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Obsessive-compulsive disorder in popular magazines.

To examine what the general public is learning about Obsessive-Compulsive Disorder (OCD) through popular magazines, all articles listed in the Reader's Guide to Periodical Literature under the topic headings of "obsessive-compulsive behavior" or "obsessive-compulsive disorder" between 1983 and 1997 were read and rated. Only 31 of the 107 articles under these headings dealt explicitly with OCD, and these were found to be reasonably accurate in their presentations of symptoms, causes, and treatments. Many of the other articles under the target headings, however, focused on incidents of "stalking" of famous people by "obsessed" fans. The implications of the content patterns of these articles for understanding and misunderstanding of OCD are discussed.

Humans↗

[A general model of the limbic system and basal ganglia: applications to schizophrenia and compulsive behavior of the obsessive type].

The paper presents a model of the behavioural functions and information processing discharged jointly by the limbic system (especially, the hippocampal formation and amygdala) and the basal ganglia (both the dorsal and ventral striatal systems). In general terms, the limbic system plus basal ganglia act as a mechanism for the attainment of goals. The sensory aspects of this overall goal-direction function (recognition of goals and evaluation of the outcomes of action) are dealt with in the limbic system; the motor aspects (establishment and execution of motor programs), in the basal ganglia. The model is applied to an understanding of the neuropsychology of schizophrenia (in particular, positive psychotic symptoms) and obsessive-compulsive disorder. In both cases, emphasis is placed on the interaction between the limbic system and the basal ganglia.

Basal Ganglia↗

Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder.

BACKGROUND: We sought to determine in a new patient sample whether symptomatic improvement in obsessive-compulsive disorder treated with behavior modification is accompanied by significant changes in glucose metabolic rates in the caudate nucleus, measured with positron emission tomography, as seen in a previous study. Second, by combining samples from this and the previous study, we also examined whether there were pathologic correlational relationships among brain activity in the orbital cortex, caudate nucleus, and thalamus that obtained before behavioral treatment of obsessive-compulsive disorder, but that decreased significantly with symptom improvement. METHODS: Nine patients with obsessive-compulsive disorder were studied with positron emission tomography before and after 10 weeks of structured exposure and response prevention behavioral and cognitive treatment. Results were analyzed both alone and combined with those from nine similar subjects from the previous study. RESULTS: Behavior therapy responders had significant (P < .05) bilateral decreases in caudate glucose metabolic rates that were greater than those seen in poor responders to treatment. Before treatment, there were significant correlations of brain activity between the orbital gyri and the head of the caudate nucleus and the orbital gyri and the thalamus on the right. These correlations decreased significantly after effective treatment. CONCLUSIONS: These results replicate and extend previous findings of changes in caudate nucleus function with behavior therapy for obsessive-compulsive disorder. A prefrontal cortico-striato-thalamic brain system is implicated in mediation of symptoms of obsessive-compulsive disorder.

Adult↗

Group behavioral therapy of obsessive-compulsive disorder: seven vs. twelve-week outcomes.

Previous research has demonstrated that individualized behavioral exposure and response prevention therapy is an effective treatment for Obsessive-Compulsive Disorder. In our prior preliminary report, 7-week group exposure and response prevention therapy was also found effective in reducing obsessions and compulsions. The present report describes a larger sample (N=113) of treatment seeking obsessive-compulsives who received group behavioral therapy. As before, group exposure and response prevention significantly improved ratings of obsessions, compulsions, and depression. These improvements were maintained at 3-month and long-term follow-up. A sub-sample of patients who received 12 weeks of treatment had outcomes at the end of the group and at follow-up that did not significantly differ from those who received 7 weeks of treatment. These results confirm the efficacy of a 7-week behavioral treatment program administered in a group format.

Adult↗

Social, communicational, and behavioral deficits associated with ring X turner syndrome.

