Biomedical subjects

Iver Hand

Publications and source records attributed to Iver Hand.

18 recordsLinked to original sources

PubMed2006

A prospective long-term follow-up study of alexithymia in obsessive-compulsive disorder.

BACKGROUND: Studies evaluating the stability of alexithymia over long follow-up periods are rare. We examined the temporal stability of alexithymia in patients with obsessive-compulsive disorder (OCD) over 6 years and the association of alexithymia with the long-term outcome of OCD. SAMPLING AND METHODS: Of 42 patients with OCD, 34 (81%) could be reassessed 6 years after inpatient treatment. The 20-item Toronto Alexithymia Scale, Yale-Brown Obsessive-Compulsive Scale, and Hamilton Depression Rating Scale were used at pretreatment, posttreatment, and follow-up. RESULTS: The 20-item Toronto Alexithymia Scale total scores and its factors 1 and 2 decreased significantly during follow-up, whereas factor 3 remained stable. High correlations of the 20-item Toronto Alexithymia Scale total scores (r = 0.84, P < .001) and its 3 factors emerged between posttreatment and follow-up, suggesting relative stability over several years. Regression analyses (with and without controlling for depressive symptoms) showed that higher alexithymia scores did not predict a worse long-term outcome of OCD. CONCLUSIONS: Relative stability over such a very long follow-up period strongly supports the view that alexithymia is a stable psychologic characteristic in patients with OCD. The result that higher alexithymia scores were not associated with poorer long-term outcome of OCD might be explained with the decrease of alexithymia during treatment and follow-up. However, our sample size was small, and further research is clearly required to evaluate the impact of changes in alexithymia and its association with the course of OCD.

Adult↗

PubMed2006

Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder.

BACKGROUND: Previous studies have found a strong association between dissociation and obsessive-compulsive disorder (OCD). The purpose of the present study was to evaluate whether dissociation is a predictor of cognitive behavior therapy (CBT) outcome in patients with OCD. METHODS: Fifty-two patients with OCD were assessed using the Dissociative Experience Scale (DES), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory. CBT lasted on average 9.5 weeks and included exposure therapy. RESULTS: Patients who dropped out due to noncompliance had higher baseline DES scores and depression scores compared to the 43 patients (83%) who completed the study. Significant OCD symptom reduction at posttreatment was observed in study completers with a large effect size (d = 1.7). More severe OCD symptoms at posttreatment were associated with higher DES scores at baseline, and treatment nonresponders had significantly higher baseline DES scores compared to responders. These associations with outcome were mainly due to the DES subfactor absorption-imaginative involvement. In regression analyses, higher absorption-imaginative involvement scores at baseline predicted poorer CBT outcome, even after controlling for depressive symptoms, comorbid axis I disorders and concomitant psychotropic drugs. CONCLUSIONS: Results from this preliminary study suggest that higher levels of dissociation (particularly absorption-imaginative involvement) in patients with OCD might predict poorer CBT outcome. If our results can be replicated, treatment outcome might be improved by additional interventions for those patients with OCD who indicate high levels of dissociation, for example by using interventions aimed at improving coping with emotionally stressful situations.

Adult↗

PubMed2005

Dissociation and symptom dimensions of obsessive-compulsive disorder. A replication study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a phenotypically very heterogeneous disease with high rates of comorbid psychiatric pathology. Previous studies have indicated that OCD is associated with higher levels of dissociation. The aims of the present study were to replicate and extend previous findings of a significant link between certain OCD symptom dimensions and dissociation. METHODS: The study sample comprised 50 patients with OCD, as confirmed by the Mini International Neuropsychiatric Interview,who had a score of at least 16 on the Yale-Brown Obsessive-Compulsive Scale. All patients were assessed with the short version of the Hamburg Obsessive-Compulsive Inventory and the Dissociative Experience Scale (DES). Correlation analyses and multiple regression analyses were performed to evaluate the relationship between OCD symptom dimensions and dissociation. RESULTS: The checking dimension was most strongly related to dissociation, followed by the symmetry/ordering and obsessive thoughts dimensions. In contrast, no significant relationship was found between dissociation and the washing/cleaning, counting/touching, and aggressive impulses/fantasies dimensions. Multiple regression analyses revealed that: (1) only the checking dimension showed an independent positive correlation with dissociation, and (2) only higher scores on the DES subscale "amnestic dissociation" were associated with higher scores for checking compulsions. CONCLUSIONS: Our results suggest that there might be a specific link between checking behavior and dissociation in OCD. Moreover, checking compulsions seem to be particularly associated with amnestic dissociation. Further studies focusing on amnestic dissociation as a potentially important determinant of checking compulsions are warranted.

