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Biomedical subjects

E Hollander

Publications and source records attributed to E Hollander.

At least 19 recordsLinked to original sources
PubMed1995

Behavioral and neuroendocrine responses to metaCPP in anorexia nervosa.

In response to the partial serotonin agonist meta-chlorophenylpiperazine (metaCPP), patients with obsessive-compulsive disorder have been reported to exhibit an increase in obsessive symptoms and a diminished release of prolactin and/or cortisol compared to controls. We examined the response to metaCPP of 10 patients with anorexia nervosa, before and after weight gain, and of eight healthy controls. Prior to weight gain, the patients exhibited a greater behavioral response to metaCPP than the controls and diminished prolactin and cortisol responses. Only the prolactin abnormality persisted after weight gain. These observations suggest that, in patients with anorexia nervosa, weight loss is associated with the development of neurobiological disturbances which are in some ways similar to those of obsessive-compulsive disorder.

Adult↗
PubMed1995

Meta-analysis of pharmacotherapy trials for obsessive-compulsive disorder.

Since the discovery that clomipramine was effective in the treatment of obsessive-compulsive disorder (OCD), trials of several different medications for OCD have been published. The question of which agent, if any, is the medication of choice in OCD is of real clinical concern. Published clinical trials were collected using computerized search on MedLine and PsychLit. Trials that met predetermined criteria were included in a meta-analysis. Analyses of variance were used to compare the specific effect sizes of different medications in OCD. In placebo-controlled trials, serotonin reuptake inhibitor (SRI) type had a significant effect on medication effect size, with clomipramine more effective than fluoxetine. Although this finding did not alter when trials were restricted to those with large numbers of subjects (n > 50), the analysis was based on a very limited number of studies. The fact that so few placebo-controlled studies have been done in OCD compromises the findings of this meta-analysis. It would be premature to extrapolate the results to clinical practice, where clomipramine and certain selective SRIs are currently and justifiably used as first-line agents. Nevertheless, the current study supports previous work suggesting that increased serotonergic specificity is not necessarily correlated with greater efficacy in the treatment of OCD. Further head-to-head comparison studies are necessary to confirm or refute this preliminary impression.

Analysis of Variance↗
PubMed1995

Compulsive and impulsive symptomatology in trichotillomania.

Although classified as a disorder of impulse control, trichotillomania (hair pulling) may have some phenomenological overlap with obsessive-compulsive disorder (OCD). The question arises as to whether trichotillomania is best conceptualized as a disorder characterized by impulsivity or compulsivity. Impulsive and compulsive symptoms and traits were compared in 43 patients who presented for treatment of trichotillomania, OCD or impulsive personality disorder. Trichotillomania patients had significantly lower scores of obsessive-compulsive symptoms than OCD patients, and significantly higher impulsiveness scores than this group. Measures of aggression did not differ significantly between groups.

Adult↗
PubMed1995

Trichotillomania and obsessive-compulsive disorder.

Trichotillomania, a disorder characterized by repetitive hair pulling, has been only recently systemically investigated. Such research was encouraged by data that showed obsessive-compulsive disorder, which is also characterized by ritual behaviors, responds selectively to serotonin reuptake inhibitors. In this review, we consider similarities and contrasts in the diagnosis, demographics, phenomenology, neurochemistry, neuropsychiatry, and treatment of trichotillomania and obsessive-compulsive disorder. We argue that a view of trichotillomania as an obsessive-compulsive spectrum disorder that may involve disturbances in grooming behaviors comprises a useful clinical and research heuristic. Nevertheless, there may also be important differences between the two disorders; in particular, trichotillomania has a number of characteristics in common with impulsive disorders. Further empirical investigation is necessary to determine the nature of these complex disorders and their relationship to one another.

Adolescent↗
PubMed1995

DSM-IV field trial: obsessive-compulsive disorder.

OBJECTIVE: Three issues relevant to revising the DSM-III-R criteria for obsessive-compulsive disorder were examined in a field trial: 1) the requirement that symptoms of obsessive-compulsive disorder be viewed by the patient as excessive or unreasonable, 2) the presence of mental compulsions in addition to behavioral compulsions, and 3) ICD-10 subcategories. METHOD: The authors studied symptom patterns of obsessive-compulsive disorder as well as strength of obsessive belief among 431 patients with obsessive-compulsive disorder at seven hospital outpatient clinics. Two methods of subject selection were used: consecutive entry of everyone who contacted the clinics for evaluation of obsessive-compulsive disorder and entry of patients with obsessive-compulsive disorder who had continuing contact with the clinics since before the field trial and who were still symptomatic. Primary measures were the Yale-Brown Obsessive Compulsive Scale and face-valid questions about fixity of obsessive-compulsive beliefs. RESULTS: The large majority of patients were uncertain about whether their obsessive-compulsive symptoms were unreasonable or excessive, and most had both mental and behavioral compulsions. Results on the ICD-10 subcategories were equivocal. CONCLUSIONS: The present results converge with previous findings to indicate a broad range of insight among patients with obsessive-compulsive disorder. The DSM-III-R requirement for insight should be de-emphasized in DSM-IV, and mental rituals should be included in the definition of compulsions.

