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PubMed1993

The nature and measurement of compulsive indecisiveness.

Indecisiveness is an often mentioned symptom of obsessive compulsive disorder and obsessive compulsive personality disorder, yet very little research has been done examining its nature and measurement. Three studies are presented here which examine the nature of compulsive indecisiveness using a newly developed scale. In study 1 the Indecisiveness Scale was correlated with measures of obsessionality and compulsive checking among normal S s. It was also correlated with the maladaptive evaluative concern dimensions of perfectionism and with compulsive hoarding. In study 2 indecisive S s (as measured by the Indecisiveness Scale) were found to score higher on measures of procrastination and general psychopathology. In addition, they reported problems in making decisions in a variety of life domains (social, academic, family and everyday). In study 3 S s who scored high on the Indecisiveness Scale were found to have longer latencies on an experimental decision-making task. The implications of these findings for the nature of indecisiveness were discussed.

Adolescent↗
PubMed2005

The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study.

Cognitive models of obsessive-compulsive disorder (OCD) posit that specific kinds of dysfunctional beliefs (e.g., pertaining to responsibility and the significance of intrusive thoughts) underlie the development of this disorder. The present study was designed to prospectively evaluate whether dysfunctional beliefs thought to underlie OCD act as a specific vulnerability factor in the pathogenesis of obsessive-compulsive symptomatology. Eighty-five individuals were prospectively followed over a period of time thought to be associated with an increased onset of OCD symptoms -- childbirth and the postpartum. The majority of these new mothers and fathers experienced intrusive infant-related thoughts and performed neutralizing behaviors similar to, but less severe than, those observed in OCD. Scores on a measure of dysfunctional beliefs thought to underlie OCD predicted the development of obsessive-compulsive symptoms after controlling for pre-existing OCD symptoms, anxiety, and depression. Dysfunctional beliefs also predicted the severity of checking, washing, and obsessional OCD symptom dimensions, but not neutralizing, ordering, or hoarding symptom dimensions. These data provide evidence for specific dysfunctional beliefs as risk factors in the development of some types of OCD symptoms.

Adolescent↗
PubMed2006

[Hoarding and severe neglect. A case report].

Severe neglect of the living space due to excessive collection of unusable objects and refuse has been named "Vermuellung" (complete congestion with garbage) since 1985 in the German literature. The internationally used terms 'hoarding' or 'Diogenes syndrome' are in fact neither synonyms nor direct translations of the term. The condition is a problem mainly in social and geriatric psychiatry, yet it is seen also in young subjects without psychopathologic features. A frequent cause for the condition is obsessive-compulsive disorder, but several other disorders are associated with it. A 58-year-old female patient with severe Vermuellung due to obsessive-compulsive disorder is presented.

Aging↗
PubMed2000

Behavioral, neurochemical and endocrinological characterization of the early social isolation syndrome.

Rearing rats in isolation has been shown to be a relevant paradigm for studying early life stress and understanding the genesis of depression and related affective disorders. Recent studies from our laboratory point to the relevance of studying the social isolation syndrome as a function of home caging conditions. Accordingly, the present series of experiments assessed the contribution of each condition to the expression of the prepulse inhibition of the acoustic startle, food hoarding and spontaneous locomotor activity. In addition, ex vivo neurochemical changes in the brains of isolated and grouped rats reared either in sawdust-lined or in grid-floor cages were determined by measuring dopamine and serotonin as well as their major metabolites in a "psychosis circuit" that includes mainly the hippocampus and selected hippocampal efferent pathways projecting towards the anterior cingulate and infralimbic cortices, nucleus accumbens, dorsolateral caudate nucleus, amygdala and entorhinal cortex. The results of the present study demonstrate that rearing rats in isolation (i) produces a syndrome of generalized locomotor hyperactivity; (ii) increases the startle response; (iii) impairs prepulse inhibition; (iv) tends to increase food hoarding behavior; (v) increases basal dopamine turnover in the amygdaloid complex; (vi) decreases basal dopamine turnover in the infralimbic part of the medial prefrontal cortex; and (vii) decreases basal turnover of serotonin in the nucleus accumbens. In the entorhinal cortex, dopamine neurotransmission seemed to be more sensitive to the caging conditions since a decreased basal turnover of dopamine was observed in grid-reared animals. Plasma corticosterone levels were also increased in grid-reared animals compared with rats reared in sawdust cages. Finally, isolates reared on grids showed a significant positive correlation between plasma corticosterone levels and dopamine in the left nucleus accumbens.Altogether, these results support the contention that there is a link between social isolation, attention deficit, spontaneous locomotor hyperactivity and reduced dopamine turnover in the medial prefrontal cortex. Furthermore, our data demonstrate that rearing rats in grid-floor cages represents a form of chronic mild stress associated with increased corticosterone levels, decreased basal turnover of entorhinal dopamine and increased dopamine activity in the left nucleus accumbens. Finally, a significant and selective decrease in the basal turnover of serotonin in the nucleus accumbens of isolated rats may be linked to the isolation-induced locomotor hyperactivity.