We describe the cognitive and behavioral characteristics of five individuals with a ring X chromosome. All subjects had a small active (early replicating) ring X chromosome. The X inactive specific transcript (XIST) locus was confirmed by fluorescent in situ hybridisation (FISH) to be present in all ring X chromosomes. Mental retardation was present in four individuals. All patients with or without mental retardation had a characteristic profile of aggression toward self and others, episodes of screaming, attentional problems, and impulsiveness. Autistic-like features were also present in all individuals and included limited communication, obsessive compulsive behavior, and social difficulties. In some cases the obsessive behavior was extreme and incapacitating. This characteristic behavioral profile may aid the diagnosis and future understanding of ring X.

Adolescent↗

Behavioral avoidance test for obsessive compulsive disorder.

Few treatment outcome studies of Obsessive Compulsive Disorder (OCD) have employed Behavioral Avoidance Tests (BATs) to assess changes in symptomatology, probably because of the difficulty of constructing such tests for a disorder which has widely varying symptoms. The few studies that have examined the psychometric properties of BATs for OCD have found mixed evidence for validity but good treatment sensitivity. The present study presents psychometric findings for a multi-step/multi-task BAT that assessed percentage of steps completed, subjective anxiety, global avoidance, and rituals. This measure was used with 50 clients diagnosed with OCD whose symptoms varied widely. The BAT demonstrated good convergent and divergent validity, as well as treatment sensitivity according to effect size calculations. A composite score combining steps, anxiety level, avoidance and rituals also performed well in psychometric tests. Strategies to reduce the complexity of scoring are presented, along with examples of several BAT tasks to enable researchers to employ this behavioral measure.

Adolescent↗

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↗

Brain-behavior relationships in obsessive-compulsive disorder.

Advances in neuroimaging have led to a greater understanding of brain-behavior relationships in obsessive-compulsive disorder (OCD). This article provides an updated review and analysis of the structural and functional neuroimaging studies in OCD published to date and discusses how evidence from various types of neuroimaging studies has been synthesized to generate and test hypotheses regarding these relationships. We also review the basic science literature on the functional neuroanatomy of cortico-basal ganglia-thalamo-cortical circuits and integrate this information with neuroimaging data in OCD, to present a theoretical model of brain mediation of OCD symptoms and response to treatment. Taken together, neuroimaging studies indicate that OCD symptoms are mediated by hyperactivity in orbitofrontal-subcortical circuits, which may be attributable to an imbalance of tone between direct and indirect striato-pallidal pathways. Serotonergic drugs may ameliorate OCD symptoms by changing the relative balance of tone through the indirect versus direct orbitofrontal-subcortical pathways, thereby decreasing activity in the overall circuit that exists in the symptomatic state.

Brain↗

Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder.

Discusses the cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder (OCD). Over the past 15 years, cognitive-behavioral psychotherapy has emerged as the psychosocial treatment of choice for OCD across lifespan. Unlike other psychotherapies that have been applied usually unsuccessfully to OCD, cognitive-behavioral treatment (CBT) presents a logically consistent and compelling relationship between the disorder, the treatment, and the specified outcome. Nevertheless, despite a consensus that CBT is usually helpful, clinicians routinely complain that patients will not comply with behavioral treatments and parents routinely complain that clinicians are poorly trained in CBT, with the result that many if not most children and adolescents are denied access to effective psychosocial treatment. This unfortunate situation may be avoidable, given an increased understanding regarding the implementation of CBT in children and adolescents with OCD. To this end, we review the principles and the practical aspects of the cognitive-behavioral treatment of OCD in youth, move on to discuss empirical studies supporting the use of CBT in the pediatric age group, and conclude by discussing directions for future research.

Adolescent↗

Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control.

