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PubMed1996

Early compliance and other factors predicting outcome of exposure for obsessive-compulsive disorder.

BACKGROUND: Identifying predictors of treatment outcome can suggest ways to improve treatment delivery and understanding of its mechanism of action. METHOD: Predictors of treatment outcome were sought among 46 out-patients with obsessive-compulsive disorder who completed a nine-week randomised controlled trial of two forms of exposure therapy with ritual prevention. RESULTS: In both exposure conditions the best predictor of good outcome at the end of treatment (week 9) and of follow-up (week 32) was early compliance in doing exposure homework within a week of starting treatment. A weaker predictor of good outcome at follow-up was within-session reduction in anxiety from weeks 0 to 4. CONCLUSION: The strongest and most consistent predictor of better outcome to weeks 9 and 32 was compliance with exposure and ritual prevention in the first week of treatment.

Adult↗
PubMed2006

Processes of inference, schizotypal thinking, and obsessive-compulsive behaviour in a normal sample.

Previous research has shown inferential confusion as measured by the Inferential Confusion Questionnaire to be related to obsessive-compulsive symptoms. A total of 108 participants (41 men and 66 women) from a normal population in The Netherlands (M age = 46 yr., SD = 15.5) completed a package of questionnaires measuring inferential confusion, schizotypal symptoms, and obsessive-compulsive behaviour. As expected, scores for both inferential confusion and schizotypal symptoms were significantly related to those for obsessive-compulsive behaviour. In addition, analysis showed that inferential confusion and schizotypal symptoms shared common variance, but both predicted an independent portion of the variance in obsessive-compulsive behaviour while controlling for neuroticism. The present results call for further inquiry into the role of inferential confusion and schizotypal thinking in obsessive-compulsive behaviour.

Adult↗
PubMedDate not supplied

[Prospective follow-up over a 12 month period of a cohort of 155 patients with obsessive-compulsive disorder: phase III National DRT-TOC Study].

In the phase III of the french national study on OCD, 155 patients suffering from an OCD (full DSM III-R criteria, score on NIMH-OC > or = 7, not treated or undertreated) had entered a naturalistic follow-up of 12 months duration. Obsessions, compulsions, depression, anxiety, impulsivity and global functioning were assessed by using NIMH-OC, CPRS-OC2, MOCI, MADRS, HAD (-A, -D), BDS (Behavioral Dyscontrol Scale), CGI and GAS (DSM III-R). From the initial population (155 patients), 130 (84%) had been treated with drugs and were "completers" and assessed at M6 and M12; 18 (11.6%) were lost to follow-up and 7 (4.5%) had dropped out because of treatment refusal, side-effect or improvement. Only 19% of patients had received a behavior therapy. In spite of selection of patients with severe and chronic OCD associated to depression (mean MADRS score = 25), 85% of treated patients had been treated with one anti-OCD drug (105 with fluoxetine, 17 with clomipramine and 17 with other antidepressants), 4.5% needed a treatment substitution and 4.5% a bitherapy (combination of 2 anti-OCD drugs); 84% of patients were considered as "good compliant" with visit agenda and treatment. At the end of follow-up, global improvement was observed in 77% of patients treated. Clinical improvement was assessed by different response criteria (final NIMH-OC score, 30% decrease on NIMH-OC, 35% decrease on MOCI, final GAF score > or = 70) which showed 4 patterns of response to treatment: "positive response on M6 and M12" = 43-64%; "only M12" (slow response) = 13-24%; "only M6" (escape or relapse) = 4-6%; "negative response on M6 and M12" (resistant OCD) = 19-33%. During 12 month treatment, 31 patients (22.5%) had presented an adverse effect in which 7 cases (5.1%) with "serious adverse event" and 5 cases (3.6%) who required treatment drop-out. Predictive factors of clinical response to anti-OCD drugs were explored: 1) "lack of insight" was the best factor to characterise the resistant group; 2) high base-line of "impulsivity" predict better response at M6; 3) important to severe slowness was associated with a longer delay to response (between M6 and M12). The results of the phase III from the french multi-site study will be compared to the international data on long-term treatment of OCD.

Adult↗
PubMed2002

[Invisible fathers: child development and family dynamics after heterologous insemination].

