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Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome.

OBJECTIVE: A significant number of patients with obsessive-compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. METHOD: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. RESULTS: The most frequent OCD symptoms were aggressive and contamination obsessions, and compulsive checking and cleaning. Patients with hoarding symptoms at baseline (n = 19) were significantly less likely to become treatment responders as compared to patients without these symptoms. Patients with sexual and religious obsessions tended to respond less frequently, although this failed to reach statistical significance (P = 0.07). Regression analyses revealed that higher scores on the hoarding dimension were predictive of non-response, even after controlling for possible confounding variables. CONCLUSION: Our results strongly indicate that in-patients with obsessive-compulsive hoarding respond poorly to CBT.

Adult↗

Compulsive-like effects of quinpirole on drinking behavior in rats are inhibited by substituting ethanol for water.

We have previously reported that in rats given the choice between operant and free access to water (contrafreeloading: CFL), repeated administrations of quinpirole, a D2/D3 dopamine receptor agonist, shifted the animals towards the operant access and inhibited water intake. The purpose of the present study was to investigate the influence of substituting different concentrations of ethanol (2, 4, 6%) for water on the effects of repeated daily administrations of vehicle or quinpirole (0.5mg/kg i.p.) in rats that for 6 days were given access to the fluid according to an FR3 schedule of reinforcement and for the following 9 days were given the choice between operant and free access to the fluid. On the first day quinpirole completely suppressed operant behavior, which however progressively increased in the subsequent sessions, approaching control levels by day 6. Ethanol presentation did not alter these effects of quinpirole. When the resource was also freely available, quinpirole produced the expected shift from free to operant access to water (CFL). Substituting ethanol for water resulted in a concentration-related reduction of the over-responding and, consequently, of CFL induced by quinpirole. In vehicle-injected subjects ethanol did not affect responding and only marginally reduced fluid intake. Thus, ethanol appears to prevent perseveration in performing needless instrumental behavior induced by repeated activation of D2/D3 receptors.

Analysis of Variance↗

Is collectionism a diagnostic clue for Diogenes syndrome?

BACKGROUND: Diogenes syndrome (DS) is characterized by extreme self-neglect, domestic squalor, and social withdrawal. Despite having been described decades ago, it is still difficult to persue a correct diagnosis in primary care clinics. METHODS: This paper reports a case of an elderly man with extreme self neglect and an abnormal collecting pattern whose condition remained undetected for many years. His collectionism was manifested with a tendency to store items in an organized manner but without a clear purpose. CONCLUSION: The authors suggest that the presence of collectionism could be a helpful clue towards diagnosis of DS in similar cases.

Aged↗

Stereotypical movements and frontotemporal dementia.

Stereotypical movements are characteristic of autism or mental retardation but can also occur in patients with dementia, particularly frontotemporal dementia (FTD). In this study, we administered the Abnormal Involuntary Movement Scale (AIMS) to 18 patients with FTD and to 18 patients with the most common form of dementia, Alzheimer's disease (AD). The AIMS scores were gathered at the initial presentation of patients who had not received antipsychotic medications. Compared to the AD patients, the FTD patients had significantly more stereotypical movements, including frequent rubbing behaviors and some self-injurious acts. All the FTD patients with stereotypical movements had compulsive-like behaviors, suggesting a similar pathophysiologic cause, and most had a decrease in their stereotypical movements with the administration of sertraline, a serotonin selective reuptake inhibitor.

Aged↗

Not just right experiences and obsessive-compulsive features: experimental and self-monitoring perspectives.

Individuals with obsessive-compulsive disorder (OCD) often report compulsions aimed at reducing feelings of something not being just right or sensations of incompleteness. Research using self-report questionnaires has demonstrated a link between not just right experiences (NJREs) and OCD symptoms (Behav. Res. Therapy 41 (2003) 681; Anxiety, 1 (1995) 208). Extending previous work, this paper presents experimental and self-monitoring data on NJREs in an undergraduate sample. NJREs produced distress and urges to change something, but feared consequences were rare. Stronger responses were found for naturally occurring self-monitored NJREs compared to NJREs elicited in the laboratory. Several significant relationships were found between features of NJREs and OC symptoms and constructs theoretically related to OCD (e.g., responsibility, incompleteness), but no significant relationships were found between features of NJREs and non-OCD-related constructs (worry, depressive symptoms, social anxiety). Further consideration of NJREs will be useful in improving our understanding of the phenomenology, neurobiological substrates, and treatment, of OCD.

