, Gerald
Symptom Overlap between Autism Spectrum Disorder, Generalized Social Anxiety Disorder and Obsessive-Compulsive Disorder in Adults: A Preliminary Case-Controlled Study
Background: Obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) frequently co-occur in persons with autism spectrum disorder (ASD). We studied which features distinguish �pure� anxiety disordered patients from those with co-morbid ASD. Method: In a case-controlled design in which groups were matched for age, sex and educational level, patients with OCD or SAD and co-morbid ASD were compared with patients
Danielle C. Cath; Natalie Ran; Johannes H. Smit; Hannie C. Comijs
Prevalence and heritability of obsessive-compulsive spectrum and anxiety disorder symptoms: A survey of the Australian Twin Registry.
While past twin studies indicate moderate levels of heritability of "obsessive-compulsive related" and anxiety disorder symptoms, no single study has reported such estimates in the same twin population nor examined potential genetic sex differences. We assessed symptoms of obsessive-compulsive disorder, body dysmorphic disorder, hoarding disorder, hypochondriasis, panic disorder, social phobia and generalized anxiety disorder in 2,495 adult twins (1,468 female). Prevalence estimates for the corresponding symptom measures were determined using empirically derived cut-off scores. Twin resemblance was assessed by Pearson correlations and biometrical model-fitting analyses, incorporating sex-specific effects, using OpenMx. Prevalence estimates ranged from 1.6% in the symptoms of generalized anxiety to 16.9% for social phobia. Female twins demonstrated significantly higher prevalence rates across all domains with the exception of obsessive-compulsive symptoms. Additive genetic factors accounted for a moderate proportion of the total liability to each symptom domain. Evidence suggesting qualitative genetic sex differences (i.e., distinct genetic influences between genders) was observed for body dysmorphic concern and panic symptoms, while quantitative differences were observed for hoarding and social phobia symptoms, indicating stronger heritability in females. Novel findings in this study include the observation of probable genetic sex differences in liability towards hoarding symptoms and dysmorphic concern, as well as the lack of such differences in hypochondriasis. The trend towards qualitative sex differences in panic symptoms has some intuitive appeal with regard to biological-experimental models of panic. � 2014 Wiley Periodicals, Inc. PMID:24756981
L�pez-Sol�, Clara; Fontenelle, Leonardo F; Alonso, Pino; Cuadras, Daniel; Foley, Debra L; Pantelis, Christos; Pujol, Jesus; Y�cel, Murat; Cardoner, Narc�s; Soriano-Mas, Carles; Mench�n, Jos� M; Harrison, Ben J
Manual-Driven Group Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Pilot Study
ObjectiveConcerns about isolation, compromised development, partial pharmacotherapy response, therapist scarcity, and inadequate cognitive-behavioral therapy (CBT) adherence led the authors to adapt a CBT protocol to a group format for adolescents with obsessive-compulsive disorder (OCD). A naturalistic, open trial of group CBT for adolescent OCD is described. The authors predicted symptom improvement and format acceptability.
Localized Orbitofrontal and Subcortical Metabolic Changes and Predictors of Response to Paroxetine Treatment in Obsessive-Compulsive Disorder
Previous positron emission tomography (PET) studies of patients with obsessive-compulsive disorder (OCD) have found elevated glucose metabolic rates in the orbitofrontal cortex (OFC) and caudate nuclei that normalize with response to treatment. Furthermore, OCD symptom provocation differentially activates specific subregions of the OFC, which have distinct patterns of connectivity and serve different functions. Therefore, we sought to determine the role
Sanjaya Saxena; Arthur L Brody; Karron M Maidment; Jennifer J Dunkin; Mark Colgan; Shervin Alborzian; Michael E Phelps; Lewis R Baxter
A Randomized, Controlled Trial of Cognitive-Behavioral Therapy for Augmenting Pharmacotherapy in Obsessive-Compulsive Disorder
Objective Although serotonin reuptake inhibitors (SRIs) are approved for the treatment of obsessive-compulsive disorder (OCD), most OCD patients who have received an adequate SRI trial continue to have clinically significant OCD symptoms. The purpose of this study was to examine the effects of augmenting SRIs with exposure and ritual prevention, an established cognitive-behavioral therapy (CBT) for OCD. Method A randomized, controlled trial was conducted at two academic outpatient clinics to compare the effects of augmenting SRIs with exposure and ritual prevention versus stress management training, another form of CBT. Participants were adult outpatients (N=108) with primary OCD and a Yale-Brown Obsessive Compulsive Scale total score ?16 despite a therapeutic SRI dose for at least 12 weeks prior to entry. Participants received 17 sessions of CBT (either exposure and ritual prevention or stress management training) twice a week while continuing SRI pharmacotherapy. Results Exposure and ritual prevention was superior to stress management training in reducing OCD symptoms. At week 8, significantly more patients receiving exposure and ritual prevention than patients receiving stress management training had a decrease in symptom severity of at least 25% (based on Yale-Brown Obsessive Compulsive Scale scores) and achieved minimal symptoms (defined as a Yale-Brown Obsessive Compulsive Scale score ?12). Conclusions Augmentation of SRI pharmacotherapy with exposure and ritual prevention is an effective strategy for reducing OCD symptoms. However, 17 sessions were not sufficient to help most of these patients achieve minimal symptoms.
Simpson, Helen Blair; Foa, Edna B.; Liebowitz, Michael R.; Ledley, Deborah Roth; Huppert, Jonathan D.; Cahill, Shawn; Vermes, Donna; Schmidt, Andrew B.; Hembree, Elizabeth; Franklin, Martin; Campeas, Raphael; Hahn, Chang-Gyu; Petkova, Eva
When cancer is associated with illness but no longer with animal or zodiac sign: investigation of biased semantic networks in obsessive-compulsive disorder (OCD).
Building upon semantic network models, it is proposed that individuals with obsessive-compulsive disorder (OCD) process ambiguous words (e.g., homographs such as cancer) preferably in the context of the OC meaning (i.e., illness) and connect them to a lesser degree to other (neutral) cognitions (e.g., animal). To investigate this assumption, a new task was designed requiring participants to generate up to five associations for different cue words. Cue words were either emotionally neutral, negative or OC-relevant. Two thirds of the items were homographs, while the rest was unambiguous. Twenty-five OCD and 21 healthy participants were recruited via internet. Analyses reveal that OCD participants produced significantly more negative and OC-relevant associations than controls, supporting the assumption of biased associative networks in OCD. The findings support the use of psychological interventions such as Association Splitting that aim at restructuring associative networks in OCD by broadening the semantic scope of OC cognitions. PMID:19640676
Jelinek, Lena; Hottenrott, Birgit; Moritz, Steffen
Obsessive compulsive disorder: is there an association with childhood streptococcal infections and altered immune function?
During the last few years, an increased interest in the possibility of immune mediated pathophysiology of obsessive compulsive disorder (OCD) and related disorders has been seen. In the late 1980s, the National Institute of Mental Health reported an increase of obsessive compulsive symptoms in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCD symptoms but no chorea led to the coining of PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus). This association has furthered interest in studying immune parameters in non-PANDAS OCD as well. This article will review the neuropsychiatric findings in OCD and Tourette syndrome (TS) with emphasis placed on PANDAS, and its association with SC, and a review of the existing studies that have assessed immunologic measures in patients with OCD and TS. PMID:11607922
Murphy, T K; Petitto, J M; Voeller, K K; Goodman, W K
Obsessive-Compulsive and Post Traumatic Avoidance Symptoms Influence the Response to Antihypertensive Therapy: Relevance in Uncontrolled Hypertension
Aim: To investigate the association of uncontrolled hypertension with psychological factors associated with high cardiovascular morbidity and mortality (type D personality, depression, posttraumatic stress-related symptoms). Methods: 205 consecutive outpatient hypertensives completed three questionnaires evaluating Type D personality (DS 16), post traumatic symptoms (revised Impact of Events Scale), symptoms of anxiety, hostility, depression and obsessive-compulsive traits (subscales of the Symptom Checklist). Uncontrolled hypertension was diagnosed when clinic sitting blood pressure was above 140/90 mmHg (130/80 in the presence of diabetes or nephropathy), despite reported adherence to treatment with at least three antihypertensive medications, including a diuretic. Results: Uncontrolled hypertension (39%), was predicted by lower scores at Symptom Checklist obsessive-compulsive subscale and higher number of post traumatic avoidance symptoms, older age, diabetes, higher systolic pressure at first visit and longstanding hypertension. Type D personality correlated with depression, hostility, anxiety, compulsiveness, history of malignancy, and older age, but not with uncontrolled hypertension. Conclusions: Uncontrolled hypertension is associated with low obsessionality and avoidance symptoms, which reduce compliance to treatment. On the contrary, type D personality is not correlated with uncontrolled hypertension, as it includes compulsiveness, which improves compliance. A multidisciplinary approach to the hypertensive patient is mandatory to establish if the psychological profile affects compliance.
Realdi, Anna; Favaro, Angela; Santonastaso, Paolo; Nuti, Marco; Parotto, Emanuela; Inverso, Giulia; Leoni, Matteo; Macchini, Luisa; Vettore, Francesca; Calo, Lorenzo; Semplicini, Andrea
The sense of incompleteness as a motivator of obsessive-compulsive symptoms: an empirical analysis of concepts and correlates.
Contemporary models of obsessive-compulsive disorder emphasize the importance of harm avoidance (HA) and related dysfunctional beliefs as motivators of obsessive-compulsive (OC) symptoms. Recently, there has been a resurgence of interest in Janet's (1908) concept of incompleteness (INC) as another potentially important motivator. Contemporary investigators define INC as the sense that one's actions, intentions, or experiences have not been properly achieved. Janet defined INC more broadly to include alexithymia, depersonalization, derealization, and impaired psychological mindedness. We conducted two studies to address four issues: (a) the clinical correlates of INC; (b) whether INC and HA are distinguishable constructs; (c) whether INC predicts OC symptoms after controlling for HA; and (d) the relative merits of broad versus narrow conceptualizations of INC. Study 1 was a meta-analysis of the clinical correlates of narrowly defined INC (16 studies, N=5,940). INC was correlated with all types of OC symptoms, and was more strongly correlated with OC symptoms than with general distress. Study 2 (N=534 nonclinical participants) showed that (a) INC and HA were strongly correlated but factor analytically distinguishable; (b) INC statistically predicted all types of OC symptoms even after controlling for HA; and (c) narrow INC was most strongly correlated with OC symptoms whereas broad INC was most strongly correlated with general distress. Although the findings are limited by being correlational in nature, they support the hypothesis that INC, especially in its narrow form, is a motivator of OC symptoms. PMID:24491200
Taylor, Steven; McKay, Dean; Crowe, Katherine B; Abramowitz, Jonathan S; Conelea, Christine A; Calamari, John E; Sica, Claudio
Obsessive-Compulsive Symptoms and Their Impacts on Psychosocial Functioning in People with Epilepsy
Background and Purpose Obsessive-compulsive symptoms (OCS) in people with epilepsy (PWE) have not been studied systematically. We evaluated the severity, predictors, and psychosocial impact of OCS in PWE. Methods We recruited PWE who visited our epilepsy clinic and age-, gender-, and education-matched healthy controls. Both PWE and healthy controls completed the Maudsley Obsessional-Compulsive Inventory (MOCI), which measures OCS. PWE also completed the Beck Depression Inventory (BDI) and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). We examined the severity of OCS in PWE relative to healthy controls. Predictors of OCS and the QOLIE-31 score were measured by regression analyses. A path analysis model was constructed to verify interrelations between the variables. Results The MOCI total score was significantly higher in PWE than in healthy controls (p=0.002). OCS were found in 20% of eligible patients. The strongest predictor of the MOCI total score was the BDI score (?=0.417, p<0.001), followed by EEG abnormality (?=0.194, p<0.001) and etiology (?=0.107, p=0.031). Epileptic syndrome, the side of the epileptic focus, and action mechanisms of antiepileptic drugs did not affect the MOCI total score. The strongest predictor of the QOLIE-31 overall score was the BDI score (?=-0.569, p<0.001), followed by seizure control (?=-0.163, p<0.001) and the MOCI total score (?=-0.148, p=0.001). The MOCI total score directly affected the QOLIE-31 overall score and also exerted indirect effects on the QOLIE-31 overall score through seizure control and the BDI score. Conclusions OCS are more likely to develop in PWE than in healthy people. The development of OCS appears to elicit psychosocial problems directly or indirectly by provoking depression or uncontrolled seizures.
Seo, Ji-Hye; Lee, Won-Kee
Inhibitory Control in Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
The clinical features of Obsessive-Compulsive Disorder (OCD) suggest that a fundamental deficit of inhibitory control is intrinsic to the disorder. In this preliminary study, we sought to examine cognitive disinhibition in OCD by using an established laboratory technique. The stop signal task was administered to a higher functioning, untreated�
Krikorian, Robert; Zimmerman, Molly E.; Fleck, David E.
Mindfulness and Acceptance-Based Behavior Therapy for Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder, marked by recurrent, intrusive, and distressing thoughts\\u000a (obsessions) and\\/or repetitive behaviors (compulsions) (American Psychiatric Association, 2004). Epidemiological data suggest\\u000a a 6-month prevalence of 1�2% (Myers et al., 1984) and a lifetime prevalence of 2�3% (Robins et al., 1984). OCD symptoms often\\u000a severely disrupt social and vocational functioning (Leon, Portera, & Weissman, 1995),
Scott E. Hannan; David F. Tolin
Early Alliance, Alliance Ruptures, and Symptom Change in a Nonrandomized Trial of Cognitive Therapy for Avoidant and Obsessive-Compulsive Personality Disorders
ERIC Educational Resources Information Center
Participants were 30 adult outpatients diagnosed with avoidant personality disorder or obsessive-compulsive personality disorder who enrolled in an open trial of cognitive therapy for personality disorders. Treatment consisted of up to 52 weekly sessions. Symptom evaluations were conducted at intake, at Sessions 17 and 34, and at the last�
Strauss, Jennifer L.; Hayes, Adele M.; Johnson, Sheri L.; Newman, Cory F.; Brown, Gregory K.; Barber, Jaques P.; Lawrenceau, Jean-Philippe; Beck, Aaron T.
Obsessive-compulsive disorder: subclassification based on co-morbidity
Background Obsessive�compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes. Method Seven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated. Results Two and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive�compulsive personality disorder (OCPD) features, high scores on the �taboo� factor of OCD symptoms, and low conscientiousness. Conclusions OCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors.
Nestadt, G.; Di, C. Z.; Riddle, M. A.; Grados, M. A.; Greenberg, B. D.; Fyer, A. J.; McCracken, J. T.; Rauch, S. L.; Murphy, D. L.; Rasmussen, S. A.; Cullen, B.; Pinto, A.; Knowles, J. A.; Piacentini, J.; Pauls, D. L.; Bienvenu, O. J.; Wang, Y.; Liang, K. Y.; Samuels, J. F.; Roche, K. Bandeen
Group Cognitive-Behavior Therapy with Family Involvement for Middle-School-Age Children with Obsessive-Compulsive Disorder: A Pilot Study
ERIC Educational Resources Information Center
Objective: Middle-school-aged children with obsessive-compulsive disorder (OCD) are poised in development between the dependency of elementary school-aged children and growing independence of adolescence. OCD patients of this age group may differ from older ones in the quality of symptoms and level of insight. We report the results of a�
Martin, Jacqueline L.; Thienemann, Margo
Cognitive Behavioral Therapy in Adults with Obsessive�Compulsive Disorder and Borderline Intellectual Functioning: A Case Series of Three Patients
Cognitive-behavior therapy (CBT) is widely accepted as the most effective psychological treatment for obsessive�compulsive\\u000a disorder (OCD). Although this modality flexibly treats a variety of OCD symptom subtypes, it is unclear how CBT should be\\u000a adapted to meet the needs of individuals with OCD and limitations in their cognitive functioning. In this paper, we report\\u000a on three adults with borderline intellectual
Steven L. Pence Jr; Mirela A. Aldea; Michael L. Sulkowski; Eric A. Storch
Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: A prospective longitudinal study
Objective The objective of this blinded, prospective longitudinal study was to determine whether new group A beta hemolytic streptococcal (GABHS) infections are temporally associated with exacerbations of tic or obsessive-compulsive (OC) symptoms in children who met published criteria for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). A group of children with Tourette syndrome and/or obsessive-compulsive disorder without a PANDAS history served as the (non-PANDAS) comparison group. Method Consecutive clinical ratings of tic and OC symptom severity were obtained for 31 PANDAS subjects and 53 non-PANDAS subjects. Clinical symptoms and laboratory values (throat cultures and streptococcal antibody titers) were evaluated at regular intervals during a 25 month period. Additional testing occurred at the time of any tic or OC symptom exacerbation. New GABHS infections were established by throat swab cultures and/or recent significant rise in streptococcal antibodies. Laboratory personnel were blinded to case or control status, clinical (exacerbation or not) condition, and clinical evaluators were blinded to the laboratory results. Results No group differences were observed in either the number of clinical exacerbations or the number of newly diagnosed GABHS infections. On only six occasions out of a total of 51 (12%) a newly diagnosed GABHS infection was followed, within two months, by an exacerbation of tic and/or OC symptoms. In every instance, this association occurred in the non-PANDAS group. Conclusions This study provides no evidence for a temporal association between GABHS infections and tic/OC symptom exacerbations in children who meet the published PANDAS diagnostic criteria.
Leckman, James F.; King, Robert A.; Gilbert, Donald L.; Coffey, Barbara J.; Singer, Harvey S.; Dure, Leon S.; Grantz, Heidi; Katsovich, Liliya; Lin, Haiqun; Lombroso, Paul J.; Kawikova, Ivana; Johnson, Dwight R.; Kurlan, Roger M.; Kaplan, Edward L.
Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts
Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are excessive, anxiety-evoking thoughts and compulsive behaviors that are generally recognized as unreasonable, but which cause significant distress and impairment. When these are the exclusive symptoms, they constitute uncomplicated OCD. OCD may also occur in the context of other neuropsychiatric disorders, most commonly other anxiety and mood disorders. The question remains as to whether these combinations of disorders should be regarded as independent, cooccurring disorders or as different manifestations of an incompletely understood constellation of OCD spectrum disorders with a common etiology. Additional considerations are given here to two potential etiology-based subgroups: (i) an environmentally based group in which OCD occurs following apparent causal events such as streptococcal infections, brain injury, or atypical neuroleptic treatment; and (ii) a genomically based group in which OCD is related to chromosomal anomalies or specific genes. Considering the status of current research, the concept of OCD and OCD-related spectrum conditions seems fluid in 2010, and in need of ongoing reappraisal.
Murphy, Dennis L.; Timpano, Kiara R.; Wheaton, Michael G.; Greenberg, Benjamin D.; Miguel, Euripedes C.
Controlled Comparison of Family Cognitive Behavioral Therapy and Psychoeducation/Relaxation Training for Child Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: To examine the efficacy of exposure-based cognitive-behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD). Method: A total of 71�
Piacentini, John; Bergman, R. Lindsey; Chang, Susanna; Langley, Audra; Peris, Tara; Wood, Jeffrey J.; McCracken, James
[Explicative psychopathology in obsessive-compulsive disorder: a postrationalist viewpoint].
While descriptive psychopathology of obsessive-compulsive disorder (OCD) is now well-established, there is still a lack of a satisfying model of explicative psychopathology that explains the mechanisms that generate obsessive phenomenology. The main attempts to delineate such a model are based on cognitive therapy: according to this approach OCD is a consequence of dysfunctional beliefs (i.e. overestimation of the risk or of the influence of one's own mind on the reality). On the contrary, according to postrationalist cognitive approach, OCD would be based on a characteristic personality structure, which could be identified not only in patients with OCD but also in those who will never develop symptoms. In symptomatic individuals this organization ("Obsessive" Personal Meaning Organization) is more rigidly structured. In particular, there is crystallization of so-called diachronic attitude, which is the key to explain most of the symptoms. PMID:22322688
Mannino, Gherardo
Cognitive Performance in a Subclinical Obsessive-Compulsive Sample 1: Cognitive Functions
Individuals who are not clinically diagnosed with obsessive-compulsive disorder (OCD) but still display obsessive-compulsive (OC) tendencies may show cognitive impairments. The present study investigated whether there are subgroups within a healthy group showing characteristic cognitive and emotional performance levels similar to those found in OCD patients and whether they differ from OCD subgroups regarding performance levels. Of interest are those cases showing subclinical symptomatology. The results revealed no impairments in the subclinical OC participants on the neuropsychological tasks, while evidence suggests that there exist high and low scores on two standardised clinical instruments (Yale-Brown Obsessive Compulsive Scale and Cognitive Assessment Instrument of Obsessions and Compulsions) in a healthy sample. OC symptoms may diminish the quality of life and prolong sustainable return to work. It may be that occupational rehabilitation programmes are more effective in rectifying subclinical OC tendencies compared to the often complex symptoms of diagnosed OCD patients. The relationship between cognitive style and subclinical OC symptoms is discussed in terms of how materials and information might be processed. Although subclinical OC tendencies would not seem to constitute a diagnosis of OCD, the quality of treatment programmes such as cognitive behavioural therapy can be improved based on the current investigation.
Johansen, Thomas; Dittrich, Winand H.
Understudied Clinical Dimensions in Pediatric Obsessive Compulsive Disorder
The present study aimed to assess the phenomenology and treatment sensitivity of insight, avoidance, indecisiveness, overvalued\\u000a responsibility, pervasive slowness, and pathological doubting among youth with Obsessive-compulsive disorder (OCD) using the\\u000a ancillary items on the Children�s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). These factors are believed to be relevant\\u000a to the clinical presentation of youth with OCD but remain understudied. Eighty-nine youth
Adam B. Lewin; Nicole Caporino; Tanya K. Murphy; Gary R. Geffken; Eric A. Storch
Obsessive-Compulsive Disorder is not a Clinical Manifestation of the DYT1 Dystonia Gene
Prior studies suggest that obsessive-compulsive symptoms (OCS) and disorder (OCD) are comorbid with dystonia. We tested if OCS/OCD is a clinical manifestation of the DYT1 dystonia mutation by interviewing members of families with an identified DYT1 mutation, and classifying by manifesting carriers (MC), non-manifesting carriers (NMC), and non-carriers (NC). We found that OCD/OCS are not increased in DYT1 mutation carriers compared with NC, nor is OCD associated with manifesting DYT1 dystonia.
Heiman, Gary A.; Ottman, Ruth; Saunders-Pullman, Rachel J.; Ozelius, Laurie J.; Risch, Neil J.; Bressman, Susan B.
A role for the precuneus in thought-action fusion: Evidence from participants with significant obsessive-compulsive symptoms?
Likelihood thought�action fusion (TAF-L) refers to a cognitive bias in which individuals believe that the mere thought of a negative event increases its likelihood of occurring in reality. TAF-L is most commonly associated with obsessive�compulsive disorder (OCD) but is also present in depression, generalized anxiety disorder and psychosis. We induced TAF-L in individuals with high (High-OC, N�=�23) and low (Low-OC, N�=�24) levels of OC traits, and used low resolution electromagnetic tomography (LORETA) to localise the accompanying electrical brain activity patterns. The results showed greater TAF-L in the High-OC than in the Low-OC group (p�<�.005), which was accompanied by significantly greater upper beta frequency (19�30�Hz) activity in the precuneus (p�<�.05). Further, the precuneus activity was positively correlated with self-reported magnitude of TAF-L (p�<�.01), suggesting a specific role of this region in this cognitive bias. Results are discussed with reference to self-referential processing and the default-mode network.
Jones, Rhiannon; Bhattacharya, Joydeep
Neural Correlates of Symptom Dimensions in Pediatric Obsessive-Compulsive Disorder: A Functional Magnetic Resonance Imaging Study
ERIC Educational Resources Information Center
The use of functional magnetic resonance imaging on a group of pediatric subjects with obsessive compulsive disorder reveals that this group has reduced activity in neural regions underlying emotional processing, cognitive processing, and motor performance as compared to control subjects.
Gilbert, Andrew R.; Akkal, Dalila; Almeida, Jorge R. C.; Mataix-Cols, David; Kalas, Catherine; Devlin, Bernie; Birmaher, Boris; Phillips, Mary L.
Circadian rhythms in obsessive-compulsive disorder.
The etiopathology and neurobiology of obsessive-compulsive disorder (OCD) are not fully understood. As for altered circadian rhythms associated with OCD, hormonal dysregulation and a delayed sleep phase have come into the focus of research. The novel antidepressant agomelatine is able to resynchronize circadian rhythms and the augmentative administration of this compound has been shown to be of benefit in some OCD patients who are refractory to common forms of pharmacotherapy. Adjunctive chronotherapy might also enhance the outcome in treatment-refractory OCD. The present review summarises the findings regarding circadian abnormalities in OCD. PMID:22543530
Lange, Klaus W; Lange, Katharina M; Hauser, Joachim; Tucha, Lara; Tucha, Oliver
Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients?
There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. Results: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior. PMID:16480944
Anholt, Gideon E; Cath, Danielle C; Emmelkamp, Paul M G; van Oppen, Patricia; Smit, Johannes H; van Balkom, Anton J L M
Altered cingulate sub-region activation accounts for task-related dissociation in ERN amplitude as a function of obsessive-compulsive symptoms
Larger Error-Related Negativities (ERNs) have been consistently found in Obsessive Compulsive Disorder (OCD) patients, and are thought to reflect the activities of a hyperactive cortico-striatal circuit during action monitoring. We previously observed that OC symptomatic students (non-patients) have larger ERNs during errors in a response competition task, yet smaller ERNs in a reinforcement learning task. The finding of a task-specific dissociation suggests that distinct yet partially overlapping medio-frontal systems underlie the ERN in different tasks, and that OC symptoms are associated with functional differences in these systems. Here, we used EEG source localization to identify why OC symptoms are associated with hyperactive ERNs to errors yet hypoactive ERNs when selecting maladaptive actions. At rest, OC symptomatology predicted greater activity in rostral anterior cingulate cortex (rACC) and lower activity in dorsal anterior cingulate cortex (dACC). When compared to a group with low OC symptom scores, the high OC group had greater rACC reactivity during errors in the response competition task and less deactivation of dACC activity during errors in the reinforcement learning task. The degree of activation in these areas correlated with ERN amplitudes during both tasks in the high OC group, but not in the low group. Interactive ACC systems associated avoidance of maladaptive actions were intact in the high OC group, but were related to poorer performance on a third task: probabilistic reversal learning. These novel findings link both tonic and phasic activities in the ACC to action monitoring alterations, including dissociation in performance deficits, in OC symptomatic participants.
Cavanagh, James F.; Grundler, Theo O.J.; Frank, Michael J.; Allen, John J.B.
Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance
Meta-analytic methods were employed to investigate the clinical significance of ex- posure therapy in the treatment of obsessive-compulsive disorder (OCD). Samples of patients treated in 16 outcome trials were compared with 9 normative samples to clarify how similar the symptoms of treated patients were to those without history of OCD. The Maudsley Obsessional-Compulsive Inventory (MOCI) was used as the basis
Jonathan S. Abramowitz
Worries and obsessions in individuals with obsessive�compulsive disorder with and without comorbid generalized anxiety disorder
Participants from the DSM-IV field trial for OCD (N=381) were divided into two groups based on the SCID interview: those who met current criteria for obsessive�compulsive disorder (OCD) but not generalized anxiety disorder (GAD) and those who met current diagnostic criteria for both. The groups were compared on their severity of obsessive and compulsive symptoms, as well as on the
Jonathan S Abramowitz; Edna B Foa
Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples
The efficacy of exposure and ritual prevention (EX\\/RP) for reducing symptoms of obsessive�compulsive disorder (OCD) has been demonstrated in several randomized controlled trials (RCTs). However, procedures used in these studies to maximize experimental control may have limited their generalizability to typical clinical practice. Treatment outcome data from 110 clinical patients receiving EX\\/RP on an outpatient fee-rbr-service basis were compared with
Martin E. Franklin; Jonathan S. Abramowitz; Michael J. Kozak; Jill T. Levitt; Edna B. Foa
Relationships between anger, symptoms, and cognitive factors in OCD checkers.
The purpose of this study was to examine whether individuals diagnosed with obsessive-compulsive disorder (OCD) with primary checking compulsions report higher levels of trait anger and anger expression compared with a student control group, and whether trait anger and anger expression are correlated with specific beliefs and interpretations that are common among individuals who compulsively check. A group of individuals with OCD reporting significant checking compulsions (n=33) and a group of undergraduate students (n=143) completed a questionnaire package that included measures of trait anger and anger expression, as well as measures of obsessive-compulsive symptoms and beliefs. The compulsive checking group reported greater trait anger, though not greater anger expression, than the student control group. Furthermore, beliefs concerning perfectionism and intolerance of uncertainty were positively correlated with anger expression and trait anger among compulsive checkers but not among the student control group. The implications of these findings are discussed in terms of cognitive-behavioural treatments for and models of compulsive checking in OCD. PMID:17723225
Radomsky, Adam S; Ashbaugh, Andrea R; Gelfand, Laurie A
Dimensions of Perfectionism in Children and Adolescents with Obsessive-compulsive Disorder
Objective To measure the association of perfectionism with obsessive-compulsive and depressive symptoms in children and adolescents with obsessive-compulsive disorder (OCD). Method: Sample consisted of 94 youth (44 boys, 49 girls; mean age = 13.2 y, SD = 2.5 y) with a DSM-IV diagnosis of OCD. Perfectionism beliefs were measured with both the Adaptive/Maladaptive Perfectionism Scale (AMPS) and a 14-item version of the Child and Adolescents Perfectionism Scale (CAPS-14). Using a hierarchical linear-regression model, we measured the association of perfectionist beliefs with severity of OCD and depressive symptoms. Results: Both AMPS and CAPS-14 scores were associated with the severity of OCD symptoms in our sample. In addition, CAPS-14 scores were associated with the severity of depressive symptoms, even when OCD symptoms were taken into account. Conclusions: Our findings lend further support to the hypothesis that perfectionism in youth with OCD is associated with variation in the severity of OCD and depressive symptoms.
Soreni, Noam; Streiner, David; McCabe, Randi; Bullard, Carrie; Swinson, Richard; Greco, Alessia; Pires, Paulo; Szatmari, Peter
Obsessive-compulsive disorder and trichotillomania: a phenomenological comparison
Background Similarities between obsessive-compulsive disorder (OCD) and trichotillomania (TTM) have been widely recognized. Nevertheless, there is evidence of important differences between these two disorders. Some authors have conceptualized the disorders as lying on an OCD spectrum of conditions. Methods Two hundred and seventy eight OCD patients (n = 278: 148 male; 130 female) and 54 TTM patients (n = 54; 5 male; 49 female) of all ages were interviewed. Female patients were compared on select demographic and clinical variables, including comorbid axis I and II disorders, and temperament/character profiles. Results OCD patients reported significantly more lifetime disability, but fewer TTM patients reported response to treatment. OCD patients reported higher comorbidity, more harm avoidance and less novelty seeking, more maladaptive beliefs, and more sexual abuse. OCD and TTM symptoms were equally likely to worsen during menstruation, but OCD onset or worsening was more likely associated with pregnancy/puerperium. Conclusions These findings support previous work demonstrating significant differences between OCD and TTM. The classification of TTM as an impulse control disorder is also problematic, and TTM may have more in common with conditions characterized by stereotypical self-injurious symptoms, such as skin-picking. Differences between OCD and TTM may reflect differences in underlying psychobiology, and may necessitate contrasting treatment approaches.
Lochner, Christine; Seedat, Soraya; du Toit, Pieter L; Nel, Daniel G; Niehaus, Dana JH; Sandler, Robin; Stein, Dan J
Situation awareness in obsessive-compulsive disorder.
Past studies have suggested that OCD patients suffer memory impairment on tasks using complex stimuli that require memory for combined elements to be maintained, but not for more simplistic memory tests. We tested this with 42 OCD patients and 42 healthy controls performed a computerized situation awareness task. In addition, participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Maudsley Obsessive-Compulsive Inventory (MOCI). The OCD patients had poorer accuracy in integration/comprehension and perception levels than controls. There were significant correlations between situational awareness scores (i.e., visuo-spatial monitoring and processing) and Y-BOCS obsession-compulsion and slowness and doubt scores of MOCI in OCD patients. In addition, there were also significant correlations between situational awareness and controlling, cleaning, slowness, rumination and total scores of MOCI in control group. Results indicated that (I) OCD patients have problems of perception, integration, and comprehension of complex visual perceptions; (II) situation awareness deficits associated with severity and prevalence of obsessions and compulsions. PMID:23537845
Tumkaya, Selim; Karadag, Filiz; Mueller, Shane T; Ugurlu, Tugce T; Oguzhanoglu, Nalan K; Ozdel, Osman; Atesci, Figen C; Bayraktutan, Mustafa
New-onset obsessive-compulsive disorder following neurosurgery for medication-refractory seizure disorder.
A 31-year-old man with medication-refractory seizures in the context of right mesial temporal lobe sclerosis and right occipital encephalomalacia is described. He experienced the onset of obsessive-compulsive symptoms following resection of the right hippocampus and right occipital pole. Semistructured psychiatric evaluation was conducted 16 months after surgery. Results indicated that he fulfilled diagnostic criteria for obsessive-compulsive disorder (OCD) and that he was not depressed at the time of the evaluation. Total score on the Yale-Brown Obsessive Compulsive Scale was 24, indicating moderate symptom severity, and he had prominent symptoms related to contamination, washing, checking, repeating rituals, and ordering. He also reported significant problems with "not just right" experiences. Treatment with sertraline resulted in apathy. To our knowledge, the present case is only the fourth reported of de novo onset OCD following neurosurgery for seizure disorder, and the first in a patient without either preexisting obsessive traits or an OCD spectrum disorder. PMID:19435591
Roth, Robert M; Jobst, Barbara C; Thadani, Vijay M; Gilbert, Karen L; Roberts, David W
Assessment and medication management of paediatric obsessive-compulsive disorder.
Paediatric obsessive-compulsive disorder (OCD) is a common, yet under-recognized, neuropsychiatric illness in both clinical and community settings. Symptoms tend to be hidden or misunderstood by affected youth, and parents may inadvertently accommodate OCD, thus worsening its severity. These symptoms may include compulsive reassurance seeking, confessing and 'just right' rituals, in addition to more classic OCD behaviours. Fortunately, numerous psychometric measures are available to assist in clinical assessment of this disorder and its sequelae. Once properly diagnosed, paediatric OCD is highly treatable with empirically proven approaches including cognitive-behaviour therapy (CBT) and serotonin reuptake inhibitor (SRI) medications. Clinically meaningful symptom improvement is the norm following these strategies, although full remission is not, as symptoms tend to wax and wane over time. Paediatric OCD is highly co-morbid with other anxiety disorders, tic disorders, depression and attention-deficit hyperactivity disorder, which also require specific attention. For moderate to severe OCD, an interdisciplinary approach combining individual and family CBT with SRI trials is recommended. For severe treatment-refractory illness, early evidence supports the benefit of augmenting agents, such as atypical antipsychotics and potentially those with glutamatergic activity. Clinical outcome assessment in paediatric OCD should always include broad domains of individual and family functioning, in addition to symptom improvement. PMID:22564131
Stewart, S Evelyn; Hezel, Dianne; Stachon, Andrea C
Virtual Reality for Obsessive-Compulsive Disorder: Past and the Future
The use of computers, especially for virtual reality (VR), to understand, assess, and treat various mental health problems has been developed for the last decade, including application for phobia, post-traumatic stress disorder, attention deficits, and schizophrenia. However, the number of VR tools addressing obsessive-compulsive disorder (OCD) is still lacking due to the heterogeneous symptoms of OCD and poor understanding of the relationship between VR and OCD. This article reviews the empirical literatures for VR tools in the future, which involve applications for both clinical work and experimental research in this area, including examining symptoms using VR according to OCD patients' individual symptoms, extending OCD research in the VR setting to also study behavioral and physiological correlations of the symptoms, and expanding the use of VR for OCD to cognitive-behavioral intervention.