This study presents the long term outcome of the psychotherapy of a girl over seven years, which was born after donor insemination (DI) and aged eight became ill with a compulsive disorder. Aspects of child development, communication within the family and family dynamics related to this specific constellation are pointed out. This case-study presents one of the very few supplements to statistic data elaborated about assitsed-reproduction-families. Implications for individual therapy and therapeutic management of the family are discussed according to development of bonding and identity of the DI-child, father's role, dynamics of the couple and the incognito of the "invisible father".

Adolescent↗
PubMed2002

Diazepam use during pregnancy: a review of the literature.

Antianxiety medications such as benzodiazepines (BZDs) are frequently and appropriately used to ameliorate the anxiety symptoms of depression, dysthymic disorder, panic disorder, agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, eating disorder, and many personality disorders. Pregnancy may be accompanied by anxiety necessitating therapeutic intervention by anxiolytic drugs like BZD. Keeping in view the potential risks of teratogenicity and direct neonatal toxicity, BZDs with established safety records should be used, while avoiding exposure in the first trimester, especially with multidrug regimens, and prescribing the lowest dose for the shortest duration. This literature review highlights information from various sources regarding safety data of exposure of pregnant and lactating mothers to long-acting BZDs, especially diazepam.

Animals↗
PubMed1985

Behavior therapy and the anxiety disorders: some conceptual and methodological issues.

Some of the methodological and conceptual issues relevant to behavior therapy treatment outcome studies for anxiety disorders are presented. The practice among behavioral researchers of measuring anxiety from 3 response systems (verbal, physiological and motoric-behavioral) is discussed. It is emphasized that many of the popular methods used to assess the 3 response systems have unknown or poor reliability or validity. From the point of view of treatment variables, it is noted that many behavioral treatment procedures are not reported in sufficient detail to allow replication or comparisons to be made across studies. In addition, it is argued that in order to improve the existing treatment procedures, it will be necessary for each study to assess the subjects' adherence to the treatment regimen, as well as their proficiency with any skills required to carry out the treatment plan. Finally, the importance of 'placebo' control groups is discussed in the context of identifying the specific factors in behavioral treatments which are responsible for change in the targeted symptoms. It is concluded that behavior therapy holds promise as an effective treatment for the anxiety disorders.

Anxiety Disorders↗
PubMed1984

Distinctive somatosensory evoked potential features in obsessive-compulsive disorder.

The purpose was to determine whether obsessive-compulsive disorder (OC) is associated with a distinctive pattern of somatosensory evoked potential (SEP) measurements, based on amplitudes of the N60 (negativity 60 msec poststimulus), P90, and N130 peaks. Previously, we found higher N60 amplitudes in 14 OC patients than in controls or other neurotics. Here, SEPs of the same 14 OCs were compared with those of 28 other neurotics, 99 nonpatients, 49 chronic schizophrenics, 27 "other" schizophrenics, 20 DSM-II latent schizophrenics, and 42 major depressives. Utilizing all available subjects, each peak amplitude was factor analyzed across 14 leads; the resulting factor scores were compared between OCs and every other group. The factor scores of OCs differed from those of all other groups, and patterns of factor score differences were similar in all comparisons. Most discriminations were replicable in split-half analyses. OC appears to be associated with a relatively distinctive pattern of middle latency SEP peak amplitude measurements.

Adult↗
PubMed1995

Behavior and the basal ganglia.

When viewed as a whole, these basal ganglia-thalamo-cortical circuits appear to play a modulating role in a wide range of behaviors. At the cortical level, given convergence upon specified regions within the frontal lobes, the behaviors in question would be those dependent upon SMA, premotor, frontal eye fields, dorsolateral, and orbitofrontal outflow targets. Broadly speaking, processes such as the generation, maintenance, switching, and blending of motor, mental, or emotional sets would be involved. Accordingly, in basal ganglia disease, the planning and the execution of the above behavioral domains can be affected. Given the diversity and complexity of activity within the basal ganglia, the consequences of disruption depend largely upon lesion site and the associated interplay of neurochemical factors. For example, in the motor domain, damage to various striatal circuitry levels can result in either hypo- or hyperkinetic disorders of movement. Following this analogy, it might also be said that diverse lesions, depending on site, can result in problems with the development and maintenance of behavioral sets ("hypophrenic") versus problems in relinquishing preferential sets ("hyperphrenic"). These contrasting patterns are best represented in PD and OCD, respectively. In the latter case, however, the "hyperphrenic" pattern would only apply to those behaviors which are part of the obsessional rituals. This suggests that procedural system "overdrive" remains domain-specific as is the case for most operations within the procedural system. To return to the broad principle of habituation, a process first described in the context of the visual system and its connections with the tail of the caudate nucleus, it would be tempting to view PD and OCD as disorders of "under" and "over" habituation to behavioral routines. Unfortunately, the situation has proven to be more complex in view of recent neuropsychological findings (Nicholson et al., in preparation). Using a variety of problem-solving and other cognitive tasks, both PD and OCD patients were found to require more practice and/or the provision of external guidelines to facilitate habit formation. Thus, in both cases, as in other disorders of the basal ganglia, the establishment of useful heuristics by which to direct adaptive behavior suffers. OCD patients therefore appear to have at least two compartmentalized types of basal ganglia dysfunction: the ritualistic compulsions and obsessions as well as the heuristic inefficiency (i.e., poor procedural mobilization). PD patients would also suffer a similar fate as it is known that the degrees of motor versus nonmotor (i.e., procedural) deficit are poorly correlated (42).(ABSTRACT TRUNCATED AT 400 WORDS)

