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PubMed2003

Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases.

OBJECTIVE: Investigation of deep brain stimulation (DBS) as a last-resort treatment alternative to capsulotomy in treatment-refractory obsessive-compulsive disorder (OCD). METHOD: Prospective single-case based design with evaluation of DBS impact on emotions, behaviour, personality traits and executive function in three patients with OCD. RESULTS: Two patients experienced sustained improvement of OCD symptoms with DBS. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) dropped 12 points and 23 points to baseline and Y-BOCS self-rating scale (Y-BOCS-SRS) and Profile of Mood States (POMS) for depression and tension decreased with increasing stimulation amplitude. Total Maladjustment Score on the Brief Psychiatric Rating Scale reduced with 44 and 59% to baseline. Reduction in psychopathology was sustained under continuous stimulation. No deleterious impact of DBS on neuropsychological testing or personality traits measured on a self-rated personality inventory was detected. CONCLUSION: These preliminary findings demonstrate that DBS may have important therapeutic benefits on psychopathology in OCD. No harmful side-effects were detected during follow-up (33/33/39 months, respectively).

Adult↗
PubMed2004

Neurological soft signs in obsessive-compulsive disorder.

BACKGROUND: Neurological soft signs (NSSs) are defined as abnormal motor or sensory findings, including involuntary movements, a variety of dispraxia, difficulties in performing rapid alternating movements, difficulties in two-point discrimination, and graphesthesia in a person without a neurological disorder which can be determined as its focus. AIMS: to investigate the relationship of NSSs with obsessive-compulsive disorder (OCD). SETTINGS AND DESIGN: This study was designed in the Psychiatry Polyclinic of Ondokuz Mayis University Hospital. After signing an informed consent form, all the subjects were divided into 2 groups: (1) the patient group and (2) the control group. MATERIAL AND METHODS: Thirty consecutive patients presenting with DSM-IV OCD were included in this study. The control group consisted of 30 healthy subjects without a psychiatric/neurological disorder. All subjects underwent a physical and neurological examination for soft signs (PANESS). STATISTICAL ANALYSIS USED: The Mann-Whitney U test was used for statistical analysis of data. RESULTS: It was seen that graphesthesia, two-point discrimination, and total PANESS scores were significantly higher in the group with OCD than the control group. In other NSSs, there was no significant difference between the patient and control groups. CONCLUSIONS: Unlike some studies, in the present study, the difference between the groups in graphesthesia compared to other NSSs was significant. The results of this preliminary study suggest that there is a relationship between NSSs and OCD. We think that NSSs may point to a structural brain abnormality in patients with OCD.

Adult↗
PubMed2004

Patterns of obsessive-compulsive symptoms and social function in schizophrenia.

Research has alternately found that obsessive and compulsive (OC) symptoms in schizophrenia are associated with graver and lesser levels of negative symptoms. One possible explanation is that there are two distinct groups of persons with OC symptoms: those with cognitive deficits and high levels of negative symptoms and those who generally function well and have low levels of negative symptoms. To examine this question, we performed a cluster analysis on 66 persons with schizophrenia spectrum disorders on the basis of their level of obsessive-compulsive phenomena and global psychosocial function. Four groups were found: high OC/good function (n=9), non-OC/poor function (n=25), non-OC/moderate function (n=20), and high OC/poor function (n=12). A MANCOVA controlling for age found significant group differences on assessments of negative symptoms, executive function and attention among groups. As predicted, the high OC/poor function group had significantly poorer attention than any other group and poorer executive function than either non-OC group. The high OC/good function had lower levels of negative symptoms than either non-OC group. Implications for research and rehabilitation are discussed.

Cluster Analysis↗
PubMed2003

Psychological profile of dysfunctional dysphonia.

