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F Neziroglu

Publications and source records attributed to F Neziroglu.

At least 19 recordsLinked to original sources
PubMed2001

Anorexia nervosa, diabetes mellitus, brain atrophy, and fatty liver.

An increased number of diabetes mellitus cases followed by the development of anorexia nervosa have been reported. In this report, the opposite has been observed in the case of a patient with anorexia nervosa who later developed insulin-dependent diabetes mellitus, associated with brain atrophy and fatty liver. The patient was treated with insulin, amitriptylene, and behavior modification. Significant improvement was noted on this regimen.

Adult↗
PubMed2001

The integration of primary anorexia nervosa and obsessive-compulsive disorder.

This paper explores the relationship between primary anorexia nervosa (PAN) and obsessive-compulsive disorder (OCD) in both their concomitant and their sequential presentation. Their clinical descriptions demonstrate the presence of obsessionality and compulsiveness that seem to interface during their course and overlap in their symptomatologies has been noted for over sixty years. However, recent research in this regard is scant. Commonalities in pathophysiology indicate disturbances in neurotransmitters, notably serotonin. Biological challenges have failed to establish a definitive correlation with PAN and OCD, whether in combination or individually. We may postulate that, with limitations, they share some anatomical pathways. The areas affected are the amygdala, cingulum and orbito-frontal cortex. Few studies, however, have been devoted to the treatment of concomitant PAN and OCD.

Anorexia Nervosa↗
PubMed2001

Predictive validity of the overvalued ideas scale: outcome in obsessive-compulsive and body dysmorphic disorders.

Overvalued ideas have been theoretically implicated in treatment failure for obsessive-compulsive disorder (OCD). Until recently, there have not been valid assessments for determining severity of overvalued ideas. One recent scale, the Overvalued Ideas Scale (OVIS; Neziroglu, McKay, Yaryura-Tobias, Stevens & Todaro, 1999, Behaviour Research and Therapy, 37, 881-902) has been found to validly measure overvalued ideas. However, its predictive utility has not been determined. Two studies were conducted to examine the extent to which the OVIS predicts treatment response. Study 1 examined the response to behavioral therapy in a group of participants diagnosed with OCD. Residual gain scores showed a significant correlation between treatment outcome for compulsions and pretreatment OVIS scores (28.1% variance accounted). Pretreatment OVIS scores were not significantly correlated with residual gains in obsessions (1.7% variance accounted). The predictive utility of the OVIS was superior to a single item assessment of overvalued ideas available on the Yale-Brown Obsessive Scale in predicting outcome for compulsions. For this item, the variance accounted for compulsions was 6.3% and for obsessions was 3.9%. Study 2 examined the response to behavioral therapy in a group of participants diagnosed with body dysmorphic disorder (BDD), a condition ostensibly linked to OCD and presumed to present with higher levels of overvalued ideas. Residual gains scores showed a significant relationship between obsessions and OVIS (accounting for 34.8% of the variance), but not for compulsions (10.2% variance accounted). As in Study 1, the predictive utility of the OVIS was superior to the single item assessment (with 0.2% variance accounted for compulsions, 2.4% variance accounted for obsessions). Taken together, the studies reported here show that this OVIS is predictive of treatment outcome, and the predictive value depends on which symptoms are used to assess outcome. Further, the scale is more effective in predicting outcome than a widely used single item assessment.

Adolescent↗
PubMed2000

Behavioral, cognitive, and family therapy for obsessive-compulsive and related disorders.

Behavioral therapy and cognitive therapy, individually and combined, are a solid base in any therapy, the goal of which is to decrease the maladaptive behaviors associated with obsessive-compulsive spectrum disorders. Future research into this area involves two branches: (1) better resolution in what components of current treatments are effective and (2) a better understanding of the cause of OCD. The therapies of choice are behavioral therapy and cognitive therapy, but often what is described as behavioral therapy and cognitive therapy varies. Further refinement of the specific components of behavioral therapy and cognitive therapy that directly apply to OCD is needed. The specific components likely include the use of ERP and rational emotive behavioral therapy but often even these therapies can be parceled into smaller discrete parts. Many facets still have not been explored thoroughly (e.g., the extent of exposure to adverse situations needed, ideal length of therapy, time needed for exposure, and the use of virtual reality versus traditional exposures). A better understanding of the biological basis for OCD also would further the field. A better understanding of the basis of this disorder also would help clinicians to treat it with medication and behavioral therapy. Research into how behavioral therapy and cognitive therapy makes neurophysiologic changes would show the effectiveness of the treatment and a biological basis. Such studies could include the use of MR imaging during different stages in behavioral therapy and the use of functional during therapy to observe changes in the brain. Although OCD still is not fully understood, researchers are now beginning to understand how to treat it, and a solid base of empiric data now exists. The authors hope that investigators will continue research toward a better understanding of this disorder so that clinicians can better help their patients.