Kim, Kwanguk; Kim, So-Yeon; Roh, Daeyoung; Kim, Sun I.
Don't judge a book by its cover: ADHD-like symptoms in obsessive compulsive disorder
Reported OCD-ADHD comorbidity rates are highly variable and the two disorders are characterized by opposite symptomatology and antithetical pathophysiology. We hypothesized that OCD-related attentional impairment could be misdiagnosed as ADHD symptoms. Thirty adults with OCD, thirty with ADHD, and thirty matched healthy controls (HC) completed disorder-specific measures and an ADHD DSM-IV based questionnaire examining childhood and current symptoms. The ADHD
Amitai Abramovitch; Reuven Dar; Andrew Mittelman; Avraham Schweiger
Attenuation of Attention Bias in Obsessive-Compulsive Disorder
Cognitive theories of obsessive-compulsive disorder (OCD) suggest that the disorder is characterized by an attention bias towards personally relevant threatening material. However, existing research on attention bias in OCD has yielded conflicting findings. One possibility that might account for the null findings is that attention bias may diminish over the course of the experiment. The present study tested this hypothesis using a visual dot-probe task with idiographic word selection. Results from our study confirmed that individuals with OC symptoms show an attention bias towards idiographically-selected, threatening information in the first block of trials, and that the degree of this bias is correlated with the severity of OC symptoms. The temporal pattern of attention bias over the course of the experiment was consistent with our hypothesis: A comparison of early and late blocks of trials revealed an attenuation of attention bias in individuals with OC symptoms, potentially reflecting habituation to threatening information over the course of the experiment.
Amir, Nader; Najmi, Sadia; Morrison, Amanda S.
Cognitive-Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive Compulsive Disorder: The Pediatric OCD Treatment Study II (POTS II) Randomized, Controlled Trial
Context The extant literature on the treatment of pediatric OCD indicates that partial response to serotonin reuptake inhibitors (SRIs) is the norm, and that augmentation with short-term OCD-specific cognitive behavior therapy (CBT) may provide additional benefit. Objective To examine the effects of augmenting SRIs with CBT or a brief form of CBT, instructions in CBT (I-CBT) delivered in the context of medication management (MM). Design A 12-week, 3 (site: Penn, Duke, Brown) � 3 (treatment conditions: MM, MM+I-CBT, & MM+CBT) � 4 (repeated measures: weeks 0, 4, 8, & 12) randomized controlled trial. Setting The outpatient clinics of three academic medical centers between 2004 and 2009. Participants Outpatients (N = 124) between the ages of 7�17 with primary OCD and a Children�s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score ? 16 despite an adequate SRI trial. Interventions Participants were randomized to receive 12 weeks of: 1) MM (7 sessions), 2) MM+I-CBT (7 sessions) or 3) MM+CBT (7 sessions of MM plus 14 concurrent CBT sessions). Main Outcome Measures Responder status as defined as a post-treatment CY-BOCS reduction of 30% or greater compared to baseline; change in continuous CY-BOCS total score over 12 weeks. Results MM+CBT was superior to MM and to MM+I-CBT on all outcome measures. In the primary ITT analysis, 68.6% in MM+CBT (95% confidence interval [CI], 53.9%�83.3%) were considered responders, which was significantly better than the 34.0% in MM+I-CBT (95% CI, 18.0% to 50.0%), and 30.0% in MM (95% CI, 14.9% to 45.1%). Planned pairwise comparisons show that MM+CBT was superior to both MM and MM+I-CBT (p < 0.01 for both). MM+I-CBT was not statistically significant from MM (p = 0.72). The number needed to treat (NNT) with MM+CBT versus MM to see one additional RESPONSE at Week 12, on average, was estimated as 3; for MM+CBT versus MM+I-CBT the NNT was also estimated as 3 ;for MM+I-CBT versus MM the NNT was estimated as 25. Conclusion Among patients age 7�17 with OCD and partial response to SRI use, the addition of CBT by a psychologist to medication management compared with medication management alone resulted in a significantly greater response rate, whereas, augmentation of medication management with the addition of instructions in CBT by the psychiatrist did not. Dissemination of full CBT augmentation for pediatric OCD partial responders of SRI should be an important public health objective.
Franklin, Martin E.; Sapyta, Jeffrey; Freeman, Jennifer B.; Khanna, Muniya; Compton, Scott; Almirall, Daniel; Moore, Phoebe; Choate-Summers, Molly; Garcia, Abbe; Edson, Aubrey L.; Foa, Edna B.; March, John S.
Obsessive-compulsive behaviors in parents of multiplex autism families.
Parents of autistic probands with high and low rates of repetitive behaviors were compared for rates of obsessive-compulsive traits and disorder. The rate of repetitive behaviors was assessed using the Autism Diagnostic Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex families. Obsessive-compulsive disorder (OCD) in parents was determined by direct interview using a parental history questionnaire, with screening for obsessive-compulsive traits using the Yale-Brown Obsessive-Compulsive Scale checklist. Children who had high total scores on the repetitive behavior domain of the ADI-R were significantly more likely to have one or both parents with obsessive-compulsive traits or disorder compared with children who had low total scores on this domain. Children with high scores on D1/D2 of the ADI-R (narrow restricted interests and rituals) were significantly more likely to have one or both parents with OCD, especially fathers, than those with low D1/D2. The occurrence of obsessive-compulsive traits or disorder in parents of autistic children in multiplex families is significantly more likely if autistic children have a high occurrence of repetitive behaviors. Dichotomizing autistic probands by severity and type of repetitive behaviors (circumscribed interests and compulsive rituals) may yield more homogenous groups, which could be helpful in genetic linkage studies. PMID:12581816
Hollander, Eric; King, Audrey; Delaney, Katherine; Smith, Christopher J; Silverman, Jeremy M
An evaluation of irreversible psychosurgical treatment of patients with obsessive-compulsive disorder in the Netherlands, 2001-2008.
Admissions for irreversible psychosurgical treatment of obsessive-compulsive disorder (OCD) by the Working Group for Indication Psychosurgery in the Netherlands were analyzed, and the postsurgical effects on symptom severity and quality of life were evaluated. The data were extracted from patient records in the period 2001-2008, and there was a postoperative assessment with a semistructured interview. Fourteen patients applied, having severe OCD with mostly one or more comorbid disorders. The mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 32 points. Four of seven patients in whom psychosurgery was deemed useful were operated on. The decrease of the Y-BOCS score from registration to after surgery was 9 points (range, 3-17 points). An improvement in social function was present in three of four patients. In conclusion, psychosurgery can be a valuable treatment option for patients with severe OCD in whom other treatments fail. PMID:23443039
van Vliet, I M; van Well, E P L; Bruggeman, Richard; Campo, Joost A; Hijman, R; van Megen, H J G M; van Balkom, A J L M; van Rijen, P C
Psychiatric morbidity with focus on obsessive�compulsive disorder in an Israeli cohort of adolescents with mild to moderate mental retardation
The study evaluated the prevalence of DSM-IV-TR-defined psychiatric disorders in adolescents with mental retardation, with\\u000a a focus on obsessive�compulsive disorder (OCD), for which data at present are sparse. Eighty-seven adolescents with mild to\\u000a moderate mental retardation attending the Israeli special-education system were screened for psychiatric disorders in general\\u000a and obsessive�compulsive symptoms in particular. Sixty-one percent had at least one psychiatric
Doron Gothelf; Olga Goraly; Sari Avni; Mike Stawski; Inbar Hartmann; Lina Basel-Vanagaite; Alan Apter
White matter abnormalities in pediatric obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a prevalent and often severely disabling illness with onset generally in childhood or adolescence. Although white matter deficits have been implicated in the neurobiology of OCD, few studies have been conducted in pediatric patients when the brain is still developing and have examined their functional correlates. In this study, 23 pediatric OCD patients and 23 healthy volunteers, between the ages of 9 and 17 years, matched for sex, age, handedness, and IQ, received a diffusion tensor imaging exam on a 3T GE system and a brief neuropsychological battery tapping executive functions. Patient symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Patients with OCD exhibited significantly greater fractional anisotropy compared to matched controls in the left dorsal cingulum bundle, splenium of the corpus callosum, right corticospinal tract, and left inferior fronto-occipital fasciculus. There were no regions of significantly lower fractional anisotropy in patients compared to controls. Higher fractional anisotropy in the splenium was significantly correlated with greater obsession severity on the CY-BOCS in the subgroup of psychotropic drug-na�ve patients. Among patients, there was a significant association between greater fractional anisotropy in the dorsal cingulum bundle and better performance on measures of response inhibition and cognitive control. The overall findings suggest a pattern of greater directional coherence of white matter tracts in OCD very early in the course of illness, which may serve a compensatory mechanism, at least for response inhibition functions typically subserved by the cingulum bundle. PMID:22871914
Gruner, Patricia; Vo, An; Ikuta, Toshikazu; Mahon, Katie; Peters, Bart D; Malhotra, Anil K; Ulu?, Aziz M; Szeszko, Philip R
White Matter Abnormalities in Pediatric Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a prevalent and often severely disabling illness with onset generally in childhood or adolescence. Although white matter deficits have been implicated in the neurobiology of OCD, few studies have been conducted in pediatric patients when the brain is still developing and have examined their functional correlates. In this study, 23 pediatric OCD patients and 23 healthy volunteers, between the ages of 9 and 17 years, matched for sex, age, handedness, and IQ, received a diffusion tensor imaging exam on a 3T GE system and a brief neuropsychological battery tapping executive functions. Patient symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Patients with OCD exhibited significantly greater fractional anisotropy compared to matched controls in the left dorsal cingulum bundle, splenium of the corpus callosum, right corticospinal tract, and left inferior fronto-occipital fasciculus. There were no regions of significantly lower fractional anisotropy in patients compared to controls. Higher fractional anisotropy in the splenium was significantly correlated with greater obsession severity on the CY-BOCS in the subgroup of psychotropic drug-na�ve patients. Among patients, there was a significant association between greater fractional anisotropy in the dorsal cingulum bundle and better performance on measures of response inhibition and cognitive control. The overall findings suggest a pattern of greater directional coherence of white matter tracts in OCD very early in the course of illness, which may serve a compensatory mechanism, at least for response inhibition functions typically subserved by the cingulum bundle.
Gruner, Patricia; Vo, An; Ikuta, Toshikazu; Mahon, Katie; Peters, Bart D; Malhotra, Anil K; Ulug, Aziz M; Szeszko, Philip R
Predictors of quality of life and functional impairment in Obsessive-Compulsive Disorder.
Obsessive-compulsive disorder (OCD) is the 10th leading cause of disability among health conditions; yet, relatively little research has focused on quality of life (QOL) and functional impairment in OCD. The present study extended existing work by examining correlates and predictors of QOL and functional impairment in 96 treatment-seeking OCD patients (in intensive outpatient and residential settings). In a model including OCD symptoms and related phenomena, and symptoms of depression and anxiety, two main findings emerged: (a) depressive symptoms predicted both QOL and functional impairment, and (b) contamination symptoms predicted functional impairment. These findings are discussed in terms of the implications for studying QOL and functional impairment in OCD. Future research should investigate the factors that predict changes in QOL and functional impairment following treatment. PMID:24746527
Jacoby, Ryan J; Leonard, Rachel C; Riemann, Bradley C; Abramowitz, Jonathan S
Mapping Structural Brain Alterations in Obsessive-Compulsive Disorder
Background: Recent technical developments have made it feasible to comprehensively assess brain anatomy in psychiatric populations. Objective: To describe the structural brain alterations detected in the magnetic resonance images of a large se- ries of patients with obsessive-compulsive disorder (OCD) using imaging procedures that allow the evaluation of vol- ume changes throughout the brain. Design: Case-control study. Setting: Referral OCD
Jesus Pujol; Carles Soriano-Mas; Pino Alonso; Narc� � s Cardoner; Jose M. Menchon; Joan Deus; Julio Vallejo
Inhibition of return in patients with obsessive-compulsive disorder
The present study is aimed at replicating and extending previous results by Nelson et al. [Psychiatry Res. 49 (1993) 183], who found decreased inhibition of return (IOR) in patients with obsessive-compulsive disorder (OCD). Thirty OCD patients, 14 psychiatric, and 14 healthy controls participated in a visual cueing experiment. The task required detection of a target stimulus at one of two
Steffen Moritz; Adrian von Muhlenenb
Cognitive Appraisals in Young People with Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Background: A number of cognitive appraisals have been identified as important in the manifestation of obsessive-compulsive disorder (OCD) in adults. There have, however, been few attempts to explore these cognitive appraisals in clinical groups of young people. Method: This study compared young people aged between 11 and 18 years with OCD (N =�
Libby, Sarah; Reynolds, Shirley; Derisley, Jo; Clark, Sarah
Obsessive-compulsive disorder phenotypes: implications for genetic studies
Obsessive-compulsive disorder (OCD) clinical presentation is remarkably diverse, and can vary both within and across patients over time. This variability in the phenotypic expression has led to the hypothesis that OCD is a heterogeneous disorder and that this heterogeneity obscures the findings of clinical, natural history and treatment response studies and complicates the search for vulnerability genes. A complete understanding
E C Miguel; J F Leckman; S Rauch; M C do Rosario-Campos; A G Hounie; M T Mercadante; P Chacon; D L Pauls
A clinical case study of the use of ecological momentary assessment in obsessive compulsive disorder.
Accurate assessment of obsessions and compulsions is a crucial step in treatment planning for Obsessive-Compulsive Disorder (OCD). In this clinical case study, we sought to determine if the use of Ecological Momentary Assessment (EMA) could provide additional symptom information beyond that captured during standard assessment of OCD. We studied three adults diagnosed with OCD and compared the number and types of obsessions and compulsions captured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) compared to EMA. Following completion of the Y-BOCS interview, participants then recorded their OCD symptoms into a digital voice recorder across a 12-h period in reply to randomly sent mobile phone SMS prompts. The EMA approach yielded a lower number of symptoms of obsessions and compulsions than the Y-BOCS but produced additional types of obsessions and compulsions not previously identified by the Y-BOCS. We conclude that the EMA-OCD procedure may represent a worthy addition to the suite of assessment tools used when working with clients who have OCD. Further research with larger samples is required to strengthen this conclusion. PMID:24860521
Tilley, P J Matt; Rees, Clare S
A clinical case study of the use of ecological momentary assessment in obsessive compulsive disorder
Accurate assessment of obsessions and compulsions is a crucial step in treatment planning for Obsessive-Compulsive Disorder (OCD). In this clinical case study, we sought to determine if the use of Ecological Momentary Assessment (EMA) could provide additional symptom information beyond that captured during standard assessment of OCD. We studied three adults diagnosed with OCD and compared the number and types of obsessions and compulsions captured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) compared to EMA. Following completion of the Y-BOCS interview, participants then recorded their OCD symptoms into a digital voice recorder across a 12-h period in reply to randomly sent mobile phone SMS prompts. The EMA approach yielded a lower number of symptoms of obsessions and compulsions than the Y-BOCS but produced additional types of obsessions and compulsions not previously identified by the Y-BOCS. We conclude that the EMA-OCD procedure may represent a worthy addition to the suite of assessment tools used when working with clients who have OCD. Further research with larger samples is required to strengthen this conclusion.
Tilley, P. J. Matt; Rees, Clare S.
Factor Analytic Study of the Children's Yale?Brown Obsessive?Compulsive Scale
ERIC Educational Resources Information Center
This study examined the psychometric properties of the Children's Yale?Brown Obsessive?Compulsive Scale (CY?BOCS; Scahill et al., 1997). Participants were 82 children and adolescents diagnosed with obsessive?compulsive disorder (OCD). Confirmatory factor analyses of 2 previously found models (Obsessions and Compulsions; Disturbance and Severity)�
Storch, Eric A.; Murphy, Tanya K.; Geffken, Gary R.; Bagner, Daniel M.; Soto, Ohel; Sajid, Muhammad; Allen, Pam; Killiany, Erin M.; Goodman, Wayne K.
MRI study of the cavum septum pellucidum in obsessive-compulsive disorder.
The cavum septum pellucidum (CSP), a putative marker of neurodevelopmental anomaly, has been associated with an increased risk of several psychiatric disorders. The purpose of this study was to evaluate the CSP in patients with obsessive-compulsive disorder (OCD) compared with healthy control subjects. Seventy-one patients with OCD and 71 healthy volunteers matched for age and sex were evaluated with magnetic resonance imaging. We evaluated the CSP using criteria employed in previous studies: presence of the CSP, length of the CSP, and overall size of the CSP, measured in five grades, ranging from grades 0 (no CSP) to 4 (severe CSP). We evaluated OCD symptom severity using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The CSP presence was significantly greater in the OCD group (60.6%) than in control subjects (29.6%), and CSP size grade was significantly larger in the OCD group (chi(2) = 15.609, P = 0.004). CSP length showed no significant group difference. Among patients with OCD, those with a CSP had higher scores on the obsession subscale of the Y-BOCS than those without a CSP (Z = -2.358, P = 0.018), while they did not show significant difference from those without a CSP in the compulsion subscale of the Y-BOCS, age, duration of illness, or age at onset. These results indicate that neurodevelopmental alterations in midline structures might contribute to the pathogenesis of OCD. PMID:19856198
Chon, Myong-Wuk; Choi, Jung-Seok; Kang, Do-Hyung; Jung, Myung Hun; Kwon, Jun Soo
A 2-Year Prospective Follow-Up Study of the Course of Obsessive-Compulsive Disorder
Background Surprisingly little is known about the long-term course of obsessive-compulsive disorder (OCD). This prospective study presents 2-year course findings, as well as predictors of course, from the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the observational course of OCD in a large clinical sample. Method The sample included 214 treatment-seeking adults with DSM-IV OCD at intake who identified OCD as the most problematic disorder over their lifetime. Subjects were enrolled from 2001�2004. At annual interviews, data on weekly OCD symptom status were obtained using the Longitudinal Interval Follow-Up Evaluation. Probabilities of full remission and partial remission over the first 2 years of collected data and potential predictors of remission were examined. Results The probability of full remission from OCD was 0.06, and the probability of partial remission was 0.24. Of the 48 subjects whose OCD symptoms partially or fully remitted, only 1 relapsed within the first 2 years. Earlier age at onset of OCD, greater severity of symptoms at intake, older age at intake, and being male were associated with a decreased likelihood of remission. Insight, diagnostic comorbidity, and treatment were not found to be associated with the likelihood of achieving full or partial remission. Conclusions Though one-quarter of the sample had periods of subclinical OCD symptoms during the prospective period, full remission was rare, consistent with the view of OCD as a chronic and persistent illness. Age at onset, OCD symptom severity, current age, and sex emerged as potent predictors of course.
Eisen, Jane L.; Pinto, Anthony; Mancebo, Maria C.; Dyck, Ingrid R.; Orlando, Maria E.; Rasmussen, Steven A.
Gender in obsessive-compulsive disorder and obsessive-compulsive spectrum disorders
Summary��\\u000a \\u000a Background: There is increasing recognition that obsessive-compulsive disorder (OCD) and putative OCD spectrum disorders (OCSDs) are\\u000a not homogenous entities. Gender may provide an important window onto the heterogeneity of these various disorders.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A MEDLINE review of gender issues in OCD and putative OCD spectrum disorders (excluding eating disorders) was undertaken\\u000a (1965�2000). These included demographic variables, clinical phenomenology, etiological
C. Lochner; D. J. Stein
Cognitive Bias Modification (CBM) of obsessive compulsive beliefs
Background Cognitive bias modification (CBM) protocols have been developed to help establish the causal role of biased cognitive processing in maintaining psychopathology and have demonstrated therapeutic benefits in a range of disorders. The current study evaluated a cognitive bias modification training paradigm designed to target interpretation biases (CBM-I) associated with obsessive compulsive disorder (OCD). Methods We evaluated the impact of CBM-I on measures of interpretation bias, distress, and on responses to three OC stressor tasks designed to tap the core belief domains of Importance of Thoughts/Control, Perfectionism/Intolerance of Uncertainty, and Contamination/Estimation of Threat in a selected sample of community members reporting obsessive compulsive (OC) symptoms (N = 89). Results Participants randomly assigned to the Positive condition evidenced a change in interpretation bias towards more positive and less negative OC-relevant interpretations following CBM-I compared to participants assigned to the Control condition. Importantly, a positivity bias was not observed for foil scenarios unrelated to the core OC belief domains. Further, participants in the Positive condition reported less distress and urge to neutralize following an OC stressor task designed to tap Importance of Thoughts/Control. No significant difference emerged on the indices of behavioural response to the OC stressor tasks. Severity of OC symptoms did not moderate the effects of positive CBM-I training. Conclusions CBM-I appears effective in selectively targeting OC beliefs. Results need to be replicated in clinical samples in order for potential therapeutic benefit to be demonstrated.
Obsessive-Compulsive Disorder (OCD)
... To dispel anxiety, some utter a name or phrase, or repeat a behavior several times. They know ... intrusive obsessive thoughts, some silently pray or say phrases to reduce anxiety or prevent a dreaded future ...
Characterization of SLITRK1 variation in obsessive-compulsive disorder.
Obsessive compulsive disorder (OCD) is a syndrome characterized by recurrent and intrusive thoughts and ritualistic behaviors or mental acts that a person feels compelled to perform. Twin studies, family studies, and segregation analyses provide compelling evidence that OCD has a strong genetic component. The SLITRK1 gene encodes a developmentally regulated stimulator of neurite outgrowth and previous studies have implicated rare variants in this gene in disorders in the OC spectrum, specifically Tourette syndrome (TS) and trichotillomania (TTM). The objective of the current study was to evaluate rare genetic variation in SLITRK1 in risk for OCD and to functionally characterize associated coding variants. We sequenced SLITRK1 coding exons in 381 individuals with OCD as well as in 356 control samples and identified three novel variants in seven individuals. We found that the combined mutation load in OCD relative to controls was significant (p?=?0.036). We identified a missense N400I change in an individual with OCD, which was not found in more than 1000 control samples (P<0.05). In addition, we showed the the N400I variant failed to enhance neurite outgrowth in primary neuronal cultures, in contrast to wildtype SLITRK1, which enhanced neurite outgrowth in this assay. These important functional differences in the N400I variant, as compared to the wildtype SLITRK1 sequence, may contribute to OCD and OC spectrum symptoms. A synonymous L63L change identified in an individual with OCD and an additional missense change, T418S, was found in four individuals with OCD and in one individual without an OCD spectrum disorder. Examination of additional samples will help assess the role of rare SLITRK1 variation in OCD and in related psychiatric illness. PMID:23990902
Ozomaro, Uzoezi; Cai, Guiqing; Kajiwara, Yuji; Yoon, Seungtai; Makarov, Vladimir; Delorme, Richard; Betancur, Catalina; Ruhrmann, Stephan; Falkai, Peter; Grabe, Hans J�rgen; Maier, Wolfgang; Wagner, Michael; Lennertz, Leonhard; Moessner, Rainald; Murphy, Dennis L; Buxbaum, Joseph D; Z�chner, Stephan; Grice, Dorothy E
Characterization of SLITRK1 Variation in Obsessive-Compulsive Disorder
Obsessive compulsive disorder (OCD) is a syndrome characterized by recurrent and intrusive thoughts and ritualistic behaviors or mental acts that a person feels compelled to perform. Twin studies, family studies, and segregation analyses provide compelling evidence that OCD has a strong genetic component. The SLITRK1 gene encodes a developmentally regulated stimulator of neurite outgrowth and previous studies have implicated rare variants in this gene in disorders in the OC spectrum, specifically Tourette syndrome (TS) and trichotillomania (TTM). The objective of the current study was to evaluate rare genetic variation in SLITRK1 in risk for OCD and to functionally characterize associated coding variants. We sequenced SLITRK1 coding exons in 381 individuals with OCD as well as in 356 control samples and identified three novel variants in seven individuals. We found that the combined mutation load in OCD relative to controls was significant (p?=?0.036). We identified a missense N400I change in an individual with OCD, which was not found in more than 1000 control samples (P<0.05). In addition, we showed the the N400I variant failed to enhance neurite outgrowth in primary neuronal cultures, in contrast to wildtype SLITRK1, which enhanced neurite outgrowth in this assay. These important functional differences in the N400I variant, as compared to the wildtype SLITRK1 sequence, may contribute to OCD and OC spectrum symptoms. A synonymous L63L change identified in an individual with OCD and an additional missense change, T418S, was found in four individuals with OCD and in one individual without an OCD spectrum disorder. Examination of additional samples will help assess the role of rare SLITRK1 variation in OCD and in related psychiatric illness.
Ozomaro, Uzoezi; Yoon, Seungtai; Makarov, Vladimir; Delorme, Richard; Betancur, Catalina; Ruhrmann, Stephan; Falkai, Peter; Grabe, Hans Jorgen; Maier, Wolfgang; Wagner, Michael; Lennertz, Leonhard; Moessner, Rainald; Murphy, Dennis L.; Buxbaum, Joseph D.; Zuchner, Stephan; Grice, Dorothy E.
Treatment of Sexual-Orientation Obsessions in Obsessive-Compulsive Disorder Using Exposure and Ritual Prevention
Presented is a case report of exposure and ritual prevention (EX/RP) therapy administered to a 51-year-old, White, heterosexual male with sexual-orientation obsessions in obsessive-compulsive disorder (OCD). The patient had been previously treated with pharmacotherapy, resulting in inadequate symptom reduction and unwanted side effects. OCD symptoms included anxiety about the possibility of becoming gay, mental reassurance, and avoidance of other men, which resulted in depressive symptoms and marital distress. The patient received 17 EX/RP sessions, administered twice per week. The effect of treatment was evaluated using standardized rating instruments and self-monitoring by the patient. OCD symptoms on the Yale-Brown Obsessive Compulsive Scale (YBOCS) fell from 24 at intake to 3 at posttreatment and to 4 at a 6-week follow-up, indicating minimal symptoms. Improvement also occurred in mood, quality of life, and social adjustment. Issues concerning the assessment and treatment of homosexuality-themed obsessions in OCD are highlighted and discussed.
Williams, Monnica T.; Crozier, Marjorie; Powers, Mark
Yale-Brown Obsessive Compulsive Scale and US National Institute of Mental Health Global Obsessive Compulsive Scale in Turkish: reliability and validity.
Fifteen patients with DSM-III-R diagnosis of obsessive-compulsive disorder (OCD) were rated according to the Turkish version of the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the US National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH-GOCS) by 7 raters independently from audiotaped interviews. Patients also completed the Maudsley Obsessive Compulsive Inventory (MOCI). Interrater reliability of Y-BOCS and NIMH-GOCS were very good as well as correlations between these two scales. The correlations of MOCI with Y-BOCS and NIMH-GOCS were not significant. We found Y-BOCS and NIMH-GOCS to be reliable and valid instruments in assessing the severity of OCD. These findings suggest that MOCI may not be a suitable instrument for assessing the severity of OCD. PMID:7676839
Tek, C; Ulu?, B; Rezaki, B G; Tanriverdi, N; Mercan, S; Demir, B; Vargel, S
Epilepsy and obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) has long been associated with epilepsy. The link with temporal lobe (usually refractory) epilepsy (TLE) is particularly prominent. Of TLE patients, 10% to 22% of patients may have OCD, often underdiagnosed in the outpatient clinic. Data on the links include case reports, case series, and controlled studies. Three larger, controlled studies in TLE patients, using comprehensive epilepsy and OCD classifications, in aggregate, have noted the obsessive qualities of washing, symmetry/exactness, and ordering, with a greater preoccupation with certain aspects of religion, compared with controls or patients with idiopathic generalized epilepsy. TLE foci may be either left- or right-sided. Social and neurobiological factors are involved in OCD in TLE. The neurobiology implicates a pathophysiological or structural impairment of the orbitofrontal-thalamic, and frontothalamic-pallidal-striatal-anterior cingulate-frontal circuits. Discrete anatomic lesions in these pathways, or their surgical removal, may induce (or conversely) improve OCD in TLE patients.
Kaplan, Peter W.
Epilepsy and obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) has long been associated with epilepsy The link with temporal lobe (usually refractory) epilepsy (TLE) is particularly prominent Of TLE patients, 10% to 22% of patients may have OCD, often underdiagnosed in the outpatient clinic. Data on the links include case reports, case series, and controlled studies. Three larger, controlled studies in TLE patients, using comprehensive epilepsy and OCD classifications, in aggregate, have noted the obsessive qualities of washing, symmetry/exactness, and ordering, with a greater preoccupation with certain aspects of religion, compared with controls or patients with idiopathic generalized epilepsy. TLE foci may be either left- or right-sided. Social and neurobiological factors are involved in OCD in TLE. The neurobiology implicates a pathophysiological or structural impairment of the orbitofrontal-thalamic, and fronto-thalamic-pallidal-striatal-anterior cingulate-frontal circuits. Discrete anatomic lesions in these pathways, or their surgical removal, may induce (or conversely) improve OCD in TLE patients. PMID:20623928
Kaplan, Peter W
Self-mutilation, anorexia, and dysmenorrhea in obsessive compulsive disorder.
This report described 19 female patients (M = 23.5) diagnosed as obsessive compulsive disorder (OCD; DSM-III-R) who exhibited additional symptoms of self-mutilation, dysmenorrhea, and dysorexia. A biphasic pattern related to menstruation during the course of OCD emerged: Phase 1, amenorrheic--characterized by anorexia nervosa, amenorrhea, and aggressive behavior, and Phase 2, postamenorrheic--characterized by self-mutilation following the return of the menstrual cycle, dysorexia, and aggressive behavior. All mutilative acts were reported by the patients to be painless and consisted of slashes. Seventy percent of the patients were sexually abused during childhood. All patients underwent an open trial of clomipramine (M = 200 mg/day) for 6 months, and intensive behavior therapy for 8 weeks. Based on clinical observations and self-reports, there was a decrease in self-harm and OCD symptoms. The emergence of OCD, self-mutilation, dysorexia, and dysmenorrhea in a sequential manner may suggest a specific clinical syndrome or the presence of an OCD subset. A biological working hypothesis of a hypothalamic dysfunction with serotonergic participation was suggested. PMID:7894450
Yaryura-Tobias, J A; Neziroglu, F A; Kaplan, S
The anteromedial GPi as a new target for deep brain stimulation in obsessive compulsive disorder.
Deep brain stimulation (DBS) is now well established in the treatment of intractable movement disorders. Over the past decade the clinical applications have expanded into the realm of psychosurgery, including depression and obsessive compulsive disorder (OCD). The optimal targets for electrode placement in psychosurgery remain unclear, with numerous anatomical targets reported for the treatment of OCD. We present four patients with Tourette's syndrome and prominent features of OCD who underwent DBS of the anteromedial globus pallidus internus (GPi) to treat their movement disorder. Their pre-operative and post-operative OCD symptoms were compared, and responded dramatically to surgery. On the basis of these results, we propose the anteromedial (limbic) GPi as a potential surgical target for the treatment of OCD, and furnish data supporting its further investigation as a DBS target for the treatment of psychiatric conditions. PMID:24524950
Nair, Girish; Evans, Andrew; Bear, Renee E; Velakoulis, Dennis; Bittar, Richard G
A quantitative analysis of facial emotion recognition in obsessive-compulsive disorder.
Obsessive-Compulsive Disorder (OCD) is characterized by persistent and unwanted obsessions generally accompanied by ritualistic behaviors or compulsions. Previous research proposed specific disgust facial emotion recognition deficits in patients with OCD. This research however, remains largely inconsistent. Therefore, the results of 10 studies contrasting facial emotion recognition accuracy in patients with OCD (n=221) and non-psychiatric controls (n=224) were quantitatively reviewed and synthesized using meta-analytic techniques. Patients with OCD were less accurate than controls in recognizing emotional facial expressions. Patients were also less accurate in recognizing negative emotions as a whole; however, this was largely due to significant differences in disgust and anger recognition specifically. The results of this study suggest that patients with OCD have difficulty recognizing specific negative emotions in faces and may misclassify emotional expressions due to symptom characteristics within the disorder. The contribution of state-related emotion perception biases to these findings requires further clarification. PMID:24411075
Daros, Alexander Robert; Zakzanis, Konstantine K; Rector, Neil Alexander
Prevalence of obsessive-compulsive disorder in Iran
BACKGROUND: Estimates of the annual prevalence for Obsessive Compulsive Disorder (OCD) were consistent across the international sites range, 1.9% � 2.5%. The nine population surveys, which used Diagnostic Interview Schedule, estimated a six-month prevalence of OCD ranging from 0.7% to 2.1%. This study performed in order to determine the prevalence of OCD in a population-based study among Iranian adults aged
Mohammad Reza Mohammadi; Ahmad Ghanizadeh; Mehdi Rahgozar; Ali Ahmad Noorbala; Haratoun Davidian; Hossein Malek Afzali; Hamid Reza Naghavi; Seyed Abbas Bagheri Yazdi; Seyed Saberi; Bita Mesgarpour; Shahin Akhondzadeh; Javad Alaghebandrad; Mehdi Tehranidoost
Attribution retraining group therapy for outpatients with major depression disorder, generalized anxiety disorder, and obsessive-compulsive disorder: a pilot study?
The aim of this present study is to examine the efficacy of attribution retraining group therapy (ARGT) and to compare the responses of outpatients with major depression disorder (MDD), generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). We carried out a prospective uncontrolled intervention study with a 8-weeks of ARGT on sixty three outpatients with MDD, GAD or OCD. Hamilton rating scale for depression, Hamilton rating scale for anxiety, Yale-Brown obsessive-compulsive scale, attribution style questionnaire, self-esteem scale, index of well-being, and social disability screening schedule were administered before and after treatment. Significant improvement in symptoms and psychological and social functions from pre- to posttreatment occurred for all participants. The changes favored MDD patients. Our study suggested that ARGT may improve the symptoms and psychological-social functions of MDD, GAD, and OCD patients. MDD patients showed the best response.
Wang, Chun; Zhang, Jie; Li, Jijun; Zhang, Ning; Zhang, Yalin
Obsessive compulsive behavior, hyperactivity, and attention deficit disorder in Sydenham chorea.
The authors investigated obsessive-compulsive behavior, obsessive-compulsive disorder (OCD), and attention deficit and hyperactivity disorder (ADHD) in 50 healthy subjects, 50 patients with rheumatic fever without chorea, and 56 patients with Sydenham chorea. Obsessive-compulsive behavior, OCD, and ADHD were more frequent in the Sydenham chorea group (19%, 23.2%, 30.4%) than in the healthy subjects (11%, 4%, 8%) and in the rheumatic fever without chorea group (14%, 6%, 8%). ADHD was more common in persistent Sydenham chorea. PMID:15911817
Maia, D�bora Palma; Teixeira, Ant�nio L�cio; Quint�o Cunningham, Mauro C�sar; Cardoso, Francisco
Obsessive-compulsive disorder and spectrum across the life span.
