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Biomedical subjects

W K Goodman

Publications and source records attributed to W K Goodman.

At least 55 records · Page 3Linked to original sources
PubMed1994

The role of central oxytocin in obsessive compulsive disorder and related normal behavior.

Oxytocin (OT) is a neurosecretory nonapeptide synthesized in hypothalamic cells, which project to widely distributed sites in the CNS as well as the neurohypophysis. Central OT affects a variety of cognitive, grooming, affiliative, sexual, and reproductive behaviors in animals. Obsessive Compulsive Disorder (OCD) includes a range of cognitive and behavioral symptoms that bear some relationship to dimensions of behavior associated with OT. Anecdotal data and a recently completed cerebrospinal fluid (CSF) study provide evidence that some forms of OCD are related to OT dysfunction. Based on these findings, we hypothesize: 1) that some forms of OCD are at the extreme end of a range of normal behaviors that are mediated by OT and related systems; and that 2) some normal cognitive, affiliative, and sexual behaviors contain elements that are similar to features of OCD. Alternative hypotheses are considered, and a series of predictions are presented concerning the relationship between central OT and the onset, course, treatment response, and response to challenge procedures seen in this form of OCD.

Animals↗
PubMed1994

"Just right" perceptions associated with compulsive behavior in Tourette's syndrome.

OBJECTIVE: Tourette's syndrome is a chronic disorder of childhood onset that is characterized by motor and phonic tics and a broad range of associated behavior including obsessive-compulsive symptoms. Less well appreciated are the sensory and other perceptually tinged mental phenomena associated with both tic and compulsive behavior. This cross-sectional study evaluated the "just-right" phenomena commonly associated with compulsive behavior in subjects with tic disorders. METHOD: A total of 134 subjects with tic disorders, aged 9 to 71 years, completed a questionnaire concerning their current and past tic symptoms. Subjects were also asked to describe their "just right" perceptions. The Yale-Brown Obsessive Compulsive Scale was used to assess severity of current obsessive-compulsive symptoms. RESULTS: Eight-one percent of the subjects with both Tourette's syndrome and obsessive-compulsive disorder (N = 31) and 56% of the subjects with Tourette's syndrome and obsessive-compulsive symptoms (N = 61) reported being aware of a need to perform compulsions until they were "just right." This awareness most commonly referred to visual or tactile (as opposed to auditory) features of the compulsive act or its consequences. Three-quarters of the subjects with these perceptions reported that they usually were aware of them immediately before or concurrently with the initiation of compulsions. CONCLUSIONS: While epidemiological studies of tic disorders and obsessive-compulsive disorder have yet to incorporate questions concerning "just right" perceptions, these results suggest that such perceptions may be commonplace in adolescent and adult subjects with both obsessive-compulsive disorder and tic disorders. They also implicate brain regions involved in the processing of sensorimotor information in the pathobiology of tic disorders.

Adolescent↗
PubMed1994

Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients.

The phenomenological features of 35 obsessive-compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.

Adult↗
PubMed1994

Dopamine antagonists in tic-related and psychotic spectrum obsessive compulsive disorder.

Serotonin uptake inhibitors (SUIs) have been established as the first-line pharmacotherapy of obsessive compulsive disorder (OCD). However, approximately one half of patients who receive an adequate trial with these agents remain clinically unchanged. The addition of drugs that enhance serotonin (5-HT) neurotransmission, such as lithium and buspirone, to ongoing treatment in SUI-refractory patients has generally proved to be an ineffective strategy. The addition of dopamine antagonists to the regimens of SUI-resistant patients appears to be a useful approach for OCD patients with a comorbid chronic tic disorder (e.g., Tourette's syndrome) and possibly for those with concurrent psychotic spectrum disorders. These drug response data suggest that both the 5-HT and dopamine systems may be involved in the treatment, and possibly the pathophysiology, of specific subtypes of OCD.

Adult↗
PubMed1993

Effects of the serotonin reuptake inhibitor fluvoxamine on yohimbine-induced anxiety in panic disorder.