Behavior Therapy↗
PubMed2000

The effect of fluvoxamine and behavior therapy on children and adolescents with obsessive-compulsive disorder.

OBJECTIVE: The efficacy of medications, consisting of serotonin partial and specific reuptake blockers, and behavior therapy, consisting of exposure and response prevention in addition to social skills training, cognitive therapy, and habit reversal, in the treatment of obsessive-compulsive disorder are well documented. The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy. METHODS: Ten children/adolescents who had not previously responded to behavior therapy were randomly assigned to two groups: fluvoxamine alone or fluvoxamine with behavior therapy. All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year. RESULTS: Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable, the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). According to the other measurements-National Institute of Mental Health-Global Obses-sive-Compulsive Scale, Clinical Global Impression-Improvement (assessing level of im-provement from week to week), and Clinical Global Impression-Severity of Illness Scale (as-sessing how ill the patient is from week to week)-improvement was not as evident. According to the CY-BOCS, those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication. At two-year follow-up, all patients continued to improve, with those in the combined approach improving more than those in the medication-alone group. CONCLUSIONS: Future studies should determine the specific effect of each treatment group, combined and singularly. Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed. The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy, according to the CY-BOCS.

Adolescent↗
PubMed2000

Parental obsessive-compulsive disorder as a prognostic factor in a year long fluvoxamine treatment in childhood and adolescent obsessive-compulsive disorder.

Interest in the treatment of pediatric obsessive-compulsive disorder (OCD) has increased as our knowledge of adult OCD has expanded. Although adults are still the majority of patients, children and adolescents with OCD are being identified and treated more frequently. As this population is better identified, prognostic factors need to be addressed to improve treatment outcome. The purpose of this study was to determine the role of family psychiatric pathology in fluvoxamine treatment outcome. Eleven children and adolescents with OCD and one of their parents participated in the study. Four parents were diagnosed with OCD, six had an Axis I diagnosis other than OCD, and one had no mental disorder [Structured Clinical Interview for the DSM-Non-Patient edition (SCID-NP)]. Each patient received fluvoxamine for 58 weeks. Dependent measures included the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the NIMH-Global Obsessive Compulsive Scale (NIMH-GOCS) and the Clinical Global Impression (CGI). Based on CY-BOCS, CGI and NIMH-GOCS scores, patients with parents who have OCD showed a clinically and statistically significant reduction in symptoms from pre- to post-treatment. Patients whose parents did not have OCD also improved. However, the improvement was statistically but not clinically significant. The presence of OCD in one parent seems to modify a child's response to medication. The results suggest that family psychopathology, specifically presence of OCD, may contribute to treatment efficacy. Further research is suggested in this area.

Adolescent↗
PubMed2000

Negative outcome after neurosurgery for refractory obsessive-compulsive spectrum disorder.

OBJECTIVE: The authors sought to determine the long-term outcome of patients with severe and refractory obsessive-compulsive disorder spectrum (OCDS) following neurosurgery. METHOD: Five patients who underwent neurosurgery as a last-resort treatment for refractory OCDS were evaluated. On all patients, posttest data was obtained from the Yale-Brown Obsessive-Compulsive Scale, The Overvalued Ideas Scale, the Beck Depression Inventory and the Beck Anxiety Inventory. Pretest scores were available on three patients as well. RESULTS: All patients failed to maintain initial improvements after surgery and relapsed. In addition, they became depressed with suicidal ideation or attempt. CONCLUSION: Complications of neurosurgery are discussed, notably relapse and depression.

Adult↗
PubMed1999

The Overvalued Ideas Scale: development, reliability and validity in obsessive-compulsive disorder.

The presence of overvalued ideas in obsessive-compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome [Kozak, M. J. & Foa, E. B. (1994). Obsessions, overvalued ideas and delusions in obsessive-compulsive disorder. Behaviour Research and Therapy, 32, 343-353]. To date, no measures have been developed which quantitatively assess levels of overvalued ideas in obsessive-compulsives. The present studies examined the psychometric properties of a scale developed to measure this form of psychopathology, the Overvalued Ideas Scale (OVIS). In study 1, 102 patients diagnosed with OCD were administered a battery of instruments including the OVIS at baseline and two weeks later, prior to initiating treatment. Results indicate that the OVIS has adequate internal consistency reliability (coefficient alpha = 0.88 at baseline), test-retest reliability (r = 0.86) and interrater reliability (r = 0.88). Moderate to high levels of convergent validity was found with measures of obsessive-compulsive symptoms, a single item assessment of overvalued ideas and psychotic symptoms. Medium levels of discriminant validity with measures of anxiety and depression was obtained in this study. Individuals determined to have high OVI showed greater stability of this pathology than those with lower OVI, suggesting that overvalued ideas are stable for extreme scorers. In study 2 a total of 40 patients participated who were diagnosed with OCD. The same battery of instruments was administered as in study 1, as well as the Beck Depression Inventory and Beck Anxiety Inventories. Results were similar to that obtained in study 1, including a relative lack of discriminant validity with self-report measures of depression and anxiety. It is suggested that further research with the OVIS may show predictive value in treatment outcome studies of OCD.