An obsessive-compulsive disorder (OCD) spectrum has been proposed, which includes a group of disorders that share certain features with OCD including clinical symptoms (repetitive behaviours and thoughts), neurobiology (e.g. neurotransmitters) and preferential response to anti-obsessional treatments, such as the selective serotonin reuptake inhibitors (SSRIs). Three distinct clusters have been identified within the OCD spectrum, i.e. disorders concerning preoccupations with bodily sensations or appearance, impulsive disorders, and neurologically based disorders, and these share phenotypic features. Using one example from each of these clusters, body dysmorphic disorder (BDD), pathological gambling (PG) and autism, respectively, the phenomenology, neurobiology and pharmacotherapy indicates that specific biological factors are shared by OCD and by these disorders and correlate with the severity of repetitive behaviours. Thus, in common with OCDs, in BDD there is increased activity in the limbic regions; in PG there is evidence of deficiencies in 5-HT function and receptors; and in autism there are restricted interests and repetitive behaviours which may be influenced by serotonergic mechanisms. Our findings support the notion that targeted treatments, for example using SSRIs, for the behaviours associated with these disorders are effective. Our review considers one SSRI treatment in particular, fluvoxamine, and conclusions should be drawn in light of this. Further testing of our hypothesis would be prudent to confirm its validity. PMID:24930787
Hollander, Eric
Effect of Prefrontal Repetitive Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder: A Preliminary Study
Objective: Prefrontal mechanisms are implicated in obsessive-compulsive disorder. The authors investigated whether prefrontal repetitive transcranial magnetic stimulation influenced obsessive-compulsive disorder symptoms. Method: Twelve patients with obsessive-compulsive disorder were given repetitive transcranial magnetic stimulation (80% motor threshold, 20 Hz\\/2 seconds per minute for 20 minutes) to a right lateral prefrontal, a left lateral prefrontal, and a midoccipital (control) site on separate
Benjamin D. Greenberg; Mark S. George; Juliet D. Martin; Jonathan Benjamin; Thomas E. Schlaepfer; Margaret Altemus; Eric M. Wassermann; Robert M. Post; Dennis L. Murphy
A Preliminary Study on the Effects of Attachment-based Intervention on Pediatric Obsessive-Compulsive Disorder
Background: Research on attachment has shed new light on understanding one of the underlying mechanisms of psychopathology in children. The aim of this study was to investigate the therapeutic efficacy of attachment-based intervention in a pediatric sample with obsessive-compulsive disorder (OCD). Methods: Twelve participants, 10-12 years of age, were treated across an eight-week period. They had not been treated with either pharmacotherapy or psychotherapy previously and remained medication-free during the attachment-based therapy. This study comprised two groups of children: The experimental group, who received attachment-based intervention, and the control group, who did not receive treatment. All participants were assessed in terms of severity of OCD symptoms by administrating the Children's Yale-Brown Obsessive-Compulsive Scale before and after the experimental group had received the therapeutic sessions. The children were assessed again one month later. The level of children's depression, and attachment insecurity, as well as their mothers� depression, OCD symptoms, and attachment insecurity, were statistically controlled in this study. Results: Multivariate analysis of covariance (MANCOVA) indicated that the OCD symptoms in children decreased significantly over the course of the therapy, and this gain was maintained at follow-up. The results of this study demonstrated that the attachment-based intervention was efficacious in alleviating the OCD symptoms. Conclusion: It is suggested that parental instruction in attachment-based relationships may help prevent young children from developing OCD symptoms in middle-childhood and adulthood.
Rezvan, Shiva; Bahrami, Fatemeh; Abedi, Mohamadreza; Macleod, Colin; Doost, Hamid Taher Neshat; Ghasemi, Vahid
Thought-action fusion in obsessive compulsive disorder
Recent psychometric results suggested that the phenomenon of thought-action fusion (TAF) is implicated in obsessive compulsive disorder (OCD). The construct of TAF has two components: (a) the belief that thinking about an unacceptable or disturbing event makes it more likely to happen and (b) the belief that having an unacceptable thought is the moral equivalent of carrying out the unacceptable
Roz Shafran; Dana S. Thordarson; S. Rachman
Temper outbursts in paediatric obsessive-compulsive disorder and their association with depressed mood and treatment outcome
Background Temper outbursts in youth with obsessive-compulsive disorder (OCD) are a common source of concern, but remain poorly understood. This study examined a set of hypotheses related to: (a) the prevalence of temper outbursts in paediatric OCD, (b) the associations of temper outbursts with OCD severity and depressive symptoms; and (c) the influence of temper outbursts on treatment response. Methods The prevalence of temper outbursts was estimated in a specialist OCD clinical sample (n = 387) using parent- and child-report. This was replicated in a community sample (n = 18,415). Associations of temper outbursts with obsessive-compulsive symptoms and with depressed mood were examined using logistic regression models. The influence of temper outbursts on treatment response was examined in a subsample of 109 patients treated with cognitive behaviour therapy (CBT) with or without medication. Results Over a third of young people with OCD displayed temper outbursts, and rates were similar across the clinical and community samples. Temper outbursts were two to three times more common in youth with OCD than in healthy controls. However, OCD symptom severity was not a strong predictor of child- or parent-reported temper outbursts. Instead, both child- and parent- reported temper outbursts were significantly associated to depressive symptoms. CBT strongly reduced OCD and depressive symptoms, as well as the severity of temper outbursts. There was no significant difference in post-treatment OCD or depression scores between those with temper outbursts compared to those without. Conclusions Temper outbursts are common in youth with OCD and are particularly related to depressed mood. They improve with CBT for OCD and do not seem to impede OCD treatment response.
Krebs, Georgina; Bolhuis, Koen; Heyman, Isobel; Mataix-Cols, David; Turner, Cynthia; Stringaris, Argyris
Neuroimaging studies in patients with obsessive-compulsive disorder in China
Summary Obsessive-compulsive disorder (OCD) is a common mental disorder of uncertain etiology. Neuroimaging studies of patients with OCD in China started to appear in the late 1990s, identifying structural abnormalities in the gray matter and white matter of the prefrontal lobe, the corpus striatum, and the thalamus. Studies using positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and magnetic resonance spectroscopy (MRS) have found increased metabolism and activation in these brain regions that are correlated with the duration, severity and cognitive symptoms of OCD. After surgery for OCD the activation in these target areas decreases. These results in China are similar to those presented in previous neuroimaging studies, including several meta-analyses from other countries.
Fan, Qing; Xiao, Zeping
Commonly asked questions in the treatment of obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a common and often a highly disabling condition that was considered untreatable before the 1960s. The advent of serotonin reuptake inhibitors and exposure and response prevention revolutionized the treatment of OCD. Although they are still the first line treatments for OCD, new treatments like augmentation strategies, brain stimulation techniques, psychosurgery, newer forms of psychotherapy (like cognitive therapy, acceptance and commitment therapy) have been added to the armamentarium. With the available treatment strategies, many patients can achieve at least partial remission of symptoms. Nevertheless, the plethora of information gives rise to many questions on their application for practicing clinicians. We provide evidence-based responses to these questions and suggest a broad guideline for treatment of OCD. PMID:24372473
Arumugham, Shyam Sundar; Reddy, Y C Janardhan
Clozapine-associated development of second-onset obsessive compulsive symptoms in schizophrenia: impact of clozapine serum levels and fluvoxamine add-on.
Among antiserotonergic second generation antipsychotics (SGA), particularly treatment with clozapine (CLZ) is associated with the development of second-onset obsessive compulsive symptoms (OCS) in schizophrenia. However, less is known regarding the factors that increase the individual susceptibility for the development of SGA-associated second-onset OCS in schizophrenia. Here we present the case of a 29-year-old female patient with disorganized schizophrenia who exhibited OCS due to fluvoxamine-induced elevation of CLZ serum levels via inhibition of CYP 1A2 und 2C19. The severity of the observed OCS featured an association with CLZ serum levels. The case illustrates the interaction between fluvoxamine add-on and CLZ serum levels on the development of OCS in schizophrenia and emphasizes the need of regular therapeutic drug monitoring. PMID:24846087
Gahr, M; Rehbaum, K; Connemann, B J
Dopaminergic activity in Tourette syndrome and obsessive-compulsive disorder.
Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) both are neuropsychiatric disorders associated with abnormalities in dopamine neurotransmission. Aims of this study were to quantify striatal D2/3 receptor availability in TS and OCD, and to examine dopamine release and symptom severity changes in both disorders following amphetamine challenge. Changes in [(11)C]raclopride binding potential (BP(ND)) were assessed using positron emission tomography before and after administration of d-amphetamine (0.3 mg kg(-1)) in 12 TS patients without comorbid OCD, 12 OCD patients without comorbid tics, and 12 healthy controls. Main outcome measures were baseline striatal D2/3 receptor BP(ND) and change in BP(ND) following amphetamine as a measure of dopamine release. Voxel-based analysis revealed significantly decreased baseline [(11)C]raclopride BP(ND) in bilateral putamen of both patient groups vs. healthy controls, differences being more pronounced in the TS than in the OCD group. Changes in BP(ND) following amphetamine were not significantly different between groups. Following amphetamine administration, tic severity increased in the TS group, which correlated with BP(ND) changes in right ventral striatum. Symptom severity in the OCD group did not change significantly following amphetamine challenge and was not associated with changes in BP(ND). This study provides evidence for decreased striatal D2/3 receptor availability in TS and OCD, presumably reflecting higher endogenous dopamine levels in both disorders. In addition, it provides the first direct evidence that ventral striatal dopamine release is related to the pathophysiology of tics. PMID:23876376
Denys, Damiaan; de Vries, Froukje; Cath, Danielle; Figee, Martijn; Vulink, Nienke; Veltman, Dick J; van der Doef, Thalia F; Boellaard, Ronald; Westenberg, Herman; van Balkom, Anton; Lammertsma, Adriaan A; van Berckel, Bart N M
Distinct functional connectivity of limbic network in the washing type obsessive-compulsive disorder.
Neurobiological models of obsessive-compulsive disorder (OCD) emphasize disturbances of the corticostriatal circuit, but it remains unclear as to how these complex network dysfunctions correspond to heterogeneous OCD phenotypes. We aimed to investigate corticostriatal functional connectivity alterations distinct to OCD characterized predominantly by contamination/washing symptoms. Functional connectivity strengths of the striatal seed regions with remaining brain regions during the resting condition and the contamination symptom provocation condition were compared among 13 OCD patients with predominant contamination/washing symptoms (CON), 13 OCD patients without these symptoms (NCON), and 18 healthy controls. The CON group showed distinctively altered functional connectivity between the ventral striatum and the insula during both the resting and symptom-provoking conditions. Also, the connectivity strength between the ventral striatum and the insula significantly correlated with contamination/washing symptom severity. As common connectivity alterations of the whole OCD subjects, corticostriatal circuits involving the orbitofrontal and temporal cortices were again confirmed. To our knowledge, this is the first study that examined specific abnormalities in functional connectivity of contamination/washing symptom dimension OCD. The findings suggest limbic network dysfunctions to play a pivotal role in contamination/washing symptoms, possibly associated with emotionally salient error awareness. Our study sample allowed us to evaluate the corticostriatal network dysfunction underlying the contamination/washing symptom dimension, which leaves other major symptom dimensions to be explored in the future. PMID:24768985
Jhung, Kyungun; Ku, Jeonghun; Kim, Se Joo; Lee, Hyeongrae; Kim, Kyung Ran; An, Suk Kyoon; Kim, Sun I; Yoon, Kang-Jun; Lee, Eun
Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis.
Psychological treatments for obsessive-compulsive disorder (OCD) are increasingly aimed at improving outcomes by directly incorporating family members to address family disruption, dysfunction, or symptom accommodation. Much remains to be learned about the pooled effects of "family inclusive treatment" (FIT) for OCD and factors that may explain variation in response. Random-effects meta-analytic procedures were conducted to empirically evaluate the overall effect of FITs on OCD, and treatment moderators. Study search criteria yielded 29 studies examining FIT response in 1,366 OCD patients. Outcome variables included OCD symptoms and global functioning. Examined moderators included age group, gender, minority status, treatment length and format, and inclusion of specific family focused treatment elements. FITs for OCD demonstrated a large overall effect on OCD symptoms (pooled d = 1.68, SE = 0.14) and global functioning (pooled d = 0.98, SE = 0.14). Moderator analyses found that individual family treatments (vs. group) and FITs targeting family accommodation of symptoms (vs. those that did not target accommodation) were associated with greater improvements in patient functioning. Results indicate a robust overall response to FITs for OCD and clarify key moderators that inform optimal circumstances for effective treatment. Findings underscore the need for continued momentum in the development, evaluation, and dissemination of FITs for OCD. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24798816
Thompson-Hollands, Johanna; Edson, Aubrey; Tompson, Martha C; Comer, Jonathan S
Moving beyond an exclusive focus on harm avoidance in obsessive compulsive disorder: considering the role of incompleteness.
Cognitive-behavioral conceptualizations of obsessive compulsive disorder (OCD) have predominantly viewed compulsions as being motivated by harm avoidance. However, sensations of things being incomplete or not "just right" may also underlie compulsions in OCD. Preliminary research suggests that distinguishing between harm avoidance and incompleteness in OCD may have practical utility, but the research on this topic is very limited to date. The current study further addressed the role of incompleteness in OCD. A confirmatory factor analysis provided evidence for harm avoidance and incompleteness as separate constructs in a student sample. Supporting the benefits of considering incompleteness in addition to harm avoidance, self-reported levels of both constructs were significantly correlated with all domains of OCD symptoms and perfectionism assessed. Further, some evidence for unique relationships was found (e.g., incompleteness with ordering and personally prescribed perfectionism; harm avoidance with obsessing). The role of incompleteness in OCD warrants greater attention. PMID:18721636
Pietrefesa, Ashley S; Coles, Meredith E
Schema and Locus of Control as Predictors of Obsessive Compulsive Disorder
Objective The study aimed to evaluate the correlation of maladjusted schema and locus of control with OCD, with the emphasis on cognitive approach to OCD. Method In this study, 273 Iranian participants were selected; of whom, 30% were male and 70% were female. Participants' age ranged from 19 to 34 and the mean age for the sample was 23.42(SD=2.46). Participants completed questionnaire batteries including measure of Levenson Locus of Control, Young Schema Scale and Y �bocsOCD Scale. One sample consisted of patients with a primary OCD according to DSM-IV criteria. The other sample selected for this cross-sectional study was university students. Result Regression statistics item and reliability analysis were calculated with SPSS and LISREL software. Obsessive compulsive disorder was significantly predicted with both schema and powerful others� locus of control, as these relations were large but association schema with OCDwas larger than the correlation OCD with powerful others (OCD with schema p.v<0.001 ?=.47 and OCD with powerful others p.v<0.001 ?=.15). Conclusion The findings of the present study showed that schema and powerful others type of locus of control, were significantly related to both total OCD symptom severity and also to other sub scale of OCD. It is important to mention that schema can significantly predict all symptoms dimension of OCD. Furthermore, the analyses showed that schema was a strong predictor for obsessive thinking.
Gasparyan, Khachatur
Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder.
Cognitive accounts of obsessive compulsive disorder (OCD) assert that core beliefs are crucial to the development, maintenance, and treatment of the disorder. There are a number of obsessive beliefs that are considered fundamental to OCD, including personal responsibility, threat estimation, perfectionism, need for certainty, importance of thoughts, and thought control. The present study investigated if pretreatment severity of obsessive beliefs, as well as the change in obsessive beliefs following treatment, predicted intensive, residential cognitive behavioral therapy (CBT) treatment outcome. A series of hierarchical regression analyses were carried out to investigate the relations between obsessive beliefs and treatment outcome. Results indicated that inflated pretreatment responsibility/threat estimation beliefs were significantly related to less overall obsessive compulsive (OC) symptom reduction at discharge, explaining 2% of the overall variance. Changes in obsessive beliefs broadly, and importance/control of thoughts specifically, were positively related to overall OC symptom reduction at discharge, respectively explaining 18% and 3.6% variance. Results are modestly consistent with a number of theoretical models, which argue that inflated responsibility, threat estimation, and thought control are important to the maintenance and treatment of OCD. PMID:22309121
Adams, Thomas G; Riemann, Bradley C; Wetterneck, Chad T; Cisler, Josh M
Development and validation of the Japanese version of the obsessive-compulsive inventory
Background The Obsessive-Compulsive Inventory (OCI) was designed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical samples. The aim of the study was to develop a Japanese version of this scale (OCI-J) and validate it in both non-clinical and clinical Japanese samples. Findings In Study 1, the OCI-J, the Maudsley Obsessional Compulsive Inventory (MOCI), and measures of anxiety and depression were administered to 150 undergraduate students (non-clinical sample) in order to investigate the internal consistency and convergent validity of the OCI-J. Furthermore, 118 non-clinical participants completed the OCI-J after a 2-week interval to determine the test-retest reliability. In Study 2, OCD participants (n?=?35), anxiety control participants with panic disorder (n?=?22), and healthy control participants (n?=?37) completed the OCI-J in order to test its clinical discrimination ability. Correlational analysis indicated moderate to high correlations between the subscales and total scores of the OCI-J and MOCI. In addition, the OCI-J and its subscales demonstrated satisfactory test-retest reliabilities. Finally, the OCI-J showed good clinical discrimination for patients with OCD from healthy and anxiety controls. Conclusions The OCI-J is a valid and reliable instrument for measuring OCD symptoms in both clinical and non-clinical samples of Japanese.
Children with obsessive-compulsive disorder: are they just "little adults"?
Childhood-onset obsessive-compulsive disorder (OCD) affects 1%�2% of children and adolescents. It is characterized by recurrent obsessions and compulsions that create distress and interfere with daily life. The symptoms reported by children are similar to those seen among individuals who develop OCD in adulthood, and the two groups of patients are treated with similar symptom-relieving behavior therapies and medications. However, there are differences in sex ratios, patterns of comorbidity, and the results of neuroimaging studies that might be important. Here we review the diagnosis and treatment of childhood-onset OCD in light of pediatric and adult studies. We also discuss current knowledge of the pathophysiology of the disorder. Despite advances in this area, further research is needed to understand better the etiopathogenesis of the disorder and to develop new, more effective therapeutic options.
Kalra, Simran K.; Swedo, Susan E.
Clinical correlates of word recognition memory in obsessive�compulsive disorder: An event-related potential study
Memory disturbances found in obsessive�compulsive disorder (OCD) may partially be related to dysfunction of cortico�subcortical circuits. However, it is still unknown how OCD symptomatology is related to memory processing. To explore this question, event-related potentials (ERPs) were recorded in a continuous word-recognition paradigm in OCD patients with either severe or moderate scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (group S
Yuanyuan Zhang; Sebastian Feutl; Ute Hauser; Claudia Richter-Witte; Philip Schmorl; Hinderk M. Emrich; Detlef E. Dietrich
... Traditionally, OCD was thought to �run in families.� Genetic studies now suggest that variations in certain genes ... might lead to some cases of OCD. Using genetic engineering, NIH-funded researchers created an OCD-like ...
A promising randomized trial of a new therapy for obsessive-compulsive disorder
Pharmacotherapy and cognitive�behavioral therapy (CBT) are currently the most effective interventions for treating obsessive�compulsive disorder (OCD). These treatments, however, are time consuming and in some cases the patients do not show significant improvement. In all, 30%�60% of OCD patients do not respond adequately to pharmacotherapy and 20%�40% of OCD patients who complete CBT do not improve significantly, suggesting a more efficacious approach is needed. The objectives of this study are to demonstrate an efficacious pharmacotherapy plus psychotherapy, named cognitive�coping therapy (CCT), for OCD and to investigate the efficacy of this approach in a larger sample size. Therefore, a total of 108 patients with OCD were randomly allocated into three groups: pharmacotherapy (N = 38), pharmacotherapy plus CBT (PCBT, N = 34), and pharmacotherapy plus CCT (PCCT, N = 36). The severity of symptoms and the patients' functioning were assessed pretreatment and after 7, 14, 21 days, and 1-, 3-, 6-, and 12-month treatment using the Yale-Brown Obsessive Compulsive Scale and Global Assessment of Functioning (GAF). Compared with the pharmacotherapy and PCBT groups, the severity of OCD symptoms was significantly reduced (P < 0.001), the rates of response (100%) and remission (85.0%) were significantly higher (P < 0.001), and relapse rate was lower (P = 0.017) in PCCT group during the 1-year follow-up. In addition, the GAF score was significantly higher in the PCCT group than in the other two groups (P < 0.001). Our preliminary data suggest that PCCT is a more efficacious psychotherapy for OCD patients than pharmacotherapy or PCBT.
Hu, Xian-Zhang; Wen, You-Sheng; Ma, Jian-Dong; Han, Dong-Ming; Li, Yu-Xia; Wang, Shu-Fan
Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective.
Obsessive-compulsive disorder (OCD) is characterized by repetitive thoughts and behaviours that are experienced as unwanted. Family and twin studies have demonstrated that OCD is a multifactorial familial condition that involves both polygenic and environmental risk factors. Neuroimaging studies have implicated the cortico-striato-thalamo-cortical circuit in the pathophysiology of the disorder, which is supported by the observation of specific neuropsychological impairments in patients with OCD, mainly in executive functions. Genetic studies indicate that genes affecting the serotonergic, dopaminergic and glutamatergic systems, and the interaction between them, play a crucial part in the functioning of this circuit. Environmental factors such as adverse perinatal events, psychological trauma and neurological trauma may modify the expression of risk genes and, hence, trigger the manifestation of obsessive-compulsive behaviours. PMID:24840803
Pauls, David L; Abramovitch, Amitai; Rauch, Scott L; Geller, Daniel A
Family-Based Treatment of Early Childhood Obsessive-Compulsive Disorder: The Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr)-A Randomized Clinical Trial.
IMPORTANCE Cognitive behavior therapy (CBT) has been established as efficacious for obsessive-compulsive disorder (OCD) among older children and adolescents, yet its effect on young children has not been evaluated sufficiently. OBJECTIVE To examine the relative efficacy of family-based CBT (FB-CBT) involving exposure plus response prevention vs an FB relaxation treatment (FB-RT) control condition for children 5 to 8 years of age. DESIGN, SETTING, AND PARTICIPANTS A 14-week randomized clinical trial (Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children [POTS Jr]) conducted at 3 academic medical centers between 2006 and 2011, involving 127 pediatric outpatients 5 to 8 years of age who received a primary diagnosis of OCD and a Children's Yale-Brown Obsessive Compulsive Scale total score of 16 or higher. INTERVENTIONS Participants were randomly assigned to 14 weeks of (1) FB-CBT, including exposure plus response prevention, or (2) FB-RT. MAIN OUTCOMES AND MEASURES Responder status defined as an independent evaluator-rated Clinical Global Impression-Improvement scale score of 1 (very much improved) or 2 (much improved) and change in independent evaluator-rated continuous Children's Yale-Brown Obsessive Compulsive Scale total score. RESULTS Family-based CBT was superior to FB-RT on both primary outcome measures. The percentages of children who were rated as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale at 14 weeks were 72% for FB-CBT and 41% for FB-RT. The effect size difference between FB-CBT and FB-RT on the Clinical Global Impression-Improvement scale was 0.31 (95% CI, 0.17-0.45). The number needed to treat (NNT) with FB-CBT vs FB-RT was estimated as 3.2 (95% CI, 2.2-5.8). The effect size difference between FB-CBT and FB-RT on the Children's Yale-Brown Obsessive Compulsive Scale at week 14 was 0.84 (95% CI, 0.62-1.06). CONCLUSIONS AND RELEVANCE A comprehensive FB-CBT program was superior to a relaxation program with a similar format in reducing OCD symptoms and functional impairment in young children (5-8 years of age) with OCD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00533806. PMID:24759852
Freeman, Jennifer; Sapyta, Jeffrey; Garcia, Abbe; Compton, Scott; Khanna, Muniya; Flessner, Chris; FitzGerald, David; Mauro, Christian; Dingfelder, Rebecca; Benito, Kristen; Harrison, Julie; Curry, John; Foa, Edna; March, John; Moore, Phoebe; Franklin, Martin
Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates
To reduce the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) for genetic, clinical and translational studies,\\u000a numerous factor analyses of the Yale-Brown Obsessive Compulsive Scale checklist (YBOCS-CL) have been conducted. Results of\\u000a these analyses have been inconsistent, likely as a consequence of small sample sizes and variable methodologies. Furthermore,\\u000a data concerning the heritability of the factors are limited. Item and category-level
Hilga Katerberg; Kevin L. Delucchi; S. Evelyn Stewart; Christine Lochner; Damiaan A. J. P. Denys; Denise E. Stack; J. Michael Andresen; J. E. Grant; Suck W. Kim; Kyle A. Williams; Johan A. den Boer; Johannes H. Smit; Patricia van Oppen; Annemiek Polman; Michael A. Jenike; Dan J. Stein; Carol A. Mathews; Danielle C. Cath
Assessment of obsessive beliefs: Comparing individuals with obsessive-compulsive disorder to a medical sample
Cognitive behavior models for Obsessive-Compulsive Disorder (OCD) are based currently on the presence of specific beliefs associated with the disorder. Among these beliefs are inflated responsibility, concerns over thought-action fusion, and overimportance of thoughts. The aim of this study was to compare scores from the subscales of the Obsessive Beliefs Questionnaire (OBQ-87), developed by the Obsessive-Compulsive Cognitions Working Group (OCCWG,
Makilim Nunes Baptista; Luiz Alberto Magna; Dean McKay; Jos� Alberto Del-Porto
Obsessive-compulsive disorder in Tourette's syndrome.
A substantial body of scientific evidence suggests that obsessive-compulsive behavior occurs in a large percentage of patients with TS. Reliable estimates suggest that nearly 50% of patients with TS have some degree of obsessive-compulsive features. Most patients with TS have only mild OCB and thus would not meet the DSM-IV diagnostic criteria for OCD. Therefore, OCB is perhaps a more appropriate characterization of this behavioral phenomenon that occurs in TS. OCB in TS appears similar to the spectrum of the tic disorder in terms of its onset, severity, and course. As with tics, OCB is typically mild and not always substantially disabling. Although clinical features between TS + OCB and primary OCD overlap considerably, patients with TS + OCB appear to experience different types of obsessive thoughts and compulsive rituals. Compelling genetic evidence suggests that OCB may be an alternative expression of the TS phenotype, which may selectively affect female gene carriers. Identifying the TS gene in the future will substantially broaden our knowledge of this intriguing neurobehavioral disorder. Finally, neurobiologic evidence points to similar anatomic and chemical substrates in the pathogenesis of TS and OCD, suggesting that these two disorders share a common pathophysiology. The clinical evaluation of patients with TS and their families should always include an assessment for OCB. Self-rated inventories of OCD such as the LOI, LOI-CV, and MOCI are useful screening scales. A more structured interview using the Y-BOCS (CY-BOCS) is useful for determining the degree and severity of OCB in TS as well as the response to therapy. Clinicians should keep in mind that OCB may be the most disabling feature of TS and may require treatment. Pharmacologic agents, such as SSRIs, and traditional behavioral therapy are proven effective treatments for OCB, which can substantially reduce the full effect of TS on patients and their families. PMID:16383224
Como, Peter G; LaMarsh, Jennifer; O'Brien, Katherine A
... the person's mind. OCD is a type of anxiety disorder. People with OCD become preoccupied with whether something ... family members who also have it or other anxiety disorders influenced by the brain's serotonin levels. Because of ...
Korean Self-Report Version of the Yale-Brown Obsessive-Compulsive Scale: Factor Structure, Reliability, and Validity
Objective Although several self-report versions of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been developed and used widely, few psychometric studies have established the construct validity of this measure. Therefore, we developed Korean self-report version of the Y-BOCS and evaluated its factor structure, reliability, and validity. Methods A non-clinical student sample (n=206) and a clinical OCD sample (n=199) completed the Korean self-report version and other measures of obsessive-compulsive disorder (OCD), depression, and anxiety. Results Consistent with the originally proposed structure, confirmatory factor analyses supported a factor structure comprised of Obsessions and Compulsions factors in the Korean self-report version. Two subscale scores and the total score of the Korean self-report version showed good internal consistency and convergent validity, but relatively poor discriminant validity. Applying a cutoff score of 16, 84% of OCD patients and 93% of the non-clinical sample were classified correctly. Conclusion Korean self-report version of the Y-BOCS is a psychometrically sound and valid measure for assessing OCD symptoms as compared with the clinician-administered version. The originally proposed division of OCD severity into obsessions and compulsions appears accurate in the Korean self-report version. The cutoff score for the Korean self-report version needs adjustment based on further researches.
Seol, Soon-Ho; Kwon, Jun Soo
Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder
Chronic tic disorders (TD) are consistently found to have high rates of comorbidity with obsessive�compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). The purpose of this study is to compare the severity of TD only to TD with comorbid OCD or ADHD based on severity of tics, measures of psychopathology and additional comorbid diagnoses. Baseline data from 158 youth with a chronic TD who participated in two longitudinal studies were examined. Fifty-three percent (N = 85) of the youth also met criteria for a diagnosis of OCD, 38.6 % (n = 61) met criteria for ADHD and 24.1 % (N = 38) met criteria for both. Measures of interest addressed severity of tics, symptoms of anxiety, depression, ADHD, psychosocial stress, global functioning and the presence of comorbid diagnoses. Youth with comorbid TD and OCD were characterized by more severe tics, increased levels of depressive and anxious symptoms, heightened psychosocial stress and poorer global functioning. Youth with comorbid TD and ADHD did not differ from those with TD alone on measures of tic severity, but experienced greater psychosocial stress and poorer global functioning. Subjects with comorbid TD and OCD had more internalizing disorders than those without OCD, while those with comorbid ADHD were more likely to meet criteria for oppositional defiant disorder. TD with OCD is a more severe subtype of TD than TD without OCD. TD with ADHD is associated with higher psychosocial stress and more externalizing behaviors. Further research is needed into the underlying relationships between these closely associated conditions.
Motlagh, Maria G.; Katsovich, Liliya; King, Robert A.; Lombroso, Paul J.; Grantz, Heidi; Lin, Haiqun; Bentley, Mary Jane; Gilbert, Donald L.; Singer, Harvey S.; Coffey, Barbara J.; Kurlan, Roger M.; Leckman, James F.
... has OCD and not even realize it. What's Life Like for Someone With OCD? Living with OCD can be very hard. Compulsions often take up lots of time and energy, making it hard to finish homework, do chores, or have any fun. Some kids even find it difficult to go ...
Autism spectrum and obsessive-compulsive disorders: OC behaviors, phenotypes and genetics.
Autism spectrum disorders (ASDs) are a phenotypically and etiologically heterogeneous set of disorders that include obsessive-compulsive behaviors (OCB) that partially overlap with symptoms associated with obsessive-compulsive disorder (OCD). The OCB seen in ASD vary depending on the individual's mental and chronological age as well as the etiology of their ASD. Although progress has been made in the measurement of the OCB associated with ASD, more work is needed including the potential identification of heritable endophenotypes. Likewise, important progress toward the understanding of genetic influences in ASD has been made by greater refinement of relevant phenotypes using a broad range of study designs, including twin and family-genetic studies, parametric and nonparametric linkage analyses, as well as candidate gene studies and the study of rare genetic variants. These genetic analyses could lead to the refinement of the OCB phenotypes as larger samples are studied and specific associations are replicated. Like ASD, OCB are likely to prove to be multidimensional and polygenic. Some of the vulnerability genes may prove to be generalist genes influencing the phenotypic expression of both ASD and OCD while others will be specific to subcomponents of the ASD phenotype. In order to discover molecular and genetic mechanisms, collaborative approaches need to generate shared samples, resources, novel genomic technologies, as well as more refined phenotypes and innovative statistical approaches. There is a growing need to identify the range of molecular pathways involved in OCB related to ASD in order to develop novel treatment interventions. PMID:20029829
Jacob, Suma; Landeros-Weisenberger, Angeli; Leckman, James F
Perceptual Properties of Obsessive Thoughts are Associated With Low Insight in Obsessive-Compulsive Disorder.
Obsessions are traditionally defined as bothersome and repetitive thoughts that the patient is unable to resist. Preliminary evidence suggests that in a subgroup of patients with obsessive-compulsive disorder (OCD), obsessions are experienced as partially perceptual. The present study explored the frequency of perceptually laden obsessions and their relationship with illness insight and depression. Twenty-six patients with OCD were administered the newly developed Sensory Properties of Obsessions Questionnaire. Participants were asked to endorse on a 5-point Likert scale whether their obsessions were associated with perceptual features. Participants showed moderate symptom severity. A total of 73% affirmed that their obsessions contained perceptual features. The predominant perceptual channels were visual, tactile, and somatic (i.e., bodily sensations). The extent of perceptual aspects associated with obsessions was strongly correlated with lack of insight (Yale-Brown Obsessive-Compulsive Scale item 11) but not depression severity. The present study suggests that obsessive thoughts are frequently accompanied by perceptual sensations, which concurs with models assuming a continuum between hallucinations and intrusions. Apparently, the more "real" or authentic the obsessive thought is experienced, the less the afflicted person is able to dismiss its content as fully irrational or absurd. PMID:24933417
Moritz, Steffen; Claussen, Marike; Hauschildt, Marit; Kellner, Michael
Autism Spectrum and Obsessive-Compulsive Disorders: OC Behaviors, Phenotypes and Genetics
Autism spectrum disorders (ASDs) are a phenotypically and etiologically heterogeneous set of disorders that include obsessive�compulsive behaviors (OCB) that partially overlap with symptoms associated with obsessive�compulsive disorder (OCD). The OCB seen in ASD vary depending on the individual�s mental and chronological age as well as the etiology of their ASD. Although progress has been made in the measurement of the OCB associated with ASD, more work is needed including the potential identification of heritable endophenotypes. Likewise, important progress toward the understanding of genetic influences in ASD has been made by greater refinement of relevant phenotypes using a broad range of study designs, including twin and family-genetic studies, parametric and nonparametric linkage analyses, as well as candidate gene studies and the study of rare genetic variants. These genetic analyses could lead to the refinement of the OCB phenotypes as larger samples are studied and specific associations are replicated. Like ASD, OCB are likely to prove to be multidimensional and polygenic. Some of the vulnerability genes may prove to be generalist genes influencing the phenotypic expression of both ASD and OCD while others will be specific to subcomponents of the ASD phenotype. In order to discover molecular and genetic mechanisms, collaborative approaches need to generate shared samples, resources, novel genomic technologies, as well as more refined phenotypes and innovative statistical approaches. There is a growing need to identify the range of molecular pathways involved in OCB related to ASD in order to develop novel treatment interventions.
Jacob, Suma; Landeros-Weisenberger, Angeli; Leckman, James F.
Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder
Cognitive-behavioral therapy can be effective for many clients who have obsessive-compulsive disorder. Despite its effectiveness, many treatment guidelines fail to describe cognitive-behavioral therapy procedures in adequate detail. The present paper will review the literature on cognitive-behavioral therapy for OCD in an attempt to provide concise, meaningful guidelines for the psychological treatment of this disorder. Cognitive-behavioral therapy includes four general components:
James C. Overholser
Obsessive-compulsiveness in a population of tinnitus patients.
The purpose of this study was to use the Maudsley Obsessional-Compulsive Inventory (MOCI) to assess obsessive-compulsiveness in a population of 196 tinnitus patients and to correlate MOCI scores with measures of anxiety, depression, and tinnitus severity. Tinnitus severity was positively correlated with measures of anxiety and depression. Depression was positively correlated with MOCI and anxiety scores. MOCI scores exhibited weaker positive correlations with tinnitus severity and anxiety. Effective management of tinnitus requires identification of psychological disorders or symptoms when they are present so that patients can receive appropriate treatment as soon as possible. The MOCI can be used to assess obsessive-compulsiveness in tinnitus patients. PMID:19205163
Folmer, Robert L; Griest, Susan E; Martin, William Hal
Assessment of Pediatric Obsessive-Compulsive Disorder: A Critical Review of Current Methodology
ERIC Educational Resources Information Center
Obsessive-compulsive disorder (OCD) is a relatively common disorder among children and adolescents, and is associated with increased risk for concurrent and future distress and impairment. Many youth who suffer from OCD go undiagnosed or misdiagnosed, and do not attain appropriate treatment in a timely manner. As a result, researchers have focused�
Merlo, Lisa J.; Storch, Eric A.; Murphy, Tanya K.; Goodman, Wayne K.; Geffken, Gary R.
