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PubMed1992

[Case report: anorexia nervosa in a 10-year-old boy].

A 10-year-old boy was admitted to the Children's Hospital with a 7-month history of disturbed eating behavior and a recent rapid weight loss: During the 24-day hospital stay the boy displayed a characteristic anorectic eating pattern, hyperactivity, anxiety, depression and compulsive behavior. Discharge followed a 4-kg weight gain. During the subsequent 12 months of outpatient care weight gain and eating behavior normalized. The boy's premorbid personality was described as compulsive and difficult. Although his intelligence was above average the boy had spelling problems and inadequate verbal skills. A change to a college-preparatory school and contact with a family with a vegetarian way of life probably precipitated the acute illness.

Anorexia Nervosa↗
PubMed1991

Stealing in eating disordered patients.

Previous studies have noted high rates of stealing behavior in patients with eating disorders. To assess the significance of stealing in eating disordered patients, the authors compared the eating and purging behavior, levels of psychologic symptomatology, and alcohol use of 181 eating disordered patients with and without a history of stealing. Overall, the patients with a history of stealing had significantly more dysfunctional eating and purging behavior. Those patients with a history of stealing reported significantly more psychological distress including more depression, interpersonal sensitivity, obsessive compulsive behavior, and hostility. The authors conclude that stealing behavior should be assessed in patients with eating disorders as a history of stealing may define a subgroup of more severely impaired patients.

Adolescent↗
PubMed2026

Sequential rTMS for MDD and OCD in a patient with left parietal perinatal ischemic infarct: a case report.

Major depressive disorder (MDD) commonly co-occurs with obsessive-compulsive disorder (OCD), resulting in greater symptom severity, functional impairment, and suboptimal response to standard pharmacologic and psychotherapeutic interventions. These challenges underscore the need for neuromodulation strategies to target distinct neural networks implicated in mood regulation and compulsivity. This report describes outcomes of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC), and low-frequency (LF) rTMS of the right orbitofrontal cortex (OFC), in a patient with comorbid MDD, OCD, and a left parietal perinatal ischemic infarct. Over the course of treatment, serial psychometric assessments demonstrated progressive reductions in frequency and intensity of depressive symptoms, anxiety, and obsessive-compulsive behaviors, measured via Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). This case adds to the growing body of literature demonstrating efficacy of DLPFC and OFC stimulation for depression and OCD. Further large-scale, blinded, and randomized trials are warranted to examine the efficacy of sequential DLPFC and OFC stimulation for comorbid MDD and OCD compared with single-site DLPFC stimulation.

dorsolateral prefrontal cortex (DLPFC)↗
PubMed1990

Obsessions and compulsions: psychometric properties of the Padua Inventory with an American college population.

The psychometric properties of the Padua inventory, a self-report measure of obsessive-compulsive behaviors, were examined in a sample of 678 American college students. Results showed good internal consistency as well as convergent and divergent validity with the subscales of the Symptom Checklist-90 Revised and the Maudsley Obsessional-Compulsive Inventory. A principal components analysis suggested a four factor solution (i.e. 'impaired control of mental activities', 'checking', 'urges and worries of losing control of motor behaviors', and 'being contaminated'). The factor structure was very similar to that found in the original Italian study of the inventory. Suggestions are made for the use of the Padua Inventory in the study of obsessions and compulsions in nonclinical samples.

Adolescent↗
PubMedDate not supplied

Oxytocin in obsessive compulsive disorder.

A double-blind, placebo-controlled study with syntocinon (oxytocin) was carried out in 12 patients, nine females and three males with obsessive compulsive disorder (OCD). Patients were treated by intranasal administration of oxytocin spray (18 IU per day) or placebo. No reductions in the number of obsessions or compulsive behaviors were observed in either treatment group. To evaluate whether a higher dosage would exert more beneficial effects, two additional patients were treated with a threefold higher dosage of oxytocin using an open design. In one patient a slight reduction in the number of checking rituals was observed, whereas in the other patient virtually no effect was observed. The results of this study do not support the hypothesis that oxytocin might be a potential anticompulsive agent.

Adult↗
PubMed1976

On the supersensitivity of dopamine receptors, induced by neuroleptics.