Adult↗
PubMed1998

Hyperphagia and self-mutilation in Prader-Willi syndrome: psychopharmacological issues.

This study focused in the treatment of two major Prader-Willi symptoms: hyperphagia and self-injurious behavior (SIB). Four patients participated in a four-year study with monthly follow-ups. Patients lived in a behaviorally structured environment, and were treated with selective serotonin reuptake blockers and phenothiazines. Psychopharmacological intervention improved SIB symptoms, but was ineffective to control appetite satiation.

Adult↗
PubMed1997

Body dysmorphic disorder: a preliminary evaluation of treatment and maintenance using exposure with response prevention.

In recent investigations, body dysmorphic disorder (BDD) has been shown to share common etiological and symptom presentation to obsessive-compulsive disorder (OCD). When treating BDD, there have been some investigations suggesting that exposure with response prevention is effective in alleviating symptoms. Ten patients diagnosed with BDD participated in a study examining the effects of treatment and maintenance using exposure with response prevention. They received a standard behavior therapy protocol which consisted of exposure in vivo and in imagery, with response prevention. Symptom severity, depression, anxiety, and avoidance were assessed weekly during treatment. Following treatment, a 6-month maintenance program was instituted for five patients, with the other five serving as controls. Patients in the maintenance program were assessed bi-weekly with all measures and a 6-month follow-up was conducted. Patients improved for measures of avoidance, BDD symptoms, depression and anxiety when using exposure with response prevention. Although all patients remained symptom free at follow-up, those in the maintenance program continued to improve. Based on these results, BDD appears to be amenable to exposure with response prevention treatment. Additional treatment gains can be obtained when structured maintenance programs are implemented.

Adult↗
PubMed1997

A review of cognitive behavioral and pharmacological treatment of body dysmorphic disorder.

Body dysmorphic disorder (BDD) first appeared in the diagnostic nomenclature in 1987 with the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised (DSM-III-R) (APA, 1987). Currently in DSM-IV (APA, 1994), the criterion of impairment in functioning was added to the already existing criteria of preoccupation with an imagined defect in appearance not accounted for by another mental disorder. The body parts most often perceived as defective are the nose, hair, and complexion. Behavioral and pharmacological studies consist primarily of case reports. Systematic desensitization, exposure and response prevention, and cognitive therapy are promising approaches that need further investigation. Pharmacological agents noted to be beneficial are the selective serotonin reuptake inhibitors. Controlled studies in this area are also needed.

Body Image↗
PubMed1996

Social skills training in a case of obsessive-compulsive disorder with schizotypal personality disorder.

The present study illustrates a case of obsessive-compulsive disorder (OCD) with schizotypal personality treated by social skills training. Prior research suggests that OCD with schizotypal personality predicts poor treatment outcome using exposure-based treatments. Following social skills treatment and at 6-month follow-up, the patient had considerable obsessive-compulsive symptom reduction, although he was still symptomatic for OCD, anxiety and depression. Controlled trails are indicated to illuminate the specific contributions of this approach for OCD with schizotypal personality disorder.

Adult↗
PubMed1995

Factor structure of the Yale-Brown Obsessive-Compulsive Scale: a two dimensional measure.

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS: Goodman, Price, Rasmussen, Mazure, Fleischman, Hill, Heninger & Charney, 1989a, b, Archives of General Psychiatry, 46, 1006-1016), a widely used measure of obsessions and compulsions, is typically used by summing the items to yield a global measure of symptom severity. However obsessive-compulsive disorder (OCD) is characterized by two distinct groups of symptoms (i.e. obsessions and compulsions), and so it was hypothesized that OCD, as assessed by the Y-BOCS, may be two dimensional. In other words, the items assessing obsessions may be factorially distinct from the items assessing compulsions. A confirmatory factor analysis (CFA) was conducted using responses from 83 OCD patients to determine whether OCD as assessed with the Y-BOCS is unidimensional or forms two distinct dimensions. Results supported a two-factor solution, and suggest that items assessing obsessions should be scored as one subscale, and items assessing compulsions scored as a separate subscale. Depression, as assessed by the Beck Depression Inventory, (Beck, Ward, Mendelsohn, Mock & Erbaugh, 1961, Archives of General Psychiatry, 4, 561-571), was correlated with both subscales. Trait anxiety, as assessed by the State-Trait Anxiety Inventory (Speilberger, 1983, Manual for the State-Trait Anxiety Inventory (Form Y). Palo-Alto, CA: Consulting Psychologists Press), was correlated with the obsessions subscale but not with the compulsions subscale.