Cognitive Inflexibility and Frontal-Cortical Activation in Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: Deficits in cognitive flexibility and response inhibition have been linked to perturbations in cortico-striatal-thalamic circuitry in adult obsessive-compulsive disorder (OCD). Although similar cognitive deficits have been identified in pediatric OCD, few neuroimaging studies have been conducted to examine its neural correlates in the�
Britton, Jennifer C.; Rauch, Scott L.; Rosso, Isabelle M.; Killgore, William D. S.; Price, Lauren M.; Ragan, Jennifer; Chosak, Anne; Hezel, Dianne M.; Pine, Daniel S.; Leibenluft, Ellen; Pauls, David L.; Jenike, Michael A.; Stewart, S. Evelyn
Error-Related Negativity and Tic History in Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: The error-related negativity (ERN) is a negative deflection in the event-related potential after an incorrect response, which is often increased in patients with obsessive-compulsive disorder (OCD). However, the relation of the ERN to comorbid tic disorders has not been examined in patients with OCD. This study compared ERN amplitudes�
Hanna, Gregory L.; Carrasco, Melisa; Harbin, Shannon M.; Nienhuis, Jenna K.; LaRosa, Christina E.; Chen, Poyu; Fitzgerald, Kate D.; Gehring, William J.
Rage Attacks in Pediatric Obsessive-Compulsive Disorder: Phenomenology and Clinical Correlates
ERIC Educational Resources Information Center
Objective: Rage attacks have been documented in youth with varied psychiatric disorders, but few data have been reported on the clinical characteristics and correlates of rage attacks among children with obsessive-compulsive disorder (OCD). Method: Participants were 86 children (ages 6-16 years) with a primary diagnosis of OCD. Patients and their�
Storch, Eric A.; Jones, Anna M.; Lack, Caleb W.; Ale, Chelsea M.; Sulkowski, Michael L.; Lewin, Adam B.; De Nadai, Alessandro S.; Murphy, Tanya K.
Treating Obsessive-Compulsive Disorder and Schizophrenia: The Case of Sam
ERIC Educational Resources Information Center
This article describes the case of Sam, a 22-year-old male with obsessive-compulsive disorder (OCD) and schizophrenia. The patient's background, the development and characteristics of his OCD and schizophrenia, and the history of what became a rather complicated treatment are described. In addition, four problem areas of therapy are identified.
Peasley-Miklus, Catherine; Massie, Elise; Baslett, Gaston; Carmin, Cheryl
Meta-Analysis of Randomized, Controlled Treatment Trials for Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: To conduct a meta-analysis on randomized, controlled treatment trials of pediatric obsessive-compulsive disorder (OCD). Method: Studies were included if they employed randomized, controlled methodology and treated young people (19 years or under) with OCD. A comprehensive literature search identified 13 RCTs containing 10�
Watson, Hunna J.; Rees, Clare S.
A School-Based Treatment Model for Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
School psychologists have expertise in the realm of school-based assessment and intervention for behavioral, educational, and psychological difficulties. Recent evidence indicates that many school psychologists lack evidenced based knowledge about assessment and treatment of pediatric Obsessive-Compulsive Disorder (OCD). Pediatric OCD is a�
Sloman, Glenn M.; Gallant, Jason; Storch, Eric A.
Ethnic Identification Biases Responses to the Padua Inventory for Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
The authors report differential item functioning (DIF) between Black and White participants completing the 60-item Padua Inventory (PI) for obsessive-compulsive disorder (OCD). The authors use an Internet-generated sample that included 105 Blacks, 67 Hispanics, 582 Whites, and 136 additional participants reporting an OCD diagnosis. Factor analysis�
Williams, Monnica; Turkheimer, Eric; Schmidt, Karen; Oltmanns, Thomas
A Review of Metacognition in Psychological Models of Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Cognitive-behavioural models and interventions for obsessive-compulsive disorder (OCD) have always included some metacognitive elements but until recently these have been predominantly construed of as cognitive as opposed to metacognitive processes. Increasingly, psychological models of OCD are now recognising the importance of metacognitive�
Rees, Clare S.; Anderson, Rebecca A.
Patient Adherence Predicts Outcome from Cognitive Behavioral Therapy in Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: To examine the effects of patient adherence on outcome from exposure and response prevention (EX/RP) therapy in adults with obsessive-compulsive disorder (OCD). Method: Thirty adults with OCD were randomized to EX/RP (n = 15) or EX/RP augmented by motivational interviewing strategies (n = 15). Both treatments included 3 introductory�
Simpson, Helen Blair; Maher, Michael J.; Wang, Yuanjia; Bao, Yuanyuan; Foa, Edna B.; Franklin, Martin
Catatonia occurs in a wide range of neuropsychiatric conditions. Among the psychiatric disorders, occurrence of catatonia has rarely been documented in obsessive-complsive disorder. Given the paucity of reports, we report two cases of obsessive compulsive disorder that presented as catatonia.
Jagadheesan, K.; Nizamie, Haque S.; Thakur, Anupam
The Myth of the Pure Obsessional Type in Obsessive-Compulsive Disorder
Background Several studies have identified discrete symptom dimensions in obsessive-compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (YBOCS-SC). The current study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Since these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called �pure obsessions� may have been overlooked. Method Participants (N=201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis. Results Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts). Conclusions This study suggests that the concept of the �pure obsessional� (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria.
Williams, Monnica T.; Farris, Samantha G.; Turkheimer, Eric; Pinto, Anthony; Ozanick, Krystal; Franklin, Martin E.; Liebowitz, Michael; Simpson, H. Blair; Foa, Edna B.
Developmental Aspects of Error and High-Conflict-Related Brain Activity in Pediatric Obsessive-Compulsive Disorder: A FMRI Study with a Flanker Task before and after CBT
ERIC Educational Resources Information Center
Background: Heightened error and conflict monitoring are considered central mechanisms in obsessive-compulsive disorder (OCD) and are associated with anterior cingulate cortex (ACC) function. Pediatric obsessive-compulsive patients provide an opportunity to investigate the development of this area and its associations with psychopathology.�
Huyser, Chaim; Veltman, Dick J.; Wolters, Lidewij H.; de Haan, Else; Boer, Frits
'Impulsive compulsivity' in obsessive-compulsive disorder: a phenotypic marker of patients with poor clinical outcome.
Although traditionally obsessive-compulsive disorder (OCD) and impulse control disorders (ICD) have represented opposing ends of a continuum, recent research has demonstrated a frequent co-occurrence of impulsive and compulsive behaviours, which may contribute to a worse clinical picture of some psychiatric disorders. We hypothesize that individuals with 'impulsive' OCD as characterized by poor insight, low resistance, and reduced control towards their compulsions will have a deteriorative course, greater severity of hoarding and/or symmetry/ordering symptoms, and comorbid ICD and/or substance use disorders (SUD). The sample consisted of 869 individuals with a minimum score of 16 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Of these, 65 had poor insight, low resistance, and reduced control towards compulsions ('poor IRC') and 444 had preserved insight, greater resistance and better control over compulsions ('good IRC'). These two groups were compared on a number of clinical and demographic variables. Individuals with poor IRC were significantly more likely to have a deteriorative course (p�<�0.001), longer duration of obsessions (p�=�0.017), greater severity of symmetry/ordering (p�<�0.001), contamination/cleaning (p�<�0.001) and hoarding (p�=�0.002) symptoms, and comorbid intermittent explosive disorder (p�=�0.026), trichotillomania (p�=�0.014) and compulsive buying (p�=�0.040). Regression analysis revealed that duration of obsessions (p�=�0.037) and hoarding severity (p�=�0.005) were significant predictors of poor IRC. In the absence of specific measures for impulsivity in OCD, the study highlights the utility of simple measures such as insight, resistance and control over compulsions as a phenotypic marker of a subgroup of OCD with impulsive features demonstrating poor clinical outcome. PMID:22647523
Kashyap, Himani; Fontenelle, Leonardo F; Miguel, Euripedes C; Ferr�o, Ygor A; Torres, Albina R; Shavitt, Roseli G; Ferreira-Garcia, Rafael; do Ros�rio, Maria C; Y�cel, Murat
Information Processing and Cognitive Behavior Therapy for Obsessive-Compulsive Disorder: Comorbidity of Delusions, Overvalued Ideas, and Schizophrenia
ERIC Educational Resources Information Center
Schizophrenia, in conjunction with obsessive-compulsive symptoms, presents significant barriers to treatment. This is true even if the obsessive-compulsive symptoms would ordinarily be considered straightforward for cognitive-behavioral treatment. These many limitations in treatment are considered here in light of the information processing�
McKay, Dean; McKiernan, Kevin
Phenomenology of Comorbid Autism Spectrum and Obsessive-Compulsive Disorders Among Children
The occurrence of obsessive-compulsive disorder (OCD) in youth with autism spectrum disorders (ASD) is common (37% prevalence\\u000a or higher) and results in additional distress and impairment. The phenomenology of OCD in youth with ASD is under-researched\\u000a to date. This study compared the clinical characteristics of youth with comorbid ASD and OCD (ASD + OCD) with age and gender\\u000a matched controls
Adam B. Lewin; Jeffrey J. Wood; Sarah Gunderson; Tanya K. Murphy; Eric A. Storch
In search of specificity: "not just right experiences" and obsessive-compulsive symptoms in non-clinical and clinical Italian individuals.
The cognitive model of OCD proposes that certain beliefs may contribute to the development and maintenance of this disorder. To date, however, it is not yet clear which beliefs are more relevant for explaining OCD symptomatology; moreover, their causal status is yet to be clearly established. In the effort to identify other constructs and processes related to OCD, the phenomenon labeled "not just right experiences" (NJREs) has received increasing attention. In this study, measures of NJREs (the NJRE-Q-R), OCD symptoms, general distress (i.e., anxiety, and depression), and perfectionism were administered to a large sample of college students and a small sample of OCD and non-OCD patients. The clinical sample also completed a measure of OC beliefs. Results showed that NJREs could be reliably measured through a self-report format in non-clinical and clinical Italian individuals. A specific association between NJREs severity and OCD symptoms was found in the non-clinical sample, after controlling for anxiety, depression, and perfectionism. The NJRE-Q-R Severity scale clearly discriminated OCD patients from patients with other anxiety disorders or depression. Lastly, the NJREs measure differentiated the clinical groups when OC beliefs were controlled, whereas OC beliefs did not discriminate among the groups after NJREs severity was controlled. The concept of NJREs may contribute to improve current psychological and biological model of OCD. PMID:20627224
Ghisi, Marta; Chiri, Luigi Rocco; Marchetti, Igor; Sanavio, Ezio; Sica, Claudio
Altered Brain Activity during Reward Anticipation in Pathological Gambling and Obsessive-Compulsive Disorder
Background Pathological gambling (PG) and obsessive-compulsive disorder (OCD) are conceptualized as a behavioral addiction, with a dependency on repetitive gambling behavior and rewarding effects following compulsive behavior, respectively. However, no neuroimaging studies to date have examined reward circuitry during the anticipation phase of reward in PG compared with in OCD while considering repetitive gambling and compulsion as addictive behaviors. Methods/Principal Findings To elucidate the neural activities specific to the anticipation phase of reward, we performed event-related functional magnetic resonance imaging (fMRI) in young adults with PG and compared them with those in patients with OCD and healthy controls. Fifteen male patients with PG, 13 patients with OCD, and 15 healthy controls, group-matched for age, gender, and IQ, participated in a monetary incentive delay task during fMRI scanning. Neural activation in the ventromedial caudate nucleus during anticipation of both gain and loss decreased in patients with PG compared with that in patients with OCD and healthy controls. Additionally, reduced activation in the anterior insula during anticipation of loss was observed in patients with PG compared with that in patients with OCD which was intermediate between that in OCD and healthy controls (healthy controls < PG < OCD), and a significant positive correlation between activity in the anterior insula and South Oaks Gambling Screen score was found in patients with PG. Conclusions Decreased neural activity in the ventromedial caudate nucleus during anticipation may be a specific neurobiological feature for the pathophysiology of PG, distinguishing it from OCD and healthy controls. Correlation of anterior insular activity during loss anticipation with PG symptoms suggests that patients with PG fit the features of OCD associated with harm avoidance as PG symptoms deteriorate. Our findings have identified functional disparities and similarities between patients with PG and OCD related to the neural responses associated with reward anticipation.
Choi, Jung-Seok; Shin, Young-Chul; Jung, Wi Hoon; Jang, Joon Hwan; Kang, Do-Hyung; Choi, Chi-Hoon; Choi, Sam-Wook; Lee, Jun-Young; Hwang, Jae Yeon; Kwon, Jun Soo
Dsm-5 obsessive-compulsive and related disorders: clinical implications of new criteria.
For the publication of DSM-5, obsessive-compulsive disorder (OCD) was the subject of significant revisions to its classification and diagnostic criteria. One of these significant changes was the placement of OCD in a new category, "Obsessive-Compulsive and Related Disorders (OCRDs)," which also includes body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, hoarding disorder, substance/medication-induced OCRD, OCRD due to another medical condition, and other specified OCRDs. Changes in the diagnostic criteria and grouping of these disorders may have significant clinical implications, and will be reviewed in this article. PMID:24616177
Van Ameringen, Michael; Patterson, Beth; Simpson, William
Humor appreciation of captionless cartoons in obsessive-compulsive disorder
Background It seems that the core neural regions and cognitive processes implicated in obsessive-compulsive disorder (OCD) pathophysiology may overlap with those involved in humor appreciation. However, to date, there have been no studies that have explored humor appreciation in OCD. The purpose of the present work was to investigate humor appreciation in a group of patients with OCD. Methods We examined 25 patients with OCD and 25 healthy controls, matched by age, education, and gender. We administered Penn's Humor Appreciation Test (PHAT), a computerized test comprising captionless cartoons by Mordillo. Each set of stimuli consisted of two almost identical drawings, one of which was funny due to the alteration of a detail in the cartoon, whereas the other was not funny. Severity of psychopathology was evaluated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results No significant effect for group, gender or group � gender interaction was found on the PHAT scores. In OCD patients, humor appreciation was not significantly associated with age of onset, duration of illness, and obsessions, but correlated significantly with compulsions. Conclusions Humor appreciation, based on captionless cartoons in OCD, does not seem to be deficient compared to healthy subjects but may be related to illness characteristics.
Neuropsychological Deficits in Obsessive-compulsive Disorder: A Comparison With Unipolar Depression, Panic Disorder, and Normal Controls
Background: The neuropsychological dysfunction as- sociated with obsessive-compulsive disorder (OCD) has similarities to the deficits reported in other affective or anxiety disorders. We directly compared cognitive func- tion in patients with OCD with that in matched patients with unipolar depression and panic disorder and healthy control subjects to establish the specific nature of neu- ropsychological deficits in OCD. Methods: Thirty
Rosemary Purcell; Paul Maruff; Michael Kyrios; Christos Pantelis
An updated review of antidepressants with marked serotonergic effects in obsessive-compulsive disorder.
Introduction: Since the recognition of the effectiveness of clomipramine in treating obsessive-compulsive disorder (OCD), a number of recent empirical studies have confirmed a key role of the serotonergic (5-HT) system in the pathophysiology of OCD. The current study presents a review of the existing double-blind studies testing 5-HT antidepressants in OCD. Areas covered: A systematic review was performed to identify double-blind, placebo-controlled, randomized clinical trials investigating the efficacy of antidepressants with marked 5-HT effects [clomipramine, selective serotonin reuptake inhibitors (SSRIs), venlafaxine, desvenlafaxine, duloxetine, mirtazapine, agomelatine, vortioxetine and vilazodone] in the short-term treatment of OCD. The search provided 29 studies investigating eight different 5-HT antidepressants. While the findings show reliable efficacy of clomipramine and SSRIs in the treatment of OCD symptoms, no double-blind studies were identified investigating the efficacy of desvenlafaxine, duloxetine, mirtazapine, agomelatine, vortioxetine or vilazodone. Expert opinion: While our results support the effectiveness of older antidepressants with marked 5-HT effects in OCD, it also suggests that newer agents should be tested more comprehensively. PMID:24766145
Pizarro, Mariana; Fontenelle, Leonardo F; Paravidino, Daniel C; Y�cel, Murat; Miguel, Eur�pedes C; de Menezes, Gabriela B
Slitrk5 deficiency impairs corticostriatal circuitry and leads to obsessive-compulsive-like behaviors in mice
Obsessive-compulsive disorder (OCD) is a common psychiatric disorder defined by the presence of obsessive thoughts and repetitive compulsive actions, and it often encompasses anxiety and depressive symptoms1,2. Recently, the corticostriatal circuitry has been implicated in the pathogenesis of OCD3,4. However, the etiology, pathophysiology and molecular basis of OCD remain unknown. Several studies indicate that the pathogenesis of OCD has a genetic component5�8. Here we demonstrate that loss of a neuron-specific transmembrane protein, SLIT and NTRK-like protein-5 (Slitrk5), leads to OCD-like behaviors in mice, which manifests as excessive self-grooming and increased anxiety-like behaviors, and is alleviated by the selective serotonin reuptake inhibitor fluoxetine. Slitrk5?/? mice show selective overactivation of the orbitofrontal cortex, abnormalities in striatal anatomy and cell morphology and alterations in glutamate receptor composition, which contribute to deficient corticostriatal neurotransmission. Thus, our studies identify Slitrk5 as an essential molecule at corticostriatal synapses and provide a new mouse model of OCD-like behaviors.
Shmelkov, Sergey V; Hormigo, Adilia; Jing, Deqiang; Proenca, Catia C; Bath, Kevin G; Milde, Till; Shmelkov, Evgeny; Kushner, Jared S; Baljevic, Muhamed; Dincheva, Iva; Murphy, Andrew J; Valenzuela, David M; Gale, Nicholas W; Yancopoulos, George D; Ninan, Ipe; Lee, Francis S; Rafii, Shahin
High-Dose Glycine Treatment of Refractory Obsessive-Compulsive Disorder and Body Dysmorphic Disorder in a 5-Year Period
This paper describes an individual who was diagnosed with obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) at age 17 when education was discontinued. By age 19, he was housebound without social contacts except for parents. Adequate trials of three selective serotonin reuptake inhibitors, two with atypical neuroleptics, were ineffective. Major exacerbations following ear infections involving Group A ?-hemolytic streptococcus at ages 19 and 20 led to intravenous immune globulin therapy, which was also ineffective. At age 22, another severe exacerbation followed antibiotic treatment for H. pylori. This led to a hypothesis that postulates deficient signal transduction by the N-methyl-D-aspartate receptor (NMDAR). Treatment with glycine, an NMDAR coagonist, over 5 years led to robust reduction of OCD/BDD signs and symptoms except for partial relapses during treatment cessation. Education and social life were resumed and evidence suggests improved cognition. Our findings motivate further study of glycine treatment of OCD and BDD.
Cleveland, W. Louis; DeLaPaz, Robert L.; Fawwaz, Rashid A.; Challop, Roger S.
[Mindfulness based cognitive therapy (MBCT) in patients with obsessive-compulsive disorder--an adaptation of the original program].
Mindfulness-based cognitive Therapy (MBCT) has shown to be effective in the relapse prevention and treatment of several psychiatric disorders. However, MBCT has not yet been applied in OCD (Obsessive-compulsive Disorder). This article proposes an adaptation of the eight-session group program for patients with residual symptoms after cognitive behavioural treatment (CBT) with exposure. It has proven feasible and was considered helpful by patients within the framework of a pilot study 1. Apart from an overview of the modified manual, OCD-specific elements are presented in detail and illustrated on the base of work sheets. The manual indicates that MBCT could be a useful supplement to CBT and is well applicable to the therapeutic needs of patients with OCD. PMID:23959536
K�lz, Anne Katrin; Rose, Nina
Augmentation effect of repetitive transcranial magnetic stimulation over the supplementary motor cortex in treatment refractory patients with obsessive compulsive disorder
Background: There are only a few effective treatment options currently available for treatment-refractory obsessive compulsive disorder (OCD). The supplementary motor area (SMA) has been reported to play an important role in the pathophysiology of OCD. Functional neuroimaging studies indicate that OCD is associated with increased activity in the SMA, caudate nucleus, and anterior cingulate gyrus. Novel treatment strategies like repetitive transcranial magnetic stimulation (rTMS) have been proposed for OCD refractory to standard treatments. These clinic-based data report on the efficacy of rTMS in medication-resistant OCD. Materials and Methods: Twelve right-handed persons with medication-resistant OCD were administered rTMS as an add-on treatment. Stimulation was given at 1 Hz for 10 seconds followed by 15 seconds pause and 100 trains of stimulus over the SMA per session for 5 days in a week. Assessments were done on yale brown obsessive compulsive scale (Y-BOCS) at baseline and at the end of rTMS intervention. Results: The subjects had a mean age of 33.17�12.74 years. Mean scores on Y-BOCS were 26.17 at baseline and 17.17 at the end of treatment, reflecting significant improvement. The subjects did not report any significant side effects except one person with known bipolar illness, who developed manic symptoms after the 3rd session of the rTMS. Conclusions: Low-frequency rTMS over the SMA appears a promising treatment strategy as an add-on treatment in treatment-refractory patients of OCD.
Kumar, Nand; Chadda, R. K.
The yale-brown obsessive-compulsive scale: factor structure of a large sample.
The Yale Brown Obsessive-Compulsive scale (Y-BOCS) is a semi-structured interview considered to be the gold standard in the measurement of obsessive-compulsive disorder (OCD) severity, yet findings about its factorial structure are conflicting. This study aimed at comparing different models, and testing whether factorial structure differs along various sub-groups. Exploratory and confirmatory factor analyses were conducted on Y-BOCS scores of a large OCD patient group (n?=?544). A three-factor structure (obsessions, compulsions, and resistance) provided the best fit for the data across different factor analytic procedures. The difference in goodness of fit between the original two factor (obsessions and compulsions) and the three-factor solutions seemed, however, very small. Since the two-factor solution is the original theory-driven structure, and the most widely used, we recommend the use of this factor. PMID:21423429
Anholt, Gideon E; van Oppen, Patricia; Cath, Danielle C; Smit, Johannes H; den Boer, Johan A; Verbraak, Marc J P M; van Balkom, Anton J L M
The Yale-Brown Obsessive-Compulsive Scale: Factor Structure of a Large Sample
The Yale Brown Obsessive-Compulsive scale (Y-BOCS) is a semi-structured interview considered to be the gold standard in the measurement of obsessive-compulsive disorder (OCD) severity, yet findings about its factorial structure are conflicting. This study aimed at comparing different models, and testing whether factorial structure differs along various sub-groups. Exploratory and confirmatory factor analyses were conducted on Y-BOCS scores of a large OCD patient group (n?=?544). A three-factor structure (obsessions, compulsions, and resistance) provided the best fit for the data across different factor analytic procedures. The difference in goodness of fit between the original two factor (obsessions and compulsions) and the three-factor solutions seemed, however, very small. Since the two-factor solution is the original theory-driven structure, and the most widely used, we recommend the use of this factor.
Anholt, Gideon E.; van Oppen, Patricia; Cath, Danielle C.; Smit, Johannes H.; den Boer, Johan A.; Verbraak, Marc J. P. M.; van Balkom, Anton J. L. M.
Altered frontal EEG asymmetry in obsessive-compulsive disorder.
Hemispheric topography of alpha band power in the electroencephalogram has been linked to approach/avoidance motivation and may index the risk for anxiety disorders and depression. We quantified lower alpha band power (8-10?Hz) in 20 patients with obsessive-compulsive disorder (OCD) and 20 matched healthy controls during blocks of rest and presentation of neutral, aversive, and OCD-related pictures. Compared to the control group, OCD patients showed altered asymmetry, with frontal alpha power in the 8-10?Hz band being more dominant in the left hemisphere across all conditions. This alteration was not observed over parietal areas, and also did not show in the upper alpha, and the theta and beta bands. This change in hemispheric topography of lower alpha band power supports the hypothesis of relatively increased avoidance motivation in OCD. Altered asymmetry appears to be traitlike in OCD, suggesting a link to depressive disorders. PMID:24673721
Ischebeck, Moritz; Endrass, Tanja; Simon, Daniela; Kathmann, Norbert
Treating disgust reactions in contamination-based obsessive-compulsive disorder.
Contamination fear associated with obsessive-compulsive disorder (OCD) has features that strongly suggest it is based in part on disgust. In particular, sympathetic magic, or the tendency for disgust-evoking stimuli to transfer that property to previously neutral stimuli, is common in contamination fear. Treatment for OCD typically involves exposure with response prevention for feared stimuli. Unexamined, however, has been the habituation for specific disgust stimuli among individuals with contamination fear. This study is a preliminary investigation with a group of primary contamination fearful participants diagnosed with OCD (C-OC; n = 9) compared to a group with primarily other symptoms of OCD (O-OC; n = 8). All participants were exposed to a set of disgust stimuli that were not associated with anxiety reactions for 30 min across five sessions, and exposed to anxiety-evoking stimuli specific to their OCD symptoms for 30 min. Comparisons showed that, while both groups had reduced disgust reactions, the C-OC group habituated more slowly and to a lesser degree than the O-OC group. No differences existed between the groups for anxiety reduction. The findings suggest that contamination fear is based in part on disgust reactions, and that disgust is amenable to exposure-based interventions. PMID:16253206
McKay, Dean
Fixity of belief, perceptual aberration, and magical ideation in obsessive-compulsive disorder.
Clinicians and researchers have pondered the intersection of obsessive-compulsive disorder (OCD) and psychosis. We examined the records of 395 individuals seeking treatment for OCD and classified participants according to their most frequent or distressing obsession and compulsion. All participants completed measures of fixity of belief, perceptual distortions, magical ideation, and psychotic symptoms. Results indicated that individuals who reported fear of harming self or others via overwhelming impulse or by mistake, and those with religious obsessions, had poorer insight and more perceptual distortions and magical ideation than did individuals with other types of obsessions. These results did not appear to reflect mere differences in OCD severity. Results are discussed in light of previous findings showing that psychotic-like symptoms are associated with attenuated treatment outcome in OCD. More research is needed to assess the absolute magnitude of psychotic-like features in OCD patients with impulse/mistake and religious obsessions and to examine whether these features interfere with standard cognitive-behavioral therapy. PMID:11764309
Tolin, D F; Abramowitz, J S; Kozak, M J; Foa, E B
Why Do Eating Disorders and Obsessive Compulsive Disorder Co-Occur?
The purpose of this study was to use an alternative, dimensionally based approach to understanding the reasons for comorbidity between eating disorders and obsessive compulsive disorder. Participants from a representative community sample (N=407; 47% female) completed self-report measures of eating pathology, obsessive-compulsive symptoms, perfectionism, and neuroticism. Hierarchical multiple regression indicated that neuroticism and perfectionism completely mediated associations between most obsessive-compulsive and eating disorder symptoms. However, body dissatisfaction shared unique associations with checking, cleaning, and obsessive rituals that could not be explained by these personality traits. Results suggest that shared personality traits play a key role in the comorbidity between eating disorders characterized by binge eating and dietary restraint and obsessive-compulsive disorder. Future studies are needed to examine whether similar underlying neurocognitive processes that give rise to compulsive checking, cleaning, and obsessive rituals may also contribute to the development and maintenance of body checking in individuals diagnosed with eating disorders.
Pollack, Lauren O.; Forbush, Kelsie T.
Psychiatric morbidity with focus on obsessive-compulsive disorder in an Israeli cohort of adolescents with mild to moderate mental retardation.
The study evaluated the prevalence of DSM-IV-TR-defined psychiatric disorders in adolescents with mental retardation, with a focus on obsessive-compulsive disorder (OCD), for which data at present are sparse. Eighty-seven adolescents with mild to moderate mental retardation attending the Israeli special-education system were screened for psychiatric disorders in general and obsessive-compulsive symptoms in particular. Sixty-one percent had at least one psychiatric disorder. Of the 13 participants receiving antipsychotic medication, none had an underlying psychotic disorder and most had anxiety or depressive disorders. OCD was detected in 11% of participants and was characterized by high rates of psychiatric comorbidities. The severity of autistic symptoms predicted 39% of the variance in the severity of OCD symptoms. Adolescents with mild to moderate mental retardation have high rates of psychiatric morbidities that are often inappropriately treated. OCD is prevalent in this population and is strongly associated with autistic symptoms. Further studies are required in adolescents with mental retardation to better delineate psychiatric morbidities and their appropriate treatment in this at-risk population. PMID:18351287
Gothelf, Doron; Goraly, Olga; Avni, Sari; Stawski, Mike; Hartmann, Inbar; Basel-Vanagaite, Lina; Apter, Alan
Reduced functional connectivity within the limbic cortico-striato-thalamo-cortical loop in unmedicated adults with obsessive-compulsive disorder.
Cortico-striato-thalamo-cortical (CSTC) loops project from the cortex to the striatum, then from the striatum to the thalamus via the globus pallidus, and finally from the thalamus back to the cortex again. These loops have been implicated in Obsessive-Compulsive Disorder (OCD) with particular focus on the limbic CSTC loop, which encompasses the orbitofrontal and anterior cingulate cortices, as well as the ventral striatum. Resting state functional-connectivity MRI (rs-fcMRI) studies, which examine temporal correlations in neural activity across brain regions at rest, have examined CSTC loop connectivity in patients with OCD and suggest hyperconnectivity within these loops in medicated adults with OCD. We used rs-fcMRI to examine functional connectivity within CSTC loops in unmedicated adults with OCD (n?=?23) versus healthy controls (HCs) (n?=?20). Contrary to prior rs-fcMRI studies in OCD patients on medications that report hyperconnectivity in the limbic CSTC loop, we found that compared with HCs, unmedicated OCD participants had reduced connectivity within the limbic CSTC loop. Exploratory analyses revealed that reduced connectivity within the limbic CSTC loop correlated with OCD symptom severity in the OCD group. Our finding of limbic loop hypoconnectivity in unmedicted OCD patients highlights the potential confounding effects of antidepressants on connectivity measures and the value of future examinations of the effects of pharmacological and/or behavioral treatments on limbic CSTC loop connectivity. Hum Brain Mapp 35:2852-2860, 2014. � 2013 Wiley Periodicals, Inc. PMID:24123377
Posner, Jonathan; Marsh, Rachel; Maia, Tiago V; Peterson, Bradley S; Gruber, Allison; Simpson, H Blair
Perceived quality of life in obsessive-compulsive disorder: related factors
BACKGROUND: Obsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres. METHODS: We measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions
Beatriz Rodriguez-Salgado; Helen Dolengevich-Segal; Manuel Arrojo-Romero; Paola Castelli-Candia; Mercedes Navio-Acosta; Maria M Perez-Rodriguez; Jeronimo Saiz-Ruiz; Enrique Baca-Garcia
Brain functional connectivity during induced sadness in patients with obsessive-compulsive disorder
Background Obsessive�compulsive disorder (OCD) is associated with a range of emotional abnormalities linked to its defining symptoms, comorbid illnesses and cognitive deficits. The aim of this preliminary study was to examine functional changes in the brain that are associated with experimentally induced sad mood in patients with OCD compared with healthy controls in a frontolimbic circuit relevant to both OCD and mood regulation. Methods Participants underwent a validated sad mood induction procedure during functional magnetic resonance imaging. Analyses focused on mapping changes in the functional connectivity of the subgenual anterior cingulate cortex (ACC) within and between the 2 groups in response to successfully induced sadness. Results We enrolled 11 patients with OCD and 10 age-, sex- and IQ-matched controls in our study. Unlike controls, patients with OCD did not demonstrate predicted increases in functional connectivity between the subgenual ACC and other frontal regions during mood induction. Instead, patients demonstrated heightened connectivity between the subgenual ACC and ventral caudate/nucleus accumbens region and the hypothalamus. Limitations Our study included a small, partially medicated patient cohort that precluded our ability to investigate sex or drug effects, evaluate behavioural differences between the groups and perform a whole-brain analysis. Conclusion The ventral striatum and ventral frontal cortex were distinctly and differentially modulated in their connectivity with the subgenual ACC during the experience of sad mood in patients with OCD. These results suggest that, in patients with OCD, induced sadness appears to have provoked a primary subcortical component of the hypothesized �OCD circuit,� which may offer insights into why OCD symptoms tend to develop and worsen during disturbed emotional states.
Fontenelle, Leonardo F.; Harrison, Ben J.; Pujol, Jesus; Davey, Christopher G.; Fornito, Alex; Bora, Emre; Pantelis, Christos; Yucel, Murat
[Assertive community treatment in patients with severe�obsessive-compulsive disorders].
For the use of psychosocial treatments for severe mental illness, there is a high evidence level. Obsessive-compulsive disorders are accompanied by severe disabilities in one third of the cases, however, there is little scientific research on the use of psychosocial therapies in patients with obsessive-compulsive disorders. In the following, the concept of an outreaching multi-professional treatment based on the assertive community treatment (ACT) method for severe compulsive illnesses is presented and discussed based on two case studies. There was an obvious reduction in clinically rated severity of obsessive-compulsive disorder symptoms, as measured by the Yale-Brown obsessive-compulsive scale (Y-BOCS), over the course of ACT. Comparison between pre- and post-treatment states demonstrated a reduction in the total Y-BOCS score after the treatment (case 1: total Y-BOCS score 37 versus 26; case 2: total Y-BOCS score 36 versus 16). PMID:24824206
Strau�, M; Jahn, I; Olbrich, S; Beyrich-Kolbus, U; Stengler, K
An Inference-Based Approach to Treating Obsessive-Compulsive Disorders
ERIC Educational Resources Information Center
This article outlines the conceptual and empirical basis for an inference-based approach (IBA) to treating obsessive-compulsive disorder (OCD). The IBA considers that in most cases the obsessional process begins with an initial doubt (e.g., "Maybe my hands are not clean"; "Perhaps the door was not locked"; "There's a chance I made an error"; "I�
O'Connor, Kieron; Koszegi, Natalia; Aardema, Frederick; van Niekerk, Jan; Taillon, Annie
Treatment of obsessive�compulsive disorder: Cognitive behavior therapy vs. exposure and response prevention
The efficacy of contemporary cognitive therapy for obsessive�compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between
Maureen L. Whittal; Dana S. Thordarson; Peter D. McLean
A Naturalistic Study of Referred Children and Adolescents with Obsessive-Compulsive Disorder.
ERIC Educational Resources Information Center
Objective: To report on clinical features, comorbidity, and response to pharmacotherapy in children and adolescents with obsessive-compulsive disorder (OCD) naturalistically followed and treated with serotonin reuptake inhibitors (SRIs). Method: A consecutive series of 94 patients (65 males, 29 females, age 13.6 [+ or -] 2.8 years), referred in�
Masi, Gabriele; Millepiedi, Stefania; Mucci, Maria; Bertini, Nicoletta; Milantoni, Luca; Arcangeli, Francesca
Decreased Family Accommodation Associated with Improved Therapy Outcome in Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitive-behavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to�
Merlo, Lisa J.; Lehmkuhl, Heather D.; Geffken, Gary R.; Storch, Eric A.
The Effectiveness of Treatment for Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis
ERIC Educational Resources Information Center
The last decade has seen a noticeable increase in the number of treatment outcome studies for pediatric obsessive-compulsive disorder (OCD). The present article describes a meta-analysis of this literature with the aim of quantifying treatment effects and examining the extent to which various patient or treatment variables are related to outcome.�
Abramowitz, Jonathan S.; Whiteside, Sephen P.; Deacon, Brett J.
