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PubMed1991

Prompting and fading in the exposure treatment of compulsive checking.

Compulsive checking can be treated effectively through the use of in vivo exposure with response prevention. However, the clinical application of these procedures can become quite complex. The therapist must help teach the client new coping skills for managing anxiety. However, many compulsive clients report a substantial reduction in the urge to check whenever accompanied by another adult. Therefore, the therapist must not be so intrusive as to reduce the impact of the exposure. Treatment procedures used with two clients are described to show how prompting can be useful for facilitating the early stages of exposure and how fading is essential in promoting self-control. Portable electronic communication devices were used to bridge the gap between therapist-assisted and self-controlled exposure sessions. Therapy was successful in reducing the frequency of checking behaviors and the subjective urge to check.

Adaptation, Psychological↗
PubMedDate not supplied

[Impulsivity: historical and conceptual review].

There is great confusion about the concept of impulsivity despite its important clinical use. Limits with others symptoms or behaviors, like aggressiveness, are imprecise, and we find no general agreement on the definition of impulsivity in the present literature. From the point of view of neurosciences, adequate identification and measurement of a symptom as impulsivity could increase the validity of syndromic diagnoses, improve the development of animal models and genetic studies, and improve the treatment of several psychiatric disorders. Based on this perspective, the overall goals of this review article are: a) to establish the historical evolution of term, concept and behavior that we presently identify as impulsivity, starting from the classical psychopathology of the will; b) to review several concepts of impulsivity described in the scientific literature, and c) to provide basic guidelines for an operative definition, just as some authors have proposed, to create research lines and understand various discoveries that basic sciences have contributed.

Compulsive Behavior↗
PubMedDate not supplied

Hospitalization of obsessive-compulsive patients: the "forgotten" factor in the behavior therapy literature.

The role of hospitalization in the treatment of obsessive-compulsive patients has been neglected to a great extent in the behavior therapy literature. For this reason existing therapeutic programs, as described and evaluated in the literature, are briefly reviewed with regard to the use of a hospital setting in the course of treatment. The advantages and limitations of both inpatient and outpatient treatment are discussed. Finally, a few guidelines are offered to decide which patients may require admission to an inpatient psychiatric setting.

Behavior Therapy↗
PubMed2006

Pervasive developmental disorders in Prader-Willi syndrome: the Leuven experience in 59 subjects and controls.

In the present study we investigated the co-morbidity of pervasive developmental disorder (PDD) in 59 Prader-Willi syndrome (PWS) individuals and in 59 non-specific mentally retarded controls, matched for IQ, gender, and age. The 'Pervasive Developmental Disorder Mentally Retardation Scale' (PDD-MRScale), a screening questionnaire based on the DSM-III-R criteria for PDD, has been applied in the PWS group and in the control group. Results of the present study revealed a striking autistic-like behavioral phenotype in the majority of the PWS individuals, particularly deficits in the quality of language and communication and of imagination and interests. This intersection with autistic symptomatology is an important addition to the behavioral phenotype in PWS persons. A first approach to delineate subtypes of autistic symptomalogy among PWS persons was performed. Nineteen percent of the PWS group did meet the full diagnostic DSM-III-R criteria for PDD in comparison with 15% in the control group. Results revealed that a higher IQ in PWS does not protect to develop genuine PDD and that uniparental disomy/imprinting mutation as genetic origin seems to be an additional risk factor for developing genuine PDD. The results of the present study suggest the importance of reconsidering the commonly recognized obsessive-compulsive like behavior in PWS persons within the broader spectrum of autism disorders.

Adolescent↗
PubMed2004

Actual and perceived memory deficits in individuals with compulsive hoarding.

Memory problems have been hypothesized to underlie compulsive hoarding behavior [Frost and Hartl, 1996: Behav Res Ther 34:341-350]. This study examined memory performance, memory confidence, and memory beliefs in 22 individuals with severe hoarding symptoms and 24 matched normal control subjects. Participants were administered two measures of learning and memory that required strategic planning and organization for successful performance: the Rey-Osterrieth Complex Figure Test (RCFT) and California Verbal Learning Test (CVLT). Self-reports of memory confidence, perceived consequences of forgetting, importance of remembering, and need to keep possessions in sight also were assessed. In comparison to controls, participants with compulsive hoarding recalled less information on delayed recall of the RCFT and CVLT and used less effective organizational strategies on the RCFT but not the CVLT. Hoarders also reported significantly less confidence in their memory, more catastrophic assessments of the consequences of forgetting, and a stronger desire to keep possessions in sight. Results provide initial evidence of learning and memory impairment and poor memory confidence in subjects with compulsive hoarding.

Adult↗
PubMed1982

[Initial results of computer analysis of behavioral systems in patients with epilepsy].

A catalogue of features for the qualitative and quantitative determination of behaviour peculiarities in epilepsy is presented (in extracts). The results of a factor analysis with Varimax rotation are discussed. Six factors were found which explain more than 45 per cent of the total variance and which could be brought in good agreement with "behaviour types" in epilepsy that have been described in the respective literature.