Adult↗

PubMed2005

Do personality disorders predict negative treatment outcome in obsessive-compulsive disorders? A prospective 6-month follow-up study.

BACKGROUND: Comorbid personality disorders (PDs) are discussed as risk factors for a negative treatment outcome in obsessive-compulsive disorder (OCD). However, studies published so far have produced conflicting results. The present study examined whether PDs affect treatment outcome in patients with OCD. METHOD: The treatment sample consisted of 55 patients with OCD who were consecutively referred to a Behaviour Therapy Unit for an in-patient or day-clinic treatment. Treatment consisted of an individualised and multimodal cognitive behaviour therapy (CBT, with or without antidepressive medication). Measurements were taken prior and after treatment and 6-month after admission. RESULTS: A large percentage of patients benefited from treatment irrespective of the presence of a PD and were able to maintain their improvement at follow-up. Duration of treatment was not prolonged in OCD patients with concomitant Axis II disorders. However, some specific personality traits (schizotypal, passive-aggressive) were baseline determinants for later treatment failure at trend level. CONCLUSIONS: Results are encouraging for therapists working with patients co-diagnosed with Axis II disorders since these patients are not necessarily non-responders. The results stress the importance of a specifically tailored treatment approach based on an individual case formulation in OCD patients with complex symptomatology and comorbid Axis II disorders.

Adolescent↗

PubMed2005

Pathological gambling is linked to reduced activation of the mesolimbic reward system.

By analogy to drug dependence, it has been speculated that the underlying pathology in pathological gambling is a reduction in the sensitivity of the reward system. Studying pathological gamblers and controls during a guessing game using functional magnetic resonance imaging, we observed a reduction of ventral striatal and ventromedial prefrontal activation in the pathological gamblers that was negatively correlated with gambling severity, linking hypoactivation of these areas to disease severity.

Adult↗

PubMed2005

Neurocognitive impairment does not predict treatment outcome in obsessive-compulsive disorder.

There is conflicting evidence pertaining to whether or not neurocognitive task performance at baseline predicts treatment response in obsessive-compulsive disorder (OCD). In the present study, we administered a set of executive neurocognitive tests with a putative sensitivity for treatment outcome to a sample of 138 OCD patients. Additionally, subjective neurocognitive dysfunction was determined via a questionnaire. All patients participated in a cognitive-behavioural treatment program (CBT). Results showed that responders (n = 73) did not differ from non-responders (n = 65) on any of the parameters except for decreased performance on the delayed alternation test (p < .1, effect size: .61). A subsidiary analysis revealed that slowing on the Trail-Making Test A and an enhanced rate of perserveration errors on the Wisconsin Card Sorting Test predicted poor outcome for the treatment of compulsions. It is concluded that neurocognitive impairment does not represent a reliable early warning sign for non-response to CBT.

Adult↗

PubMed2005

Temporal stability of symptom dimensions in adult patients with obsessive-compulsive disorder.

BACKGROUND: Although symptoms of obsessive-compulsive disorder (OCD) are heterogeneous, considerable advances have been made in subtyping OCD based on factor-analysed symptom dimensions. However, there is very little empirical data on the longitudinal course of symptom dimensions in adult OCD. METHODS: We examined prospectively the temporal symptom stability in adult OCD patients. Of 54 baseline OCD inpatients, 43 (80%) were re-assessed with the Yale-Brown Obsessive-Compulsive Scale symptom checklist after 6 years on average. RESULTS: Significant changes occurred within the symptom dimensions aggressive/checking, symmetry/ordering, and contamination/cleaning, whereas the others (hoarding, sexual/religious) remained unchanged from baseline to follow-up. Shifts between different dimensions from baseline to follow-up were rare, the score of each dimension at follow-up was most strongly predicted from the score of the same dimension at baseline. LIMITATIONS: The main limitation of the present study is the relatively small sample size. Furthermore, not the same raters conducted the baseline and follow-up assessments. CONCLUSIONS: Symptom dimensions seem to be remarkably stable over several years in adult OCD, despite various treatments and significant improvements in symptom severity. This underlines the usefulness of these symptom dimensions for studies of biological and genetic markers, comorbidity and treatment response predictors.