D-Cycloserine for Treatment Nonresponders with Obsessive-Compulsive Disorder: A Case Report
ERIC Educational Resources Information Center
Despite being the most effective treatment available, as many as one third of patients who receive exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) do not initially respond to treatment. Recent research suggests that the n-methyl d-aspartate (NMDA) receptor partial agonist D-Cycloserine (DCS) may speed up the course�
Norberg, Melissa M.; Gilliam, Christina M.; Villavicencio, Anna; Pearlson, Godfrey D.; Tolin, David F.
Power spectral EEG analysis and EEG variability in obsessive-compulsive disorder
Summary Spectral EEG characteristics of thirteen patients with severe Obsessive-Compulsive Disorder (OCD) were investigated topographically. The finding of predominantly left posterior frontal to mid-temporal theta-2 is discussed in light of previous EEG studies and recent neuroradiologic findings.
Peter Perros; Edwin S. Young; James J. Ritson; Greg W. Price; Peter Mann
School Psychologists' Views and Management of Obsessive-Compulsive Disorder in Children and Adolescents
ERIC Educational Resources Information Center
Over the past decade, an increasing body of research has been conducted on evidence-based psychological and psychiatric treatment for pediatric obsessive-compulsive disorder (OCD). Despite this improved understanding, however, these treatments are not being performed. This study descriptively examined the practices and views of school�
Gallant, Jason; Storch, Eric A.; Valderhaug, Robert; Geffken, Gary R.
Recent Developments in the Assessment and Treatment of Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Although tremendous strides have recently been made in the development of assessment and treatment methods for pediatric obsessive-compulsive disorder (OCD), more accurate methods for diagnosis, more effective treatments, and more refined instruments for monitoring progress during therapy are still needed. The present commentary highlights the�
Berman, Noah C.; Abramowitz, Jonathan S.
Acceptance and Commitment Therapy as a Treatment for Scrupulosity in Obsessive Compulsive Disorder
ERIC Educational Resources Information Center
This study evaluated acceptance and commitment therapy (ACT) for scrupulosity-based obsessive compulsive disorder (OCD). Five adults were treated with eight sessions of ACT, without in-session exposure, in a multiple baseline across participants design. Daily monitoring of compulsions and avoided valued activities were tracked throughout the�
Dehlin, John P.; Morrison, Kate L.; Twohig, Michael P.
Treatment of Obsessive Compulsive Disorder in Young Children: An Intervention Model and Case Series
ERIC Educational Resources Information Center
This article presents an intervention model for young children with obsessive-compulsive disorder (OCD). The intervention, designed to reduce compulsive behavior and improve parenting practices, was tested using a multiple baseline design with 7 children (M = 6 years old; 57% female) in which participants were randomly assigned to 1, 2, or 3 weeks�
Ginsburg, Golda S.; Burstein, Marcy; Becker, Kimberly D.; Drake, Kelly L.
Family Factors Predict Treatment Outcome for Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: To examine family conflict, parental blame, and poor family cohesion as predictors of treatment outcome for youths receiving family-focused cognitive behavioral therapy (FCBT) for obsessive-compulsive disorder (OCD). Method: We analyzed data from a sample of youths who were randomized to FCBT (n = 49; 59% male; M age = 12.43 years) as�
Peris, Tara S.; Sugar, Catherine A.; Bergman, R. Lindsey; Chang, Susanna; Langley, Audra; Piacentini, John
Animal models of obsessive-compulsive disorder: Exploring pharmacology and neural substrates
During the last 30 years there have been many attempts to develop animal models of obsessive-compulsive disorder (OCD). Most models have not been studied further following the original publication, and in the past few years, most papers present studies employing a few established animal models, exploring the neural basis of compulsive behavior and developing new treatment strategies. Here we summarize
Noa Albelda; Daphna Joel
Systematic Review of Proinflammatory Cytokines in Obsessive-Compulsive Disorder
Several studies have examined levels of proinflammatory cytokines, such as tumor necrosis factor (TNF)-?, interleukin (IL)-1?, and IL-6. This meta-analysis was conducted to examine the association between obsessive-compulsive disorder (OCD) and plasma serum levels of proinflammatory cytokines. Twelve studies met inclusion criteria. The meta-analysis demonstrated a significant reduction in IL-1? levels in OCD. No significant difference in plasma levels of IL-6 or TNF-? was demonstrated. Stratified subgroup analysis revealed possible moderating effects of age and medication use on IL-6 levels. Studies including children on psychotropic medication had lower plasma IL-6 levels. Stratified subgroup analysis revealed a moderating effect of comorbid depression on TNF-? levels. Elevated TNF-? levels were reported in studies that included individuals with comorbid depression. Future studies examining immune function in OCD should adjust for potential confounding due to medication use and comorbid depression. Further studies assessing cerebrospinal fluid cytokine levels in OCD are also needed.
Gray, Simon M.; Bloch, Michael H.
Abnormal small-world architecture of top-down control networks in obsessive-compulsive disorder
Background Obsessive�compulsive disorder (OCD) is a common neuropsychiatric disorder that is characterized by recurrent intrusive thoughts, ideas or images and repetitive ritualistic behaviours. Although focal structural and functional abnormalities in specific brain regions have been widely studied in populations with OCD, changes in the functional relations among them remain poorly understood. This study examined OCD�related alterations in functional connectivity patterns in the brain�s top�down control network. Methods We applied resting-state functional magnetic resonance imaging to investigate the correlation patterns of intrinsic or spontaneous blood oxygen level�dependent signal fluctuations in 18 patients with OCD and 16 healthy controls. The brain control networks were first constructed by thresholding temporal correlation matrices of 39 brain regions associated with top�down control and then analyzed using graph theory-based approaches. Results Compared with healthy controls, the patients with OCD showed decreased functional connectivity in the posterior temporal regions and increased connectivity in various control regions such as the cingulate, precuneus, thalamus and cerebellum. Furthermore, the brain�s control networks in the healthy controls showed small-world architecture (high clustering coefficients and short path lengths), suggesting an optimal balance between modularized and distributed information processing. In contrast, the patients with OCD showed significantly higher local clustering, implying abnormal functional organization in the control network. Further analysis revealed that the changes in network properties occurred in regions of increased functional connectivity strength in patients with OCD. Limitations The patient group in the present study was heterogeneous in terms of symptom clusters, and most of the patients with OCD were medicated. Conclusion Our preliminary results suggest that the organizational patterns of intrinsic brain activity in the control networks are altered in patients with OCD and thus provide empirical evidence for aberrant functional connectivity in the large-scale brain systems in people with this disorder.
Zhang, Tijiang; Wang, Jinhui; Yang, Yanchun; Wu, Qizhu; Li, Bin; Chen, Long; Yue, Qiang; Tang, Hehan; Yan, Chaogan; Lui, Su; Huang, Xiaoqi; Chan, Raymond C.K.; Zang, Yufeng; He, Yong; Gong, Qiyong
Assessment of obsessive-compulsive disorder.
Self-report assessment devices of obsessive-compulsive symptoms are widely used by behavior therapists. In the present investigation, psychometric characteristics and concurrent, discriminant, and factorial validity of the Maudsley Obsessional Compulsive Inventory (MOCI) were studied in clinical samples. Test-retest reliability was high. The internal consistency was high for the total score and moderate for the subscales, checking and cleaning. The slowness and doubting subscales appeared to be less useful. The MOCI was found to reliably discriminate between obsessional patients on one hand and normals, patients with anorexia nervosa and anxiety disorders, on the other, but failed to discriminate obsessionals from depressives. Concurrent validity and factorial validity were satisfactory. The MOCI may be used to evaluate effects of treatment, but it is less sensitive than target ratings of obsessional problems. PMID:10224952
Emmelkamp, P M; Kraaijkamp, H J; van den Hout, M A
Tourette syndrome and obsessive-compulsive disorder are neuropsychiatric disorders that have sparked considerable interest over the decades. They are the focus of research for a remarkable diversity of disciplines, ranging from neuroimagers and prenatal epidemiologists to experts in the neural circuits that connect the cortex with the basal ganglia, as well as neuroimmunologists focusing on brain-based autoimmune phenomena. Several hypotheses have been put forward to explain the onset and exacerbation of these illnesses. Here we discuss the clinical phenomenology and treatment options that are currently available. New psychopharmacological agents are being used that are based on a greater understanding of the neurobiology and are being used in combination with behavioral interventions. Longitudinal clinical investigations into clinical symptoms and the natural course are providing additional clues on the underlying pathophysiology. Recent advances in research models are also reviewed in an attempt to clarify some of the molecular etiologies that lead to these disorders.
Lombroso, Paul J.; Scahill, Lawrence
A magnetic resonance spectroscopy investigation of obsessive-compulsive disorder and anxiety.
The aim of the current study was to use proton magnetic resonance spectroscopy (MRS) to investigate potential irregularities in neurochemical compounds in obsessive-compulsive disorder (OCD) and the extent to which these irregularities are related to state anxiety. Single voxel MRS was used to image the head of the caudate nucleus (HOC) and orbitofrontal white matter (OFWM) bilaterally in adult patients with OCD and a control group. The results indicated that patients with OCD had increased levels of a combined measure of glutamate and glutamine (Glx/Cr) and N-acetyl-l-aspartic acid (NAA/Cr) relative to creatine in the right OFWM and reduced levels of myo-inositol relative to creatine (mI/Cr) in the HOC bilaterally. Correlational analyses indicated that Glx/Cr in the OFWM was related to OCD symptoms, while mI/Cr in the HOC was related to trait and/or state anxiety. Reanalysis of the significant group differences controlling for state anxiety symptoms erased three of the four group differences. These results are discussed in context of the methodological difficulties facing this area of research. PMID:16507346
Whiteside, Stephen P; Port, John D; Deacon, Brett J; Abramowitz, Jonathan S
Obsessive-compulsive and eating disorders: comparison of clinical and personality features.
The aim of the present study was to determine whether anorexia nervosa (AN), bulimia nervosa (BN) and obsessive-compulsive disorder (OCD) share clinical and psychopathological traits. The sample consisted of 90 female patients (30 OCD; 30 AN; 30 BN), who had been consecutively referred to the Department of Psychiatry, University Hospital of Bellvitge, Barcelona. All subjects met DSM-IV criteria for those pathologies. The assessment consisted of the Maudsley Obsessive-Compulsive Inventory (MOCI), Questionnaire of obsessive traits and personality by Vallejo, Eating Attitudes Test-40 (EAT-40), Eating Disorder Inventory (EDI), and Beck Depression Inventory (BDI). ANCOVA tests (adjusted for age and body mass index) and multiple linear regression models based on obsessive-compulsiveness, obsessive personality traits and perfectionism, as independent variables, were applied to determine the best predictors of eating disorder severity. On ancova several significant differences were found between obsessive-compulsive and eating-disordered patients (MOCI, P < 0.001; EAT, P < 0.001; EDI, P < 0.001), whereas some obsessive personality traits were not eating disorder specific. A total of 16.7% OCD patients presented a comorbid eating disorder, whereas 3.3% eating disorders patients had an OCD diagnosis. In the eating disorder group, the presence of OC symptomatology was positively associated (r = 0.57, P < 0.001) with the severity of the eating disorder. The results were maintained after adjusting for comorbidity. Although some obsessive-compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different. PMID:17610663
Jim�nez-Murcia, Susana; Fern�ndez-Aranda, Fernando; Raich, Rosa M; Alonso, Pino; Krug, Isabel; Jaurrieta, Nuria; Alvarez-Moya, Eva; Labad, Javier; Mench�n, Jose M; Vallejo, Julio
Functional Magnetic Resonance Imaging during Planning before and after Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
Objective: Pediatric obsessive compulsive disorder (OCD) has been associated with cognitive abnormalities, in particular executive impairments, and dysfunction of frontal-striatal-thalamic circuitry. The aim of this study was to investigate if planning as an executive function is compromised in pediatric OCD and is associated with�
Huyser, Chaim; Veltman, Dick J.; Wolters, Lidewij H.; de Haan, Else; Boer, Frits
Metacognition, specific obsessive-compulsive beliefs and obsessive-compulsive behaviour
Cognitive distortions and beliefs have been found to be associated with obsessive-compulsive disorder. Most of these cognitive distortions are supposed to be non-specifically related to obsessive-compulsive behaviour in general, rather than specific domains of beliefs being related to specific forms of obsessive-compulsive behaviour. The aim of the present study was to investigate whether specific cognitive domains are related to specific
Paul M. G. Emmelkamp; A. Aardema
Late-onset obsessive-compulsive disorder associated with left cerebellar lesion.
The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology. An involvement of fronto-striatal circuits has been strongly suggested, whereas cerebellum remains so far scarcely explored. We present here the description of a "pure" late-onset OCD associated with a cerebellar lesion, neither comorbid with other mental disorders nor with neurological syndromes. To our knowledge, this condition was not previously described in literature. The patient is a 62-year-old woman who developed a late-onset OCD associated with a left cerebellar lesion due to an arachnoid cyst in the left posterior fossa. We debate the possible role of the cerebellar lesion in favoring a transition from a predisposing liability (namely an obsessive-compulsive personality disorder and a depressive status) to the onset of OCD in this woman. PMID:24771488
Tonna, Matteo; Ottoni, Rebecca; Ossola, Paolo; De Panfilis, Chiara; Marchesi, Carlo
Proton magnetic resonance spectroscopy of prefrontal white matter in psychotropic na�ve children and adolescents with obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) has a typical onset during childhood or adolescence. Although recent in-vivo proton magnetic resonance spectroscopy ((1)H-MRS) studies report gray matter metabolite abnormalities in children and adolescents with OCD, there are no existing (1)H-MRS studies that measure white matter (WM) metabolite levels in this population. In the present study, we measured metabolite levels in the left and right prefrontal WM (LPFWM and RPFWM, respectively) of psychotropic-na�ve children and adolescents with OCD (LPFWM: N=15, mean age 13.3�2.4 years; right RPFWM: N=14, mean age 13.0�2.3 years) and healthy controls (LPFWM: N=17, mean age 11.8�2.7 years; RPFWM: N=18, mean age 12.2�2.8 years). Spectra were acquired using a 3T single voxel PRESS sequence (1.5�2.0�2.0cm(3)). When age and sex effects were controlled, OCD patients had higher levels of RPFWM choline and N-acetyl-aspartate (NAA). In addition, RPFWM levels of NAA, creatine and myo-inositol were positively and significantly correlated with severity of OCD symptoms. In summary, this is the first published study of WM metabolite levels in children and adolescents with OCD. Our preliminary findings lend further support to the previous findings of WM abnormalities in OCD. PMID:24602517
Weber, Alexander Mark; Soreni, Noam; Stanley, Jeffrey A; Greco, Alessia; Mendlowitz, Sandra; Szatmari, Peter; Schachar, Russell; Mannasis, Katharina; Pires, Paulo; Swinson, Richard; Noseworthy, Michael D
Screening for Obsessive-Compulsive Disorder (OCD)
... Support Groups in Australia Support Groups in South Africa Helping Others Children Spouse or Partner Older Adults ... Facts Find Help News and Research Tips for Soldiers and Veterans Tips for Families and Friends Taking ...
MRI study of the cavum septum pellucidum in obsessive�compulsive disorder
The cavum septum pellucidum (CSP), a putative marker of neurodevelopmental anomaly, has been associated with an increased\\u000a risk of several psychiatric disorders. The purpose of this study was to evaluate the CSP in patients with obsessive�compulsive\\u000a disorder (OCD) compared with healthy control subjects. Seventy-one patients with OCD and 71 healthy volunteers matched for\\u000a age and sex were evaluated with magnetic
Myong-Wuk Chon; Jung-Seok Choi; Do-Hyung Kang; Myung Hun Jung; Jun Soo Kwon
The Relationship between Insight and Uncertainty in Obsessive-Compulsive Disorder
Background: The aim of this study was to investigate the relationship between the levels of insight and checking-related uncertainty in patients with obsessive-compulsive disorder (OCD). Sampling and Methods: Twenty OCD patients with checking compulsions and without current comorbidity were recruited. We used an experimental paradigm that gave subjects the opportunity to check during a decision-making task, thereby allowing for the
Nematollah Jaafari; Bruno Aouizerate; Jean Tignol; Wissam El-Hage; Issa Wassouf; Dominique Guehl; Bernard Bioulac; Marie-Laure Daniel; Jerome Lacoste; Roger Gil; Pierre Burbaud; Jean-Yves Rotge
Strategies to Control Unwanted Intrusive Thoughts: Which are Relevant and Specific in Obsessive-Compulsive Disorder?
Current cognitive-behavioral approaches to Obsessive-Compulsive Disorder (OCD) propose that chronic thought suppression and\\u000a other dysfunctional strategies to control negative unwanted intrusions play an important role in the genesis and\\/or maintenance\\u000a of the disorder. However, little empirical research has been devoted to investigating which control and\\/or suppression methods\\u000a are used most often by OCD patients, and which could be considered specific
Amparo Belloch; Carmen Morillo; Gemma Garcia-Soriano
A neuropsychiatric review of pediatric obsessive-compulsive disorder: etiology and efficacious treatments
Pediatric obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric condition associated with broad impairments in functioning. This paper outlines current etiological theories of OCD, providing a review of neuroanatomical, neurochemical, neuroimmunological, and cognitive�behavioral explanations. Subsequently, first-line treatment modalities are discussed (serotonin reuptake inhibitors [SRIs] and cognitive�behavioral therapy [CBT] with exposure and response prevention [E/RP]) in the context of recent pharmacological, CBT, and combined trials.
Lewin, Adam B; Storch, Eric A; Geffken, Gary R; Goodman, Wayne K; Murphy, Tanya K
Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder
The cerebral metabolic rate for glucose was studied in 18 adults with childhood-onset obsessive-compulsive disorder (OCD) and in age- and sex-matched controls using positron emission tomography and fludeoxyglucose F 18. Both groups were scanned during rest, with reduced auditory and visual stimulation. The group with OCD showed an increased glucose metabolism in the left orbital frontal, right sensorimotor, and bilateral
S. E. Swedo; M. B. Schapiro; C. L. Grady; D. L. Cheslow; H. L. Leonard; A. Kumar; R. Friedland; S. I. Rapoport; J. L. Rapoport
Obsessive compulsive disorder and migraine: case report, diagnosis and therapeutic approach
Psychiatric disorders, notably mood and anxiety disorders, are frequently associated with migraine and chronic daily headaches.\\u000a The obsessive�compulsive disorder (OCD) is included in the spectrum of anxiety disorders and may be a comorbid condition in\\u000a headache patients. However, little information has been reported in the literature about this association. This is an important\\u000a issue as OCD may contribute to the
Luiz Paulo Bastos Vasconcelos; Melissa Costa Silva; Esther Ang�lica Coelho Costa; Ariovaldo Alberto da Silva J�nior; Rodrigo Santiago G�mez; Ant�nio L�cio Teixeira
The prevalence of obsessive-compulsive disorder in Japan: a study of students using the Maudsley Obsessional-Compulsive Inventory and DSM-III-R.
The prevalence of obsessive-compulsive disorder (OCD) was measured in 424 Japanese students using a Japanese version of the Maudsley Obsession-Compulsive Inventory (MOCI-J). Six students (1.7%) of 350 interviewed students were diagnosed as OCD according to DSM-III-R. When the cut-off point of the MOCI-J was 12, the sensitivity was 100% and the specificity was 96%. Our results suggest that individuals with OCD are not rare among the young Japanese population and that the MOCI-J is a useful tool for screening OCD. PMID:8608432
Tadai, T; Nakamura, M; Okazaki, S; Nakajima, T
Agomelatine Augmentation of Escitalopram Therapy in Treatment-Resistant Obsessive-Compulsive Disorder: A Case Report
Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them. Several augmentation strategies have been proposed, including the use of atypical antipsychotics and antidepressant combinations. In the present paper we describe the case of a young female patient suffering from severe treatment-resistant OCD who remitted as a result of agomelatine augmentation of escitalopram therapy.
De Berardis, Domenico; Serroni, Nicola; Marini, Stefano; Martinotti, Giovanni; Ferri, Francesca; Callista, Gaetano; La Rovere, Raffaella; Moschetta, Francesco Saverio; Di Giannantonio, Massimo
Design and Rationale for a Randomized Controlled Trial Testing the Efficacy of Aerobic Exercise for Patients with Obsessive-Compulsive Disorder
Background Over the last two decades very few advances have been made in the development of new treatments for obsessive-compulsive disorder (OCD). While patients with OCD improve with available treatments (pharmacotherapy and/or cognitive-behavioral therapy), moderate levels of OCD symptoms often persist even with adequate doses and durations of these treatments. Building on the growing body of evidence for the efficacy of exercise in the treatment of other psychiatric disorders, interventions to increase aerobic exercise in patients with OCD represent a potentially useful yet relatively unexplored strategy in OCD. Methods/Design One hundred and two (102) patients with clinically significant OCD symptoms despite current engagement in recommended treatments (pharmacotherapy and/or CBT) will be randomly assigned to receive either a 12-week moderate intensity aerobic exercise (AE) intervention or a health education control (HEC) intervention. Follow-up interviews will be conducted at the end of treatment and at 3-, 6- and 12-months post-intervention. They will assess OCD severity, nonspecific anxiety, depression, quality of life, cardiorespiratory fitness and cognition (executive function). Discussion If efficacy is established, patients with OCD who have clinically significant residual symptoms despite current pharmacotherapy or CBT would gain a valuable and practical treatment augmentation option.
Abrantes, Ana M.; McLaughlin, Nicole; Greenberg, Benjamin D.; Strong, David R.; Riebe, Deborah; Mancebo, Maria; Rasmussen, Steven; Desaulniers, Julie; Brown, Richard A.
The structure of the corpus callosum in obsessive compulsive disorder.
Abnormal brain connectivity has recently been reported in obsessive compulsive disorder (OCD). However, structural differences in the corpus callosum (CC), the primary structure connecting the two hemispheres, have not been extensively studied. In this case-control study, we recruited 30 patients with OCD and 30 healthy control subjects carefully matched for age, sex and handedness. Combining surface-based mesh-modeling and voxel-based morphometry (VBM), we compared callosal thickness and white matter (WM) density in patients and controls. We investigated associations between callosal structure and cortical gray matter (GM) density, and we related CC measures to neuropsychological performance in OCD. OCD patients showed small anterior and posterior callosal regions compared to healthy control subjects. In the OCD group, anterior callosal thickness was positively correlated with GM density of the right mid-dorso-lateral prefrontal (BA 9/46) area, while posterior callosal thickness was positively correlated with GM density in the left supramarginal gyrus (BA 40). Moreover, posterior callosal WM density was positively correlated with verbal memory, visuo-spatial memory, verbal fluency, and visuo-spatial reasoning performances. Callosal attributes were related to GM density in cortical areas innervated by the CC, and were also related to performance in cognitive domains impaired in the disorder. The CC may therefore be integrally involved in OCD. PMID:23078960
Di Paola, M; Luders, E; Rubino, I A; Siracusano, A; Manfredi, G; Girardi, P; Martinotti, G; Thompson, P M; Chou, Y-Y; Toga, A W; Caltagirone, C; Spalletta, G
Obsessive-compulsive disorder: a "sensory-motor" problem?
Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition. Although its pathophysiology is not completely understood, neurophysiologic and neuroimaging data have disclosed functional abnormalities in the networks linking frontal cortex, supplementary motor and premotor areas, striatum, globus pallidus, and thalamus (CSPT circuits). By means of transcranial magnetic stimulation (TMS) it is possible to test inhibitory and excitatory circuits within motor cortex. Previous studies on OCD patients under medication have demonstrated altered cortical inhibitory circuits as tested by TMS. On the other hand there is growing evidence suggesting an alteration of sensory-motor integration. Therefore, the aim of the present study was to evaluate sensory-motor integration (SAI and LAI), intracortical inhibition, and facilitation in drug-na�ve OCD patients, using TMS. In our sample, we have demonstrated a significant SAI reduction in OCD patients when compared to a cohort of healthy individuals. SAI abnormalities may be related to a dysfunction of CSPT circuits which are involved in sensory-motor integration processes. Thus, it can be speculated that hypofunctioning of such system might impair the ability of OCD patients to suppress internally triggered intrusive and repetitive movements and thoughts. In conclusion, our data suggest that OCD may be considered as a sensory motor disorder where a dysfunction of sensory-motor integration may play an important role in the release of motor compulsions. PMID:24631627
Russo, M; Naro, A; Mastroeni, C; Morgante, F; Terranova, C; Muscatello, M R; Zoccali, R; Calabr�, R S; Quartarone, A
Emotion and internal experience in Obsessive Compulsive Disorder: reviewing the role of alexithymia, anxiety sensitivity and distress tolerance.
Increasing attention has focused on the role of emotion and internal experience in Obsessive Compulsive Disorder (OCD). This review examines three key constructs that capture different aspects of understanding, appraisal and tolerance of internal states in OCD - alexithymia, anxiety sensitivity (AS) and distress tolerance (DT). The review examines the evidence for the role each of these constructs plays in OCD and considers whether conclusions can be drawn about the implications for our understanding and treatment of OCD. There is evidence that all three are elevated in clinical cases compared to controls, but there is no evidence that any of the three shows specificity for OCD over other anxiety disorders. However, the review has highlighted significant methodological heterogeneity and consequent variation in findings that currently limits broader conclusions from being drawn. There is an indication that this is a valuable area to explore and future studies should focus on deriving greater conceptual clarity around these constructs, independently replicating findings, and establishing a common methodology to enhance the comparability of studies. Studies exploring the ways in which internal experience, cognitions and symptoms may relate to one another would be of significant value in developing models that then lead to improved treatment approaches. PMID:24682109
Robinson, Lucy J; Freeston, Mark H
Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V?
The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V. PMID:20533367
Phillips, Katharine A; Stein, Dan J; Rauch, Scott L; Hollander, Eric; Fallon, Brian A; Barsky, Arthur; Fineberg, Naomi; Mataix-Cols, David; Ferr�o, Ygor Arzeno; Saxena, Sanjaya; Wilhelm, Sabine; Kelly, Megan M; Clark, Lee Anna; Pinto, Anthony; Bienvenu, O Joseph; Farrow, Joanne; Leckman, James
Expressed Emotions in Patients with Obsessive Compulsive Disorder: A Case Control Study
Background: Expressed emotion (EE) is the attitude that the relatives show towards the illness and the person. EE is identified as a direct factor in the relapse of patients with psychological disorders. Literature on EE in anxiety disorders is limited. Role of EE in obsessive compulsive disorder (OCD) may help in better understanding of the role of social factors in OCD. Aim: To compare EE in patients with OCD and compare with controls. Materials and Methods: The sample included 30 cases and 30 age and sex matched controls. The patients were diagnosed as having OCD using International Classification of Diseases-10 Diagnostic Criteria for Research (ICD-10 DCR) criteria. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess severity of OCD among patients. General health questionnaire (GHQ) was used to rule out any psychiatric disorder among control population. EE was assessed in cases and controls using Family Emotional Involvement and Criticism Scale (FEICS). Chi-square test and t-test were used to assess the difference between two groups. Results: OCD patients in comparison controls had significantly increased total FEICS score (P = 0.001). There was an increase in both subscales of perceived criticism (PC) with P = 0.001 and emotional involvement (EI) with P = 0.001 in patients with OCD than controls. Conclusion: EE are significantly increased in patients with OCD. EE should be assessed regularly in patients with OCD.
Koujalgi, Sateesh R.; Nayak, Raghavendra B.; Patil, Nanasaheb M.; Chate, Sameeran S.
Impulse control disorders in children and adolescents with obsessive compulsive disorder
The aim of this study was to examine current prevalences, clinical correlates and patterns of co-occurrence of impulse control disorders (ICDs) in children and adolescents with obsessive compulsive disorder (OCD). We examined rates and clinical correlates of comorbid ICDs in 70 consecutive child and adolescent subjects with lifetime DSM-IV OCD (32.9% females; mean age = 13.8 � 2.9 years). Comorbidity data were obtained with structured clinical interviews using DSM-IV criteria. OCD severity was assessed with the Child Yale-Brown Obsessive Compulsive Scale. All variables were compared in OCD subjects with and without current ICDs. 12 (17.1%) subjects met criteria for a current ICD. Pathological skin picking and compulsive nail biting were the most common ICDs with current rates of 12.8% and 10.0%, respectively. OCD subjects with current ICDs were significantly more likely to have a co-occurring tic disorder (66.7% vs. 20.7%; p=.003). Although having an ICD was associated with greater numerical scores of OCD symptomatology, these differences were not statistically significant. There were no sex-specific patterns of ICD occurrence in children and adolescents with OCD. Certain ICDs are common among children and adolescents with OCD. Better identification of ICDs in children and adolescents with OCD is needed, as are empirically validated treatments for youth with co-occurring ICDs.
Grant, Jon E.; Mancebo, Maria C.; Eisen, Jane L.; Rasmussen, Steven A.
Translational approaches to obsessive-compulsive disorder: from animal models to clinical treatment.
Obsessive-compulsive disorder (OCD) is characterized by obsessions (intrusive thoughts) and compulsions (repetitive ritualistic behaviours) leading to functional impairment. Accumulating evidence links these conditions with underlying dysregulation of fronto-striatal circuitry and monoamine systems. These abnormalities represent key targets for existing and novel treatment interventions. However, the brain bases of these conditions and treatment mechanisms are still not fully elucidated. Animal models simulating the behavioural and clinical manifestations of the disorder show great potential for augmenting our understanding of the pathophysiology and treatment of OCD. This paper provides an overview of what is known about OCD from several perspectives. We begin by describing the clinical features of OCD and the criteria used to assess the validity of animal models of symptomatology; namely, face validity (phenomenological similarity between inducing conditions and specific symptoms of the human phenomenon), predictive validity (similarity in response to treatment) and construct validity (similarity in underlying physiological or psychological mechanisms). We then survey animal models of OC spectrum conditions within this framework, focusing on (i) ethological models; (ii) genetic and pharmacological models; and (iii) neurobehavioural models. We also discuss their advantages and shortcomings in relation to their capacity to identify potentially efficacious new compounds. It is of interest that there has been rather little evidence of 'false alarms' for therapeutic drug effects in OCD models which actually fail in the clinic. While it is more difficult to model obsessive cognition than compulsive behaviour in experimental animals, it is feasible to infer cognitive inflexibility in certain animal paradigms. Finally, key future neurobiological and treatment research areas are highlighted. PMID:21486280
Fineberg, N A; Chamberlain, S R; Hollander, E; Boulougouris, V; Robbins, T W
Translational approaches to obsessive-compulsive disorder: from animal models to clinical treatment
Obsessive-compulsive disorder (OCD) is characterized by obsessions (intrusive thoughts) and compulsions (repetitive ritualistic behaviours) leading to functional impairment. Accumulating evidence links these conditions with underlying dysregulation of fronto-striatal circuitry and monoamine systems. These abnormalities represent key targets for existing and novel treatment interventions. However, the brain bases of these conditions and treatment mechanisms are still not fully elucidated. Animal models simulating the behavioural and clinical manifestations of the disorder show great potential for augmenting our understanding of the pathophysiology and treatment of OCD. This paper provides an overview of what is known about OCD from several perspectives. We begin by describing the clinical features of OCD and the criteria used to assess the validity of animal models of symptomatology; namely, face validity (phenomenological similarity between inducing conditions and specific symptoms of the human phenomenon), predictive validity (similarity in response to treatment) and construct validity (similarity in underlying physiological or psychological mechanisms). We then survey animal models of OC spectrum conditions within this framework, focusing on (i) ethological models; (ii) genetic and pharmacological models; and (iii) neurobehavioural models. We also discuss their advantages and shortcomings in relation to their capacity to identify potentially efficacious new compounds. It is of interest that there has been rather little evidence of �false alarms� for therapeutic drug effects in OCD models which actually fail in the clinic. While it is more difficult to model obsessive cognition than compulsive behaviour in experimental animals, it is feasible to infer cognitive inflexibility in certain animal paradigms. Finally, key future neurobiological and treatment research areas are highlighted. LINKED ARTICLES This article is part of a themed issue on Translational Neuropharmacology. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2011.164.issue-4
Fineberg, NA; Chamberlain, SR; Hollander, E; Boulougouris, V; Robbins, TW
Prospective, Longitudinal Study of Tic, Obsessive-Compulsive, and Attention-Deficit\\/Hyperactivity Disorders in an Epidemiological Sample
ObjectiveUnderstanding the interrelatedness of tics, obsessive-compulsive disorder (OCD), and attention-deficit\\/ hyperactivity disorder (ADHD) has been complicated by studying only cross-sectional samples of clinically referred subjects. The authors report the cross-sectional and longitudinal associations of these disorders in an epidemiological sample of children followed prospectively into early adulthood.
Brief Report: Exposure and Response Prevention for Obsessive Compulsive Disorder in a 12-Year-Old with Autism
ERIC Educational Resources Information Center
Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2%�
Lehmkuhl, Heather D.; Storch, Eric A.; Bodfish, James W.; Geffken, Gary R.
Reduced Prefrontal Hemodynamic Response in Pediatric Obsessive-Compulsive Disorder as Measured by Near-Infrared Spectroscopy
ERIC Educational Resources Information Center
Recent developments in near-infrared spectroscopy (NIRS) have enabled non-invasive clarification of brain functions in psychiatric disorders. Functional neuroimaging studies of patients with obsessive-compulsive disorder (OCD) have suggested that the frontal cortex and subcortical structures may play a role in the pathophysiology of the disorder.�
Ota, Toyosaku; Iida, Junzo; Sawada, Masayuki; Suehiro, Yuko; Yamamuro, Kazuhiko; Matsuura, Hiroki; Tanaka, Shohei; Kishimoto, Naoko; Negoro, Hideki; Kishimoto, Toshifumi
A transgenic model of comorbid Tourette's syndrome and obsessive-compulsive disorder circuitry
The tic disorder Tourette's Syndrome (TS) and obsessive-compulsive disorder (OCD) are comorbid behavioral disorders, suggesting a shared but still unknown neuronal basis. To �circuit-test� such behaviors, we previously engineered transgenic mice expressing a neuropotentiating protein (cholera toxin A1 subunit) within a cortical-limbic subset of dopamine D1-receptor expressing (D1+) neurons known to trigger glutamatergic excitation of orbitofrontal, sensorimotor, limbic and efferent
E J Nordstrom; F H Burton
Potentials and Limitations of Cognitive Treatments for Obsessive?Compulsive Disorder
Exposure and response prevention (ERP) is a well?established treatment for obsessive?compulsive disorder (OCD). However, it is not completely effective for many patients, and some do not benefit from or tolerate this treatment. Over the past 3 decades there has been growing interest in using cognitive interventions, either as adjuncts or alternatives to exposure?based treatments such as ERP, to address these
Jonathan S. Abramowitz; Steven Taylor; Dean McKay
Do Obsessive-Compulsive Patients and Abstinent Heroin Addicts Share a Common Psychophysiological Mechanism?