Adolescent↗
PubMed2005

Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men.

OBJECTIVES: We sought to identify the determinants of sexual transmission risk behavior by HIV-positive individuals. We examined social cognitive theory (SCT) variables, which have been found to mediate the effectiveness of HIV risk reduction interventions. We also sought to identify contextual influences that might contribute to initial levels of SCT factors such as self-efficacy. METHOD: In the present study, a series of social cognitive variables and a number of factors hypothesized to influence self-efficacy were assessed among participants at baseline in the Seropositive Urban Men's Intervention Trial. Variables tested for their effects on self-efficacy included hedonistic and self-evaluative outcome expectancies, sexual compulsivity, a history of childhood sexual abuse, drug use, and race. Models predicting condom use during anal sex with partners of HIV-negative or unknown status were tested separately for main partners and for non-main partners. RESULTS: Self-efficacy was associated with condom use in both analyses. Contextual influences on condom use with main partners were fewer and operated mostly via effects on self-efficacy. Influences on condom use with non-main partners exerted both direct effects on condom use and effects mediated by self-efficacy. Drug use was predictive of condom use with non-main, but not main, partners. DISCUSSION: The present results support the approach of addressing both standard SCT factors, and when possible contextual factors in interventions for HIV-positive men.

Adult↗
PubMed1989

[Repetition and its psychic function].

Thoughts on repetition as a psychic process and not as conduct or behavior. Placing the phenomenon in the framework of the relationship to objects and in its relation to defense mechanisms in general. Which leads to discussing its connections to a death-instinct and masochism, and to situate narcissism as an easy way to find a balance as opposed to an elaborate and thrifty but disordered imbalance, and in its constructive value for one's identity.

Adolescent↗
PubMed1994

Naloxone attenuates drinking behavior in psychiatric patients displaying self-induced water intoxication.

1. The present study was performed to examine the effect of naloxone on drinking behavior in three schizophrenic inpatients with psychosis, intermittent hyponatremia, and polydipsia. 2. Their body weight were checked five times daily and the maximum weight gain during a day was chosen as an index of their polydipsia. 3. After control recording for six weeks, a daily naloxone (0.6 mg) injection series was performed once every two weeks for three series (six weeks). Withdrawal of this drug for six weeks resulted in weight gain recovering to control level. 4. The present study showed that naloxone seems to be a potential treatment for psychiatric patients displaying self-induced water intoxication and that endogenous opioid systems are involved in the compulsive drinking behavior of this syndrome.

Drinking Behavior↗
PubMed1980

Fire-setting on an adolescent inpatient unit: an analysis.

A one time series of fire-setting episodes on an inpatient adolescent service are analyzed from a systems standpoint for the purpose of primary prevention. This paper documents that fire-setting behavior can occur in individuals with no prior history of fire-setting and that losses to the hospital system proper can be psychologically coupled to losses felt by an individual. Specific recommendations are offered based on both case history analysis of the protagonists and the psychosocial determinants of the hospital system. A selective literature review compares this experience with others.

Acting Out↗
PubMed1998

Opioid antagonists in the treatment of impulse-control disorders.

BACKGROUND: Symptoms of impulse-control disorders are generally refractory to psychotherapeutic or pharmacologic treatments. Recent study results suggest that opioid antagonists may reduce human urges, one of the core symptoms of impulse-control disorders. The author discusses the rationale for and the potential utility of the opioid antagonists in the treatment of impulse-control disorders. METHOD: Work by preclinical and clinical investigators on the subject of motivation and its contextually relevant behavior is reviewed. The review includes the pharmacologic modulation of the motivation or drive and subsequent changes in behavior in animals and humans. On the basis of these reviews, the author prescribed naltrexone for up to 9 months to 15 patients who had impulse-control disorder, and 3 select cases are reported. RESULTS: Naltrexone was generally well tolerated, and there were no hepatic side effects. Naltrexone appears to reduce urge-related symptoms and decreases the problematic behaviors such as pathological gambling. The effect appears to be sustained. In general, 50 mg/day of naltrexone was not effective. Most patients required higher doses. Results were similar in the 12 other cases not reported here. CONCLUSION: Naltrexone may be of use in select impulse-control disorder patients. Other opioid antagonists such as nalmefene also need to be tested. Until controlled study data become available, the present report should be viewed as preliminary.

Adult↗
PubMed2006

Contribution of drug doses and conditioning periods to psychomotor stimulant sensitization.