Different neuroleptics caused dopamine receptor blockade (antagonism against methylphenidate-induced compulsive gnawing) for varying lengths of time. When the receptor blockade had expired, supersensitivity to dopamine agonists (occurrence of apomorphine-induced compulsive gnawing and enhancement of methylphenidate-induced gnawing) developed and persisted for varying periods of time. The degree and duration of supersensitivity was related to the degree and duration of the preceding receptor blockade. Inhibition of catecholamine or 5-HT synthesis had no influence on development of supersensitivity. Stimulation with a dopamine agonist, apomorphine, during the period of the development of supersensitivity did not modify the enhanced receptor supersensitivity. A cholinergic-dopaminergic balance was shown to be involved in the manifestation of compulsive behavior during the supersensitivity phase. Tolerance to the dopamine antagonistic effect of a neuroleptic also developed after a single neuroleptic treatment, most likely due to increased sensitivity of the receptors for the dopamine agonist. It is concluded, that the dopamine receptor blockade induced by a single dose of a neuroleptic agent is a dynamic phenomenon which in the course of time is replaced by an increased sensitivity of the receptors to dopamine agonists. Noradrenergic or 5-HT neuron systems do not seem to be involved in the neuroleptic-induced supersensitivity, whereas a dopaminergic-cholinergic balance is operative in the supersensitivity situation.

Animals↗
PubMed1992

Dental treatment of patients with Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome, a familial neurologic disorder with onset in early life, is characterized by chronic intermittent motor and vocal tics. Many of the orofacial tics and compulsive behaviors seen in this disorder may cause destructive oral lesions. The medications used in treating the syndrome may adversely interact with dental therapeutic agents, frequently cause hyposalivation associated with the development of dental caries and periodontal disease, and may produce tardive dyskinesia with buccolingual choreiform movements. The oral signs and symptoms associated with the syndrome are reviewed, and modifications in dental treatment on the basis of the patient's behavioral alterations, and current drug therapy are suggested.

Bruxism↗
PubMed1979

The relationship between nitrous oxide conscious sedation and the hypnotic state.

To evaluate the hypothesis that inhalation of low levels of nitrous oxide-oxygen produces an altered state of consciousness similar to hypnosis, 20 subjects were given three suggestions (analgesia, compulsive behavior, and amnesia) during double-blind administration of either nitrous oxide-oxygen or oxygen. Results suggest that administration of nitrous oxide-oxygen may be of increased clinical usefulness if it is combined with careful use of suggestion.

Anesthesia, Dental↗
PubMed1992

[Psychosomatic findings in patients with contact granuloma--initial results].

In a prospective study, 33 patients with vocal cord granulomas were seen in a psychosomatic interview and given questionnaires. Results showed the significance of psychosomatic factors in the occurrence of vocal cord granulomas. Psycho-social stress situations, particularly in private lives, and losses of emotionally significant persons were of prime importance. Two types of personalities--a narcissistic and a psychosomatic type--were represented about equally. In the personality structure of the patients, compulsive behavior was diagnosed most frequently while depressive features occurred to a lesser degree. Supportive and expressive psychotherapy was indicated in two thirds of the cases.

Adult↗
PubMed1992

Anorexia nervosa as a compulsive behaviour disease.

A number of anorexic young women develop bulimia, a condition in which binge eating is driven so intensely they cannot resist it. Although this drive has the character of a compulsion the patients do not as a rule suffer from obsessional-compulsive neurosis. A questionnaire was developed and used to determine whether similar compulsive drives manifest themselves in restricting anorexics and whether there are compulsive features resembling patients with compulsive personality disorder (as described in DSM-III) in eating disorders. A total of 162 patients were studied, comprising 42 controls, 30 depressed patients, 34 non-bingeing anorexics, 28 bingeing anorexics and 28 compulsive patients. The questionnaire was shown to be a stable instrument and, on the compulsion scale, the anorexics, bulimics and compulsive patients all scored very highly (mean +/- S.E.; 32.1 +/- 1.9, 35.8 +/- 1.9, 28.0 +/- 2.2, respectively) compared to the controls (13.1 +/- 1.1, p < 0.005). The compulsive patients did not have anorexia-type eating disorders. It was concluded that many of the factors which underlie compulsive personality disorder are present in primary eating disorders and the compulsive nature of anorexia could not be ignored when treatment was considered. The difference between compulsive behaviour and addiction is discussed in the light of the failure of long-term naloxone infusion to cure severe anorexia, even though some patients had dramatic weight gains associated with the antilipolytic action of naloxone.