Background\\/Aim: Working memory (WM) and attentional deficits have been implicated in the pathophysiology of both obsessive-compulsive disorder (OCD) and opioid addiction. The P300 component of event-related potentials (ERPs) is considered as an index of on-line updating of WM and\\/or attentional operations involved in this function. The present study aimed at comparing the P300 elicited during a WM test in patients
Charalabos Papageorgiou; Andreas Rabavilas; Ioannis Liappas; Costas Stefanis
Mindfulness and Obsessive-Compulsive Disorder: Developing a Way to Trust and Validate One's Internal Experience
\\u000a Obsessive-compulsive disorder (OCD) is a chronic and often severe psychiatric disease. It is characterized by recurrent, intrusive\\u000a and distressing thoughts, images, or impulses (obsessions) and\\/or repetitive mental or overt acts (compulsions or neutralizing\\u000a behaviors) performed to reduce or remove distress and anxiety caused by these obsessive thoughts and to prevent any perceived\\u000a harmful consequences (American Psychiatric Association, 2000). This disorder
Fabrizio Didonna
Obsessive compulsive disorder is prevalent, disabling, incompletely understood, and often resistant to current therapies. Established treatments consist of specialized cognitive-behavioral psychotherapy and pharmacotherapy with medications targeting serotonergic and dopaminergic neurotransmission. However, remission is rare, and more than a quarter of OCD sufferers receive little or no benefit from these approaches, even when they are optimally delivered. New insights into the disorder, and new treatment strategies, are urgently needed. Recent evidence suggests that the ubiquitous excitatory neurotransmitter glutamate is dysregulated in OCD, and that this dysregulation may contribute to the pathophysiology of the disorder. Here we review the current state of this evidence, including neuroimaging studies, genetics, neurochemical investigations, and insights from animal models. Finally, we review recent findings from small clinical trials of glutamate-modulating medications in treatment-refractory OCD. The precise role of glutamate dysregulation in OCD remains unclear, and we lack blinded, well-controlled studies demonstrating therapeutic benefit from glutamate-modulating agents. Nevertheless, the evidence supporting some important perturbation of glutamate in the disorder is increasingly strong. This new perspective on the pathophysiology of OCD, which complements the older focus on monoaminergic neurotransmission, constitutes an important focus of current research and a promising area for the ongoing development of new therapeutics.
Pittenger, Christopher; Bloch, Michael H.; Williams, Kyle
Response Inhibition and Interference Control in Obsessive-Compulsive Spectrum Disorders
Over the past 20?years, motor response inhibition and interference control have received considerable scientific effort and attention, due to their important role in behavior and the development of neuropsychiatric disorders. Results of neuroimaging studies indicate that motor response inhibition and interference control are dependent on cortical�striatal�thalamic�cortical (CSTC) circuits. Structural and functional abnormalities within the CSTC circuits have been reported for many neuropsychiatric disorders, including obsessive�compulsive disorder (OCD) and related disorders, such as attention-deficit hyperactivity disorder, Tourette�s syndrome, and trichotillomania. These disorders also share impairments in motor response inhibition and interference control, which may underlie some of their behavioral and cognitive symptoms. Results of task-related neuroimaging studies on inhibitory functions in these disorders show that impaired task performance is related to altered recruitment of the CSTC circuits. Previous research has shown that inhibitory performance is dependent upon dopamine, noradrenaline, and serotonin signaling, neurotransmitters that have been implicated in the pathophysiology of these disorders. In this narrative review, we discuss the common and disorder-specific pathophysiological mechanisms of inhibition-related dysfunction in OCD and related disorders.
van Velzen, Laura S.; Vriend, Chris; de Wit, Stella J.; van den Heuvel, Odile A.
Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial- or Nonresponders
ERIC Educational Resources Information Center
Serotonin reuptake inhibitor medications and cognitive-behavioral therapy (CBT) are both effective treatments for pediatric obsessive-compulsive disorder (OCD). Despite recommendations that youth with OCD be treated with CBT alone or together with serotonin reuptake inhibitor medication, many youth are treated with medication alone or with non-CBT�
Marien, Wendi E.; Storch, Eric A.; Geffken, Gary R.; Murphy, Tanya K.
Gray Matter Alterations in Obsessive-Compulsive Disorder: An Anatomic Likelihood Estimation Meta-Analysis
Many voxel-based morphometry (VBM) studies have found abnormalities in gray matter density (GMD) in obsessive�compulsive disorder (OCD). Here, we performed a quantitative meta-analysis of VBM studies contrasting OCD patients with healthy controls (HC). A literature search identified 10 articles that included 343 OCD patients and 318 HC. Anatomic likelihood estimation meta-analyses were performed to assess GMD changes in OCD patients relative to HC. GMD was smaller in parieto-frontal cortical regions, including the supramarginal gyrus, the dorsolateral prefrontal cortex, and the orbitofrontal cortex, and greater in the basal ganglia (putamen) and the anterior prefrontal cortex in OCD patients relative to HC. No significant differences were found between children and adults. Our findings indicate differences in GMD in parieto-frontal areas and the basal ganglia between OCD patients and HC. We conclude that structural abnormalities within the prefrontal-basal ganglia network are involved in OCD pathophysiology.
Rotge, Jean-Yves; Langbour, Nicolas; Guehl, Dominique; Bioulac, Bernard; Jaafari, Nematollah; Allard, Michele; Aouizerate, Bruno; Burbaud, Pierre
The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review
Objective Obsessive-compulsive personality disorder (OCPD) traits and obsessive-compulsive disorder (OCD) are commonly associated with patients with Anorexia Nervosa (AN). The aim of this review was to systematically search the literature to examine whether OCPD and OCD are positively associated with excessive exercise in patients with AN. Method A systematic electronic search of the literature (using PsycInfo, Medline and Web of Knowledge) was undertaken to identify relevant publications until May 2012. Results A total of ten studies met criteria for inclusion in the review. The design of the studies varied from cross-sectional to retrospective and quasi-experimental. Seven out of the ten studies reviewed demonstrated a positive relationship between OCPD and/or OCD in AN patients who exercise excessively, whilst three studies found a lack of relationship, or a negative relationship, between these constructs. Conclusion There is evidence from the literature to suggest that there is a positive relationship between OCPD and excessive exercise in patients with AN. However, the relationship between OCD and excessive exercise is less clear and further research is required to qualify the strength of such relationships. Future research should utilise the most comprehensive and reliable clinical assessment tools, and address prognostic factors, treatment factors and specific interventions for patients with OCPD and/or OCD and excessive exercise.
A Case of Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
This article presents the case of a 51-year old woman with obsessive-compulsive disorder. "Caroline" reported obsessions of harming people secondary to spreading her "bad energy," which is experienced as dust on her hands and in her mouth. To prevent harm coming to others she mentally "vacuums" the dust, creates mental protective barriers around�
Twohig, Michael P.; Whittal, Maureen L.
The Developmental Course of Anxiety Symptoms during Adolescence: The TRAILS Study
ERIC Educational Resources Information Center
Background: Little is known about the development of anxiety symptoms from late childhood to late adolescence. The present study determined developmental trajectories of symptoms of separation anxiety disorder (SAD), social phobia (SoPh), generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD) in a large�
Van Oort, F. V. A.; Greaves-Lord, K.; Verhulst, F. C.; Ormel, J.; Huizink, A. C.
Patient satisfaction with specialized mental health service for obsessive-compulsive disorder
Background Patient satisfaction is an important outcome variable that is increasingly used in mental health service evaluation. There are no results available for patients with obsessive-compulsive disorder (OCD) yet. Methods Using the Verona Service Satisfaction Scale, patient satisfaction with a specialized mental health service was examined in patients with OCD. Results OCD patients were overall satisfied with the professional help provided, whereas satisfaction with the professional involvement of relatives within the treatment and health care process was found to be quite low. Patients with more severe OCD, as measured by the Yale-Brown Obsessive-Compulsive Scale, as well as chronically ill and more disabled patients were more likely to be dissatisfied with the overall care they received. Patient satisfaction plays an important role in the long-term course of an illness such OCD. This seems to be decreased so longer illness is not or badly treated. There is a stronger need for involvement of family members in the treatment and health care of patients with OCD. Conclusions More OCD-specific treatment offers have to be established for patients with this long-term illness such as psychotherapy in groups.
The heterogeneous structure of schizotypal personality disorder: item-level factors of the Schizotypal Personality Questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality.
A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed. PMID:18489212
Chmielewski, Michael; Watson, David
Normative Childhood Repetitive Routines and Obsessive Compulsive Symptomatology in 6-Year-Old Twins
ERIC Educational Resources Information Center
Background: To investigate the association between normative repetitive routines of childhood and paediatric obsessive compulsive symptom syndrome (OCSS) and the extent to which it is genetically mediated. Methods: In a two-phase design a community sample of 4,662 6-year-old twin-pairs were sampled and 854 pairs were assessed in the second phase�
Bolton, Derek; Rijsdijk, Fruhling; Eley, Thalia C.; O'Connor, Thomas G.; Briskman, Jacqueline; Perrin, Sean
Is there a relationship between clozapine and obsessive-compulsive disorder?: A retrospective chart review
The emergence of obsessive-compulsive symptoms during clozapine treatment has been reported in recent case studies, yet the incidence and significance of this finding is still unclear pending reliable data from a larger sample of patients. Hospital records of 142 randomly selected inpatients started on clozapine treatment at McLean Hospital before July 1, 1992, were reviewed retrospectively. Based on a limited
S Nassir Ghaemi; Carlos A Zarate; Anand P Popli; Srinivasan S Pillay; Jonathan O Cole
The effect of mCPP on tics and obsessive-compulsive phenomena in Gilles de la Tourette syndrome
Rationale: Family genetic and phenomenological studies support an interrelationship between Gilles de la Tourette syndrome (GTS) and\\u000a obsessive-compulsive disorder (OCD). Some authors consider GTS as part of a serotonergically mediated cluster of OCD spectrum\\u000a disorders. Objective: To study serotonergic mechanisms in GTS, the effect of the relatively selective 5-HT2c agonist meta-chlorophenylpiperazine (m-CPP) was assessed. Methods: We studied the behavioural effects
Danielle C. Cath; Harm J. Gijsman; Rik C. Schoemaker; Jean M. T. van Griensven; Nancy Troost; Godfried M. J. van Kempen; Adam F. Cohen
How to treat the untreated: effectiveness of a self-help metacognitive training program (myMCT) for obsessive-compulsive disorder
Despite advances in the understanding and treatment of obsessive-compulsive disorder (OCD), many patients undergoing interventions display incomplete symptom reduction. Our research group has developed a self-help manual entitled �My Metacognitive Training for OCD� (myMCT) aimed at raising patients' awareness about cognitive biases that seem to subserve OCD. The training is particularly intended for patients currently unable or unwilling to attend standard therapy, or in cases where such a treatment option is not available. For the present study, 86 individuals suffering from OCD were recruited over the Internet. Following the initial assessment participants were either immediately emailed the myMCT manual or allocated to a waitlist group. After 4 weeks, a second assessment was performed. The myMCT group showed significantly greater improvement for OCD symptoms according to the Y-BOCS total score compared with the waitlist group (d =.63), particularly for obsessions (d=.69). Medium to strong differences emerged for the OCI-R (d =.70) and the BDI-SF (d =.50). The investigation provides the first evidence for the effectiveness of the myMCT for OCD.
Moritz, Steffen; Jelinek, Lena; Hauschildt, Marit; Naber, Dieter
Poor performance on the Iowa gambling task in children with obsessive-compulsive disorder
Background Several lines of evidence implicate orbitofrontal cortex dysfunction in the pathophysiology of obsessive-compulsive disorder (OCD). The purpose of this study was to investigate neuropsychological dysfunction of the orbitofrontal cortex in children with OCD. Methods The Iowa Gambling Task (IGT), which reflects orbitofrontal cortex function, and the Wisconsin Card Sorting Test (WCST), which is associated with functioning of the dorsolateral prefrontal cortex, were administered to 22 children with OCD and 22 healthy controls matched for gender, age, and intelligence. Results OCD patients displayed poor performance on the IGT. In contrast, performance on the WCST was not impaired in OCD patients compared to controls. Conclusions These findings are in line with previous studies demonstrating that OCD in childhood is associated with a dysfunction of orbitofrontal-striatal-thalamic circuitry.
Do patients with OCD and pathological gambling have similar dysfunctional cognitions?
The obsessive-compulsive spectrum disorder (OCSD) theory postulates that a wide range of disorders is closely related to OCD. Current cognitive models ascertain that certain beliefs leading to misinterpretation of the significance of intrusions are important in the etiology and maintenance of OCD. This study examined whether pathological gambling, a disorder belonging to the OC spectrum, is characterized by similar dysfunctional cognitions as OCD. Dysfunctional beliefs of OCD patients were compared to those of patients with pathological gambling, panic disorder and normal controls. These beliefs were measured by the Obsessive-compulsive Beliefs Questionnaire-87 (OBQ-87), which was developed by a group of leading OCD researchers [Behav. Res. Ther. 35 (1997) 667]. It was hypothesized that according to the OCSD theory, pathological gamblers would exhibit similar cognitions to OCD patients, as well as increased levels of OCD symptoms. Analysis showed that OCD patients exhibited higher OBQ-87 scores than both panic patients and normal controls, but equal to pathological gambling patients. Pathological gamblers exhibited, however, no increase in OCD symptoms. These mixed results do not seem to support the OC spectrum theory for pathological gambling, moreover being contradictory to contemporary cognitive OCD models. PMID:15033499
Anholt, Gideon E; Emmelkamp, Paul M G; Cath, Danielle C; van Oppen, Patricia; Nelissen, Henri; Smit, Johannes H
The role of NMDA receptors in the signal attenuation rat model of obsessive�compulsive disorder
Rationale��In recent years, an increasing body of evidence points to the involvement of the glutamatergic system and specifically the\\u000a glutamatergic ionotropic N-methyl-d-aspartate (NMDA) receptor in the pathophysiology of obsessive�compulsive disorder (OCD).\\u000a \\u000a \\u000a \\u000a \\u000a Objectives��To test the role of NMDA receptors in compulsive behavior using the signal attenuation rat model of OCD. In this model, �compulsive�\\u000a behavior is induced by attenuating a signal
Noa Albelda; Nitza Bar-On; Daphna Joel
Religiosity and obsessive-compulsive behavior in Israeli Jews.
Individual differences in obsessive-compulsive (OC) behavior in various cultures correlate with religiosity. The current paper explored the so far unstudied relationship between religiosity and OC behavior in Israeli Jews. Two studies were conducted. Study 1 focused on the relationship between religiosity and OC behavior in a representative sample of Israeli students. Study 2 focused on religious change and OC behavior in a non-random sample of 31 individuals who had become more religious (the MR group), and 30 individuals who were less religious (the LR group) than their parents. Instruments used were the Maudsley obsessive-compulsive inventory (MOCI), the student religiosity questionnaire, and questions about parental home observance, upbringing, and changes in religiosity. In the first study, no association was found between religiosity and OC behavior. Religiosity was related to some degree to perfectionism and to the parental attitude to upbringing. In the second study, a significant difference was observed between the MR and the LR groups on OC behavior as measured by the MOCI. Conclusion, among Israeli Jews a lot of religious observance is non-reflective, and is not associated with individual differences in personality or OC symptoms. Those who undergo religious change may do so in response to their behavioral propensities. One such path is that the more OC become MR, and the less OC less religiously observant. PMID:15896283
Zohar, Ada H; Goldman, Eitan; Calamary, Ramit; Mashiah, Merav
Genome-wide association study of obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a common, debilitating neuropsychiatric illness with complex genetic etiology. The International OCD Foundation Genetics Collaborative (IOCDF-GC) is a multi-national collaboration established to discover the genetic variation predisposing to OCD. A set of individuals affected with DSM-IV OCD, a subset of their parents, and unselected controls, were genotyped with several different Illumina SNP microarrays. After extensive data cleaning, 1465 cases, 5557 ancestry-matched controls and 400 complete trios remained, with a common set of 469,410 autosomal and 9657 X-chromosome single nucleotide polymorphisms (SNPs). Ancestry-stratified case-control association analyses were conducted for three genetically-defined subpopulations and combined in two meta-analyses, with and without the trio-based analysis. In the case-control analysis, the lowest two P-values were located within DLGAP1 (P=2.49 � 10(-6) and P=3.44 � 10(-6)), a member of the neuronal postsynaptic density complex. In the trio analysis, rs6131295, near BTBD3, exceeded the genome-wide significance threshold with a P-value=3.84 � 10(-8). However, when trios were meta-analyzed with the case-control samples, the P-value for this variant was 3.62 � 10(-5), losing genome-wide significance. Although no SNPs were identified to be associated with OCD at a genome-wide significant level in the combined trio-case-control sample, a significant enrichment of methylation QTLs (P<0.001) and frontal lobe expression quantitative trait loci (eQTLs) (P=0.001) was observed within the top-ranked SNPs (P<0.01) from the trio-case-control analysis, suggesting these top signals may have a broad role in gene expression in the brain, and possibly in the etiology of OCD. PMID:22889921
Stewart, S E; Yu, D; Scharf, J M; Neale, B M; Fagerness, J A; Mathews, C A; Arnold, P D; Evans, P D; Gamazon, E R; Davis, L K; Osiecki, L; McGrath, L; Haddad, S; Crane, J; Hezel, D; Illman, C; Mayerfeld, C; Konkashbaev, A; Liu, C; Pluzhnikov, A; Tikhomirov, A; Edlund, C K; Rauch, S L; Moessner, R; Falkai, P; Maier, W; Ruhrmann, S; Grabe, H-J; Lennertz, L; Wagner, M; Bellodi, L; Cavallini, M C; Richter, M A; Cook, E H; Kennedy, J L; Rosenberg, D; Stein, D J; Hemmings, S M J; Lochner, C; Azzam, A; Chavira, D A; Fournier, E; Garrido, H; Sheppard, B; Uma�a, P; Murphy, D L; Wendland, J R; Veenstra-VanderWeele, J; Denys, D; Blom, R; Deforce, D; Van Nieuwerburgh, F; Westenberg, H G M; Walitza, S; Egberts, K; Renner, T; Miguel, E C; Cappi, C; Hounie, A G; Concei��o do Ros�rio, M; Sampaio, A S; Vallada, H; Nicolini, H; Lanzagorta, N; Camarena, B; Delorme, R; Leboyer, M; Pato, C N; Pato, M T; Voyiaziakis, E; Heutink, P; Cath, D C; Posthuma, D; Smit, J H; Samuels, J; Bienvenu, O J; Cullen, B; Fyer, A J; Grados, M A; Greenberg, B D; McCracken, J T; Riddle, M A; Wang, Y; Coric, V; Leckman, J F; Bloch, M; Pittenger, C; Eapen, V; Black, D W; Ophoff, R A; Strengman, E; Cusi, D; Turiel, M; Frau, F; Macciardi, F; Gibbs, J R; Cookson, M R; Singleton, A; Hardy, J; Crenshaw, A T; Parkin, M A; Mirel, D B; Conti, D V; Purcell, S; Nestadt, G; Hanna, G L; Jenike, M A; Knowles, J A; Cox, N; Pauls, D L
Abnormal processing of deontological guilt in obsessive-compulsive disorder.
Guilt plays a significant role in the occurrence and maintenance of obsessive-compulsive disorder (OCD). Two major types of guilt have been identified: one deriving from the transgression of a moral rule (deontological guilt DG), another (altruistic guilt AG), relying on the assumption of having compromised a personal altruistic goal. Clinical evidence suggests that OCD patients are particularly sensitive to DG, but not AG. In this functional magnetic resonance imaging (fMRI) study, we investigated brain response of OCD patients while processing DG and AG stimuli. A previously validated fMRI paradigm was used to selectively evoke DG and AG, and anger and sadness, as control emotions in 13 OCD patients and 19 healthy controls. Patients' behavioral results showed a prominent attitude to experience guilt, compared to controls, while accomplishing task. fMRI results revealed that patients have reduced activation in the anterior cingulate (ACC) and frontal gyrus when experiencing guilt, regardless of its specific type (DG or AG). When separately considering each type of guilt (against each of its control), patients showed decreased activation in the ACC, the insula and the precuneus, for DG. No significant differences were observed between groups when processing AG, anger or sad stimuli. This study provides evidence for an abnormal processing of guilt, and specifically DG, in OCD patients. We suggest that decreased activation may reflect patients' cerebral efficiency, which derives from their frequent exposure to guilty feelings ("neural efficiency hypothesis"). In conclusion, our study confirms a selective abnormal processing of guilt, and specifically DG, in OCD. PMID:23681167
Basile, Barbara; Mancini, Francesco; Macaluso, Emiliano; Caltagirone, Carlo; Bozzali, Marco
High-frequency stimulation of deep brain structures in obsessive-compulsive disorder: the search for a valid circuit.
Obsessive-compulsive disorder (OCD) is a common, disabling, psychiatric disease combining intrusive thoughts (obsessions) and repetitive behaviours (compulsions). Although most patients respond well to conventional pharmacological and/or psychological therapy, 25-30%, often with extremely severe symptoms, fail to improve after treatment. High-frequency stimulation of deep brain structures (basal ganglia included), a surgical technique developed for movement disorders and otherwise known as deep brain stimulation (DBS), has been proposed as an alternative to ablative surgery for these intractable cases. Here, we review the scientific data that explain why the use of this technique is currently being investigated in OCD, from the first hypotheses based on neuroimaging studies (anatomical and functional) to more recent animal models and clinical observations. The general outcome of each clinical trial is outlined in order to discuss its relation to pathophysiology; however, more specific clinical information (side-effects, latencies, and other behavioural modifications) is not given. Finally, a description of the models of OCD that stem from these data and how they might be affected by DBS is provided. PMID:21039951
Haynes, William I A; Mallet, Luc
Alexithymia, suicidal ideation, and serum lipid levels among drug-na�ve outpatients with obsessive-compulsive disorder.
Objective: As obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder with a significant suicide risk, the individuation of potential biomarkers of suicidality, such as cholesterol levels, may enable recognition of at-risk subjects. Therefore, the aims of this study were to: 1) evaluate potential differences in clinical and laboratory parameters between patients with and without alexithymia and compare them with healthy controls; and 2) investigate which clinical and laboratory variables were associated with suicidal ideation. Methods: 79 drug-na�ve adult outpatients with a DSM-IV diagnosis of OCD were recruited. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), suicidal ideation was assessed with the Scale for Suicide Ideation, and depressive symptoms were evaluated with the Montgomery-�sberg Depression Rating Scale (MADRS). Serum lipid levels of 40 healthy controls were also evaluated. Results: Alexithymic patients had altered serum lipid levels in comparison with non-alexithymics and healthy controls. Using a linear regression model, the presence of symmetry/ordering obsessions and compulsions, lower HDL-C levels, and difficulty in identifying feelings dimension of the TAS-20 were associated with higher suicidal ideation. Conclusions: Alexithymic individuals with OCD may exhibit dysregulation of the cholesterol balance, which in turn may be linked to suicidal ideation. Further prospective studies are required to elucidate this potential association. PMID:24554275
De Berardis, Domenico; Serroni, Nicola; Marini, Stefano; Rapini, Gabriella; Carano, Alessandro; Valchera, Alessandro; Iasevoli, Felice; Mazza, Monica; Signorelli, Maria; Aguglia, Eugenio; Perna, Giampaolo; Martinotti, Giovanni; Varasano, Paola A; Pressanti, Gabriella Lucidi; Di Giannantonio, Massimo
Obsessive Compulsive Personality Disorder and Parkinson's Disease
Objectives To evaluate the frequency of personality disorders in Parkinson�s disease (PD) patients and in a group of healthy controls. Methods Patients affected by PD diagnosed according to the United Kingdom Parkinson�s disease Society Brain Bank diagnostic criteria and a group of healthy controls were enrolled in the study. PD patients with cognitive impairment were excluded from the study. Structured Clinical Interview for Personality Disorders-II (SCID-II) has been performed to evaluate the presence of personality disorders. Presence of personality disorders, diagnosed according to the DSM-IV, was confirmed by a psychiatric interview. Clinical and pharmacological data were also recorded using a standardized questionnaire. Results 100 PD patients (57 men; mean age 59.0�10.2 years) and 100 healthy subjects (52 men; mean age 58.1�11.4 years) were enrolled in the study. The most common personality disorder was the obsessive-compulsive personality disorder diagnosed in 40 PD patients and in 10 controls subjects (p-value<0.0001) followed by the depressive personality disorder recorded in 14 PD patients and 4 control subjects (p-value 0.02). Obsessive-compulsive personality disorder was also found in 8 out of 16 de novo PD patients with a short disease duration. Conclusion PD patients presented a high frequency of obsessive-compulsive personality disorder that does not seem to be related with both disease duration and dopaminergic therapy.
Raciti, Loredana; Contrafatto, Donatella; Bruno, Elisa; Dibilio, Valeria; Sciacca, Giorgia; Mostile, Giovanni; Petralia, Antonio; Zappia, Mario
Memory deficits in patients with DSM-IV obsessive-compulsive disorder.
Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers' rituals. Another account of doubting implicates meta-cognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Ged�chtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to meta-cognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required. PMID:11316955
Zitterl, W; Urban, C; Linzmayer, L; Aigner, M; Demal, U; Semler, B; Zitterl-Eglseer, K
Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder
The cerebral metabolic rate for glucose was studied in 18 adults with childhood-onset obsessive-compulsive disorder (OCD) and in age- and sex-matched controls using positron emission tomography and fludeoxyglucose F 18. Both groups were scanned during rest, with reduced auditory and visual stimulation. The group with OCD showed an increased glucose metabolism in the left orbital frontal, right sensorimotor, and bilateral prefrontal and anterior cingulate regions as compared with controls. Ratios of regional activity to mean cortical gray matter metabolism were increased for the right prefrontal and left anterior cingulate regions in the group with OCD as a whole. Correlations between glucose metabolism and clinical assessment measures showed a significant relationship between metabolic activity and both state and trait measurements of OCD and anxiety as well as the response to clomipramine hydrochloride therapy. These results are consistent with the suggestion that OCD may result from a functional disturbance in the frontal-limbic-basal ganglia system.
Swedo, S.E.; Schapiro, M.B.; Grady, C.L.; Cheslow, D.L.; Leonard, H.L.; Kumar, A.; Friedland, R.; Rapoport, S.I.; Rapoport, J.L.
Homotypic versus Heterotypic Continuity of Anxiety Symptoms in Young Adolescents: Evidence for Distinctions between DSM-IV Subtypes
ERIC Educational Resources Information Center
Objective: To investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. Method: 2,067 individuals (51.4% girls) from a�
Ferdinand, Robert F.; Dieleman, Gwen; Ormel, Johan; Verhulst, Frank C.
Psychiatric Symptoms Associated with Focal Hand Dystonia
Myoclonus dystonia and idiopathic dystonia are associated with a greater frequency of obsessive compulsive disorder (OCD) and major depression. We investigated the frequency of OCD in 39 patients with primary focal hand dystonia (FHD) using a semistructured interview. OCD and subsyndromal OCD was diagnosed in 5 of 39 (12.82%) patients with FHD, whereas OCD occurs in 2.3% of the general population. Recurrent depression occurred in (7 of 39) 17.95% of patients with FHD along with a family history of depression in (16 of 39) 41.02%. Overlapping mechanisms manifesting as FHD may also predispose to OC symptoms and likely implicates a common striatal dysfunction.
Voon, Valerie; Butler, Tracy R.; Ekanayake, Vindhya; Gallea, Cecile; Ameli, Rezvan; Murphy, Dennis L.; Hallett, Mark
[Self-evaluation of obsessive-compulsive disorder. Adaptation and validation of two psychometric scales to the French version].
Reliable and valid measures of obsessive-compulsive behaviors are essential to investigation of obsessive-compulsive disorder (OCD). With observer-rated scales, accurate self-assessment is also required in the evaluation of OCD. In a collaborative study, two psychometric instruments for self assessment of OCD were translated and adapted into a french version: The Maudsley Obsessive-Compulsive Inventory (MOCI). and the Lynfield Obsessional-Compulsive Questionnaire (LOCQ) with 2 scores generated for "resistance" (LOCQ-R) and "interference" (LOCQ-I). The validity and the reliability of these two instruments were studied within different selected psychiatric groups, OCD, Panic disorder with or without Agoraphobia, Major Depression, and in a control group. Between-groups comparison showed that MOCI and LOCQ global scores (respectively 17 +/- 3.9 for MOCI global score, p < 0.01; and 40.3 +/- 11.0 for LOCQ-R, 43.1 +/- 12.0 for LOCQ-I global scores, p < 0.0001) can differentiate between the obsessional patients and the other groups. An overlap between OCD and Major Depression groups was observed on MOCI "doubting" and "slowness" sub-scores. By comparing MOCI and LOCQ global scores with observer-rated scales of obsessive-compulsive behaviour, we found adequate correlations: CPRS-OC (subscale of Comprehensive Psychiatric Rating Scale for Obsessions and Compulsions) (r > 0.5; p < 0.01), CAC (Compulsive Activities Check-list) (r > 0.6; p < 0.01), and global time spent on rituals (r > 0.5; p < 0.01). The total MOCI and LOCQ scores were significantly, but weakly correlated with depression and anxiety measures (r = 0.30-0.49).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8275910
Hantouche, E; Guelfi, J D
Reduced dorsolateral prefrontal cortical hemodynamic response in adult obsessive-compulsive disorder as measured by near-infrared spectroscopy during the verbal fluency task
Background Near-infrared spectroscopy has helped our understanding of the neurobiological mechanisms of psychiatric disorders and has advantages including noninvasiveness, lower cost, and ease of use compared with other imaging techniques, like functional magnetic resonance imaging. The verbal fluency task is the most common and well established task used to assess cognitive activation during near-infrared spectroscopy. Recent functional neuroimaging studies have shown that the orbitofrontal cortex and other brain regions, including the dorsolateral prefrontal cortex, may play important roles in the pathophysiology of obsessive-compulsive disorder (OCD). This study aimed to evaluate hemodynamic responses in the dorsolateral prefrontal cortex in patients with OCD using near-infrared spectroscopy during the verbal fluency task and to compare these with dorsolateral prefrontal cortex responses in healthy controls. Methods Twenty patients with OCD and 20 controls matched for age, gender, handedness, and estimated intelligence quotient participated in this study. The verbal fluency task was used to elicit near-infrared spectroscopic activation and consisted of a 30-second pre-task, followed by three repetitions of a 20-second verbal fluency task (total 60 seconds), followed by a 70-second post-task period. The near-infrared spectroscopy experiment was conducted on the same day as surveys of obsessive-compulsive symptoms, depression, and anxiety. Z-scores for changes in the concentration of oxygenated hemoglobin were compared between the OCD patients and controls in 14 channels set over the left and right dorsolateral prefrontal cortex and frontopolar areas. Results During the verbal fluency task, significant task-related activation was detected in both the OCD group and the controls. Changes in oxygenated hemoglobin concentration in the right dorsolateral prefrontal cortex were significantly smaller in the OCD group than in the controls, but were not statistically significant after correction for multiple comparisons. Conclusion Patients with OCD have reduced prefrontal, especially right dorsolateral prefrontal, cortical hemodynamic responses as measured by near-infrared spectroscopy during the verbal fluency task. These results support the hypothesis that the dorsolateral prefrontal cortex plays a role in the pathophysiology of OCD.
Hirosawa, Rikuei; Narumoto, Jin; Sakai, Yuki; Nishida, Seiji; Ishida, Takuya; Nakamae, Takashi; Takei, Yuichi; Fukui, Kenji
Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity
Individuals with obsessive�compulsive disorder (OCD) have also been shown to have comorbid lifetime diagnoses of major depressive disorder (MDD; rates greater than 70%), bipolar disorder (rates greater than 10%) and other anxiety disorders (e.g. panic disorder, post-traumatic stress disorder (PTSD)). In addition, overlap exists in some common genetic variants (e.g. the serotonin transporter gene (SLC6A4), the brain-derived neurotrophic factor (BDNF) gene), and rare variants in genes/chromosomal abnormalities (e.g. the 22q11 microdeletion syndrome) found across the affective/anxiety disorder spectrums. OCD has been proposed as a possible independent entity for DSM-5, but by others thought best retained as an anxiety disorder subtype (its current designation in DSM-IV), and yet by others considered best in the affective disorder spectrum. This review focuses on OCD, a well-studied but still puzzling heterogeneous disorder, regarding alterations in serotonergic, dopaminergic and glutamatergic neurotransmission in addition to other systems involved, and how related genes may be involved in the comorbidity of anxiety and affective disorders. OCD resembles disorders such as depression, in which gene � gene interactions, gene � environment interactions and stress elements coalesce to yield OC symptoms and, in some individuals, full-blown OCD with multiple comorbid disorders.
Murphy, Dennis L.; Moya, Pablo R.; Fox, Meredith A.; Rubenstein, Liza M.; Wendland, Jens R.; Timpano, Kiara R.
Sequential super-stereotypy of an instinctive fixed action pattern in hyper-dopaminergic mutant mice: a model of obsessive compulsive disorder and Tourette's
BACKGROUND: Excessive sequential stereotypy of behavioral patterns (sequential super-stereotypy) in Tourette's syndrome and obsessive compulsive disorder (OCD) is thought to involve dysfunction in nigrostriatal dopamine systems. In sequential super-stereotypy, patients become trapped in overly rigid sequential patterns of action, language, or thought. Some instinctive behavioral patterns of animals, such as the syntactic grooming chain pattern of rodents, have sufficiently complex
Kent C Berridge; J Wayne Aldridge; Kimberly R Houchard; Xiaoxi Zhuang
Preliminary Findings of Antistreptococcal Antibody Titers and Basal Ganglia Volumes in Tic, Obsessive-compulsive, and Attention-Deficit\\/Hyperactivity Disorders
Background: Previous studies have provided prelimi- nary serological evidence supporting the theory that symp- toms of tic disorders or obsessive-compulsive disorder (OCD) may be sequelae of prior streptococcal infection. It is unclear, however, whether previously reported as- sociations with streptococcal infection were obscured by the presence of diagnostic comorbidities. It is also un- known whether streptococcal infection is associated in
Bradley S. Peterson; James F. Leckman; Daniel Tucker; Lawrence Scahill; Lawrence Staib; Heping Zhang; Robert King; Donald J. Cohen; John C. Gore; Paul Lombroso
Familiality of Tourette Syndrome, Obsessive-Compulsive Disorder, and Attention-Deficit/Hyperactivity Disorder: Heritability Analysis in a Large Sib-Pair Sample
ERIC Educational Resources Information Center
Objective: Tourette syndrome (TS) is a neuropsychiatric disorder with a genetic component that is highly comorbid with obsessive-compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD). However, the genetic relations between these disorders have not been clearly elucidated. This study examined the familial relations among TS,�
Mathews, Carol A.; Grados, Marco A.
Similarities and Differences between Children and Adolescents with Autism Spectrum Disorder and Those with Obsessive Compulsive Disorder: Executive Functioning and Repetitive Behaviour
ERIC Educational Resources Information Center
In order to examine hypothesized underlying neurocognitive processes in repetitive behaviour, children and adolescents (7-16 years) with autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) were compared on a range of executive function (EF) measures. Performance on neuropsychological tests assessing executive functioning showed�
Zandt, Fiona; Prior, Margot; Kyrios, Michael
Obsessive-compulsive disorder: a new risk factor for Alzheimer disease?
We describe a case of a 75-year-old woman referred to the Memory Clinic of the neurological Department of Charles Nicolle Hospital, Tunis, for cognitive decline and behavioral disturbances. Her past medical history was marked by severe obsessive-compulsive disorder (OCD) with contamination obsessions and washing compulsions. She has a family history for OCD and/or of dementia in 15 members. Clinical features, along with neuropsychological findings and Brain imaging were in favor of Alzheimer disease (AD). The present report is the first family study reporting the possible association of OCD and AD. The glutamatergic dysfunction may be a common pathophysiology of OCD and AD explaining this association. PMID:21290158
Mrabet Khiari, Hela; Achouri, Afef; Ben Ali, Nadia; Cherif, Aroua; Batti, Hend; Messaoud, Taieb; Mrabet, Amel
An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents.
