Biomedical subjects

Martin Kloss

Publications and source records attributed to Martin Kloss.

9 recordsLinked to original sources

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

Severity of subjective cognitive impairment in patients with obsessive-compulsive disorder and depression.

Previous research on obsessive-compulsive disorder (OCD) has consistently found cognitive impairments in the domains of executive and nonverbal (memory) functioning, particularly in patients with comorbid depressive symptoms. In contrast, little is known about the degree to which such deficits are cognizant to patients or the degree to which these impairments interfere with daily activities. The aim of the present study was to assess prevalence and specificity of subjective cognitive dysfunction in OCD patients. A self-rating scale, the Subjective Neurocognition Inventory (SNI), was administered to 67 OCD patients upon admission to hospital. Forty healthy and 30 depressed participants served as controls. Relative to healthy participants, OCD patients reported greater impairment on SNI subscales measuring psychomotor speed, selective and divided attention. Impairments in the OCD group were particularly pronounced in patients with severe OCD or depressive psychopathology. OCD patients were no more disturbed than depressed participants on any of the domains tested. Memory problems were only reported by a minority of OCD patients-even in patients with checking compulsions. In conjunction with prior studies showing few memory difficulties in non-depressed OCD patients, present findings further challenge the memory deficit hypothesis which claims that checking compulsions are a dysfunctional compensation for real or imagined forgetfulness.

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

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↗

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

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↗