Acoustic Stimulation↗
PubMed1995

The value of possessions in compulsive hoarding: patterns of use and attachment.

Hoarding behavior, patterns of use of possessions, and emotional attachment to possessions were examined among a sample of female undergraduates and a sample of community volunteers. Hoarding behavior was associated with a decreased frequency of use of possessions and excessive concern about maintaining control over possessions. Furthermore, high scores on the hoarding scale were associated with higher levels of perceived responsibility for: (1) being prepared; and (2) the well-being of the possession. Hoarding was also associated with greater emotional attachment to possessions and to the reliance on possessions for emotional comfort. The implications of these findings for the definition of hoarding are discussed.

Adult↗
PubMed2002

Health implications of animal hoarding.

Animal hoarding is a poorly understood phenomenon, the public health implications of which are not well documented. In this study, professionals dealing with hoarding cases submitted 71 case report forms. The hoarders' residences were characterized by extreme clutter and poor sanitation that impaired ability to maintain functional households. Appliances and utilities were frequently nonfunctional, and animal excrement sometimes accumulated to the extent that the homes were unfit for human habitation. The majority of cases satisfied criteria for adult self-neglect, and dependent elderly people, children, or disabled individuals were present in many of the residences. Animal hoarding may be a sentinel for a range of medical, social, and economic problems. More research addressing the causes and features of animal hoarding is needed to shed light on appropriate interventions.

Adult↗
PubMed1999

Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder.

OBJECTIVE: No consistent predictors of outcome have been identified for the pharmaco-therapy of obsessive-compulsive disorder (OCD). Recent factor analytic studies have identified meaningful symptom dimensions that may be related to response to serotonin reuptake inhibitors and other treatments. METHOD: A total of 354 outpatients with primary OCD were administered the Yale-Brown Obsessive Compulsive Scale Symptom Checklist, and its 13 main symptom categories were factor analyzed by using principal components analysis. The identified symptom dimensions were then entered into multiple regression models as outcome predictors of response to serotonin reuptake inhibitors and placebo response in a group of 150 nondepressed subjects who completed six double-blind, placebo-controlled trials with a serotonin reuptake inhibitor (clomipramine, fluvoxamine, fluoxetine, sertraline, and paroxetine). Eighty-four patients received a serotonin reuptake inhibitor and 66, placebo. RESULTS: The principal components analysis identified five factors that explained 65.5% of variance in outcome: symmetry/ordering, hoarding, contamination/cleaning, aggressive/checking, and sexual/religious obsessions. Serotonin reuptake inhibitors were significantly superior to placebo on all outcome measures. Initial severity of OCD was related to greater posttreatment severity of OCD. Higher scores on the hoarding dimension predicted poorer outcome following treatment with serotonin reuptake inhibitors, after control for baseline severity. No predictors of placebo response were identified. Exclusion of clomipramine did not modify the overall results, suggesting a cross-serotonin reuptake inhibitor effect. CONCLUSIONS: The identified symptom dimensions are largely congruent with those identified in earlier reports. Patients with OCD vary in their response to treatment with serotonin reuptake inhibitors. The presence of hoarding obsessions and compulsions is associated with poorer response to serotonin reuptake inhibitors.