Adolescent↗
PubMed1992

Onset of obsessive-compulsive disorder in pregnancy.

OBJECTIVE: Although the role of pregnancy and childbirth in postpartum psychosis and depression has been studied, the association between pregnancy and obsessive-compulsive disorder has not been specifically addressed. The authors evaluated the role of pregnancy in the onset of obsessive-compulsive disorder. METHOD: Female patients with obsessive-compulsive disorder (N = 106) completed a questionnaire assessing age at onset of symptoms, marital status, number of children, age at each pregnancy, and life events associated with the onset of obsessive-compulsive disorder. RESULTS: Of the 106 women, 42 were childless and 59 had at least one child each; five others were also childless but had had abortions (N = 4) or a miscarriage (N = 1). Of the 42 women without children, 12 (28.6%) had first experienced obsessive-compulsive symptoms between the ages of 13 and 15 years, but there were two peaks of onset for the women with children: ages 22-24 and 29-32 years. Of the 59 patients with children, 23 (39.0%) had experienced symptom onset during pregnancy; this was the first pregnancy for 12, the second pregnancy for eight, and the third pregnancy for three. Four of the five women who had had abortions or a miscarriage had experienced the onset or an exacerbation of obsessive-compulsive symptoms during pregnancy. CONCLUSIONS: The association between pregnancy and the onset of obsessive-compulsive symptoms in these female patients highlights the need for further research on psychological and biological factors associated with pregnancy and obsessive-compulsive disorder.

Abortion, Induced↗
PubMed1990

An obsessive-compulsive view of obesity and its treatment.

It was hypothesized that some obese individuals who are obsessed with food and who eat compulsively may not respond to the stimulus control techniques widely used in treating obesity. Sixty-eight participants were administered a measure of obsessive tendencies and randomly assigned to three treatment modalities: (a) Exposure and response prevention; (b) Stimulus control; (c) Control. Results indicated that participants who scored high on the Eating Obsessive Compulsive questionnaire (EOC) maintained weight loss significantly better with exposure and response prevention (ERP) training than did either the stimulus control or the control group. It was concluded that for the obsessive-compulsive eater, ERP training is the treatment of choice.

Adult↗
PubMed1985

Clomipramine and imipramine in obsessive-compulsive disorder.

Twenty-three outpatients with primary obsessive-compulsive disorder (OCD) were started in a 12-week double-blind clinical trial of clomipramine (CLI) (n = 11) and imipramine (IMI) (n = 12). There was no placebo and no crossover. After 6 weeks of treatment, data on 19 subjects (9 CLI, 10 IMI) were available. After week 12, the sample was reduced to 16 patients (8 CLI, 8 IMI). At both time points, OCD symptoms showed modest reductions (in comparison with the pretreatment baseline) in both CLI and IMI groups. Both drugs showed a major antidepressant effect. Analyses accounting for the differences in the baseline levels indicated a somewhat superior effect of CLI over IMI on OCD as well as depression. The effect of CLI and IMI on OCD was independent of the initial severity of depression. There were no clear differences in the safety of the treatments.

Adult↗
PubMed1978

A study of relationships of serum glucose, insulin, free fatty acids, and free and total tryptophan to mental illness.

To explore possible disturbances of cerebral monoamines linked to glucose metabolism, 18 schizophrenics, 21 neurotics, and 21 controls were given a 5-hr glucose tolerance test, and the effect of the glucose load on total and free tryptophan, insulin, and free fatty acids in serum was studied in medication-free patients. The data indicated intragroup differences (fasting to subsequent hours) in serum glucose, insulin, free fatty acids, and free and total tryptophan values. Intergroup differences were noted in insulin values at the first hour, in free fatty acids at fasting with neurotics exhibiting the highest values, and in free tryptophan at fasting with schizophrenics having the lowest values. Schizophrenics with perceptual disturbances (e.g., hallucinations) exhibited lower free tryptophan values when compared with other schizophrenics. The results indicated a glucose-tryptophan interaction in schizophrenics.

Adolescent↗