Biomedical subjects

David Mataix-Cols

Publications and source records attributed to David Mataix-Cols.

34 records · Page 2Linked to original sources

PubMed2004

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.

Adolescent↗

PubMed2004

Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder.

CONTEXT: Obsessive-compulsive disorder (OCD) is clinically heterogeneous, yet most previous functional neuroimaging studies grouped together patients with mixed symptoms, thus potentially reducing the power and obscuring the findings of such studies. OBJECTIVE: To investigate the neural correlates of washing, checking, and hoarding symptom dimensions in OCD. DESIGN: Symptom provocation paradigm, functional magnetic resonance imaging, block design, and nonparametric brain mapping analyses. SETTING: University hospital. PARTICIPANTS: Sixteen patients with OCD (11 inpatients, 5 outpatients) with mixed symptoms and 17 healthy volunteers of both sexes. Intervention All subjects participated in 4 functional magnetic resonance imaging experiments. They were scanned while viewing alternating blocks of emotional (washing-related, checking-related, hoarding-related, or aversive, symptom-unrelated) and neutral pictures, and imagining scenarios related to the content of each picture type.Main Outcome Measure Blood oxygenation level-dependent response. RESULTS: Both patients and control subjects experienced increased subjective anxiety during symptom provocation (patients significantly more so) and activated neural regions previously linked to OCD. Analyses of covariance, controlling for depression, showed a distinct pattern of activation associated with each symptom dimension. Patients demonstrated significantly greater activation than controls in bilateral ventromedial prefrontal regions and right caudate nucleus (washing); putamen/globus pallidus, thalamus, and dorsal cortical areas (checking); left precentral gyrus and right orbitofrontal cortex (hoarding); and left occipitotemporal regions (aversive, symptom-unrelated). These results were further supported by correlation analyses within patients, which showed highly specific positive associations between subjective anxiety, questionnaire scores, and neural response in each experiment. There were no consistently significant differences between patients with (n = 9) and without (n = 7) comorbid diagnoses. CONCLUSIONS: The findings suggest that different obsessive-compulsive symptom dimensions are mediated by relatively distinct components of frontostriatothalamic circuits implicated in cognitive and emotion processing. Obsessive-compulsive disorder may be best conceptualized as a spectrum of multiple, potentially overlapping syndromes rather than a unitary nosologic entity.

Adult↗

PubMed2004

Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions.

This article describes a broad-spectrum, computer-aided self-help clinic that raised the throughput of anxious/depressed patients per clinician and lowered per-patient time with a clinician without impairing effectiveness. Many sufferers improved by using one of four computer-aided systems of cognitive behavior therapy (CBT) self-help for phobia/panic, depression, obsessive-compulsive disorder, and general anxiety. The systems are accessible at home, two by phone and two by the Web. Initial brief screening by a clinician can be done by phone, and if patients get stuck they can obtain brief live advice from a therapist on a phone helpline. Such clinician-extender systems offer hope for enhancing the convenience and confidentiality of guided self-help, reducing the per-patient cost of CBT, and lessening stigma. The case examples illustrate the clinical process and outcomes of the computer-aided system.

Adult↗

PubMed2004

Patterns of neural response to emotive stimuli distinguish the different symptom dimensions of obsessive-compulsive disorder.

Despite its heterogeneous symptomatology, obsessive-compulsive disorder (OCD) is currently conceptualized as a unitary diagnostic entity. Recent factor-analytic studies have identified several OCD symptom dimensions that are associated with different demographic variables, comorbidity, patterns of genetic transmission, and treatment response. Functional abnormalities in neural systems important for emotion perception, including the orbitofrontal cortex, lateral prefrontal cortex, anterior cingulate gyrus, and limbic regions, have been reported in OCD. In this review, we discuss the extent to which neurobiological markers may distinguish these different symptom dimensions and whether specific symptom dimensions, such as contamination/washing, are associated with abnormalities in emotion and, in particular, disgust, perception in OCD. Also discussed are findings that indicate that anxiety can be induced in healthy volunteers in response to OCD symptom-related material, and that associated increases in activity within neural systems important for emotion perception occur to washing- and hoarding-related material in particular in these subjects. Further examination of neural responses during provocation of different symptom dimensions in OCD patients will help determine the extent to which specific abnormalities in neural systems underlying emotion perception are associated with different symptom dimensions and predict treatment response in OCD.

Adult↗

PubMed2004

Computer-aided self-help for phobia/panic via internet at home: a pilot study.

In an open study, ten people with phobia or panic disorder who could not travel repeatedly to a therapist accessed a computer-aided exposure self-help system (FearFighter) at home on the internet with brief therapist support by telephone. They improved significantly, and their outcome and satisfaction resembled those in patients with similar disorders who used FearFighter in clinics with brief face-to-face therapist support.