Adolescent↗
PubMed2000

Quantitative and qualitative aspects of obsessive-compulsive behaviour in children with attention-deficit hyperactivity disorder compared with tic disorder.

OBJECTIVE: Within the framework of associated psychopathology in child psychiatric disorders, this study focused on quantitative and qualitative aspects of obsessive-compulsive behaviour (OCB) in both attention-deficit hyperactivity disorder (ADHD) and chronic tic disorder/Tourette's disorder (TD). METHOD: Forty-two healthy controls, 41 children with ADHD and 38 children with TD, aged 9-13 years, were investigated using the Leyton Obsessional Inventory--Child Version (LOI-CV), the Child Behaviour Checklist (CBCL) and an expert-rated structured parent interview to reflect a cross-informant view of OCB. RESULTS: Unexpectedly, self-reports of children with ADHD rather than children with TD showed the highest OCB scores in the LOI-CV. Qualitatively, ADHD-related OCB focused on the item subsets concerning 'dirt and contamination', 'repetition', 'overconscientiousness', and 'hoarding'. In the parent-rated CBCL, similar levels of OCB were reported for ADHD and TD patients. In contrast, only children with TD showed clinically relevant OCB according to expert ratings. CONCLUSION: Not only young TD patients but also children with ADHD should be investigated and monitored carefully for quantitative and qualitative aspects of OCB comorbidity.

Adolescent↗
PubMed1983

Drugs taken by a population based sample of subjects 65 years and over in New Zealand.

Drug taking by a population based sample of 559 subjects aged 65 years and over was investigated. The median number of drugs prescribed for those 65-79 years was 1.5 drugs per subject and for those 80 years and over was 2.1 drugs per subject. In those 80 years and over, over 30% were taking diuretics, over 20% were taking digoxin and over 30% were taking psychotropic drugs. Analysis of those taking six or more drugs showed that the number of drugs prescribed could be reduced by avoiding duplication of drugs with similar action, avoiding unnecessary drugs and avoiding drugs of no proven value. The majority of subjects knew the purpose of their medications, were able to read the prescription instructions and complied with these instructions. Sharing and hoarding of tablets were uncommon.

Aged↗
PubMed2006

Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The authors examined how specific OCD symptom dimensions were related to neuropsychological functions using multiple regression analyses. A total of 39 OCD patients and 40 controls completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994), which is a test of decision making, and the Wisconsin Card Sorting Test (R. K. Heaton, 1981), which is a test of set shifting. OCD patients and controls showed comparable decision making. However, patients with prominent hoarding symptoms showed impaired decision making on the IGT as well as reduced skin conductance responses. OCD patients had poorer set shifting abilities than controls, and symmetry/ordering symptoms were negatively associated with set shifting. These results help explain previous inconsistent findings in neuropsychological research in OCD and support recent neuroimaging data showing dissociable neural mechanisms involved in mediating the different OCD symptom dimensions.

Adolescent↗
PubMed2002

Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents.

The purpose of this study was to discriminate subtypes of obsessive-compulsive disorder (OCD) in a clinical sample of children and adolescents. Sixty OCD patients were assessed in two outpatient psychiatric clinics; 15 patients had a lifetime history of tics and 45 patients had no tic history. Interviews were conducted with the patients and their parents by a child psychiatrist using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). The symptom checklist of the CY-BOCS was used to categorize obsessions and compulsions. Discriminant function analysis was used to compare the two groups in their symptomatology. There was no difference between the two groups in seven obsession categories. However, there was a significant difference between the two groups in seven compulsion categories. Ordering, hoarding, and washing compulsions were more common in those with no tic history. The results indicate that tic-related OCD may be differentiated from non-tic-related OCD early in life by the presence or absence of certain compulsive symptoms.

