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[Male anorectic behavior. Obsession with ponderal identity. Nosologic and therapeutic considerations].
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The genesis of obsessional phenomena.
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A child psychiatric study on Sudanese Arab children.
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[Several characterologic features of the personality in prolonged neurosis with obsessional inclinations].
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Study of compulsive buying in patients presenting obsessive-compulsive disorder.
OBJECTIVE: The authors assessed the prevalence of compulsive buying (CB) among patients presenting an obsessive-compulsive disorder (OCD). They compared the buying style of patients with and without CB. METHOD: One thousand five hundred consecutive patients were assessed by a general practitioner in Paris (France). Sixty patients presenting with OCD were included. Patients with CB associated with OCD (n = 14) were compared with those with "pure" OCD (n = 46). Sixty patients paired for sex and age and free from OCD, depression, and anxiety were also recruited among the clients of the same general practitioner. We compared 3 groups: controls, patients with OCD, and patients with OCD + CB. RESULTS: Prevalence of CB was 23% (14 cases) among patients with OCD and 6% (4 cases) in controls (chi(2)(1) = 5.3, P = .02). Patients presenting with OCD + CB had a higher number of Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition diagnostic criteria for OCD than patients with pure OCD (6.1 and 5.4, respectively, P = .001). Depression was more frequent in the OCD + CB group (78%) than in the OCD group (42%) and in controls (10%) (P = .02). Patients from the OCD + CB group had higher score at the CAGE questionnaire than those of the OCD group (2 vs 0.7, P = .003). Patients with OCD + CB considered 42% of their purchases as occasions not to be passed up compared with 15.4% in the OCD group and 8.6% in controls. OCD+CD patients used the items they bought after a longer delay than controls and patients with pure OCD (8.2 vs 3 and 3.1 days, respectively). CONCLUSION: Compulsive buying is more frequent in OCD than in controls. Patients presenting with OCD + CB show more depressive disorders and drink more alcohol. They are more highly implicated in the items they buy and they are more often disappointed by the items once they possess them.
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.
Compulsive hoarding: a disease or a sign of a deeper disorder?
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Memory bias, confidence and responsibility in compulsive checking.
Recent research suggests that there is a positive memory bias for threatening information in compulsive cleaners. However, the relationship between OCD and memory is likely to be more complex when the compulsive behaviour is checking. Hence, we decided to explore this relationship in a clinical sample of people who check compulsively. Participants completed a diagnostic interview and were then asked to complete a standard 'baseline' check which normally causes distress/discomfort. Two additional checks were then completed--one under conditions of high responsibility and one under low responsibility. The order of responsibility manipulation was randomized across participants. After each check, participants completed a Memory and Confidence Interview which assessed memory for threat-relevant and threat-irrelevant aspects of the check, and also confidence in memory for the check. One week later, participants came into the laboratory to complete additional Memory and Confidence Interviews after watching a videotape of the checks completed earlier in their own homes. These videotaped checks were taken as conditions of 'no responsibility'. Results show a positive memory bias for threat-relevant information. As responsibility was inflated, this positive memory bias was amplified. Under conditions of no responsibility, no memory bias was detectable. Also, responsibility appears to have had a greater impact on confidence in memory than on memory itself in OCD. The results are discussed in terms of the mnestic deficit theory of OCD and in terms of cognitive-behavioural approaches to understanding the disorder.
[123I]-beta-CIT SPECT imaging shows reduced thalamus-hypothalamus serotonin transporter availability in 24 drug-free obsessive-compulsive checkers.
Numerous findings indicate alterations in brain serotonin systems in obsessive-compulsive disorder (OCD). We investigated the in vivo availability of thalamus-hypothalamus serotonin transporters (SERT) in patients with DSM-IV OCD who displayed prominent behavioral checking compulsions (OC-checkers). Four hours after injection of [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([(123)I]-beta-CIT), single photon emission computed tomography (SPECT) scans were performed in 24 medication-free non-depressed OC-checkers and 24 age- and gender-matched healthy controls. For quantification of brain serotonin transporter availability, a ratio of specific to non-displaceable [(123)I]-beta-CIT brain binding was used (V''(3)=(thalamus and hypothalamus-cerebellum)/cerebellum). Drug-free non-depressed OC-checkers showed an 18% reduced brain serotonin transporter availability in the thalamus and hypothalamus, as compared with healthy control subjects (1.38+/-0.19 vs 1.69+/-0.21; p<0.001). There was a strong negative correlation between severity of OC symptomatology (Y-BOCS scores) and SERT availability (r=-0.80; p<0.001). Moreover, we found a significant positive correlation between illness duration and serotonin transporter availability (r=0.43; p<0.05). This first report of significantly reduced [(123)I]-beta-CIT binding in the thalamus-hypothalamus region in OC-checkers suggests reduced brain serotonin transporter availability, which is more pronounced with increased severity of OC symptomatology and short duration of illness. The results provide direct evidence for an involvement of the serotonergic system in the pathophysiology of OCD.
Cucurbitacins as kairomones for diabroticite beetles.