RATIONALE: Repeated intermittent administration of psychostimulant drugs such as amphetamine and cocaine can cause sensitization (reverse tolerance) to the locomotor-stimulating actions in rats. Sensitization to the stimulant effects of these drugs might contribute to the development and maintenance of addictive behaviors (e.g. compulsive drug use). OBJECTIVES: Studies were designed to systematically examine how testing conditions affect the development and expression of locomotor sensitization to cocaine and amphetamine. METHODS: Rats were treated once daily with intraperitoneal (i.p.) administration of amphetamine (0.5-2.0 mg/kg) or cocaine (5.0-20 mg/kg) and placed in activity chambers for 30, 60, or 120 min. All amphetamine-preexposed rats were challenged with 0.5 mg/kg amphetamine, and all cocaine-preexposed rats were challenged with 5.0 mg/kg cocaine for 120-minute activity tests 2 weeks after the final injection. RESULTS: Rats treated repeatedly with 2.0 mg/kg amphetamine and tested for 60 min in activity chambers or 20 mg/kg cocaine and tested for 30 min in activity chambers were most active in response to the drug challenge. These time points coincide with the maximal behavioral effects of each drug, as measured after the first injection. In contrast, rats treated with 2.0 mg/kg amphetamine and tested for 30 min or 20 mg/kg cocaine and tested for 120 min were least active in response to the drug challenge. CONCLUSIONS: Repeated association of the peak behavioral effects of high doses of amphetamine or cocaine with the drug-paired environment produces maximal expression of sensitized locomotor responses. Certain testing conditions appear to disrupt sensitization to these same doses of the drugs.

Amphetamine↗
PubMed2003

Effects of behavior therapy on regional cerebral blood flow in obsessive-compulsive disorder.

Very few functional neuroimaging studies have been performed on patients with obsessive-compulsive disorder (OCD) undergoing behavior therapy, even though it is recognized to be an effective treatment for this disorder. We measured the regional cerebral blood flow (rCBF) using the Xenon inhalation method in 31 treatment-refractory patients with OCD and the same number of age-matched normal controls. We also studied changes in rCBF in 22 OCD patients who had demonstrated a significant improvement after the behavior therapy. The OCD patients showed a significant bilateral elevation in the rCBF in the basal ganglia compared with the normal controls. After successful treatment, a significant decrease was found in the rCBF in the right head of the caudate nucleus that tended to correlate with clinical improvement.

Adolescent↗
PubMed1996

Involvement of the endogenous opioid system in the drinking behavior of schizophrenic patients displaying self-induced water intoxication: a double-blind controlled study with naloxone.

Previously we found significant suppression of polydipsia in a schizophrenic patient with PIP syndrome (psychosis, intermittent hyponatremia, and polydipsia). Suppression was obtained with a small dose of naloxone injected once every 2 weeks in long-term repeated studies. We attempted to confirm the effect of naloxone on PIP syndrome by using a double-blind controlled study. The body weights of eight schizophrenic inpatients with PIP syndrome were checked five times daily, and the maximum weight gain during 1 day was chosen as an index of their polydipsia. Naloxone (0.6 mg in three divided doses) or placebo (saline) injection was given once every 2 weeks three times. Assignment to either the naloxone or placebo series was done randomly in a double-blind, crossover design. Naloxone decreased the maximum weight gain per day significantly in five cases. However, naloxone also increased weight gain significantly in three cases. There was no correlation of the weight-increasing effect of naloxone with the duration and intensity of excessive drinking. Our findings showed that the endogenous opioid system might be related to compulsive drinking behavior in the PIP syndrome and that opioid antagonists such as naloxone or naltrexone could be useful in the therapy of PIP syndrome.

Adult↗
PubMed2001

The effect of the NMDA receptor blocker, dextromethorphan, on cribbing in horses.

Stereotypic cribbing in horses is thought to involve excess dopaminergic activity within the striatum. Various models of stress-induced stereotypies including cribbing in horses postulate that stress stimulates the release of endorphins, triggering the release of striatal dopamine. Dopamine in turn activates basal ganglia motor programs, reinforcing behavior via a reward mechanism. Furthermore, the release of dopamine by endorphins has been shown to depend on activation of NMDA receptors. In the present study, horses identified as cribbers and volunteered by their owners were treated with the NMDA receptor antagonist dextromethorphan (DM). When DM was administered via jugular injection (1 mg/kg), eight of nine horses responded with reductions in cribbing rate (CR) compared to baseline, and cribbing was suppressed completely for a period of time in almost half of the horses tested.

Animals↗
PubMed2000

Three studies on the factorial distinctiveness of binge eating and bulimic symptoms among nonclinical men and women.

OBJECTIVE: According to DSM-IV's proposed nosology, binge eating disorder is separable from bulimia nervosa. The basis for separation rests with compensatory behaviors (e.g., induced vomiting)-people with bulimia nervosa engage in compensatory behaviors, whereas those with binge eating disorder do not. We addressed the validity of this nosology. METHODS: In three studies on 2,015 young men and women, we used factor-analytic techniques to assess whether bulimic and binge eating symptoms are separable in men and women. Results and Discussion Results of the three studies converged: Although binge eating symptoms may be distinct from bulimic symptoms among young men, the two syndromes are factorially inseparable among young women. Nosologic and sociocultural implications are noted.

Adolescent↗