To assess the effects of the selective serotonin reuptake blocker fluvoxamine on noradrenergic function in patients with panic disorder, an intravenous yohimbine challenge test was administered to eight patients with panic disorder before and after 8 weeks of fluvoxamine treatment and to a parallel group of eight patients treated with placebo. Fluvoxamine treatment reduced yohimbine-induced anxiety while placebo treatment had no effect on this variable. Both fluvoxamine and placebo treatment had little effect on biochemical or physiologic responses to yohimbine.

Adult↗
PubMed1993

The pharmacotherapy of obsessive-compulsive disorder.

Potent inhibitors of 5-hydroxytryptamine (5-HT) reuptake have clearly been established as the first-line pharmacotherapy for treatment of obsessive-compulsive disorder (OCD). Although a variety of tricyclic antidepressants and monoamine oxidase inhibitors have similar efficacy in the treatment of depression and panic disorder, potent blockade of 5-HT transport appears to be a prerequisite for effective treatment of OCD. Adding agents that enhance 5-HT neurotransmission to ongoing treatment in patients whose OCD is refractory to 5-HT reuptake inhibitors has not yielded impressive results. However, the addition of low-dose dopamine (DA) antagonists to the regimens of treatment-resistant patients appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chronic tic disorder such as Tourette's syndrome. Because of the toxicity associated with neuroleptics, a time-limited trial of those agents, with reassessment at regular intervals, is indicated. Pharmacologic studies suggest that both the 5-HT and DA systems may be critical to the treatment and possibly the pathophysiology of OCD.

1-Naphthylamine↗
PubMed1993

The serotonin hypothesis of obsessive compulsive disorder.

The above studies investigating the responsivity of the 5-HT system to provocation provide some support for the hypothesis drawn from the results of pharmacologic treatment trials and studies of biological markers that dysregulation of the 5-HT system may be involved in the pathogenesis of OC symptoms. While results of several studies document blunting of neuroendocrine responses to 5-HT agonists, only one study suggests a small increase in responsiveness compared to healthy controls. Combined with neurophysiologic data suggesting net increases in 5-HT functioning following treatment with SRIs, these results suggest that the primary deficit in OCD is not one of increased 5-HT responsivity. Exacerbation of OC symptoms sometimes observed during mCPP challenge is not entirely consistent with this hypothesis and additional studies are required to clarify the significance of these findings. However, behavioral hypersensitivity coupled with neuroendocrine hyposensitivity to serotonergic stimulation might characterize the serotonergic dysfunction accompanying OCD. The complexity of the 5-HT system, and the likelihood that behavioral and neuroendocrine responses are mediated by different receptor subtypes makes this hypothesis entirely plausible. The efficacy of SRIs in the treatment of OCD remains the firmest evidence of serotonergic involvement in this condition. Results of challenge studies in OCD also suggest a possible dysregulation in 5-HT function, although the precise nature of this disturbance remains elusive. Neuroendocrine responses to 5-HT agonists generally are consistent with a tendency toward hyposensitivity in OCD. Behavioral results, while more mixed, indicate a hypersensitivity to 5-HT agonists. Further refinement in dependent and independent variables used in challenge studies may clarify remaining questions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Limited therapeutic effect of addition of buspirone in fluvoxamine-refractory obsessive-compulsive disorder.

The authors found that buspirone added to the treatment of 33 patients with obsessive-compulsive disorder who were refractory to the serotonin reuptake inhibitor fluvoxamine was no better than placebo in reducing obsessive-compulsive, depressive, or anxiety symptoms. This finding suggests that addition of buspirone to ongoing fluvoxamine therapy is not an effective treatment strategy for most patients with obsessive-compulsive disorder.

Adult↗
PubMed1993

Inpatient treatment of patients with severe obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder may experience severely disabling symptoms and require hospitalization. Based on treatment of 77 such patients admitted to a long-term general psychiatric research unit over a seven-year period, the authors present pharmacologic, psychosocial, and behavioral management strategies for treating these patients on general psychiatric units. The treatment guidelines require only modest modifications of standard practice and can be adapted for use on general units without specialized staff training. Some patients with obsessive-compulsive disorder exhibit strong control and dependency needs and disrupt the milieu in characteristic ways. These patients may generate conflict among staff about whether the patients can control obsessive-compulsive behaviors; they may anger other patients because of the large amount of staff attention they demand. Educating staff about obsessive-compulsive patients' control and dependency needs and enlisting the support of fellow patients can improve the milieu.