The characteristic bitter substances of the Cucurbitaceae act as kairomones for a large group of diabroticite beetles (Chrysomelidae, Galerucinae, Luperini), promoting host selection and compulsive feeding behavior. These beetles (e.g., Diabrotica undecimpunctata howardi) respond to as little as 1 ng of cucurbitacin (Cuc) B on thin-layer plates by arrest and compulsive feeding. Six species of diabroticite beetles were about 10 times more responsive to Cuc B than to Cuc E and less responsive to Cuc D, I, and L. Chloroform extracts of 18 species of Cucurbita were developed on thin-layer chromatograms and exposed to diabroticite beetles. The feeding patterns showed pronounced beetle responses to three general Cuc distribution patterns: Cuc B and D as in Cucurbita andreana and C. ecuadorensis; Cuc E and I as in C. okeechobeensis and C. martinezii; and Cuc E glycoside in C. texana. All the diabroticites responded in exactly the same feeding patterns. The results demonstrate a coevolutionary association between the Cucurbitaceae and the Luperini, during which the intensely bitter and toxic Cucs that arose to repel herbivores and protect the plants from attack became specific kairomone feeding stimulants for the beetles.
Some similarities and differences between obsessional ruminations and morbid preoccupations.
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[Loss of psychic self-activation and stereotyped mental activity caused by a frontal lesion. Relation of the obsessive-compulsive disorder].
A case of frontal lobe lesions is reported, its interest being that it is similar to a syndrome that we have previously described as the consequence of lenticular nucleus lesions. This syndrome includes primarily a loss of psychic self-activation (psychic akinesia) and compulsive or pseudo-compulsive activities. In the present case the lesions involved the deep white matter of the prefrontal cortex on both sides, and were most extensive in the depth of the middle frontal gyrus. This similitude brings further support to the notion that subcortical damage of the lenticular nuclei can induce a frontal-like syndrome. The similitude with some of the behavioural aspects or depressive of hebephrenic states is emphasized. The occurrence of stereotyped mental activities is the basis for a discussion of the relationships with some features of obsessive-compulsive neurosis.
Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: an open clinical trial.
OBJECTIVE: The purpose of this open clinical trial was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). METHOD: Children and adolescents with diagnosed OCD (N = 14) received cognitive-behavioral treatment, seven patients received intensive treatment (mean = 18 sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment with serotonin reuptake inhibitors and six received cognitive-behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale. RESULTS: Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at follow-up (mean time to follow-up = 9 months). CONCLUSIONS: Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-behavioral pharmacological, and combined treatments.
Compulsive disorder and acquired antisocial behavior in frontal lobe dementia.
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Dysfunctional action monitoring hyperactivates frontal-striatal circuits in obsessive-compulsive disorder: an event-related fMRI study.
Converging evidence suggests that hyperactivity in frontal-striatal circuits and in action-monitoring processes characterizes obsessive-compulsive disorder (OCD). It remains unclear, however, just how these abnormalities in brain function translate into the cognitive, affective, and behavioral manifestations of OCD. One possibility is that exaggerated or false error signals generated by the anterior cingulate (ACC) underlie compulsive behaviors by triggering the feeling that things are "not just right" even when no actual error has been made. Since recurrent compulsive behavior typically follows correct completion of a behavioral task (e.g., hand washing), ACC hyperactivity should be observed during correctly completed, high-conflict trials as well as during error trials. Frontal-striatal regions would also be expected to be activated during both trial types, as these regions are robustly associated with OCD across multiple neuroimaging paradigms. To test this hypothesis, 14 OCD patients and 14 matched controls completed a speeded reaction time task during functional magnetic resonance imaging (fMRI). Only correctly rejected, high-conflict trials produced excessive activation in both action monitoring (rostral and caudal ACC, LPFC) and frontal striatal regions (lateral orbitofrontal cortex (OFC), caudate, and thalamus) among OCD patients when compared to healthy controls. Portions of the posterior cingulate were also hyperactive among OCD patients. These results suggest that correctly rejected, high-conflict trials that require response inhibition may provide a better model than error trials of compulsive behaviors in OCD.
Categorization in compulsive hoarding.
Based on hypothesizing about the role of information processing, and in particular, underinclusive categorization in compulsive hoarding, this study examined categorization processes in people with clinically significant compulsive hoarding problems. Twenty-one participants with primary compulsive hoarding, 21 with OCD without hoarding, and 21 non-psychiatric controls completed three categorization tasks. Hoarding and OCD participants reported significantly more distress prior to each of the three tasks than did controls. On tasks sorting common household items, the groups did not differ on the number of piles created nor on the amount of time taken to sort. However, on a task sorting personally relevant items, hoarding participants took more time, created more piles, and reported more anxiety than non-psychiatric controls. Hoarders also took more time than the OCD group, and tended to create more piles. Hoarding severity was correlated with the number of piles created, but only when the objects were personally relevant. Results support under-inclusive categorizing for people with compulsive hoarding, but the effect was largely confined to objects of personal relevance.