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PubMed1994

Tourette syndrome: a hereditary neuropsychiatric spectrum disorder.

The objective was to determine if the high frequency of behavioral problems in Tourette syndrome (TS) probands is the result of the pleiotrophic expression of the Gts genes or due to ascertainment bias. It was possible to distinguish between these two hypotheses by comparing the frequency of these behaviors in nonproband relatives with TS to relatives without TS. Twenty behavioral problems were prospectively assessed in a consecutive series of 361 TS probands, 113 nonproband TS relatives, 380 relatives without TS, and 68 controls, by the administration of a questionnaire based on the Diagnostic Interview Schedule and the DSM-III-R. Significance was set at a very conservative level of p < or = .001. Except for problems with smoking, reading and compulsive eating, all other behaviors were significantly more common in nonproband TS relatives than in relatives without TS. The relatives were also dichotomized on the basis of each of the behavioral problems. Regardless of the behavioral trait used, there was a higher frequency of all other behaviors in those who were positive versus those who were negative for that behavior. Ranking according to the number of behaviors that were significant indicated that mania, obsessive-compulsive behaviors and schizoid behaviors represented higher degrees of expression of the Gts genes than chronic tics. These results indicate that the Gts genes cause a spectrum of behavioral disorders in addition to chronic tics, indicate that TS is a behavioral spectrum disorder, and emphasize the role of genetic factors in a wide range of human behaviors.

Adolescent↗
PubMed1995

Body dysmorphic disorder, pathological gambling, and sexual compulsions.

This article focuses on body dysmorphic disorder (BDD), pathological gambling, and sexual compulsions within the realm of obsessive-compulsive spectrum disorders. These three disorders affect sizable numbers of the population, have an early age at onset and chronic courses, and seem to have a preferential response to serotonin reuptake inhibitors (SRIs). They also have a high comorbidity with obsessive-compulsive disorder, depression, and other impulse control disorders. BDD patients lie more toward the compulsive/risk-aversive end of the dimensional model of obsessive-compulsive spectrum disorder and often have poor insight. Pathological gambling patients lie more toward the impulsivity/novelty-seeking end of the OCD spectrum and often have features of inattention. Sexual obsessions and/or compulsions encompass a heterogeneous group of disorders, as exhibited by differential response to SRIs within this group. These three disorders fall within a new and evolving field that requires further investigation and reconceptualization. This concept may have far-reaching consequences and yield more significant treatment outcomes.

Adolescent↗
PubMedDate not supplied

Adult men and women with trichotillomania. A comparison of male and female characteristics.

Trichotillomania (hair pulling) has been considered a disorder that primarily affects women. It is rarely reported in men. Such rarity may reflect distinct clinical features in men that call for different treatment strategies. To investigate potential gender differences in trichotillomania, the authors systematically assessed the descriptive and phenomenological characteristics as well as psychiatric comorbidity of 14 male hair pullers and compared them to 128 female hair pullers who had been similarly assessed. Although a few gender differences existed, male trichotillomania was very similar to that seen in women. These results suggest that gender-specific treatment is not justified at this time; however, a more thorough psychiatric screening should be done with men because they may have additional psychiatric comorbidity.

Adult↗
PubMed1980

Behavioral and pharmacological treatment of obsessive-compulsive disorders.

Single-case experimental designs were used to evaluate behavioral and pharmacological treatments in obsessive-compulsive disorders. Four patients were treated in variants of ABAB withdrawal design using behavioral and self-report data as dependent variables. Three of the four patients responded to behavioral or pharmacological treatment, whereas one patient responded to neither intervention.

Adolescent↗
PubMed2000

Hypersomnia after head-neck trauma: a medicolegal dilemma.