Adult↗
PubMed1993

The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder.

This retrospective case-controlled analysis evaluated treatment response to the serotonin reuptake inhibitor fluvoxamine in patients with obsessive-compulsive disorder (OCD), with or without a comorbid chronic tic disorder. Thirty-three fluvoxamine-treated OCD patients with a concurrent chronic tic disorder were compared with 33 age- and sex-matched OCD patients without chronic tics who had received fluvoxamine treatment in the same setting during the same period of time and in a similar manner. Although both groups of patients demonstrated statistically significant reductions in obsessive-compulsive, depressive, and anxiety symptoms with fluvoxamine treatment, the frequency and magnitude of response of obsessive-compulsive symptoms was significantly different between the two groups. A clinically meaningful improvement in obsessive-compulsive symptoms occurred in only 21% of OCD patients with comorbid chronic tics compared with a 52% response rate in OCD patients without chronic tics. Moreover, OCD patients with a concurrent chronic tic disorder showed only a 17% reduction in Yale-Brown Obsessive-Compulsive Scale scores compared with a 32% decrease in the severity of obsessive-compulsive symptoms in those OCD patients without chronic tics. These results suggest that serotonin reuptake inhibitor monotherapy may be less efficacious for improving obsessive-compulsive symptoms in OCD patients with than without tics. Combined with differences in the clinical phenomenology between these two groups, these treatment response data support the hypothesis that OCD patients with a comorbid chronic tic disorder may be a clinically meaningful subtype.

Adult↗
PubMed1993

The psychopharmacology of obsessive compulsive disorder. Implications for treatment and pathogenesis.

Recent advances in the pharmacotherapy of obsessive compulsive disorder (OCD) have led to a significant reduction in suffering and a return to productive living for many patients previously considered refractory to treatment. Potent inhibitors of 5-hydroxytryptamine (5-HT) re-uptake clearly have been established as the first-line pharmacotherapy for treatment of OCD. The addition of agents that enhance 5-HT neurotransmission to ongoing treatment in patients whose OCD is refractory to 5-HT re-uptake inhibitors has not yielded impressive results. The addition of dopamine (DA) antagonists to the regimens of treatment-resistant patients appears to be a potentially useful strategy for the specific subgroup of OCD patients with a comorbid chronic tic disorder such as Tourette's syndrome. Pharmacologic studies suggest that both the 5-HT and DA systems may be critical to the treatment and possibly the pathophysiology of OCD.

Behavior Therapy↗
PubMed1993

Biological approaches to treatment-resistant obsessive compulsive disorder.

Biological approaches to the patient with treatment-resistant obsessive compulsive disorder are briefly reviewed. The most commonly employed strategy involves combining a potent serotonin reuptake inhibitor (SRI) (e.g., clomipramine or fluvoxamine) with another medication that may exert effects on the brain serotonin system. Open-label reports regarding the addition of tryptophan, fenfluramine, lithium, or buspirone to ongoing SRI therapy of obsessive compulsive disorder are encouraging. However, the anti-obsessive compulsive efficacy of SRI-lithium and SRI-buspirone combination therapy has not been confirmed in recent controlled trials. Preliminary evidence suggests that addition of neuroleptic may benefit SRI-refractory obsessive compulsive disorder patients who have a comorbid chronic tic disorder. Other biological approaches (e.g., electroconvulsive therapy and psychosurgery) are considered in terms of their narrowly defined roles in the treatment of patients with SRI-resistant obsessive compulsive disorder. Finally, an algorithm is proposed for those patients with obsessive compulsive disorder who fail to respond to an adequate trial with a potent SRI.

Behavior Therapy↗
PubMed1992

Clomipramine in autism: preliminary evidence of efficacy.

This report provides preliminary evidence for the efficacy of clomipramine in the treatment of young adults with autistic disorder. Four of five outpatients with autistic disorder showed significant improvement in social relatedness, obsessive compulsive symptoms, and aggressive and impulsive behavior with clomipramine treatment. These findings are consistent with previous evidence, suggesting that serotonin neurotransmission may be relevant to the treatment, and possibly the pathophysiology, of some symptoms of autistic disorder.

Adolescent↗