Adolescent↗
PubMed1991

Healing the wounded, neglected inner child of the past.

Childhood experiences of the past can have a destructive effect on the present. The inner child in each person is the core of the personality that has been molded by the directions on how to act to be loved that the person receives in childhood. Painful experiences and lack of nurturing in dysfunctional families wound the inner child and contaminate adult experiences. Many persons with eating disorders have a wounded or neglected inner child that affects their adult lives. Characteristically, they demonstrate problems with trust, intimacy, addictive and compulsive behaviors, and codependence among others. Healing the inner child by grieving neglected childhood developmental needs is a long process, but one that improves the quality of one's life. Nurses, depending on their educational background and clinical skills, can help clients move toward understanding and healing the wounded, neglected inner child of the past.

Adult↗
PubMed1991

[Psychogenic hemorrhages].

Psychogenic "purpura" consists in the spontaneous appearance of recurrent bruising, it is a reality which is still unexplained. Most often woman with an underlying emotional disorder are affected. In addition to cutaneous ecchymoses and hematomas they may have menometrorrhagia, hematuria, epistaxis and gastrointestinal bleeding in addition to many other complaints encompassing multiple organ systems. Cutaneous bruising is heralded by a burning or stinging sensation followed after a few hours by local warmth, puffiness and erythema, most often with some itching. The pain subsides when the ecchymoses appear a day later or earlier. Blood coagulation and hemostatic tests remain normal in all patients. A rare but poorly studied variety of psychogenic bleeding are religious or other stigmata with periodic bleeding at hands and feet, under the left breast and at the forehead, occasionally with bloody tears. It would be risky to substitute one poorly understood diagnosis (stigmata) with another (hysterical conversion). It is very difficult to distinguish spontaneous psychogenic from selfinflicted iatrogenic bleeding (purpura factitia) because patients may have the same obsessive-compulsive behavior or hysterical trait. Moreover, patients with self-induced bleeding act in a most clever manner and their continuous observation is difficult. The differential diagnosis with the "battered child" syndrome is rather easy. Other bleeding disorders with normal coagulation tests are an inherited failure of the collagen biosynthesis (f.i. Ehlers-Danlos syndrome) or congenital or acquired vascular disorders (purpura senilis of Bateman, vitamin C deficiency, morbus Schamberg, purpura annularis of Majocchi, orthostatic purpura). There is virtually no scientific information on the interaction between the nervous system and hemostasis or blood coagulation. The only therapeutic approach in patients with psychogenic bleeding is psychiatric with particular attention to the sociocultural background of the patient and his family.

Child↗
PubMed1990

An epidemiologic study of Tourette's syndrome in a single school district.

To evaluate the frequency of Gilles de la Tourette's syndrome (TS) in children, 3034 students in three schools in a single school district in greater Los Angeles were monitored frequently over a 2-year period by a school psychologist thoroughly familiar with the symptoms of the disorder. A portion of the cases were also evaluated in a TS clinic. A total of 14 males fulfilled the Tourette Syndrome Association research criteria for definite TS. When corrected for the number of students in special education classes in the monitored schools, the frequency of definite TS in males was 1 in 152. An additional 7 males who differed only in that they were not observed for a full year were termed definite TS less than 1 year. When the two groups were combined, the frequency of definite TS was 1 in 95 for males and 1 in 759 for females. These figures do not include an additional 10 males diagnosed as having definite transient tic disorder, 2 males diagnosed as having probable TS, and 10 males diagnosed as having possible TS. In addition to tics, most of these children had problems with attention span, obsessive compulsive behavior, and learning and/or conduct disorders. Seventy percent of the students with definite TS or definite TS less than 1 year were in special education classes. Twelve percent of the children in special education classes had definite TS or definite TS less than 1 year, and 28% were in one of the diagnostic categories of definite, probable, or possible. All of the 10 definite TS patients that were seen in the clinic had attention-deficit hyperactivity disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