BACKGROUND: The demand for effective behavior therapy for obsessive-compulsive disorder (OCD) by exposure and ritual prevention exceeds its supply by trained therapists. A computer-guided behavior therapy self-help system (BT STEPS) was created that patients access by telephone from home via interactive voice response technology. This study compared the value of computer-guided behavior therapy value with that of clinician-guided behavior therapy and systematic relaxation as a control treatment. METHOD: After screening by a clinician, 218 patients with DSM-IV OCD at 8 North American sites were randomly assigned to 10 weeks of behavior therapy treatment guided by (1) a computer accessed by telephone and a user workbook (N = 74) or (2) a behavior therapist (N = 69) or (3) systematic relaxation guided by an audiotape and manual (N = 75). RESULTS: By week 10, in an intent-to-treat analysis, mean change in score on the Yale-Brown Obsessive Compulsive Scale was significantly greater in clinician-guided behavior therapy (8.0) than in computer-guided (5.6), and changes in scores with both clinician-guided and computer-guided behavior therapy were significantly greater than with relaxation (1.7), which was ineffective. Similarly, the percentage of responders on the Clinical Global Impressions scale was significantly (p < .05) greater with clinician-guided (60%) than computer-guided behavior therapy (38%), and both were significantly greater than with relaxation (14%). Clinician-guided was superior to computer-guided behavior therapy overall, but not when patients completed at least 1 self-exposure session (N = 36 [65%]). At endpoint, patients were more satisfied with either behavior therapy group than with relaxation. Patients assigned to computer-guided behavior therapy improved more the longer they spent telephoning the computer (mostly outside usual office hours) and doing self-exposure. They improved slightly further by week 26 follow-up, unlike the other 2 groups. CONCLUSION: For OCD, computer-guided behavior therapy was effective, although clinician-guided behavior therapy was even more effective. Systematic relaxation was ineffective. Computer-guided behavior therapy can be a helpful first step in treating patients with OCD when clinician-guided behavior therapy is unavailable.

Adolescent↗

Behavioral group therapy with obsessive-compulsives: an overview.

During the last two decades, effective psychotherapeutic interventions have been developed and proven successful in treating patients with Obsessive-Compulsive Disorder (OCD). Behavior therapy, using exposure to anxiety-evoking stimuli and response prevention directed toward rituals, provides lasting benefit for most patients who engage in and comply with treatment. A recent study indicated that, for certain OCD patients, these interventions could be applied successfully in a group therapy context. This article describes the general procedures used in this study to treat obsessive-compulsives with exposure and response prevention in a group context.

Behavior Therapy↗

Validity of the Obsessive Compulsive Drinking Scale (OCDS): does craving predict drinking behavior?

OBJECTIVE: The Obsessive Compulsive Drinking Scale (OCDS), a 14-item, self-report questionnaire, was developed to measure alcohol-related craving. The OCDS may provide a measure of the state of illness among alcohol-dependent individuals and may have value in predicting subsequent drinking behavior. The present study was conducted to evaluate the factor structure and the concurrent, construct, and predictive validity of the OCDS. METHODS: Data on desire to drink and on drinking behavior were obtained from 127 alcohol-dependent subjects who participated in a 12-week outpatient pharmacotherapy trial and a 3-month posttreatment follow-up. RESULTS: Principal components analysis of the OCDS indicated that three factors best described its structure: obsessions, drinking control and consequences, and alcohol consumption. Data also supported the concurrent and discriminant validity of the OCDS. However, the OCDS total score showed limited validity in predicting drinking during a posttreatment follow-up period. Furthermore, the only empirically derived factor that predicted drinking during this period was the alcohol consumption factor. CONCLUSIONS: As might be expected, the OCDS questions on drinking behavior predict subsequent drinking behavior. However, the instrument does not appear to provide a general measure of alcohol-related illness. The utility of the OCDS in studies of alcoholism treatment outcome requires clearer definition.

Adolescent↗

[Treatment of a case of chronic obsessive troubles through combined behavioral therapy (author's transl)].

Behavior therapy of a young man, suffering from grave obsessive and compulsive troubles is the first example of combined therapy, with individual therapy, family therapy as group therapy. Two steps are find in the cure. There are benefits--trust and hope--due to psychiatric hospitalization and generous and constant affection of the sponse. The sponse was the key of reciprocal inhibition necessary to the control of anxieties due to the treatment. The aim reached was the control of obsessions and compulsions lasting for more than sixteen years.

Adult↗