OBJECTIVES: To evaluate the severity of daytime sleepiness in patients with a history of head trauma who complain of daytime somnolence, to investigate polygraphic abnormalities during nocturnal sleep, and to determine whether daytime sleepiness was the cause or consequence of the head trauma. METHODS: The authors performed a systematic evaluation of 184 patients comprised of clinical interviews, sleep disorders questionnaires, sleepiness and depression scales, medical and neurologic evaluations, sleep logs with actigraphy, nocturnal polysomnography, and the Multiple Sleep Latency Test (MSLT). Assessments of sleepiness before the accident were based on bed partner interviews, coworker and employer reports, health reports, driving records, and employment history that included absenteeism. RESULTS: Post-traumatic complaint of somnolence was associated with variable degrees of impaired daytime functioning in more than 98% of patients. Patients who were in a coma for 24 hours, who had a head fracture, or who had immediate neurosurgical interventions were likely to have scores > 16 points on the Epworth Sleepiness Scale (ESS) and < or = 5 minutes on the MSLT. Pain at night was an important factor in nocturnal sleep disruption and daytime sleepiness. Sleep-disordered breathing was a common finding and was the only finding in whiplash patients with daytime sleepiness. Extensive evaluation of pretrauma behavior supported the conclusion that the onset of symptomatic sleep-disordered breathing was associated with the trauma. The patients who showed a "compulsive presleep behavior" were severely impaired in performing their daily activities. CONCLUSIONS: A systematic approach is required when dealing with patients complaining of hypersomnia following a head-neck trauma.

Adolescent↗
PubMed2004

'Compulsive' lever-pressing in rats is attenuated by the serotonin re-uptake inhibitors paroxetine and fluvoxamine but not by the tricyclic antidepressant desipramine or the anxiolytic diazepam.

Rats undergoing extinction of lever-pressing for food after the attenuation of an external feedback for this behavior, exhibit excessive lever-pressing unaccompanied by an attempt to collect a reward, which may be analogous to the excessive and unreasonable behavior seen in obsessive-compulsive disorder (OCD). Given that one of the most salient features of OCD is its selective response to treatment with serotonin re-uptake inhibitors (SRIs), the present study compared the effects of the SRIs paroxetine and fluvoxamine on compulsive lever-pressing, with those of the tricyclic antidepressant, desipramine, and the benzodiazepine, diazepam, which are not effective in the treatment of OCD. Paroxetine (1-15 mg/kg) and fluvoxamine (10-20 mg/kg) dose-dependently reduced the number of compulsive lever-presses and the number of lever-presses followed by an attempt to collect a reward; desipramine (5-15 mg/kg) dose-dependently reduced only the number of lever-presses followed by an attempt to collect a reward; diazepam (2-10 mg/kg) did not affect either type of lever-pressing, except for the highest dose (10 mg/kg), which almost completely abolished lever-press responding. When administered in an extinction session not preceded by signal attenuation, paroxetine, fluvoxamine and desipramine affected only the number of lever-presses followed by an attempt to collect a reward, whereas diazepam (4-8 mg/kg) decreased both types of lever-presses. The present findings strengthen the suggestion that compulsive lever-pressing may serve to model compulsive behavior in OCD, and lends the model predictive validity.

Animals↗
PubMed2006

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.

Adult↗
PubMed2006

Deep brain stimulation in Tourette's syndrome: two targets?

In this report, we describe the effects of bilateral thalamic stimulation in one patient and of bilateral pallidal stimulation in another patient. Both patients suffered from intractable Tourette's syndrome (TS). Any conservative treatment had failed or had been stopped because of unbearable side effects in the 2 patients. In both cases, there was no comorbidity except for associated behavioral symptoms (compulsions). Electrodes were implanted at the level of the medial part of the thalamus (centromedian nucleus, the substantia periventricularis, and the nucleus ventro-oralis internus) in one patient and in the posteroventral part of the globus pallidus internus (GPi) in the other patient. In both cases, deep brain stimulation (DBS) resulted in a substantial reduction of tics and compulsions. These data show that bilateral DBS of the thalamus as well as of the GPi can have a good effect on tics and behavioral symptoms in patients suffering from intractable TS.

Adult↗