Adolescent↗
PubMed2004

Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy.

A symptom-based subgroup taxonomy for obsessive-compulsive disorder (OCD) was evaluated and refined. The Yale-Brown Obsessive-Compulsive Scale symptom checklist was scored and cluster analysis was conducted with a sample of OCD patients (N = 114). Results were compared to Calamari et al.'s (Behaviour Research and Therapy 37 (1999) 113) five subgroup model. Rules for determining the number of subgroups supported a more complex model. In between sample comparisons, a stable contamination subgroup was found in both a five and seven subgroup taxonomy. Between sample stability was not as strong for Harming, Obsessionals, Symmetry, and Certainty subgroups. Hoarding, as a distinctive subgroup, was unstable in separate samples. When the Calamari et al. sample and the present sample were combined (N = 220), we found a reliable Hoarding subgroup. More interpretable and stable models emerged with the combined samples suggesting that large clinical samples are needed to identify OCD subgroups. Greater support was found for a seven subgroup taxonomy based subgroup interpretability and validation measure differences. The potential utility of symptom-based subgroup models of OCD and alternative approaches are discussed. Identification of reliable and valid OCD subtypes may advance theory and treatment.

Cluster Analysis↗
PubMed1996

[Modern typology of symptoms and obsessive-compulsive syndromes: results of a large French study of 615 patients].

OBJECTIVES: The most common strategy to search for homogenous subgroups of Obsessive-Compulsive Disorder (OCD) patients has been based on the OCD symptoms themselves as a classifying variables. The purpose of this study was to: expand recognition of major clinical OCD subtypes in a large cohort of patients recruited from the national french survey: "Screening-Understanding-Treating OCD"; reproduce preliminary data coming from a US collaborative study on OCD sub-types [Baer L, J Clin Psychiatry, 1994; 55 (3):18-23]. METHOD: From 731 OCD/OCS (OC disorder or syndromes) patients recruited in the phase 1 of the national french survey, complete collected data on the Y-BOCS Symptom Checklist (YBOCS-CL) were obtained in 615 patients and on the OCD spectrum inventory in 646 patients. Principal components analysis (PCA) was firstly applied on major symptom categories of the YBOCS-CL, and next on each individual symptom. Gender effect on clinical aspects of OCD was also explored by comparative descriptive analysis. RESULTS: The first PCA on major symptoms categories confirmed the grouping of all categories in three major factors, named as following: Facteur 1 = "Predominantly Compulsive" (loaded with items of symmetry, order, hoarding, repeting, counting, checking); Facteur 2 = "Predominantly Obsessive" (loaded with aggression, violent, religious, sexual obsessions) and Facteur 3 = "Mixed" (with contamination and somatic obsessions and washing compulsions). Our data seemed to be very close to US collaborative study that had found in a sample of 107 OCD patients, the presence of the same three major clinical factors. The second PCA applied on all YBOCS-CL individual items had provided interesting items groupings, suggesting a reorganization and re-labelling of YBOCS-CL symptoms categories. Therefore, a new presentation of the YBOCS-CL can be proposed with a more clinical relevance than the original version. Results from OC spectrum inventory showed high comorbidity rate with many of OCD related disorders. Finally, a gender influence on OC clinical manifestations was observed, especially more severity and higher rate of difficult OC-subtypes in male patients. The french national survey data on OC symptoms sub-typing and clustering showed a "natural" groupings of OC symptom categories which add more validity to the subtypes proposed by ICD-10 (based on syndromal predominance : obsessions, compulsions or mixed). These sub-categories are not part of the DSM III-R, neither of the new version of DSM IV!

Adult↗
PubMed2003

Predictors of response in anxiety disorders.