Adult↗

PubMed2005

Extent, profile and specificity of visuospatial impairment in obsessive-compulsive disorder (OCD).

Recent reviews on the neurocognitive profile of patients diagnosed with obsessive-compulsive disorder (OCD) have converged on the assumption that both visuospatial and especially nonverbal memory performance are impaired in OCD. However, as most prior studies have contrasted performance of OCD patients with healthy controls only, no inferences can yet be drawn about the specificity of these deficits to OCD. Further, the administration of complex and multifunctional tasks limit conclusions about clearly defined cognitive deficits. The present study compared 71 OCD patients to 30 healthy and 33 psychiatric control participants on a large battery of visuospatial and nonverbal memory tasks at two time-points. In addition, a visuospatial battery (VS battery), which assesses a wide range of elementary visuospatial functions, was administered. While OCD patients performed worse than healthy controls on some complex tasks (e.g., Block Design), no visuospatial component proved to be impaired specifically in OCD. OCD patients and controls performed similarly on parameters of nonverbal memory. Regarding organizational strategy, OCD patients performed worse than healthy (but not psychiatric) control participants on two out of three Rey-figure trials (copy and immediate). It is suggested that prior research overestimated the severity and significance of visuospatial and nonverbal memory impairment in OCD.

Adult↗

PubMed2005

Childhood separation anxiety and separation events in women with agoraphobia with or without panic disorder.

OBJECTIVE: This study aimed to investigate the association between separation anxiety and actual separation events during childhood in adult patients with agoraphobia with or without panic disorder (PD). METHOD: Forty-two women with agoraphobia with or without PD participated in long-term follow-ups after exposure-in-vivo treatment. We assessed separation anxiety and separation events from age 0 to 18 years, as well as adult separation from a spouse. RESULTS: Childhood separation experiences (55%) and separation anxiety were significantly higher in patients than in healthy subjects, but both conditions were not associated with each other. Childhood separation anxiety was related to adult separation events. CONCLUSIONS: Retrospective measures of childhood separation anxiety appear to be confounded by adult separation events. Thus the conclusion of whether childhood anxiety is a consequence of actual childhood separation events cannot be drawn, owing to a lacking association between both ratings.

Adolescent↗

PubMed2004

Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial.

Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder (OCD) who have received adequate treatment are rare. In the current study, 30 of 37 inpatients (81%) with severe OCD were followed up 6-8 years after treatment with cognitive-behavioral therapy (CBT) in combination with either fluvoxamine or placebo in a randomized design. The significant improvements (with large effectsizes) in obsessive-compulsive symptoms from pre- to post-treatment (41% reduction on the Y-BOCS) remained stable at follow-up (45 %). Responder rates, defined as > or = 35% reduction on the Y-BOCS, were 67% and 60%, respectively. Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up. Re-hospitalization, which occurred in 11 patients (37 %), was associated with more severe depressive symptoms at pre-treatment and living without a partner. Full symptom remission at follow-up, defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD, was achieved by 8 patients (27 %). Patients without full remission at follow-up had a significantly longer history of OCD, assessed at pretreatment, compared to remitted patients. The shortterm treatment outcome had no predictive value for the long-term course. Throughout the naturalistic follow-up, nearly all patients (29 patients) received additional psychotherapy and/or medication. This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods.

Adult↗

PubMed2004

Dimensional structure of the Hamilton Depression Rating Scale in patients with obsessive-compulsive disorder.

Comorbid depression is frequent in obsessive-compulsive disorder (OCD) and is acknowledged as a major confound in biological and neurocognitive investigations in OCD. The aim of the present study was to assess the distribution of depressive symptoms in a large OCD sample (n=162) and to analyze the dimensional structure of the Hamilton Depression Rating Scale (HDRS) in OCD. Major depressive disorder according to DSM-IV criteria was apparent in approximately one third of the patients. Frequent symptoms were depressed mood, reduced ability to work, anxiety symptoms and guilt feelings. HDRS scores were submitted to a varimax-rotated factor analysis. In accordance with studies conducted with depressed samples, multi-dimensional solutions suggesting three to six factors emerged. Subsequent confirmatory factor analysis revealed satisfactory fit indices for a four-factorial solution comprising core depressive symptoms, sleep disturbance, anxiety and gastrointestinal problems. Aggression-related obsessions as well as the overall severity of obsessions were related to core depressive symptoms. Anxiety symptoms were associated with excessive rituals. Greater recognition of depressive sub-components may help to raise the replicability of empirical findings in OCD research as there is evidence from both depression and OCD samples that distinct depressive syndromes have different biological correlates.