Adult↗

PubMed2004

Personality characteristics in obsessive-compulsive disorder and individuals with subclinical obsessive-compulsive problems.

OBJECTIVE: To assess the relationship between normal personality traits and obsessive-compulsive (OC) phenomena in individuals with subclinical OC problems and patients whose problems met diagnostic criteria for obsessive-compulsive disorder (OCD). METHOD: In Study 1, 25 healthy volunteers with high scores on the Padua Inventory (PI) and 28 controls with low scores on the PI were compared on the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), the Eysenck Personality Questionnaire (EPQ), and measures of depression and state anxiety. In Study 2, 56 treatment-seeking participants meeting DSM-IV criteria for OCD and 40 healthy volunteers of similar sociodemographic characteristics were compared on the same measures. RESULTS: Both individuals with subclinical OC problems and OCD patients scored significantly higher than their respective control groups on sensitivity to punishment, neuroticism and psychoticism. OCD patients, but not individuals with subclinical OC problems, scored lower in extraversion than their respective controls. Neuroticism was the strongest predictor of high scores on the PI in Study 1, while psychoticism was the strongest predictor of the presence of an OCD diagnosis in Study 2. CONCLUSION: Healthy participants with high scores on OC measures and OCD patients share various personality traits but can also be distinguished according to the level of extraversion, neuroticism and psychoticism.

Adolescent↗

PubMed2003

Neural correlates of anxiety associated with obsessive-compulsive symptom dimensions in normal volunteers.

BACKGROUND: The neural correlates of anxiety associated with obsessive-compulsive symptomlike provocation in normal volunteers are unknown. METHODS: Ten healthy volunteers participated in four functional magnetic resonance experiments. Subjects were scanned while viewing alternating blocks of emotional (normally aversive, washing-relevant, checking-relevant, or hoarding-relevant pictures) and neutral pictures, and imagining scenarios related to the content of each picture type. Nonparametric brain mapping analyses were used. RESULTS: In response to the provocative pictures in all experiments, increases in subjective anxiety and activation in bilateral ventral prefrontal, limbic, dorsal prefrontal, and visual regions were demonstrated. Anxiety related to different symptom dimensions was associated with different patterns of activation: provocation of washing-relevant anxiety predominantly activated dorsal and ventral prefrontal regions; checking-relevant anxiety predominantly activated dorsal prefrontal regions; and hoarding-relevant anxiety predominantly activated ventral prefrontal regions and the left amygdala. CONCLUSIONS: Our findings support a dimensional model of obsessive-compulsive disorder (OCD) whereby 1) the brain systems implicated in the mediation of anxiety in response to symptom-related material in normal subjects are similar to those identified in OCD patients during symptom provocation, and 2) anxiety associated with different symptom dimensions is associated with differential patterns of activation of these neural systems. Further investigation of the neural basis of OCD symptom dimensions is required.

Adult↗

PubMed2003

Declarative and procedural learning in individuals with subclinical obsessive-compulsive symptoms.

Previous neuropsychological research suggests that psychometrically defined subclinical obsessive-compulsive (OC) individuals perform worse than non-OC controls on specific tests of executive functioning. This study aimed to extend these findings by comparing the performance of 25 subclinical OC and 28 non-OC control subjects on measures of declarative learning (Rey Auditory Verbal Learning Test), motor procedural learning (star maze), spatial problem solving (single administration of the 3-disk version of the Tower of Hanoi; TH3), and "cognitive" procedural learning (repeated administrations of the 4-disk version of the Tower of Hanoi; TH4). In addition, the subjects were administered measures of general intelligence, anxiety and depression. No between-group differences were observed on measures of declarative and motor procedural learning. Subclinical OC subjects needed significantly more moves than controls to solve TH3, suggesting poorer spatial problem solving ability. A significant group x trial interaction on the TH4 suggested reduced cognitive skill acquisition in the subclinical OC group. However, performance on TH3 and TH4 was significantly correlated in the OC group but not in the control group, suggesting that the suboptimal acquisition of cognitive skills among subclinical OC subjects is more likely to be related to inefficient spatial problem solving strategies than to a cognitive procedural learning deficit per se. These results replicate and expand upon previous findings and support a dimensional model of Obsessive-Compulsive Disorder.

Adolescent↗

PubMed2003

Relation of neurological soft signs to nonverbal memory performance in obsessive-compulsive disorder.