Anxiety disorder variables such as duration, severity of illness, and comorbidity with other anxiety or mood disorders appear to identify individuals who are at the greatest risk of treatment nonresponse. Conversely, in accord with clinical experience, shorter periods of illness, less severe illness, being treatment naive, and the absence of comorbidity tend to identify patients who are likely to respond robustly to medication management. Symptom clusters in OCD and PTSD are promising as a means of stratifying those more likely to respond to standard pharmacologic treatment. The presence of hoarding or sexual obsessions seems to presage poorer response in OCD, while the presence of dissociative symptoms in PTSD has been linked to high nonspecific treatment response rates to placebo. Genotyping individuals with respect to genes that are thought to have an important role in the underlying disease process, such as the work with the 5HTTL-PR allele, is exciting and is perhaps the first glimmer of using genotyping to identify treatment strategies or to predict the likelihood or speed of response. The use of neuroimaging as a means of identifying individuals who may respond favorably to pharmacologic or neurosurgical intervention is still in its infancy. As a strategy, it may help combine symptom severity and response variables into a clear neurobiologic vulnerability model of illness. In the future, it may be possible to identify specific treatment interventions for specific patterns of abnormal metabolic rates in certain areas of the brain. However, it should be emphasized that such an approach has not been empirically demonstrated in a rigorous experimental context at this time.

Anxiety Disorders↗
PubMed2004

The relationship between miscellaneous symptoms and major symptom factors in obsessive-compulsive disorder.

The diverse symptomatology of obsessive-compulsive disorder (OCD) is being increasingly regarded as reducible to a few symptom dimensions. However, prevailing factor-analytically derived models of symptom structure omit a number of the well-recognized "miscellaneous" symptoms of OCD. This study sought to determine whether miscellaneous OCD symptoms, ascertained by the Yale-Brown Obsessive-Compulsive Scale symptom checklist, could be differentially and reliably predicted by four symptom factors (obsessions and checking, symmetry and ordering, contamination and cleaning, and hoarding) in two independent groups of individuals with OCD (n=381 and n=107). Logistic regression analyses were used to determine the association of each of the miscellaneous symptoms with the symptom factors; then a single confirmatory factor analysis was conducted to test the model of associations in the smaller sample. Sixteen (89%) of the 18 symptoms examined were reliably predicted by one (11 items) or two (5 items) of the factors, with obsessions and checking and symmetry and ordering emerging as foremost predictors. The expanded four-factor model showed good fit with data from the second sample. Results are conceptually meaningful, but suggest the inadequacy of groupings based solely upon overt behaviors. These findings may aid clinical understanding of OCD and be of value to studies using symptom factors to guide investigation of its causes and correlates.

Adult↗
PubMed2005

A multidimensional model of obsessive-compulsive disorder.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition. This heterogeneity can reduce the power and obscure the findings from natural history studies to genome scans, neuroimaging, and clinical trials. The authors review the evidence supporting a multidimensional model of OCD. METHOD: Computerized and manual literature searches were performed to identify factor-analytic studies of obsessive-compulsive symptoms before data from disciplines that bear on the potential usefulness of these dimensions were considered. Selection criteria included the novelty and importance of studies and their relevance to outcomes of interest to well-informed mental health professionals. RESULTS: Twelve factor-analytic studies involving more than 2,000 patients were identified that consistently extracted at least four symptom dimensions: symmetry/ordering, hoarding, contamination/cleaning, and obsessions/checking. These dimensions were associated with distinct patterns of comorbidity, genetic transmission, neural substrates, and treatment response. The evidence supporting the hoarding dimension is particularly robust. CONCLUSIONS: The complex clinical presentation of OCD can be summarized with a few consistent, temporally stable symptom dimensions. These can be understood as a spectrum of potentially overlapping syndromes that may 1) coexist in any patient, 2) be continuous with normal obsessive-compulsive phenomena, and 3) extend beyond the traditional nosological boundaries of OCD. Although the dimensional structure of obsessive-compulsive symptoms is imperfect, this quantitative approach to phenotypic traits has the potential to advance our understanding of OCD and may aid in the identification of more robust endophenotypes. The need for a dimensional rating scale and suggestions for future research aimed at reducing the burden of this disorder are discussed.

Brain↗