Adult↗

PubMed2004

Positive schizotypal symptoms predict treatment outcome in obsessive-compulsive disorder.

Previous research has suggested that the presence of schizotypal personality disorder may represent a risk factor for treatment failure in obsessive-compulsive disorder (OCD). Relying on a dimensional approach, the present study investigated whether the predictive importance of schizotypal personality is shared by all of its features to the same extent or whether it is confined to a subset of symptoms. Fifty-three patients underwent multi-modal cognitive-behavioral therapy with or without adjunctive antidepressive medication. Therapy response was defined as a 35% decline of the Y-BOCS total score. At baseline assessment, patients were asked to fill out the schizotypal personality questionnaire, the perceptual aberration scale and the Beck depression inventory. Stepwise regression analysis and group comparisons conducted with the schizotypal and depression scales revealed that elevated scores in the positive schizotypal scales, especially perceptual aberrations, were highly predictive for treatment failure. Responders to treatment and non-responders did not significantly differ on other variables or on scores in two scales which measured response biases. The study provides evidence that positive schizotypal symptoms are antecendents for treatment failure in OCD. It needs to be evaluated whether these at-risk individuals benefit from additional intervention, such as the adminstration of low-dose atypical neuroleptics and specifically tailored behavorial intervention.

Adult↗

PubMed2004

Examination of emotional Stroop interference in obsessive-compulsive disorder.

Previous research has produced conflicting findings on whether or not patients with subclinical or manifest obsessive-compulsive disorder (OCD) share an attentional bias for anxiety-related material. In the present study, 35 OCD patients were compared with 20 healthy controls on their performance in an emotional Stroop paradigm. Nine different stimulus conditions were compiled, including sets for depression-related and anxiety-related words as well as stimuli from two constructs with a potential relevance for the pathogenesis and maintenance of OCD symptomatology: responsibility and conscientiousness. Patients did not show enhanced interference for any of the conditions. Syndrome subtype and severity, avoidance and speed of information processing did not moderate results. The present study concurs with most prior research that OCD patients display no interference effect for general threat words. It deserves further consideration, that emotional interference effects in OCD as seen in other anxiety disorders occur when using idiosyncratic word material with a direct relation to the individual's primary concerns.

Adult↗

PubMed2003

Impact of comorbid depressive symptoms on nonverbal memory and visuospatial performance in obsessive-compulsive disorder.

INTRODUCTION: Recent research has suggested that some executive dysfunctions in obsessive-compulsive disorder (OCD) represent an epiphenomenon of comorbid depressive symptoms. The present study investigated whether the impact of comorbid depressive symptoms on cognitive dysfunction in OCD extends to nonverbal memory impairment. METHODS: A total of 32 OCD patients and 20 healthy controls took part in the study. Participants were administered a neurocognitive battery with a focus on nonverbal memory and visuospatial functions. RESULTS: While evidence was provided that neurocognitive processes necessitating visuospatial transformation and visuoconstruction are deficient in OCD patients regardless of comorbid depressive symptoms, nonverbal memory dysfunctions were only apparent for patients with elevated scores in the Hamilton Depression (HDRS) Rating Scale (total score > or = 8). Correlations with subscores of the HDRS revealed that core depressive symptoms are related to nonverbal memory deficits in OCD. Mental rotation, middle discrimination, and position discrimination were found to be unaffected in OCD. Y-BOCS scores, length of illness, onset of illness, number of hospital admissions, and checking compulsions were not associated with neurocognitive disturbances. CONCLUSIONS: Nonverbal memory is disturbed in only a subgroup of OCD patients displaying elevated HDRS scores (HDRS > or = 8). It is claimed but awaits further empirical testing that differences in depression profile across OCD studies have contributed to inconsistencies in prior investigations on neurocognitive functioning in OCD. Our results are questioning the hypothesis that nonverbal deficits are a causal factor for the development of checking compulsions.