Few studies have examined the relation between neurological soft signs (NSS) and neuropsychological performance in Obsessive-Compulsive Disorder (OCD). Thirty outpatients with primary OCD and 30 matched normal controls were administered the Cambridge Neurological Inventory and the Rey-Osterrieth Complex Figure Test (RCFT). A series of multiple regression models tested the relationship between NSS and performance on the RCFT. Patients presented significantly more neurological soft signs than controls on both sides of the body, and were impaired on the free recall and organization scores of the RCFT. Nonverbal memory deficits in OCD were predicted independently by organizational strategies during the copy condition of the RCFT, and neurological soft signs. There might be at least two variables independently mediating nonverbal memory deficits in OCD: (1) a cognitive organization and planning component, and (2) a complex motor regulatory component.

Adult↗

PubMed2003

Pragmatic evaluation of computer-aided self-help for anxiety and depression.

BACKGROUND: Most anxiety/depression is not effectively treated. Aims Open evaluation of a free clinic giving immediate computer-aided cognitive-behavioural therapy (CBT) self-help plus brief advice from a therapist. METHOD: Test of outcome of self-referrals who used one of four computer-aided CBT systems for depression, phobia/panic, general anxiety or obsessive-compulsive disorder. RESULTS: The equivalent of one full-time clinician managed 355 referrals over a year. Of the 266 who had a screening interview 79% were suitable. Completers and non-completers of computer-aided CBT had similar pre-treatment features, with very chronic, moderately severe problems. Completers of the computer-aided self-help had a mean total of an hour's live therapist support over 12 weeks. They improved significantly and clinically meaningfully with three of the four systems and felt 'fairly satisfied'. Improvement resembled that in controlled and other trials of computer-aided CBT. CONCLUSIONS: Computer-aided self-help is a 'clinician extender'that greatly cuts per-patient therapist time without impairing improvement. It could reduce the per-patient cost of CBT.

Adult↗

PubMed2002

Neuropsychological performance in medicated vs. unmedicated patients with obsessive-compulsive disorder.

To date, there have been no formal investigations of neuropsychological performance in patients with obsessive-compulsive disorder (OCD) taking psychotropic medications. The purpose of this study was to determine whether medicated and unmedicated patients with OCD demonstrate differences in neuropsychological functioning. Fifty-two patients with a primary DSM-IV diagnosis of OCD participated in the study; 28 were taking serotonin reuptake inhibitors (SRIs), and 24 were treatment-naïve (n=8) or had finished a washout period prior to their inclusion in other studies (n=16). The groups were well matched with regard to demographic and clinical variables, including symptom severity. Each group was administered a comprehensive neuropsychological battery to assess general intelligence, attention, verbal and non-verbal working memory, declarative and procedural learning, visuo-constructive skills, and executive functions. SRI-medicated did not differ from SRI-free patients on any neuropsychological measure. Benzodiazepines seemed to improve the patients' functioning on a semantic verbal fluency test. In addition, there were significant interactions between SRIs and benzodiazepines on the perseverative errors of the Wisconsin Card Sorting Test and on reaction times. SRI-medicated patients with OCD are able to perform on cognitive functioning tests at a comparable level with that of SRI-free patients, and these results have positive implications for OCD patients who respond to SRIs. The interactions between SRIs and benzodiazepines and their effect on cognition in OCD are likely to be complex and deserve further study.

Adult↗

PubMed2002

Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study.

OBJECTIVE: Little is known about the longitudinal course of symptoms in adult patients with obsessive-compulsive disorder (OCD), although some evidence exists regarding symptom stability in children and adolescents. This study systematically investigated the temporal stability of individual symptoms and symptom dimensions of OCD in adult patients who were followed prospectively for 2 years. METHOD: One hundred seventeen adult outpatients with OCD from three U.S. sites were administered the Yale-Brown Obsessive Compulsive Scale symptom checklist four times over a period of 2 years. Eighty-one (69%), 83 (71%), and 67 (57%) patients were available 6 months, 1 year, and 2 years after initial screening, respectively. Different analytic methods assessed the stability of OCD symptoms within and between previously identified symptom dimensions. RESULTS: For the most part, patients maintained their symptoms throughout follow-up, although some symptoms were more stable than others. For the symptoms that changed, changes occurred within rather than between symptom dimensions; qualitative shifts from one dimension to another were rare. The strongest predictor of the presence of a particular symptom was having had that symptom in the past. Although most patients had received pharmacological and behavioral treatment during the follow-up period, changes within symptom dimensions could not be explained by overall clinical improvement over time. CONCLUSIONS: Symptoms of adult patients with OCD might be more stable across time than previously thought, with some symptoms waxing and waning within symptom dimensions and rarely involving shifts between dimensions. Longer follow-up studies involving larger samples are needed to better understand the fluctuations of OCD symptoms across time.

Adult↗

PubMed2002

Is the use of the wooden and computerized versions of the Tower of Hanoi puzzle equivalent?