Affect↗
PubMed1998

Neurosurgical treatment of obsessive-compulsive disorder.

BACKGROUND: Case reports suggest that neurosurgical operations can improve symptoms in patients with severe treatment-refractory obsessive-compulsive disorder (OCD). However, it is unclear which procedure is best and which may produce the most side-effects. METHOD: I review the literature on the efficacy and complications of four frequently used neurosurgical procedures (cingulotomy, capsulotomy, limbic leucotomy and subcaudate tractotomy) that are used to treat refractory OCD. RESULTS: Since the vast majority of patients who underwent surgery were severely and chronically disabled, it is likely that these procedures were of assistance in alleviating some of their symptoms. It is currently impossible to determine which surgical procedure is the best for a particular patient. CONCLUSIONS: Despite a lack of controlled data and inconsistencies in the literature, it appears that when non-surgical treatments have failed to improve OCD symptoms significantly in severely ill patients, at least partial relief can be obtained by some people with OCD by neurosurgery. Results of cumulative studies strongly support the need for continued research in this area.

Cognition Disorders↗
PubMed2006

Obsessive-compulsive behaviours in specific situations: the relative influence of appraisals of control, responsibility and threat.

Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts by the individual to control their thoughts and by taking action through rituals in order to prevent feared or personally distressing outcomes. While cognitive theories of OCD have generated supportive research findings and effective treatments, they have not considered broader control beliefs that may motivate aspects of OC-phenomenology. We have previously proposed that broader control beliefs, specifically desire for control and sense of control, may play a role in OC-symptoms (Moulding & Kyrios, 2006). In the present study, non-clinical participants (N=219) were presented with four hypothetical scenarios relevant to an OCD-checking concern, and using a manipulation paradigm, the relationship between control constructs and appraisals hypothesized to be relevant to OCD (threat, responsibility) was examined. Desire for control was moderately affected to responsibility and threat appraisals, while sense of control did not relate to these constructs. The relationship between aspects of OC-phenomenology and appraisals of control, responsibility and threat were also investigated. Higher desire for control predicted both affect and action, while a lower sense of control predicted higher distress and action, over-and-above appraisals of threat and responsibility. Control appraisals were particularly relevant to use of action, and to affect in the low responsibility situations. A possible interactive model of desire for control, threat and responsibility is discussed.

Adolescent↗
PubMed2006

Mental disorders in female prisoners.

OBJECTIVE: The objective of the study was to investigate the rates of mental disorder among women in prison in Victoria, and to compare with community rates. DESIGN: A midnight census of all women in prison in Victoria was undertaken. Respondents were interviewed with a version of the Composite International Diagnostic Interview (CIDI), an adapted version of the Personality Diagnostic Questionnaire (PDQ-4+) and a demographics questionnaire. MAIN OUTCOME MEASURES: Twelve-month prevalence rates of ICD-10 mental disorders including depressive disorders, anxiety disorders and drug-related disorders were examined. Prevalence of personality disorders was also investigated. RESULTS: Eighty-four per cent of the female prisoners interviewed met the criteria for a mental disorder (including substance harmful use/dependence) in the year prior to interview. This rate was reduced to 66% when drug-related disorders were excluded. Forty-three per cent of subjects were identified as cases on a personality disorder screener. For all disorders, (except obsessive-compulsive disorder and alcohol harmful use) women in prison had a significantly greater likelihood of having met the 12-month diagnostic criteria when compared to women in the community. The most prevalent disorders among the female prisoners were: drug use disorder (57%), major depression (44%), Posttraumatic stress disorder (36%), and personality disorders. Almost a quarter (24%) of respondents were identified as a 'case' on the psychosis screen. CONCLUSIONS: In the present study female prisoners had significantly higher rates of the mental disorders investigated (with the exceptions of OCD and alcohol harmful use) when compared with women in the community. The pattern of disorder found among female prisoners is consistent with the abuse literature, suggesting that histories of abuse among the prison population may account for part of the discrepancy. These results highlight the need for improved assessment and treatment resources to meet the demands of this population.