Journal Article↗

PubMed2002

Dimensional structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used instrument to assess obsessive-compulsive symptomatology. The present study provides evidence that the Y-BOCS is best represented by a three-dimensional model comprising severity of obsessions (factor 1), severity of compulsions (factor 2) and resistance to symptoms (factor 3). On the basis of exploratory factor analysis, this structure was found for both baseline (n = 109) and discharge ratings (n = 68) following a multimodal cognitive-behavioral intervention. The factor solution remained essentially unchanged when two optional items (items 1b and 6b) were dropped from analysis. The three-factor structure was replicated with confirmatory factor analysis and showed better fit than previously proposed single- and two-factor models. For future research, we propose a new Y-BOCS scoring algorithm that takes this factor structure into account. A further result was that resistance significantly declined in response to cognitive-behavioral intervention, whereas drug treatment alone did not seem to moderate this variable according to previous research conducted by Kim et al. [Psychiatry Research 51 (1994) 203-211].

Adult↗

PubMed2002

Serum cholesterol level comparison: control subjects, anxiety disorder patients, and obsessive-compulsive disorder patients.

OBJECTIVE: To determine whether panic disorder is associated with elevated serum cholesterol levels. Serum cholesterol levels of panic disorder patients are reported to be elevated. This could explain the higher-than-expected cardiovascular mortality in this population. Some evidence exists wherein cholesterol levels are also increased in patients with general anxiety disorder and phobias. To date, there are only 2 reports on cholesterol levels of obsessive-compulsive disorder (OCD) patients, giving controversial results. METHOD: We compared serum cholesterol levels of anxiety disorder patients, OCD patients, and normal control subjects with each other (n = 60 in each group). Serum cholesterol was measured in each subject before treatment. Subjects of the 3 groups were matched by age and sex. RESULTS: Patients with anxiety disorders and OCD had elevated cholesterol levels, compared with normal control subjects. Cholesterol levels in OCD patients were comparable with those in patients with phobia. CONCLUSIONS: Our data support the assumption that elevation in cholesterol level is not a specific feature of panic disorder (as most assumed), but more generally associated with anxiety disorders. Increased cholesterol levels in patients with anxiety disorders and OCD may be of clinical relevance.

Adult↗

PubMed2002

Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia.

The present study investigated whether schizophrenic, unipolar depressive, and obsessive-compulsive psychiatric patients show a distinguishable profile in tasks considered sensitive to frontal lobe functioning. Three psychiatric samples, each comprising 25 patients with little symptomatic overlap, were compared to 70 healthy controls. Participants completed several executive tasks (Wisconsin Card Sorting Test (WCST), verbal fluency, digit span, Stroop, and Trail-Making). Except for age, which was entered as a covariate, subjects did not differ in any sociodemographic background variable. Healthy controls showed superior performance relative to depressive and schizophrenic patients who exhibited comparable deficits in all tasks. Obsessive-compulsive disorder (OCD) patients revealed dysfunctions in the Trail-Making Tests A and B and in the fluency task. Dysfunctions in the domains of working memory, verbal fluency, distractibility, and concept formation were not confined to a specific psychiatric population.

Journal Article↗

PubMedDate not supplied

A prospective study of alexithymia in obsessive-compulsive patients treated with multimodal cognitive-behavioral therapy.

BACKGROUND: Alexithymia as a predictor of treatment outcome in psychotherapy has often been discussed but rarely evaluated in prospective studies. The present study evaluated the absolute and relative stability of alexithymia in patients with obsessive-compulsive disorder (OCD), and the predictive value of alexithymia for the outcome of treatment. METHODS: We conducted a prospective study with 42 inpatients receiving intensive, multimodal cognitive-behavioral therapy (CBT). Patients were assessed for alexithymia at pre- and post-treatment with the 20-item Toronto Alexithymia Scale (TAS-20), for obsessive-compulsive symptoms and depression with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the 21-item Hamilton Depression Rating Scale (HDRS). RESULTS: OCD and comorbid depression showed a highly significant symptom-reduction from pre- to post-treatment while no absolute changes in the TAS-20 total scores and its factors 1 and 3 occurred. Only factor 2 scores decreased significantly, but with a smaller effect size than the effect sizes for the changes in Y-BOCS and HDRS. Alexithymia scores at pre-treatment correlated significantly with alexithymia scores at the end of treatment, indicating its relative stability. In the linear regression analyses, no variables were identified that predicted significantly the outcome of treatment. CONCLUSIONS: Our findings support the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon in obsessive-compulsive patients. Alexithymia scores do not predict response to multimodal CBT in OCD. It might be an effect of CBT that patients could at least partly regain or newly learn the capability to describe their feelings.

Adult↗