The purpose of this study was to examine whether a computerized administration of the Tower of Hanoi (TH) puzzle is equivalent to the classic wooden version of this test. Two groups of healthy volunteers were administered the 2 versions of the TH in a randomized counterbalanced design. The results showed no differences between the 2 versions of the TH on any dependent variable, indicating that their use is equivalent. Men performed better than women in this test, although this finding was independent of the TH version administered. It remains to be tested whether age and computer experience affect performance differentially on the computerized and the wooden versions of the TH puzzle and whether these results are replicated in brain-damaged patients.

Adult↗

PubMedDate not supplied

Reliability and validity of the work and social adjustment scale in phobic disorders.

The Work and Social Adjustment Scale (WSAS) is a simple widely used 5-item measure of disability whose psychometric properties need more analysis in phobic disorders. The reliability, factor structure, validity, and sensitivity to change of the WSAS were studied in 205 phobic patients (73 agoraphobia, 62 social phobia, and 70 specific phobia) who participated in various open and randomized trials of self-exposure therapy. Internal consistency of the WSAS was excellent in all phobics pooled and in agoraphobics and social phobics separately. Principal components analysis extracted a single general factor of disability. Specific phobics gave less consistent ratings across WSAS items, suggesting that some items were less relevant to their problem. Internal consistency was marginally higher for self-ratings than clinician ratings of the WSAS. Self-ratings and clinician ratings correlated highly though patients tended to rate themselves as more disabled than clinicians did. WSAS total scores reflected differences in phobic severity and improvement with treatment. The WSAS is a valid, reliable, and change-sensitive measure of work/social and other adjustment in phobic disorders, especially in agoraphobia and social phobia.

Adult↗

PubMedDate not supplied

Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial.

BACKGROUND: Recent factor-analytic studies in obsessive-compulsive disorder (OCD) identified consistent symptom dimensions. Support for the validity of these dimensions comes from studies of psychiatric comorbidity, functional brain imaging, genetic transmission, and treatment response to medications. This study examined whether previously identified OCD symptom dimensions are associated with treatment compliance and response to behaviour therapy (BT) for OCD. METHODS: One hundred and fifty-three OCD outpatients who participated in a multi-centre randomised controlled trial of computer- versus clinician-guided BT for OCD were included in the study. Logistic and multiple regression models tested for significant predictors of compliance with and response to BT and relaxation. RESULTS: The patients studied were phenomenologically comparable (including the presence of 'pure' obsessions and mental rituals) to those in previous serotonin reuptake inhibitor (SRI) trials and those in clinical epidemiology studies. High scorers on the 'hoarding' dimension were more likely to drop out prematurely from the study and tended to improve less. For those completing treatment, the strongest predictor of outcome was pre-treatment severity. Initial depression scores were unrelated to outcome. After controlling for symptom severity, higher scores on the 'sexual/religious obsessions' factor predicted poorer outcome with BT, especially when computer-guided. CONCLUSIONS: BT is especially indicated for OCD patients with aggressive/checking, contamination/cleaning and symmetry/ordering symptoms. Previous accounts of unsuccessful BT in patients with hoarding symptoms may be due in part to their propensity to drop out earlier from treatment. Patients with sexual/religious obsessions, but not those with mental rituals, might respond less well to traditional BT techniques. Existing treatments need to be refined and/or new treatments developed to improve these patients' adherence and response to treatment.

Adult↗

PubMedDate not supplied

Convergent and discriminant validity of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist.

BACKGROUND: The factor structure of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (Y-BOCS-SC) has been well established, but its convergent and divergent reliability have yet to be studied. METHODS: Fifty-six obsessive-compulsive disorder (OCD) patients were administered the clinician-administered Y-BOCS-SC and Hamilton Rating Scale for Depression (HRSD), together with the self-administered Maudsley Obsessive Compulsive Inventory (MOCI), Padua Inventory (PI), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). RESULTS: Overall, the correspondence between the Y-BOCS-SC and self-administered measures of OCD symptoms was poor to moderate. Its convergent validity was adequate for its washing dimension but poor for its other dimensions. The discriminant validity of the Y-BOCS-SC was adequate, showing little overlap with overall illness severity (total Y-BOCS) and state measures (BDI, STAI, HRSD). In contrast, self-administered OCD measures were significantly correlated with overall illness severity and state measures. CONCLUSIONS: The convergent validity of the Y-BOCS-SC was generally poor and this could only be partially explained by the incomplete coverage of some OCD symptoms in the self-administered scales. Its discriminant validity was good. Both self- and clinician-administered measures should be used in OCD research, as they seem to measure relatively non-overlapping constructs. Further research on the psychometric properties of the Y-BOCS-SC is needed.

Adult↗