Adult↗
PubMed2003

Lamotrigine prevents ketamine but not amphetamine-induced deficits in prepulse inhibition in mice.

RATIONALE: Lamotrigine, a broad-spectrum anticonvulsant known to block brain sodium channels, is effective in the treatment of persons with bipolar disorder, perhaps by virtue of its ability to reduce glutamate release. Furthermore, lamotrigine decreases the perceptual abnormalities produced by the N-methyl- d-aspartate (NMDA) antagonist ketamine in humans, similar to the effects of the atypical antipsychotic clozapine. Acutely manic bipolar patients, like persons with schizophrenia, Tourette's, and obsessive compulsive disorder, exhibit decreases in sensorimotor gating, as measured by prepulse inhibition of the startle response (PPI). OBJECTIVE: We assessed the ability of lamotrigine to reduce the PPI-disruptive effects of ketamine and the dopaminergic agent amphetamine in two inbred mouse strains, C57BL/6J and 129SvPasIco. METHODS: Mice were tested in a standard PPI paradigm after administration of lamotrigine (0, 6.7, 13, or 27 mg/kg) or a combination of lamotrigine (27 mg/kg) and either d-amphetamine (10 mg/kg) or ketamine (100 mg/kg). RESULTS: In the 129SvPasIco mice, lamotrigine reversed the ketamine-induced PPI deficit, without altering PPI in control mice. In C57BL/6J mice, however, 27 mg/kg lamotrigine generally increased PPI in both control and ketamine-treated mice. Lamotrigine did not ameliorate the amphetamine-induced PPI deficit in either strain. CONCLUSIONS: In conclusion, lamotrigine can increase PPI on its own and prevent ketamine-induced, but not amphetamine-induced, disruptions of PPI. These results suggest that lamotrigine may exert its effects on PPI through the glutamatergic system.

Acoustic Stimulation↗
PubMed2000

Compulsivity and obsessionality in opioid addiction.

Seventy-one individuals with opioid dependence undergoing ambulatory treatment participated in a personal interview assessing the importance of their opioid-use rituals, the severity of compulsivity and obsessionality in relation to their drug use, and the number of obsessive compulsive disorder (OCD) symptoms. The level of compulsivity and obsessionality in opioid dependence was comparable to that found in OCD and alcohol addiction. The importance of rituals was inversely related to the number of opioid lapses during rehabilitation treatment and positively correlated with the number of non-drug-related OCD symptoms. Based on established norms for OCD symptoms, we estimated that 11.4% of our sample would meet diagnostic criteria for OCD, a rate which is over 4 times higher than the rate of OCD in the general population.

Adult↗
PubMedDate not supplied

Patterns of relation and premorbid personality in late paraphrenia and depression.

38 patients with late paraphrenia and 38 with endogenous depression of late onset were compared regarding interpersonal relations and personality traits by means of semistructured interviews. The prevalence of premorbid personality disorder was determined by the Structured Clinical Interview for DSM-III-R Personality Disorders. The main objective of the study was to look for lifetime relation patterns and personality traits distinguishing the two groups and pointing to a specific premorbid vulnerability of paranoid and depressive patients. A high rate of personality disorder comorbidity was found in both groups, with mainly paranoid and schizoid disorder in late paraphrenic patients (39%) and avoidant, dependent or compulsive personality in depressives (35%). As a rule, this corresponded to a lifelong pattern of seclusion and self-sufficiency in the paranoid, and of close intimacy and heteronomy in the depressive patients. On the basis of the results, a polar typology of personality and interpersonal relations in both patient groups is developed.

Age Factors↗