Adult↗
PubMed1995

Body dysmorphic disorder in the DSM-IV field trial for obsessive-compulsive disorder.

OBJECTIVE: This study investigated the prevalence and phenomenology of body dysmorphic disorder in patients with obsessive-compulsive disorder. METHOD: The authors studied 442 patients who participated in the DSM-IV field trial for obsessive-compulsive disorder. RESULTS: Twelve percent (N = 51) of the patients had a lifetime comorbid diagnosis of body dysmorphic disorder. Patients with and without body dysmorphic disorder did not differ in demographic characteristics of obsessive-compulsive symptoms. Patients with obsessive-compulsive disorder and body dysmorphic disorder had more anxious, impulsive, and schizotypal features than patients with obsessive-compulsive disorder alone. Age at onset was similar for the two disorders, and severity correlated. However, insight was significantly more impaired for body dysmorphic disorder than for obsessive-compulsive disorder. CONCLUSIONS: As previously thought, these findings suggest that the two disorders are strongly related but also have differences that require further investigation.

Adult↗
PubMed1995

An open trial of valproate in borderline personality disorder.

BACKGROUND: Target symptoms in pharmacotherapy of borderline personality disorder include mood instability, anxiety, and impulsivity. Valproate appears useful for the treatment of these target symptoms in several disorders, and carbamazepine has been found effective for such symptoms in borderline personality disorder. We therefore conducted a preliminary open-label trial of valproate in borderline personality disorder. METHOD: Eleven patients who met DSM-III-R criteria for borderline personality disorder were entered into an 8-week study of valproate. Exclusion criteria included current major depression or major medical disorder. All patients were in psychotherapy at least once a week for a minimum of 8 weeks prior to starting medication. Valproate was increased as tolerated to reach blood levels of 50 to 100 micrograms/mL. Clinician- and self-rated scales were completed each week. RESULTS: Three patients did not complete the study. Of completers, 4 of 8 patients were responders ("much less" or "less") on clinician-rated change scores for overall pathology and for mood. Three of 8 patients were responders on change scores for anxiety, anger, impulsivity, and rejection sensitivity. There was a significant (p = .03) decrease in total Symptom Checklist-90 scores between the start and end of the trial. On the Overt Aggression Scale (Modified), total other-directed assault did not significantly decrease, but there was a significant (p = .02) decrease in global subjective irritability. CONCLUSION: Valproate led to overall improvement in 50% of a small sample of borderline personality disorder patients who completed an 8-week open trial. The medication was modestly helpful for mood and irritability as well as for anxiety, anger, rejection sensitivity, and impulsivity, but specific therapeutic effects varied from patient to patient. More extensive controlled trials of anticonvulsants for impulsive personality disorders are warranted.

Adult↗
PubMed1995

Clinical profile, comorbidity, and treatment history in 123 hair pullers: a survey study.

BACKGROUND: Trichotillomania, characterized by an irresistible urge to pull one's hair, may be more prevalent than previously believed. Despite increasing attention devoted to this topic in the recent literature, there are few studies based on large samples that are potentially generalizable to a community population. METHOD: Surveys addressing clinical profile, comorbidity, and treatment history were mailed to all responders to a nationally distributed magazine article on trichotillomania. Out of 772 surveys sent, 123 completed surveys were returned. RESULTS: While there was a predominance of females in the whole sample, female-to-male prevalence was lower in children than adults. Onset was predominantly in childhood (mean age = 11 years), most frequently in middle childhood and least frequently before age 6. Subjects pulled hair from a variety of sites, including scalp, eyelashes, eyebrows, pubic region, face, and body, but the highest incidence and severity involved scalp hair. Children under 6 were more likely than other age groups to pull scalp hair and possibly less likely to pull other hair. In adults, symptom profile was not associated with age at onset. While subjects reported high rates of comorbid conditions in both self and family, trichotillomania was reportedly formally diagnosed in only 40% of the subjects. Although subjects reported a range of treatments, the majority (58%) reported no treatment history. Finally, only minimal improvement was reported for all modalities, with no significant difference in response to psychotherapy, behavior therapy, clomipramine, or fluoxetine. CONCLUSION: Trichotillomania is a chronic illness that may be difficult to treat. Controlled studies on comorbidity, epidemiology, treatment-seeking patterns, and long-term treatment response are needed.