Adolescent↗

Spontaneous decay of compulsive urges: the case of covert compulsions.

It is well established that many patients with obsessive-compulsive disorder have covert, or internal, compulsions. Empirical studies of this phenomenon, however, are limited. The present study followed the paradigm developed by Rachman and his colleagues for the study of overt compulsions. Patients with urges to carry out covert compulsions underwent an experimental procedure in which their compulsive urges were provoked, followed by a period of response prevention. The strength of the compulsive urges and associated discomfort were monitored. There was marked, and relatively rapid, spontaneous decay of both the compulsive urges and the discomfort. Implications of these results are discussed.

Adolescent↗

Behavioral and psychiatric disorders in adult male carriers of fragile X.

OBJECTIVE: In the present study we examined the incidence of psychiatric and behavioral problems among male carriers of the fragile X gene. METHOD: Retrospective data on carrier males were gathered using the family informant method. Each of 56 fragile X carrier women was interviewed about her father by an examiner blind to the father's carrier status. The interviewer administered measures of (1) behaviors related to DSM-III-R Axis I disorders, (2) adult attention-deficit hyperactivity disorder (ADHD) behaviors, (3) parental bonding skills, and (4) abusive behaviors. The endorsements from 24 women with fragile X fathers were compared with endorsements from 32 women with nonfragile X fathers. RESULTS: The results show a higher incidence of psychopathology among the fragile X males (relative to nonfragile X fathers) for behaviors related to adult ADHD, parental bonding, abuse; and particularly for alcohol abuse/dependence and obsessive-compulsive disorder behaviors. CONCLUSIONS: These findings support the hypotheses that some "nonpenetrant" males may indeed be mildly affected carriers and that there is a broad spectrum of involvement among carrier males.

Adult↗

Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex.

OBJECTIVE: Studies of the neurobiological processes underlying drug addiction primarily have focused on limbic subcortical structures. Here the authors evaluated the role of frontal cortical structures in drug addiction. METHOD: An integrated model of drug addiction that encompasses intoxication, bingeing, withdrawal, and craving is proposed. This model and findings from neuroimaging studies on the behavioral, cognitive, and emotional processes that are at the core of drug addiction were used to analyze the involvement of frontal structures in drug addiction. RESULTS: The orbitofrontal cortex and the anterior cingulate gyrus, which are regions neuroanatomically connected with limbic structures, are the frontal cortical areas most frequently implicated in drug addiction. They are activated in addicted subjects during intoxication, craving, and bingeing, and they are deactivated during withdrawal. These regions are also involved in higher-order cognitive and motivational functions, such as the ability to track, update, and modulate the salience of a reinforcer as a function of context and expectation and the ability to control and inhibit prepotent responses. CONCLUSIONS: These results imply that addiction connotes cortically regulated cognitive and emotional processes, which result in the overvaluing of drug reinforcers, the undervaluing of alternative reinforcers, and deficits in inhibitory control for drug responses. These changes in addiction, which the authors call I-RISA (impaired response inhibition and salience attribution), expand the traditional concepts of drug dependence that emphasize limbic-regulated responses to pleasure and reward.

Behavior, Addictive↗

Tic or compulsion?: it's Tourettic OCD.

A subgroup of individuals suffering from obsessive-compulsive disorder (OCD) frequently present to treatment with an atypical yet distinguishable array of symptoms akin to both Tourette's disorder (TD) and OCD. These individuals often receive standard treatments for OCD (or less likely, TD) that fail to address the blended features of their presentation. It is argued that these individuals would be better served, both psychotherapeutically and pharmacologically, by the adoption of a Tourettic OCD (TOCD) conceptual framework.

Adult↗