Five hundred and sixty-two, 16- to 17-year-old consecutive inductees into the Israeli Army, constituting a random sample of their cohort, were screened for obsessive-compulsive disorder (OCD), Tourette's syndrome, transient tics (TT), chronic multiple tics (CMT), and attention-deficit hyperactive disorder (ADHD). Two child psychiatrists interviewed the subjects, using screening items from structured interviews that implement DSM-III-R diagnostic criteria. For OCD, a point prevalence of 3.6% was found, 3.9% for ADHD, 1.8% for CMT, and 1.6% for TT. For ADHD, TT, and CMT, but not for OCD, there was a significantly higher prevalence for males than for females. Among the OCD individuals, there was an elevation of TT, CMT, and Tourette's syndrome relative to the population rates. PMID:1429405
Zohar, A H; Ratzoni, G; Pauls, D L; Apter, A; Bleich, A; Kron, S; Rappaport, M; Weizman, A; Cohen, D J
Quantitative morphology of the corpus callosum in obsessive-compulsive disorder
Neuroimaging studies have implicated the corpus callosum (CC) in the pathophysiology of obsessive-compulsive disorder (OCD). Putative dysfunctions in prefrontal cortical regions suggest anomalies in anterior segments of the CC. However, recent studies have also implicated the middle and posterior CC. The present study soughts to examine the CC using parcellation scheme informed by diffusion tensor imaging. Anatomic brain magnetic resonance scans were obtained from 21 OCD subjects (mean age = 26.9�9.93) and 42 healthy age- and sex-matched controls (mean age = 26.6�9.46) between the ages of 14 and 49. Area and volume measures of five subregions of the CC were obtained via manual tracings. A multivariate analysis of variance (after correcting for multiple comparisons) identified smaller area and volume in the mid-anterior region of the CC in OCD patients relative to controls. These findings implicate medio-frontal regions of the cortex in the pathophysiology of OCD.
Lopez, Katherine C.; Lalonde, Francois; Mattai, Anand; Wade, Benjamin; Clasen, Liv; Rapoport, Judith; Giedd, Jay N.
Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale in schizophrenia patients.
Although a sizeable minority of people with schizophrenia manifest obsessive and compulsive symptoms, to our knowledge there are no studies of the psychometric performance of measures such as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The present study examined psychometric properties of the Y-BOCS in patients with recent-onset schizophrenia and comorbid obsessive-compulsive symptoms (OCS). To 37 patients with recent-onset schizophrenia and related disorders and comorbid OCS taken from 135 consecutively admitted patients we administered the Y-BOCS at admission and 6 weeks later. The Y-BOCS showed good internal consistency and interrater reliability in this population; however, findings concerning the divergent validity against depressive and negative symptoms are inconsistent. PMID:17065972
de Haan, Lieuwe; Hoogeboom, Britt; Beuk, Nico; Wouters, Luuk; Dingemans, Peter M A J; Linszen, Don H
EEG-vigilance differences between patients with borderline personality disorder, patients with obsessive-compulsive disorder and healthy controls
The regulation of brain activation, as assessed with the EEG, is a state modulated trait. A decline to lowered EEG-vigilance\\u000a states has been found to be associated with emotional instability in older studies, but has not been systematically studied\\u000a in patients with borderline personality disorder (BPD). Twenty unmedicated BPD patients were compared to 20 unmedicated patients\\u000a with obsessive-compulsive disorder (OCD)
Ulrich Hegerl; Michael Stein; Christoph Mulert; Roland Mergl; Sebastian Olbrich; Eva Dichgans; Dan Rujescu; Oliver Pogarell
A controlled positron emission tomography study of obsessive and neutral auditory stimulation in obsessive-compulsive disorder with checking rituals
Ten nondepressed patients with obsessive-compulsive disorder (OCD) who were characterized by predominant checking rituals were compared with 10 age- and sex-matched control subjects. Hemispheric and regional cerebral blood flow levels (rCBF) were measured with positron emission tomography (H215O) across four conditions: rest, auditory stimulation with idiosyncratic normal or abnormal obsession, auditory stimulation with neutral verbal stimuli, and rest. Order of
Jean Cottraux; Daniel G�rard; Luc Cinotti; Jean-Claude Froment; Marie-Pierre Deiber; Didier Le Bars; G�rard Galy; Philippe Millet; Claire Labb�; Frank Lavenne; Martine Bouvard; Fran�ois Maugui�re
Effects of axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia
The impact of concurrent axis I diagnoses and axis II traits on the efficacy of a 22-session exposure-based treatment program for 43 outpatients with panic disorder and agoraphobia (PDA) and 63 with obsessive-compulsive disorder (OCD) was examined. Trained interviewers used the Structured Clinical Interview for DSM-III-R (SCID) to assess axis I diagnoses and the SCID-II to identify the number of
Gail Steketee; Dianne L. Chambless; Giao Q. Tran
Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders
Purpose Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. Methods A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale�Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures. Main Results Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission. Conclusion Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases.
Simpson, H. Blair; Wetterneck, Chad T.; Cahill, Shawn P.; Steinglass, Joanna E.; Franklin, Martin E.; Leonard, Rachel C.; Weltzin, Theodore E.; Riemann, Bradley C.
Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders.
Purpose: Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. Methods: A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale--Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures. Main Results: Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission. Conclusion: Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases. PMID:23316878
Simpson, H Blair; Wetterneck, Chad T; Cahill, Shawn P; Steinglass, Joanna E; Franklin, Martin E; Leonard, Rachel C; Weltzin, Theodore E; Riemann, Bradley C
A review of obsessive-compulsive disorder in children and adolescents
This article is a review of recent literature on obsessive-compulsive disorder in the pediatric population. Areas covered include: a brief historical perspective, clinical presentation in relation to symptoms found in different age groups, epidemiology, psychiatric comorbidity, etiology (with regards to genetics, neuroimaging, and familial factors), clinical course and prognosis, and treatment, with special emphasis on individual and family-based cognitive-behavioral therapy and psychopharmacology.
Boileau, Bernard
A possible association of recurrent streptococcal infections and acute onset of obsessive-compulsive disorder.
Rheumatic fever is an immunologically mediated disease that follows infection by group A beta-hemolytic Streptococcus (GABHS). In rheumatic fever, antibodies generated against GABHS cross-react with the heart, joints, skin, and other sites, inducing an inflammatory, multisystem disease. Brain tissue-specific antibodies have been demonstrated in a subset of children with Sydenham chorea (a component of the Jones criteria for the diagnosis of rheumatic fever), and most Sydenham chorea patients manifest obsessive-compulsive symptoms very similar to those in traditional obsessive-compulsive disorder. The parallels drawn from the paradigm of Sydenham's chorea to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is an area of active controversy. Newly emerging information on the role of GABHS superantigens in the pathogenesis of rheumatic fever is of particular interest. In this article, we review the microbial characteristics of GABHS and the subsequent immune responses to GABHS as a possible etiology of PANDAS. PMID:15377732
Kim, Suck Won; Grant, Jon E; Kim, Sandra I; Swanson, Todd A; Bernstein, Gail A; Jaszcz, Waclaw B; Williams, Kyle A; Schlievert, Patrick M
Obsessed not to forget: Lack of retrieval-induced suppression effect in obsessive-compulsive disorder.
The aim of the present study was to investigate the role of executive functions in resolving memory interference in a clinical sample of patients with obsessive-compulsive disorder (OCD). Retrieval of memories has been shown to involve some form of executive act that diminishes the accessibility of rival memory traces, leading to retrieval-induced forgetting (RIF). These executive control processes might suppress unwanted thoughts and irrelevant memories during competitive retrieval. We assessed RIF with the retrieval practice paradigm among 25 OCD patients and 25 healthy controls matched for age and education. Retrieval of target memories led to enhancement of target memory recall in both groups, but suppression of related memories (RIF) occurred only among controls. Our results suggest that suppression of irrelevant, interfering memories during competitive recall is impaired in OCD. PMID:24794155
Demeter, Gyula; Keresztes, Attila; Hars�nyi, Andr�s; Csig�, Katalin; Racsm�ny, Mih�ly
Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder in a Child with Asperger Syndrome: A Case Report.
ERIC Educational Resources Information Center
This case report outlines the cognitive-behavioral treatment of obsessive-compulsive disorder in a 7-year-old female with Asperger syndrome. Interventions were based upon the work of March and Mulle and were adapted in light of the patient's cognitive, social, and linguistic characteristics. Symptoms improved markedly after 6 months of treatment.�
Reaven, Judy; Hepburn, Susan
The Role of Glutamate Signalling in the Pathogenesis and Treatment of Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a common and often debilitating neuropsychiatric condition characterized by persistent intrusive thoughts (obsessions), repetitive ritualistic behaviours (compulsions) and excessive anxiety. While the neurobiology and etiology of OCD has not been fully elucidated, there is growing evidence that disrupted neurotransmission of glutamate within corticalstriatal-thalamocortical (CSTC) circuitry plays a role in OCD pathogenesis. This review summarizes the findings from neuroimaging, animal model, candidate gene and treatment studies in the context of glutamate signalling dysfunction in OCD. First, studies using magnetic resonance spectroscopy are reviewed demonstrating altered glutamate concentrations in the caudate and anterior cingulate cortex of patients with OCD. Second, knockout mouse models, particularly the DLGAP3 and Slitrk5 knockout mouse models, display remarkably similar phenotypes of compulsive grooming behaviour associated with glutamate signalling dysfunction. Third, candidate gene studies have identified associations between variants in glutamate system genes and OCD, particularly for SLC1A1 which has been shown to be associated with OCD in five independent studies. This converging evidence for a role of glutamate in OCD has led to the development of novel treatment strategies involving glutamatergic compounds, particularly riluzole and memantine. We conclude the review by outlining a glutamate hypothesis for OCD, which we hope will inform further research into etiology and treatment for this severe neuropsychiatric condition.
Wu, Ke; Hanna, Gregory L.; Rosenberg, David R.; Arnold, Paul D
Magnetoencephalography reveals altered auditory information processing in youth with obsessive-compulsive disorder.
Patients with obsessive-compulsive disorder (OCD) often report sensory intolerances which may lead to significant functional impairment. This study used auditory evoked fields (AEFs) to address the question of whether neural correlates of sensory auditory information processing differ in youth with OCD compared with healthy comparison subjects (HCS). AEFs, recorded with a whole head 275-channel magnetoencephalography system, were elicited in response to binaural auditory stimuli from 10 pediatric subjects with OCD (ages 8-13, mean 11 years, 6 males) and 10 age- and gender-matched HCS. Three major neuromagnetic responses were studied: M70 (60-80 ms), M100 (90-120 ms), and M150 (130-190 ms). When compared with HCS, subjects with OCD demonstrated delayed latency of the M100 response. In subjects with OCD the amplitude of the M100 and M150 responses was significantly greater in the right hemisphere compared with the left hemisphere. Current results suggest that when compared with HCS, subjects with OCD have altered auditory information processing, evident from the delayed latency of the M100 response, which is thought to be associated with the encoding of physical stimulus characteristics. Interhemispheric asymmetry with increased M100 and M150 amplitudes over the right hemisphere compared with the left hemisphere was found in young OCD subjects. These results should be interpreted with caution due to the high variability rate of responses in both HCS and OCD subjects, as well as the possible effect of medication in OCD subjects. PMID:23545237
Korostenskaja, Milena; Harris, Elana; Giovanetti, Cathy; Horn, Paul; Wang, Yingying; Rose, Douglas; Fujiwara, Hisako; Xiang, Jing
Intrusive thoughts in obsessive-compulsive disorder and eating disorder patients: a differential analysis.
The present study aims to compare the unwanted intrusions experienced by obsessive-compulsive (OCD) and eating disorder (ED) patients, their appraisals, and their control strategies and analyse which variables predict the intrusions' disruption and emotional disturbance in each group. Seventy-nine OCD and 177 ED patients completed two equivalent self-reports designed to assess OCD-related and ED-related intrusions, their dysfunctional appraisals, and associated control strategies. OCD and ED patients experienced intrusions with comparable frequency and emotional disturbance, but OCD patients experienced greater disruption. Differences appeared between groups on some appraisals and control strategies. Intolerance to uncertainty (OCD group) and thought importance (ED group) predicted their respective emotional disturbance and disruption. Additionally, control importance (OCD group) and thought-action fusion moral (OCD and ED groups) predicted their emotional disturbance. OCD and ED share the presence of intrusions; however, different variables explain why they are disruptive and emotionally disturbing. Cognitive intrusions require further investigation as a transdiagnostic variable. PMID:24596069
Garc�a-Soriano, Gemma; Roncero, Maria; Perpi��, Conxa; Belloch, Amparo
Increased prevalence of the seven-repeat variant of the dopamine D4 receptor gene in patients with obsessive-compulsive disorder with tics
The polymorphism characterized by a varying number of 48 bp repeats (VNTR) in the dopamine D4 receptor (DRD4) gene was examined in 61 obsessive-compulsive disorder (OCD) probands with and without tics. Most of the OCD patients with tics showed at least one copy of the 7-fold variant compared to those affected subjects without tics (91 vs. 48%, respectively, Yates corrected
Carlos Cruz; Beatriz Camarena; Nicole King; Francisco P�ez; Deborah Sidenberg; Juan Ram�n de la Fuente; Humberto Nicolini
A Double-blind, Placebo-Controlled Study of Risperidone Addition in Serotonin Reuptake Inhibitor-Refractory Obsessive-compulsive Disorder
Background:Todate,only1controlledstudyhasfound a drug (haloperidol) to be efficacious in augmenting re- sponse in patients with obsessive-compulsive disorder (OCD) refractory to serotonin reuptake inhibitor (SRI) monotherapy; patients with comorbid chronic tic disor- ders showed a preferential response. This report de- scribes the first controlled study of risperidone addition in patients with OCD refractory to treatment with SRI alone. Methods: Seventy adult patients
Christopher J. McDougle; C. Neill Epperson; Gregory H. Pelton; Suzanne Wasylink; Lawrence H. Price
Metabolic Imaging of Anterior Capsular Stimulation in Refractory Obsessive-Compulsive Disorder: A Key Role for the Subgenual Anterior Cingulate and Ventral Striatum
High-frequency anterior capsular stimulation is a new, promis- ing, and reversible neuromodulatory treatment in the research stage for patients with refractory obsessive-compulsive disorder (OCD). The mechanism of action is unknown but hypothesized to be secondary to interruption of the corticothalamostriatocortical circuit.Methods: 18F-FDG PET was performed on 6 consecutive OCD patients preoperatively and after stimulation. The results were compared with those
Koenraad Van Laere; Bart Nuttin; Loes Gabriels; Patrick Dupont; Steve Rasmussen; Benjamin D. Greenberg
Internet-Delivered Cognitive Behavior Therapy for Adolescents with Obsessive-Compulsive Disorder: An Open Trial
Background International guidelines recommend Cognitive Behavior Therapy (CBT) as the first line treatment for pediatric obsessive-compulsive disorder (OCD). However, a substantial proportion of patients do not have access to such treatment. We developed and tested the feasibility, efficacy and acceptability of a novel therapist-guided, Internet-delivered CBT (ICBT) platform for adolescents with OCD. Methods An interactive, age-appropriate ICBT platform (�BiP OCD�) was developed. Twenty-one adolescents (12�17 years) with a DSM-IV diagnosis of OCD and their parents were enrolled in the study. All participants received 12 weeks of ICBT with therapist support. The primary outcome measure was the Children�s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Acceptability was assessed at post-treatment. Results Participants completed on average 8.29 (SD?=?3.0) of the 12 treatment chapters. Treatment yielded significant improvements on all clinician-, parent- and most self-administered outcome measures, with a large effect size of d?=?2.29 (95% CI 1.5�3.07) on the CY-BOCS. Patients continued to improve at follow-up. At 6-month follow-up, 71% were classified as responders (?35% decrease on the CY-BOCS) and 76% as being in remission (CY-BOCS score ?12). Average clinician support time was less than 20 minutes per patient per week. The majority of participants felt that BiP OCD was age-appropriate and rated the treatment as good or very good. Conclusions ICBT could be efficacious, acceptable, and cost-effective for adolescents with OCD. More rigorously controlled studies are needed to further evaluate the treatment. Trial Registration ClinicalTrials.gov; NCT01809990.
Lenhard, Fabian; Vigerland, Sarah; Andersson, Erik; Ruck, Christian; Mataix-Cols, David; Thulin, Ulrika; Ljotsson, Brjann; Serlachius, Eva
Predictors of Treatment Response in Pediatric Obsessive-Compulsive Disorder
ERIC Educational Resources Information Center
The study examines predictors of treatment response in pediatric obsessive-compulsive disorder, which is a severe mental illness causing distress and impaired functioning. Summarized findings of psychosocial factors and medication interventions are presented.
Ginsburg, Golda S.; Kingery, Julie Newman; Drake, Kelly L.; Grados, Marco A.
The Preliminary Development of a New Self-Report Measure for OCD in Young People.
ERIC Educational Resources Information Center
This study seeks to develop a reliable self-report instrument to assess obsessive-compulsive disorder (OCD) in young people. The children's Obsessional Compulsive Inventory had good internal consistency, criterion validity and was significantly correlated with the Children's Yale-Brown Obsessive Compulsive Scale. This preliminary new measure could�
Shafran, Roz; Frampton, Ian; Heyman, Isobel; Reynolds, Martina; Teachman, Bethany; Rachman, S.
The cognitive mediation of obsessive-compulsive handwashing
The potential mediating roles of danger expectancies, responsibility, perfectionism, anticipated anxiety and self-efficacy on obsessive-compulsive handwashing were examined. Ratings were obtained from 27 obsessive-compulsive patients before and during a behavioural avoidance test involving a compound stimulus of potting soil, animal hair, food scraps and raw meat. Correlation and partial correlation analyses were conducted to examine the relationships between the cognitive
Mairwen K. Jones; Ross G. Menzies
Pathological gambling and compulsive buying: do they fall within an obsessive-compulsive spectrum?
Both compulsive buying (CB) and pathological gambling (PG) have been proposed as members of a spectrum of disorders related to obsessive-compulsive disorder (OCD). The spectrum hypothesis originated in the early 1990s and has gained considerable support, despite the lack of empirical evidence. Interest in this hypothesis has become critical because some investigators have recommended the creation of a new category that includes these disorders in DSM-5, now under development. In this article, the authors describe the origin of the obsessive-compulsive (OC) spectrum and its theoretical underpinnings, review both CB and PG, and discuss the data both in support of and against an OC spectrum. Both disorders are described in terms of their history, definition, classification, phenomenology, family history, pathophysiology, and clinical management. The authors conclude that: (i) CB and PG are probably not related to OCD, and there is insufficient evidence to place them within an OC spectrum in DSM-V; (ii) PG should stay with the impulse-control disorders (ICDs); and ( iii) a new diagnosis of CB should be created and be classified as an ICD.
Black, Donald W.; Shaw, Martha; Blum, Nancee
Investigation of Attentional Bias in Obsessive Compulsive Disorder with and without Depression in Visual Search
Whether Obsessive Compulsive Disorder (OCD) is associated with an increased attentional bias to emotive stimuli remains controversial. Additionally, it is unclear whether comorbid depression modulates abnormal emotional processing in OCD. This study examined attentional bias to OC-relevant scenes using a visual search task. Controls, non-depressed and depressed OCD patients searched for their personally selected positive images amongst their negative distractors, and vice versa. Whilst the OCD groups were slower than healthy individuals in rating the images, there were no group differences in the magnitude of negative bias to concern-related scenes. A second experiment employing a common set of images replicated the results on an additional sample of OCD patients. Although there was a larger bias to negative OC-related images without pre-exposure overall, no group differences in attentional bias were observed. However, OCD patients subsequently rated the images more slowly and more negatively, again suggesting post-attentional processing abnormalities. The results argue against a robust attentional bias in OCD patients, regardless of their depression status and speak to generalized difficulties disengaging from negative valence stimuli. Rather, post-attentional processing abnormalities may account for differences in emotional processing in OCD.
Morein-Zamir, Sharon; Papmeyer, Martina; Durieux, Alice; Fineberg, Naomi A.; Sahakian, Barbara J.; Robbins, Trevor W.
Inhibitory deficit in semantic conflict in obsessive-compulsive disorder: an event-related potential study.
The present study examines the inhibitory function of patients with obsessive-compulsive disorder (OCD) involved in semantic conflict using event-related potentials (ERPs). EPRs were recorded in a group of 18 medicine-free OCD patients and 18 normal controls using a modified Stroop paradigm in which the participants were asked to make a judgment of congruent or incongruent stimuli. The reaction time to color-word incongruent stimuli in the OCD group was significantly longer than the reaction time to congruent stimuli. In the OCD group, a significant negativity shift was discovered in P350 amplitude and N450 amplitude in response to incongruent stimuli, a shift not present in the control group. The amplitude of difference waveform was significantly higher for OCD than for control subjects. The findings probably revealed an inhibitory deficit in patients with OCD when performing semantic conflict tasks. The results suggest that this type of inhibitory deficit may be the cause of increased Stroop effects in patients with OCD, and one of contributors to the pathophysiology of OCD. PMID:23939286
Lei, Hui; Yi, Jinyao; Wang, Haixing; Zhang, Xiaocui; Dong, Jiaojiao; Zhou, Cheng; Fan, Jie; Zhong, Mingtian; Zhu, Xiongzhao
BDNF Val66Met modifies the risk of childhood trauma on obsessive-compulsive disorder.
Childhood trauma has been linked to the development of later psychopathology, including obsessive-compulsive disorder (OCD). Although evidence exists to suggest that genetic and environmental factors are involved in the aetiology of OCD, little attention has been paid to the interactions that exist between genes and environment. The aim of this study was to investigate gene-by-environment interactions between childhood trauma and the BDNF Val66Met variant in patients with OCD. Childhood trauma was assessed in 134 OCD patients and 188 controls using the Childhood Trauma Questionnaire (CTQ). Linear regression models were used for statistical analyses. Gene-environment interactions were estimated by including a combined genotype and CTQ score in the models as interaction terms. All analyses were adjusted for age, gender, CTQ minimisation-denial score and home language by including them in the logistic regression models as covariates. Childhood trauma, specifically emotional abuse and neglect, increased the odds of having OCD significantly (p < 0.001). Although no significant association was observed between BDNF Val66Met and the development of OCD, interaction analysis indicated that the BDNF Met-allele interacted with childhood emotional abuse to increase the risk of OCD significantly in a dose-dependent manner (p = 0.024). To our knowledge, this is one of the first studies to investigate gene-environment interactions in OCD, and the findings indicate the importance of collating genetic and environmental variables in future studies. PMID:24050777
Hemmings, Sian Megan Joanna; Lochner, Christine; van der Merwe, Lize; Cath, Danielle C; Seedat, Soraya; Stein, Dan J
Concurrent and prospective associations of habitual overgeneral memory and prospection with symptoms of depression, general anxiety, obsessive compulsiveness, and post-traumatic stress.
Reduced memory specificity is associated with depression, post-traumatic stress disorder (PTSD), and some other forms of psychopathology. Reduced memory specificity is also associated with reduced specificity of envisioned future events. Research in this area has mostly relied on cue-word methods that include explicit instructions to develop specific memories of future events. These methods are limited in their ability to assess how participants habitually remember the past and imagine the future when the specificity constraints inherent in the cue-word task are removed. Sentence completions tasks have been developed that can be used to assess habitual patterns of memory and prospection. Little is known about the association of habitual memory and prospection with concurrently and prospectively assessed psychopathology. In the current study 142 participants completed sentence completion tasks tapping habitual memory and prospection at baseline and completed measures tapping psychological symptoms at baseline and 1 year later. Among other things, it was found that reduced memory specificity (but not reduced future specificity) was associated with concurrent and later depression, as well as with symptom levels of PTSD tapped 1 year beyond baseline. PMID:23947792
Boelen, Paul A; Huntjens, Rafaele J C; van den Hout, Marcel A
Brain Regional ?-[11C]Methyl-L-Tryptophan Trapping in Medication-Free Patients With Obsessive-Compulsive Disorder
Context The hypothesis of a serotonin (5-hydroxytryptamine [5-HT]) dysfunction in obsessive-compulsive disorder (OCD) stems largely from the clinical efficacy of 5-HT reuptake inhibitors. Serotonergic abnormalities in the unmedicated symptomatic state, however, remain to be fully characterized. Objective To investigate brain regional 5-HT synthesis, as indexed by positron emission tomography and the ?-[11C]methyl-L-tryptophan trapping constant (K*), in treatment-free adults meeting criteria for OCD. Design Between-group comparison. Setting Department of Psychiatry and Montreal Neurological Institute, McGill University, and Department of Psychology, McGill University Health Centre, Quebec, Canada. Participants Twenty-one medication-free patients with OCD (15 men with a mean [SD] age of 33.2 [9.3] years and 6 women with a mean [SD] age of 35.8 [7.1] years) and 21 healthy controls matched for age and sex (15 men with a mean [SD] age of 32.9 [10.1] years and 6 women with a mean [SD] age of 36.5.5 [8.6] years). Main Outcome Measure The ?-[11C]methyl-L-tryptophan brain trapping constant K*, which was analyzed with Statistical Parametric Mapping (SPM8) and with proportional normalization (extent threshold of 100 voxels with a peak threshold of P?.005). Results Compared with healthy controls, the patients with OCD exhibited significantly greater ?-[11C]methyl-L-tryptophan trapping in the right hippocampus and left temporal gyrus (Brodmann area 20). In the larger sub-sample of all men, these same differences were also evident, as well as higher K* values in the caudate nucleus. Individual differences in symptom severity correlated positively with K* values sampled from the caudate and temporal lobe of the patients with OCD, respectively. There were no regions where the patients exhibited abnormally low K* values. Volumetric analyses found no morphometric alterations that would account for the group differences. Conclusion The results support previous reports of greater striatal and temporal lobe activity in patients with OCD than in healthy controls and suggest that these disturbances include a serotonergic component. Previously reported glucose metabolic disturbances in OCD involving the orbitofrontal and cingulate cortices, in comparison, might reflect postsynaptic changes in the serotonergic system.
Berney, Alexandre; Leyton, Marco; Gravel, Paul; Sibon, Igor; Sookman, Debbie; Neto, Pedro Rosa; Diksic, Mirko; Nakai, Akio; Pinard, Gilbert; Todorov, Christo; Okazawa, Hidehiko; Blier, Pierre; Nordahl, Thomas Edward; Benkelfat, Chawki
Multivariate pattern analysis of DTI reveals differential white matter in individuals with obsessive-compulsive disorder.
Diffusion tensor imaging (DTI) studies have revealed group differences in white matter between patients with obsessive-compulsive disorder (OCD) and healthy controls. However, the results of these studies were based on average differences between the two groups, and therefore had limited clinical applicability. The objective of this study was to investigate whether fractional anisotropy (FA) of white matter can be used to discriminate between patients with OCD and healthy controls at the level of the individual. DTI data were acquired from 28 OCD patients and 28 demographically matched healthy controls, scanned using a 3T MRI system. Differences in FA values of white matter between OCD and healthy controls were examined using a multivariate pattern classification technique known as support vector machine (SVM). SVM applied to FA images correctly identified OCD patients with a sensitivity of 86% and a specificity of 82% resulting in a statistically significant accuracy of 84% (P ? 0.001). This discrimination was based on a distributed network including bilateral prefrontal and temporal regions, inferior fronto-occipital fasciculus, superior fronto-parietal fasciculus, splenium of corpus callosum and left middle cingulum bundle. The present study demonstrates subtle and spatially distributed white matter abnormalities in individuals with OCD, and provides preliminary support for the suggestion that that these could be used to aid the identification of individuals with OCD in clinical practice. PMID:24048702
Li, Fei; Huang, Xiaoqi; Tang, Wanjie; Yang, Yanchun; Li, Bin; Kemp, Graham J; Mechelli, Andrea; Gong, Qiyong
Generalization of Conditioned Fear and Obsessive-Compulsive Traits
Generalization of conditioned fear refers to the transfer of the conditioned fear response to stimuli that resemble the original conditioned stimulus. Overgeneralization of conditioned fear has been associated with panic disorder and generalized anxiety disorder and may be relevant to obsessive-compulsive (OC) symptoms as well. This study represents the first attempt to determine the degree to which individuals with high versus low OC traits over generalize conditioned fear. We hypothesized that the high OC individuals, particularly those characterized by overestimation of threat, would show overgeneralization of conditioned fear compared to controls as measured by behavioral and psychophysiological (fear-potentiated startle) measures. The results of this study show an interaction between the high and low Threat Estimation groups as measured by the Obsessive Beliefs Questionnaire, which suggests that those who have a tendency to overestimate threat show overgeneralization of conditioned fear. This finding suggests that the relation between OC symptoms and overgeneralization of conditioned fear may be specific to the high threat estimation component of OC symptoms.
Kaczkurkin, Antonia N; Lissek, Shmuel
Always on guard: Test of high vs. low control conditions in obsessive-compulsive disorder patients.
Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder characterized by recurrent obsessive thoughts and/or compulsive behaviors. It has been shown that OCD patients suffer from deficits in executive control. During Stroop task performance, it was found that cognitive control in healthy participants adjusts adaptively - control is reduced when conflict is less likely. Twenty-four individuals meeting criteria for OCD and 27 controls carried out two blocks of a Stroop task; one with high control (a third of the trials were neutral) and one with low control (75% of the trials were neutral). In the healthy control group, results replicated previous findings showing increased interference and decreased facilitation in the low control condition compared to the high control condition. OCD participants, on the other hand, showed no difference in results between the two blocks. Moreover, in the high control condition, interference was larger and facilitation was smaller compared to healthy controls, indicating less efficient executive control for both the informational and task conflict. We concluded that healthy controls adjust the level of control to changing circumstances whereas OCD patients have difficulties to adaptively make such adjustments. Implications for this novel evidence of deficient executive control of flexibility in OCD patients are discussed. PMID:24947916
Kalanthroff, Eyal; Anholt, Gideon E; Henik, Avishai
Conscientiousness and obsessive-compulsive personality disorder.
A dimensional perspective on personality disorder hypothesizes that the current diagnostic categories represent maladaptive variants of general personality traits. However, a fundamental foundation of this viewpoint is that dimensional models can adequately account for the pathology currently described by these categories. While most of the personality disorders have well established links to dimensional models that buttress this hypothesis, obsessive-compulsive personality disorder (OCPD) has obtained only inconsistent support. The current study administered multiple measures of 1) conscientiousness-related personality traits, 2) DSM-IV OCPD, and 3) specific components of OCPD (e.g., compulsivity and perfectionism) to a sample of 536 undergraduates who were oversampled for elevated OCPD scores. Six existing measures of conscientiousness-related personality traits converged strongly with each other supporting their assessment of a common trait. These measures of conscientiousness correlated highly with scales assessing specific components of OCPD, but obtained variable relationships with measures of DSM-IV OCPD. More specifically, there were differences within the conscientiousness instruments such that those designed to assess general personality functioning had small to medium relationships with OCPD, but those assessing more maladaptive variants obtained large effect sizes. These findings support the view that OCPD does represent a maladaptive variant of normal-range conscientiousness. PMID:22448765
Samuel, Douglas B; Widiger, Thomas A
Obsessive-compulsive-like reasoning makes an unlikely catastrophe more credible.
When obsessive-compulsive (OC) patients are confronted with disorder-relevant situations, they tend to reason in chains of small steps between the current situation and a highly improbable catastrophe. It was hypothesized that this type of "perseverative reasoning" would increase the subjective likelihood of the feared catastrophe. In an experiment with 63 healthy undergraduates, we tested whether OC-like perseverative reasoning induces feelings of uncertainty about a harmful outcome and makes this outcome more credible. Furthermore, we explored whether making multiple series of events increases these effects. Participants were administered a neutral situation with a catastrophic improbable outcome. In a pre- and post-test, they rated the credibility of this outcome and feelings of uncertainty about the outcome. In between, two experimental groups were instructed to generate respectively one or five series of intermediate steps between the situation and the harmful outcome, while a control group carried out a filler task. Consistent with the predictions, perseverative reasoning enhanced the credibility of a negative, improbable outcome. However, there were no differences between the two experimental conditions (one or five reasoning chains), and perseverative reasoning did not increase uncertainty about the outcome. The OC-like generation of small steps between an innocuous situation and a negative outcome increases the credibility of a feared outcome, potentially serving to maintain obsessive-compulsive disorder (OCD) problems. PMID:21349245
Giele, Catharina L; van den Hout, Marcel A; Engelhard, Iris M; Dek, Eliane C P; Hofmeijer, Floor Klein
[Present contribution of neurosciences to a new clinical reading of obsessive-compulsive disorder].
Obsessive-compulsive disorder (OCD), that affects 2 to 3% of the general population, is characterized by recurrent intrusive thoughts and repetitive, time-consuming behaviors. It is a severely incapacitating mental illness that causes profound impairment in psychosocial functioning and quality of life. Although the physiopathology of OCD is still far from resolved, the existence of a biological basis for OCD is now clearly established and should be interpreted from phenomenological considerations, on the one hand, and in the light of our increasing knowledge of the physiology of cortico-subcortical functional loops, on the other. In a phenomenological view, the heart of the obsessional process is the subject's underlying impression that "something is wrong". In other words, obsessions may be thought of as the permanent perception of a mistake and/or error in certain behavioral situations. Compulsions occur as behavioral responses aimed at relieving the tensions or anxiety generated by the situation. If obtained, this relief may be felt to be a form of reward. Nevertheless, it is only transient, thereby creating a feeling of considerable anxiety. This contributes to immediately reproducing the behavior in a cyclic manner, on the basis of an internal motivational state through an expectation of the reward. Therefore, it can be assumed that several malfunctioning processes are altered within the OCD: 1) error recognition; and, 2) emotion and motivation. This suggests that there is a dysfunction of the brain regions mediating these cognitive and emotional functions. Experimental neurophysiology in laboratory animals indicates the central role of the fronto-subcortical circuits originating in the orbitofrontal and anterior cingulate cortices, respectively. The orbitofrontal cortex (OFC) and ventromedial areas are involved in appraisal of the emotional and motivational values of environmental information, and in integrating the subject's prior experience, which is crucial in decision-making. The OFC also contributes to the selection, comparison and judgment of stimuli and error detection. The anterior cingulate cortex (ACC) is comprised of 1) a ventral or affective region that could keep attention on the internal emotional and motivational status and regulation of autonomic responses, and 2) a dorsal and cognitive region that serves a wide range of functions including attention, working memory, error detection, conflict monitoring, response selection, and anticipation of incoming information. Ventral striatum, that is intimately connected to the OFC and ACC, participates in the preparation, initiation and execution of behavioral responses oriented toward reward delivery following the cognitive and emotional integration of behaviorally relevant information at the cortical level. Functional imaging research in humans has shown an increased functional activity in the OFC, ACC, head of the caudate nucleus and thalamus in OCD patients. These functional abnormalities have been found in basal conditions and during provocation tests. Moreover, the therapeutic efficacy of antidepressants with preponderant serotonin-reuptake inhibiting properties and cognitive-behavioral therapies seems to be associated with a progressive reduction in activity of the OFC, ACC and the caudate nucleus. Therefore, these observations are suggestive of the responsibility of 5HT neurotransmission in the dysfunction of the frontal-subcortical loops that emanate from the OFC and ACC. However, several lines of research suggest that the dopamine system, with which 5HT interacts, may play a major role in the expression of OC symptoms. In conclusion, it seems that in OCD there is a dysfunction of the brain regions that belong to the orbitofrontal and anterior cingulate loops in view of evidence obtained from separate and complementary approaches. PMID:17675916
Aouizerate, B; Rotg�, J Y; Bioulac, B; Tignol, J
Methodological issues in the obsessive-compulsive spectrum.