Adolescent↗
PubMed1995

Depersonalization disorder and self-injurious behavior.

Depersonalization is a subjective sense of unreality regarding various aspects of the self, experienced as disconnectedness from one's own body, mentations, feelings, or actions. When episodes of depersonalization are recurrent or persistent and lead to distress or dysfunction, the diagnosis of depersonalization disorder is made. Certain similarities in phenomenology, comorbidity, neurochemistry, and treatment response suggest a relationship to the obsessive-compulsive spectrum. However, depersonalization is a very poorly studied condition, and any conclusions must be viewed tentatively. Self-injurious behaviors are defined as intentionally self-inflicted bodily injuries without lethal intent. Basic categories are briefly described. Subsequently, the phenomenology and biology of both impulsive and compulsive self-injurious behaviors, and their relationship to the obsessive-compulsive spectrum, are discussed.

Adolescent↗
PubMed1995

Body dysmorphic disorder, pathological gambling, and sexual compulsions.

This article focuses on body dysmorphic disorder (BDD), pathological gambling, and sexual compulsions within the realm of obsessive-compulsive spectrum disorders. These three disorders affect sizable numbers of the population, have an early age at onset and chronic courses, and seem to have a preferential response to serotonin reuptake inhibitors (SRIs). They also have a high comorbidity with obsessive-compulsive disorder, depression, and other impulse control disorders. BDD patients lie more toward the compulsive/risk-aversive end of the dimensional model of obsessive-compulsive spectrum disorder and often have poor insight. Pathological gambling patients lie more toward the impulsivity/novelty-seeking end of the OCD spectrum and often have features of inattention. Sexual obsessions and/or compulsions encompass a heterogeneous group of disorders, as exhibited by differential response to SRIs within this group. These three disorders fall within a new and evolving field that requires further investigation and reconceptualization. This concept may have far-reaching consequences and yield more significant treatment outcomes.

Adolescent↗
PubMed1994

Brain event-related potential correlates of overfocused attention in obsessive-compulsive disorder.

A hypothesis of overfocused attention in obsessive-compulsive disorder was investigated by measuring auditory event-related potentials (ERPs) during a selective attention task. Unmedicated patients (n = 18) with this disorder showed significantly larger attention-related processing negativity (PN), with earlier onset and longer duration, than did normal controls (n = 15). In the N200 region (160-250 ms), PN was larger in patients with fewer nonspecific neurological soft signs. This task, however, did not yield any group differences in mismatch negativity (N2a) or classical N200 (N2b). P300 amplitudes for attended targets were smaller for patient than normal groups, but the reverse was true for P300 and positive slow wave amplitudes for unattended nontargets. Collectively, these ERP abnormalities suggest a misallocation of cognitive resources. Because of the importance of the frontal lobe in the control of selective attention, PN enhancement in patients with obsessive-compulsive disorder may reflect hyperactivation of this region. This conceptualization is consistent with recent functional neuroimaging findings.

Adult↗
PubMed1994

Low platelet monoamine oxidase activity in pathological gambling.

Decreased platelet monoamine oxidase (MAO) activity has been reported in association with sensation-seeking personality type and in some mental disorders associated with a lack of impulse control. Pathological gambling itself has been related with both sensation-seeking and reduced impulse control. Platelet MAO activity was investigated in 15 DSM-III-R pathological gamblers from our outpatient clinic. Gamblers had a significantly lower platelet MAO activity than a group of 25 healthy controls. The range of MAO levels in gamblers was also significantly shorter than in controls. In controls, platelet MAO levels showed the previously described negative correlations with sensation-seeking scores but not in gamblers. The findings are consistent with previous studies showing an association of low platelet MAO activity with impulse control disorders and raise some interesting therapeutic alternatives for pathological gambling.

Adult↗
PubMed1994

A survey of the phenomenology and pharmacotherapy of compulsive and impulsive-aggressive symptoms in Prader-Willi syndrome.

Prader-Willi Syndrome (PWS) is a congenital disorder characterized by hyperphagia as well as by other behavioral disturbances such as self-mutilation and temper outbursts. Some of these symptoms have been reported to respond to psychotropic medications. A systematic survey was conducted to gather information on the phenomenology and pharmacotherapy of compulsive and impulsive-aggressive symptoms in PWS. Both compulsive and impulsive-aggressive symptoms are frequent in this population. Pharmacotherapeutic intervention may have a role in the management of these symptoms. Rigorous diagnostic and treatment studies should be undertaken in this population.

Adolescent↗