The obsessive-compulsive spectrum is a heterogeneous class of conditions. Recently, expert consensus has emerged regarding possible candidate disorders [Mataix-Cols, D., Petrusa, A., Leckman, J.F., 2007. Issues for DSM-V: How should obsessive-compulsive and related disorders should be classified. American Journal of Psychiatry, 164, 1313-1314]. Further, expert survey data suggest that obsessive-compulsive disorder is composed of overlapping subtypes. However, methodological approaches for testing whether candidate disorders properly belong in the spectrum have varied widely, and do not necessarily differentiate conditions from subtypes. We describe preliminary methodological and statistical recommendations for a systematic approach to determining what constitutes a subtype, how to determine inclusion in the spectrum, and means for ruling out candidate disorders. PMID:19804912
McKay, Dean; Neziroglu, Fugen
White matter abnormalities of fronto-striato-thalamic circuitry in obsessive-compulsive disorder: A study using diffusion spectrum imaging tractography.
Previous studies have reported white matter abnormalities in patients with obsessive-compulsive disorder (OCD). This study aimed to further explore white matter abnormalities in OCD patients through diffusion spectrum imaging (DSI) and tractography of the two white matter tracts which most probably play an important role in OCD neuropathology: the anterior segment of cingulum bundles (ACB) and the anterior thalamic radiations (ATR). Twelve right-handed, medicated adult patients with OCD and 12 matched controls underwent DSI on a 3 tesla magnetic resonance imaging (MRI) system. Tractography based on DSI data was reconstructed to define the ACB and ATR. Mean generalized fractional anisotropy (GFA) was calculated for each targeted tract and was used to analyze local changes in microstructural integrity along individual tracts. There was a significantly lower mean GFA in both the right ATR and left ACB in OCD subjects compared to controls. OCD subjects also demonstrated decreased left-lateralized asymmetry of the ACB when compared to controls. Furthermore, the mean GFA of the left ACB positively correlated with OCD subjects' obsessive subscores on the Yale-Brown Obsessive-Compulsive scale. This study supports the white matter abnormalities in the ACB and ATR of OCD subjects, which corroborates neurobiological models that posit a defect in fronto-striato-thalamic circuitry in OCD. PMID:21546223
Chiu, Chen-Huan; Lo, Yu-Chun; Tang, Hwa-Sheng; Liu, I-Chao; Chiang, Wen-Yang; Yeh, Fang-Cheng; Jaw, Fu-Shan; Tseng, Wen-Yih Isaac
The role of the brain-derived neurotrophic factor SNP rs2883187 in the phenotypic expression of obsessive-compulsive disorder.
We investigated the association between a brain-derived neurotrophic factor (BDNF) gene polymorphism and clinical features in a sample of patients with obsessive-compulsive disorder (OCD). A total of 100 patients diagnosed with OCD according to the Diagnostic and Statistical Manual IV criteria and 110 control subjects were included in this study. The distribution of a single nucleotide polymorphism rs2883187 was compared in OCD patients and normal controls. Clinical features were compared between the subgroups of OCD patients with different genotypes. There was no significant difference for the allele frequencies and genotype distributions between the OCD and control groups. The Hamilton Anxiety Rating Scale, Yale-Brown Obsessive Compulsive Scale obsession and total scores were found to be higher in patients with the CC genotype than in the patients who are homozygous for the T allele. The rates of OCD in first-degree relatives of OCD patients who were homozygous for the C allele were significantly higher, compared to those with CT and TT genotypes. Our results indicate that the CC genotype may be associated with the severity and increased familial loading of OCD. Further investigation based on larger populations is needed to reveal the full association of the BDNF polymorphism with OCD. PMID:24291483
T�kel, Ra?it; Ozata, Berna; Ozt�rk, Nalan; Ertekin, Banu Aslanta?; Ertekin, Erhan; Direskeneli, G�her Saruhan
The relationship between impulse control disorders and obsessive-compulsive disorder: a current understanding and future research directions
Impulse control disorders (ICDs) constitute a heterogeneous group of conditions linked diagnostically by difficulties in resisting �the impulse, drive, or temptation to perform an act that is harmful to the person or to others.� Specific ICDs share clinical, phenomenological and biological features with obsessive-compulsive disorder (OCD) that have suggested that these disorders might be categorized together. However, other data suggest significant differences between OCD and ICDs. In this article, clinical, phenomenological and biological features of the formal ICDs are reviewed and compared and contrasted with those of OCD. Available data indicate substantial differences between ICDs and OCD that suggest independent categorizations. Existing research gaps are identified and avenues for future research suggested.
Potenza, Marc Nicholas; Koran, Lorrin Michael; Pallanti, Stefano
PANS - A Detailed Study of the Patients, Their Symptoms, Biomarkers and Treatment Offered in a Scandinavian Cohort
Obsessive-compulsive Disorder With Acute Onset; PANDAS; Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections; Pediatric Acute-onset Neuropsychiatric Syndrome (PANS); Childhood Acute Neuropsychiatric Symptoms (CANS); Obsessive-compulsive Disorder
DSM-IV obsessive-compulsive personality disorder: prevalence in patients with anxiety disorders and in healthy comparison subjects.
The relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not yet been fully clarified. The aim of the present study was to analyze DSM-IV OCPD prevalence rates in OCD and panic disorder (PD) patients to test for the specificity of the OCPD-OCD link, and to compare them to OCPD prevalence in a control group of subjects without any psychiatric disorder. A total of 109 patients with a principal diagnosis of DSM-IV (SCID-I) OCD and 82 with PD were interviewed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) in order to assess the prevalence of OCPD. All patients with a coexisting axis I diagnosis were excluded from the study to eliminate confounding factors when evaluating the association between prevalence rates of OCPD and anxiety disorder diagnoses. An exclusion criteria was also a Hamilton Depression Rating Scale (HAM-D) score >/=16. A sample of comparison subjects (age 18 to 65 years) without any psychiatric disorder was recruited from people registered with two general practitioners (GPs), whether or not they consulted the doctor, in order to evaluate OCPD prevalence rate in the community. A significant difference was found between the prevalence of OCPD in OCD (22.9%) and in PD (17.1%) on one hand, and that in the comparison sample (3.0%) on the other. No differences were found between the two psychiatric groups, even when splitting the samples according to gender. Our study failed to support the hypothesis of a specific relationship between OCPD and OCD; we confirmed the higher prevalence rate of this personality disorder in OCD subjects with regard to the general population, but we also confirmed the higher rate of OCPD in another anxiety disorder which is phenomenologically well characterized and different from OCD, such as PD. PMID:15332194
Albert, Umberto; Maina, Giuseppe; Forner, Federica; Bogetto, Filippo
Serotonin transporter promoter gain-of-function genotypes are linked to obsessive-compulsive disorder.
A functional serotonin transporter promoter polymorphism, HTTLPR, alters the risk of disease as well as brain morphometry and function. Here, we show that HTTLPR is functionally triallelic. The L(G) allele, which is the L allele with a common G substitution, creates a functional AP2 transcription-factor binding site. Expression assays in 62 lymphoblastoid cell lines representing the six genotypes and in transfected raphe-derived cells showed codominant allele action and low, nearly equivalent expression for the S and L(G) alleles, accounting for more variation in HTT expression than previously recognized. The gain-of-function L(A)L(A) genotype was approximately twice as common in 169 whites with obsessive-compulsive disorder (OCD) than in 253 ethnically matched controls. We performed a replication study in 175 trios consisting of probands with OCD and their parents. The L(A) allele was twofold overtransmitted to the patients with OCD. The HTTLPR L(A)L(A) genotype exerts a moderate (1.8-fold) effect on risk of OCD, which crystallizes the evidence that the HTT gene has a role in OCD. PMID:16642437
Hu, Xian-Zhang; Lipsky, Robert H; Zhu, Guanshan; Akhtar, Longina A; Taubman, Julie; Greenberg, Benjamin D; Xu, Ke; Arnold, Paul D; Richter, Margaret A; Kennedy, James L; Murphy, Dennis L; Goldman, David
Serotonin uptake and imipramine binding in the blood platelets of obsessive-compulsive disorder patients.
14C-Serotonin (5-HT) uptake and 3H-imipramine binding (IB) were studied in the blood platelets of 20 obsessive-compulsive disorder (OCD) patients, 53 normal controls (5-HT uptake) and 32 normal controls (IB binding). The maximum number of binding sites (Bmax) was significantly decreased in OCD patients compared to normal controls, but there was no difference in the affinity for 3H-imipramine (Kd). The affinity for 5-HT uptake (Km) was also decreased in the OCD patients but the maximum velocity of 5-HT uptake sites (Vmax) was not significantly different in OCD patients and normal volunteers. There were trends for the Slowness Subscale of the Maudsley Obsessional-Compulsive Inventory (MOCI) to be positively correlated with the Km of 5-HT uptake (p = 0.094), whereas the Global Scale, Checking Subscale, and Doubting Conscientiousness Subscale of MOCI were negatively correlated with the Kd of IB (p = 0.066, p = 0.08, and p = 0.062, respectively). The results provide further evidence for the dysfunction of the serotonergic system in OCD. PMID:1655071
Bastani, B; Arora, R C; Meltzer, H Y
Partitioning the Heritability of Tourette Syndrome and Obsessive Compulsive Disorder Reveals Differences in Genetic Architecture
The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained by all SNPs for two phenotypically-related neurobehavioral disorders, obsessive-compulsive disorder (OCD) and Tourette Syndrome (TS), using GCTA. Our analysis yielded a heritability point estimate of 0.58 (se?=?0.09, p?=?5.64e-12) for TS, and 0.37 (se?=?0.07, p?=?1.5e-07) for OCD. In addition, we conducted multiple genomic partitioning analyses to identify genomic elements that concentrate this heritability. We examined genomic architectures of TS and OCD by chromosome, MAF bin, and functional annotations. In addition, we assessed heritability for early onset and adult onset OCD. Among other notable results, we found that SNPs with a minor allele frequency of less than 5% accounted for 21% of the TS heritability and 0% of the OCD heritability. Additionally, we identified a significant contribution to TS and OCD heritability by variants significantly associated with gene expression in two regions of the brain (parietal cortex and cerebellum) for which we had available expression quantitative trait loci (eQTLs). Finally we analyzed the genetic correlation between TS and OCD, revealing a genetic correlation of 0.41 (se?=?0.15, p?=?0.002). These results are very close to previous heritability estimates for TS and OCD based on twin and family studies, suggesting that very little, if any, heritability is truly missing (i.e., unassayed) from TS and OCD GWAS studies of common variation. The results also indicate that there is some genetic overlap between these two phenotypically-related neuropsychiatric disorders, but suggest that the two disorders have distinct genetic architectures.
Davis, Lea K.; Yu, Dongmei; Keenan, Clare L.; Gamazon, Eric R.; Konkashbaev, Anuar I.; Derks, Eske M.; Neale, Benjamin M.; Yang, Jian; Lee, S. Hong; Evans, Patrick; Barr, Cathy L.; Bellodi, Laura; Benarroch, Fortu; Berrio, Gabriel Bedoya; Bienvenu, Oscar J.; Bloch, Michael H.; Blom, Rianne M.; Bruun, Ruth D.; Budman, Cathy L.; Camarena, Beatriz; Campbell, Desmond; Cappi, Carolina; Cardona Silgado, Julio C.; Cath, Danielle C.; Cavallini, Maria C.; Chavira, Denise A.; Chouinard, Sylvain; Conti, David V.; Cook, Edwin H.; Coric, Vladimir; Cullen, Bernadette A.; Deforce, Dieter; Delorme, Richard; Dion, Yves; Edlund, Christopher K.; Egberts, Karin; Falkai, Peter; Fernandez, Thomas V.; Gallagher, Patience J.; Garrido, Helena; Geller, Daniel; Girard, Simon L.; Grabe, Hans J.; Grados, Marco A.; Greenberg, Benjamin D.; Gross-Tsur, Varda; Haddad, Stephen; Heiman, Gary A.; Hemmings, Sian M. J.; Hounie, Ana G.; Illmann, Cornelia; Jankovic, Joseph; Jenike, Michael A.; Kennedy, James L.; King, Robert A.; Kremeyer, Barbara; Kurlan, Roger; Lanzagorta, Nuria; Leboyer, Marion; Leckman, James F.; Lennertz, Leonhard; Liu, Chunyu; Lochner, Christine; Lowe, Thomas L.; Macciardi, Fabio; McCracken, James T.; McGrath, Lauren M.; Mesa Restrepo, Sandra C.; Moessner, Rainald; Morgan, Jubel; Muller, Heike; Murphy, Dennis L.; Naarden, Allan L.; Ochoa, William Cornejo; Ophoff, Roel A.; Osiecki, Lisa; Pakstis, Andrew J.; Pato, Michele T.; Pato, Carlos N.; Piacentini, John; Pittenger, Christopher; Pollak, Yehuda; Rauch, Scott L.; Renner, Tobias J.; Reus, Victor I.; Richter, Margaret A.; Riddle, Mark A.; Robertson, Mary M.; Romero, Roxana; Rosario, Maria C.; Rosenberg, David; Rouleau, Guy A.; Ruhrmann, Stephan; Ruiz-Linares, Andres; Sampaio, Aline S.; Samuels, Jack; Sandor, Paul; Sheppard, Brooke; Singer, Harvey S.; Smit, Jan H.; Stein, Dan J.; Strengman, E.; Tischfield, Jay A.; Valencia Duarte, Ana V.; Vallada, Homero; Van Nieuwerburgh, Filip; Veenstra-VanderWeele, Jeremy; Walitza, Susanne; Wang, Ying; Wendland, Jens R.; Westenberg, Herman G. M.; Shugart, Yin Yao; Miguel, Euripedes C.; McMahon, William; Wagner, Michael; Nicolini, Humberto; Posthuma, Danielle; Hanna, Gregory L.; Heutink, Peter; Denys, Damiaan; Arnold, Paul D.; Oostra, Ben A.; Nestadt, Gerald; Freimer, Nelson B.; Pauls, David L.; Wray, Naomi R.
Genomewide Linkage Analysis of Obsessive Compulsive Disorder Implicates Chromosome 1p36
Background Obsessive compulsive disorder (OCD) has a complex etiology involving both genetic and environmental factors. However, the genetic causes of OCD are largely unknown, despite the identification of several promising candidate genes and linkage regions. Methods Our objective was to conduct genetic linkage studies of the type of OCD thought to have the strongest genetic etiology (i.e., childhood-onset OCD), in 33 Caucasian families with ?2 childhood-onset OCD-affected individuals from the United States (US) (N=245 individuals with genotype data). Parametric and non-parametric genome-wide linkage analyses were conducted with Morgan and Merlin in these families using a selected panel of single nucleotide repeat polymorphisms (SNPs) from the Illumina 610-Quad Bead Chip. The initial analyses were followed by fine-mapping analyses in genomic regions with initial heterogeneity LOD (HLOD) scores of ?2.0. Results We identified five areas of interest (HLOD score ?2) on chromosomes 1p36, 2p14, 5q13, 6p25, and 10p13. The strongest result was on chromosome 1p36.33-p36.32 (HLOD=3.77, suggestive evidence for linkage after fine-mapping). At this location, several of the families showed haplotypes co-segregating with OCD. Conclusions The results of this study represent the strongest linkage finding for OCD in a primary analysis to date, and suggest that chromosome 1p36, and possibly several other genomic regions, may harbor susceptibility loci for OCD. Multiple brain-expressed genes lie under the primary linkage peak (approximately 4 mb in size). Follow-up studies, including replication in additional samples and targeted sequencing of the areas of interest, are needed to confirm these findings and to identify specific OCD risk variants.
Mathews, Carol A.; Badner, Judith A.; Andresen, J. Michael; Sheppard, Brooke; Himle, Joseph A.; Grant, Jon E.; Williams, Kyle A; Chavira, Denise A.; Azzam, Amin; Schwartz, Maxine; Reus, Victor I.; Kim, Suck Won; Cook, Edwin H.; Hanna, Gregory L.
Nosological status of compulsive hoarding: obsessive-compulsive disorder subtype or independent clinical entity.
This theoretical study reviews the main research and findings on the nosological status of compulsive hoarding. Specifically, it describes available empirical evidence in order to determine their independence or inclusion within the obsessive-compulsive disorder (OCD), a mental disorder in which it has traditionally been included as one more subtype or dimension. Regarding this issue, the results found in the scientific literature show that persons with compulsive hoarding have distinct characteristics in different external criteria like sociodemographic variables, premorbid personality, degree of insight, neuroanatomical and genetic factors, neuropsychological profile, clinical course, levels of dysfunctionality and finally, treatment outcome. These conclusions are discussed and the proposal for the creation of a new clinical entity called �hoarding disorder� is evaluated. PMID:24844811
Fr�as-Ib��ez, Alvaro; Palma-Sevillano, Carol; Bar�n-Fern�ndez, Francisco; Bern�ldez-Fern�ndez, Inma; Aluco-S�nchez, Elena
Clinical correlates of word recognition memory in obsessive-compulsive disorder: an event-related potential study.
Memory disturbances found in obsessive-compulsive disorder (OCD) may partially be related to dysfunction of cortico-subcortical circuits. However, it is still unknown how OCD symptomatology is related to memory processing. To explore this question, event-related potentials (ERPs) were recorded in a continuous word-recognition paradigm in OCD patients with either severe or moderate scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (group S and group M, n=8 each) and in normal healthy controls (n=16). Typically ERPs to repeated items are characterized by more positive waveforms beginning approximately 250 ms post-stimulus. This "old/new effect" has been shown to be relevant for memory processing. The early old/new effect (ca. 300-500 ms) with a frontal distribution is proposed to be a neural correlate of familiarity-based recognition. The late old/new effect (post-500 ms) is assumed to reflect conscious memory retrieval processes. The OCD group S showed a normal early old/new effect and a reduced late old/new effect compared with group M and the control group, but no difference was found between group M and the control group. Source analyses for the late old/new effect showed statistically reduced cerebral activation in the anterior cingulate for OCD group S in contrast to the control group. Additionally, the early old/new effect in OCD group S was negatively correlated with the Y-BOCS total scores, and the late old/new effect was negatively correlated with obsession sub-scores. The severely, not moderately, ill OCD patients showed an impaired conscious recollection of the word-to-be-remembered, which suggested an impairment of working memory capacity in these patients due to a dysfunction in the frontal and cingulate cortex. PMID:18308520
Zhang, Yuanyuan; Feutl, Sebastian; Hauser, Ute; Richter-Witte, Claudia; Schmorl, Philip; Emrich, Hinderk M; Dietrich, Detlef E
Prevalence and profile of obsessive-compulsive trait in patients with chronic migraine and medication overuse.
Patients with chronic migraine (CM) and medication overuse headache (MOH) have high frequency of psychiatric comorbidity or psychopathological traits, the presence of which can influence the clinical course. The presence of subclinical obsessive compulsive disorder (OCD) is underestimated in migraine patients. The aim of this study was to estimate the prevalence and profile of obsessive-compulsive (OBS) trait in a sample of CM patients with MOH using the OBS questionnaire of Spectrum Collaborative Project. According to the new international classification of headache disorders (ICHD-III beta) criteria, 106 patients (15�M, 91�F, mean age 47.3�years) were selected in a consecutive clinical series. Our results showed that 36�% of patients with CM and MOH were positive at OBS-questionnaire. As far as the profile of OBS trait, we performed an evaluation of prevalence of items separating the first part of the questionnaire (childhood/adolescence and doubts in lifetime) from the other five domains: 21�% of the patients showed prevalence of items in childhood/adolescence domain; 79�% in doubts in lifetime domain; as for other five domains, 10.5�% of patients had prevalence of pathological answers among hypercontrol, 5.2�% in spending time, 23.7�% in perfectionism, 29�% in repetition and automation, and 31.5�% in specific themes (obsessive thoughts). The presence of subclinical OCD in migraine patients, and the link between progression to CM, particularly through MO, and OBS trait is still not well defined. The use of specific tools to assess this possible comorbidity should be encouraged in clinical and research settings. PMID:24867863
Curone, M; Tullo, V; Lovati, C; Proietti-Cecchini, A; D'Amico, D
Single photon emission computed tomography of the brain with Tc-99m HMPAO during sumatriptan challenge in obsessive-compulsive disorder: investigating the functional role of the serotonin auto-receptor.
1. Symptoms of obsessive-compulsive disorder (OCD) may be acutely exacerbated by administration of certain serotonin agonists Exacerbation of OCD symptoms by sumatriptan, a 5HT1D agonist (Zohar, 1993), is consistent with pre-clinical data suggesting that the serotonin auto-receptor plays an important role in this disorder (El Mansari et al, 1995). 2. In order to investigate the functional role of the serotonin auto-receptor in OCD, the authors undertook single photon emission computed tomography in OCD patients after administration of sumatriptan and placebo. The authors hypothesized that, as in the case of m-chlorophenylpiperazine (mCPP) challenge (Hollander et al, 1995), exacerbation of OCD symptoms would be accompanied by increased cortical metabolism and thus blood flow, and more specifically by increased activity in the orbitofrontal-striatal circuit. They also expected, that as in the case of mCPP challenge (Hollander et al, 1993), exacerbation of OCD symptoms would be associated with a relatively poor response to subsequent treatment with serotonin specific reuptake inhibitors. 3. Sumatriptan (100 mg orally) and placebo were administered on separate days to 14 patients who met DSM-IV diagnostic criteria for OCD, using a randomized double-blind design. After 90 minutes, patients were injected with Tc-99m HMPAO and underwent single photon emission computed tomography (SPECT) of the brain. Activity in regions of interest was calculated, and compared using repeated measures analysis of variance. Patients were subsequently treated with a serotonin specific reuptake inhibitor (SSRI). 4. Behavioral response to sumatriptan was heterogenous, with 4 patients showing acute exacerbation, and 4 patients demonstrating a decrease in symptoms. On sumatriptan challenge, there was a significant association between symptom exacerbation and decreased activity in frontal areas. There was an association between decreased activity in an inferior frontal area with worse response to treatment, and also patients with symptom exacerbation after sumatriptan had poorer response to SSRI treatment. 5. Heterogeneity of behavioral response to sumatriptan in OCD is consistent with previous studies demonstrating conflicting and heterogenous behavioral responses to serotonergic challenges (Hollander et al, 1992), and with underlying heterogeneity in the neurobiology of this disorder. 6. It may be hypothesized that increased frontal activity in some patients with OCD is itself a compensatory mechanism. In patients with such compensatory hyperactivity, administration of a serotonin auto-receptor agonist results in decreased frontal activity and exacerbation of OCD symptoms. These patients may also be less likely to respond to treatment with a SSRI. 7. Further work combining pharmacological challenge paradigms and functional imaging techniques in OCD may be helpful in elucidating the neurobiology of this complex disorder. PMID:10621951
Stein, D J; Van Heerden, B; Wessels, C J; Van Kradenburg, J; Warwick, J; Wasserman, H J
Increased Self-Report of Obsessive-Compulsive Behaviors Among Hemodialysis Patients: A Case-Control Study
Background: Patients with end-stage renal insufficiency undergoing hemodialysis show important psychiatric morbidity, particularly increased depression and anxiety. Obsessive-compulsive symptoms, however, are much less frequently investigated. The purpose of the present study was thus to assess obsessive-compulsive symptoms in hemodialysis patients. Method: Patients treated at an outpatient hospital hemodialysis unit (July 2007) were compared with controls on scores on the Maudsley Obsessional-Compulsive Inventory (MOCI) and its checking, cleaning, slowness, and doubting components as well as on measures of emotional (Beck Depression Inventory-Fast Screen), anxiety (Beck Anxiety Inventory), and cognitive (Trail Making Test) status. Student t tests, analyses of covariance, or nonparametric tests were used. Correlations were applied between behavioral outcomes and demographic, clinical, and laboratory data of patients. Results: Patients showed more obsessive traits than controls on the MOCI total score (P < .001) and on the checking, cleaning, and doubting subscales. Significant differences between groups occurred also in Beck Depression and Anxiety Inventories (P ? .001). The MOCI total score did not correlate with marital status, education level, duration of hemodialysis, or the other psychological instrument scores in patients. By contrast, the MOCI total score was associated with the level of creatinine, and it showed an inverse correlation with the urea reduction ratio in patients (P < .05). Conclusions: Obsessive-compulsive symptoms may constitute an important aspect of the psychiatric profile of patients undergoing hemodialysis. Potential interpretation involves disease- and treatment-associated factors or adaptive responses to emergence of otherwise uncontrollable stress.
Messinis, Lambros; Dendias, George; Siavelis, Christos; Triantafyllou, Aggeliki; Papathanasopoulos, Panagiotis
Lack of association between obsessive-compulsive disorder and the dopamine D{sub 3} receptor gene: Some preliminary considerations
Controversial results possibly suggesting an association between Tourette`s syndrome (TS) and excess of homozygosity at an Msc I polymorphism in the Dopamine D{sub 3} receptor (DRD{sub 3}) gene have recently been reported. Since a relationship between obsessive-compulsive disorder (OCD) and Tourette`s syndrome (TS) has been suggested, in this study we assessed the frequency of this 2-allele polymorphism in a sample of 97 OCD patients and in 97 control subjects. No statistically significant differences in allele or genotype frequencies were found. Thus this mutation in the coding sequence of the DRD{sub 3} gene is unlikely to confer susceptibility to OCD. 28 refs., 21 tabs.
Catalano, M.; Sciuto, G.; Di Bella, D. [Univ. of Milan Medical School (Italy)] [and others
Obsessive-Compulsive Disorder (For Parents)
... common among kids and teens: grooming rituals, including hand washing, showering, and teeth brushing repeating rituals, including going ... the following possible signs of OCD: raw, chapped hands from constant washing unusually high rate of soap or paper towel ...
Preliminary Study of OCD and Health Disparities at the U.S.-Mexico Border
The widespread and devastating nature of obsessive compulsive disorder (OCD) sharply contrasts with the paucity of research involving Mexican Americans and Mexicans who suffer from this condition. This mixed-methods preliminary study was intended to provide initial data and to pilot the procedures for a larger investigation of the cultural identification, symptomatology, health concerns, coping mechanisms, and quality of life of Mexican Americans and Mexicans with OCD living in the U.S.-Mexico border region of El Paso, Texas and Ciudad Juarez, Mexico. For the sample of six participants, whose symptoms ranged from moderate to extreme, OCD was associated with marked impairment in quality of life, particularly in terms of social functioning, an area of central importance for many Mexican Americans and Mexicans. Areas of further study were identified, with the aim of developing culturally sensitive interventions to decrease health disparities involving OCD.
Olson, Tom; Vera, Beatriz; Perez, Oriana
A randomized clinical trial of Acceptance and Commitment Therapy vs. Progressive Relaxation Training for obsessive compulsive disorder
Objective Effective treatments for adult OCD exist, but refusal and drop-out rates are high and treatments are not effective for all individuals who complete them. Thus, additional treatment options are needed. This study investigated the effectiveness of eight sessions of Acceptance and Commitment Therapy (ACT) for adult obsessive compulsive disorder (OCD) compared to Progressive Relaxation Training (PRT). Method 79 adults (66% Female) diagnosed with OCD (M age=37, 89% Caucasian) participated in a randomized clinical trial of 8 sessions of ACT or PRT with no in-session exposure. The following assessments were completed at pretreatment, posttreatment, and three month follow-up by an assessor who was unaware of treatment conditions: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory-II, Quality of Life Scale, Acceptance and Action Questionnaire, Thought Action Fusion Scale, and Thought Control Questionnaire. The Treatment Evaluation Inventory-Short Form was completed at posttreatment. Results ACT produced greater changes at posttreatment and follow-up over PRT on OCD severity (Y-BOCS: ACT pre=24.22, post=12.76, follow-up=11.79; PRT pre=25.4, post=18.67, follow-up=16.23), and produced greater change on depression among those reporting at least mild depression before treatment. Clinically significant change in OCD severity occurred more in the ACT condition than PRT using multiple criteria (clinical response rates: ACT post=46-56%, follow-up 46-66%; PRT post=13%-18%, follow-up 16-18%). Quality of life improved in both conditions but was marginally in favor of ACT at post. Finally, treatment refusal (2.4% ACT, 7.8% PRT) and drop-out (9.8% ACT, 13.2% PRT) were low in both conditions. Conclusions ACT is worth exploring further as a treatment for OCD.
Twohig, Michael P.; Hayes, Steven C.; Plumb, Jennifer C.; Pruitt, Larry D.; Collins, Angela B.; Hazlett-Stevens, Holly; Woidneck, Michelle R.
Internet-based cognitive bias modification for obsessive compulsive disorder: study protocol for a randomized controlled trial
Background Cognitive bias modification (CBM) interventions have demonstrated efficacy in augmenting core biases implicated in psychopathology. The current randomized controlled trial (RCT) will evaluate the efficacy of an internet-delivered positive imagery cognitive bias modification intervention for obsessive compulsive disorder (OCD) when compared to a control condition. Methods/Design Patients meeting diagnostic criteria for a current or lifetime diagnosis of OCD will be recruited via the research arm of a not-for-profit clinical and research unit in Australia. The minimum sample size for each group (alpha set at 0.05, power at .80) was identified as 29, but increased to 35 to allow for 20% attrition. We will measure the impact of CBM on interpretations bias using the OC Bias Measure (The Ambiguous Scenarios Test for OCD ;AST-OCD) and OC-beliefs (The Obsessive Beliefs Questionnaire-TRIP; OBQ-TRIP). Secondary outcome measures include the Dimensional Obsessive-Compulsive Scale (DOCS), the Patient Health Questionnaire (PHQ-9), The Kessler Psychological Distress Scale (K10), and the Word Sentence Association Test for OCD (WSAO). Change in diagnostic status will be indexed using the OCD Mini International Neuropsychiatric Interview (M.I.N.I) Module at baseline and follow-up. Intent-to-treat (ITT) marginal and mixed-effect models using restricted maximum likelihood (REML) estimation will be used to evaluate the primary hypotheses. Stability of bias change will be assessed at 1-month follow-up. Discussion A limitation of the online nature of the study is the inability to include a behavioral outcome measure. Trial registration The trial was registered on 10 October 2013 with the Australian New Zealand Clinical Trials Registry (ACTRN12613001130752)
Candidate genes and functional noncoding variants identified in a canine model of obsessive-compulsive disorder
Background Obsessive-compulsive disorder (OCD), a severe mental disease manifested in time-consuming repetition of behaviors, affects 1 to 3% of the human population. While highly heritable, complex genetics has hampered attempts to elucidate OCD etiology. Dogs suffer from naturally occurring compulsive disorders that closely model human OCD, manifested as an excessive repetition of normal canine behaviors that only partially responds to drug therapy. The limited diversity within dog breeds makes identifying underlying genetic factors easier. Results We use genome-wide association of 87 Doberman Pinscher cases and 63 controls to identify genomic loci associated with OCD and sequence these regions in 8 affected dogs from high-risk breeds and 8 breed-matched controls. We find 119 variants in evolutionarily conserved sites that are specific to dogs with OCD. These case-only variants are significantly more common in high OCD risk breeds compared to breeds with no known psychiatric problems. Four genes, all with synaptic function, have the most case-only variation: neuronal cadherin (CDH2), catenin alpha2 (CTNNA2), ataxin-1 (ATXN1), and plasma glutamate carboxypeptidase (PGCP). In the 2�Mb gene desert between the cadherin genes CDH2 and DSC3, we find two different variants found only in dogs with OCD that disrupt the same highly conserved regulatory element. These variants cause significant changes in gene expression in a human neuroblastoma cell line, likely due to disrupted transcription factor binding. Conclusions The limited genetic diversity of dog breeds facilitates identification of genes, functional variants and regulatory pathways underlying complex psychiatric disorders that are mechanistically similar in dogs and humans.
Psychometric Properties of the Arabic Version of the Obsessive Compulsive Beliefs Questionnaire-44 in a Student Population
Objective We examined the psychometric properties of the Arabic version of the Obsessive Compulsive Beliefs Questionnaire-44 (OBQ-44) in a sample of Kuwait University students. This questionnaire was developed by the Obsessive Compulsive Cognitions Working Group in order to assess belief domains believed to be crucial in the development of obsessive compulsive symptoms. Method The Arabic version of the OBQ-44 was developed according to the standard translation and back-translation methods. The Arabic versions of the OBQ-44, the Maudsley Obsessive - Compulsive Inventory (MOCI), and Beck Depression Inventory-Revised (BDI-II) were then administered on a sample of 200 Kuwait University students from the faculty of humanities chosen through random cluster sampling. Retest was administered within a 4 week time period. Results The results of principle component factor analysis with varimax rotation indicated 6 factors which overlapped to a high degree. A 3 factor solution was chosen based on the scree plot and factor loadings which explained 36.12% of the variance. The factors were labeled as responsibility and threat estimation (RT), importance and control of thought (ICT) and perfectionism/Certainty (PC). The reliability coefficient of the three factors and the total score were assessed using three methods: Internal consistency, Test-retest reliability and Split-half reliability. Results showed an acceptable internal consistency for the Arabic version of the OBQ-44. Regarding the validity of OBQ-44, the instrument correlated with the total score of MOCI and most of its subscales. Conclusion These data support the reliability and validity of the OBQ-44 in a sample of Kuwait University students.
Rahat, Maryam; Mohamadi, Norolah
Neuronal activity correlated with checking behaviour in the subthalamic nucleus of patients with obsessive-compulsive disorder.
Doubt, and its behavioural correlate, checking, is a normal phenomenon of human cognition that is dramatically exacerbated in obsessive-compulsive disorder. We recently showed that deep brain stimulation in the associative-limbic area of the subthalamic nucleus, a central core of the basal ganglia, improved obsessive-compulsive disorder. To understand the physiological bases of symptoms in such patients, we recorded the activity of individual neurons in the therapeutic target during surgery while subjects performed a cognitive task that gave them the possibility of unrestricted repetitive checking after they had made a choice. We postulated that the activity of neurons in this region could be influenced by doubt and checking behaviour. Among the 63/87 task-related neurons recorded in 10 patients, 60% responded to various combinations of instructions, delay, movement or feedback, thus highlighting their role in the integration of different types of information. In addition, task-related activity directed towards decision-making increased during trials with checking in comparison with those without checking. These results suggest that the associative-limbic subthalamic nucleus plays a role in doubt-related repetitive thoughts. Overall, our results not only provide new insight into the role of the subthalamic nucleus in human cognition but also support the fact that subthalamic nucleus modulation by deep brain stimulation reduced compulsive behaviour in patients with obsessive-compulsive disorder. PMID:23365104
Burbaud, Pierre; Clair, Anne-H�l�ne; Langbour, Nicolas; Fernandez-Vidal, Sara; Goillandeau, Michel; Michelet, Thomas; Bardinet, Eric; Ch�reau, Isabelle; Durif, Franck; Polosan, Mircea; Chabard�s, Stephan; Fontaine, Denys; Magni�-Mauro, Marie-Noelle; Houeto, Jean-Luc; Bataille, Beno�t; Millet, Bruno; V�rin, Marc; Baup, Nicolas; Krebs, Marie-Odile; Cornu, Philippe; Pelissolo, Antoine; Arbus, Christophe; Simonetta-Moreau, Marion; Yelnik, J�r�me; Welter, Marie-Laure; Mallet, Luc
Superstitiousness in obsessive-compulsive disorder
It has been speculated that superstitiousness and obsessivecompulsive disorder (OCD) exist along a continuum. The distinction between supe