A high degree of emotional maladjustment can be detected in dysfunctional dysphonia. In these patients, it is not rare to observe an immediate resolution of the phoniatric disorder, but it is equally as common to identify a significant rate of recurrence (> 10%) in the short and long term. This phenomenon may be due to poor adaptive ability in the presence of mood disorders. Aims of this study were: a. selection of a suitable instrument to identify "minor" and "major" symptoms of psychiatric nature in dysphonic subjects; b. evaluation of profile of mood disorders in dysfunctional dysphonic adults. Hopkins Symptom Check List 90 was chosen. This is a scale of self-evaluation, adapted in Italian, complete (9 dimensions) and easy to use. It is employed to evaluate the following dimensions: somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, sleep disorders. Three groups were studied: group 1:40 patients (36 female, 4 male; aged 18-62 years, mean 42) with dysfunctional dysphonia; group 2: 20 patients (18 female, 2 male; aged 19-61 years, mean 43) with ENT disorders; group 3: 20 subjects (18 female, 2 male; aged 18-62 years, mean 42.2) as controls. In the statistical analysis, a one-way variance between the three groups and a post-hoc analysis using Schiffé test (level of significance 0.05) were carried out. Results showed significant differences between group 1 and groups 2 and 3 as far as concerns anxiety, phobia, obsessive-compulsive, interpersonal sensitivity and somatization variables. A significant difference was found only between groups 1 and 3 as far as concerns the variables: sleep disorders, depression and paranoid ideation. No significant difference emerged between the groups regarding psychoticism and anger/hostility dimensions. The present study identified a definite profile of minor personality disorders, of an anxious nature, with evidence of somatization, interpersonal sensitivity and obsessive-compulsive type traits, significantly prevailing in dysfunctional dysphonic subjects. Symptom Check List-90 has, therefore, proven to be an adequate instrument in the more complete definition of subjects affected by dysfunctional dysphonia aiming at referral to an integrated protocol which focuses on phoniatric treatment using an approach which acts upon the behavioural aspects of communication.

Adolescent↗
PubMed1998

Adult head-banging and stereotypic movement disorders.

Stereotypic movement disorders (SMD) such as head-banging, which are common among children with mental retardation or pervasive developmental disorders, may also occur in intellectually normal adults. We report a 27-year history of daily head-banging with self-injury in a 49-year-old man with normal cognition. The patient had no personal or family history of Tourette's syndrome, tic disorder, obsessive-compulsive disorder (OCD), or mental retardation. The frequency of his stereotypical head-banging increased with anxiety, loud noises with startle, and boredom. He reported a sense of pleasure from his head-banging, and the frequency of this behavior decreased when he was treated with the opioid antagonist naltrexone. Although not diagnostic, the self-stimulatory or pleasurable component of head-banging, body-rocking, thumb-sucking, and other SMD may help distinguish them from tics, Tourette's syndrome, OCD, and deliberate self-harming behavior. This report reviews the disorders associated with SMD and discusses the potential mechanisms for these behaviors. The treatment of SMD includes drugs that work through opioid, serotonergic, or dopaminergic systems.

Adult↗
PubMed2002

Body dysmorphic disorder in outpatients with major depression.

BACKGROUND: Body dysmorphic disorder (BDD) is a distressing and impairing preoccupation with an imagined or slight defect in appearance, with depression as its most frequent comorbid condition. The purpose of this study was to evaluate the rate of BDD in a cohort of consecutive outpatients with typical and atypical major depressive disorder. METHODS: Three hundred and fifty consecutive outpatient subjects with major depression who entered an antidepressant treatment study were evaluated drug-free with the SCID-P, SCID-II, a diagnostic module for BDD, and other measures. Depressed subjects with comorbid BDD were compared to those without BDD with regard to demographics, course of depression, comorbid conditions, and other relevant variables. RESULTS: Twenty-eight (8.0%) subjects had a lifetime history of BDD and 23 (6.6%) had current BDD. Those with comorbid lifetime BDD had an earlier age of onset of depression and longer duration of the current episode, but not a greater number of depressive episodes or greater severity of depression. Subjects with and without BDD were similar with respect to age, gender, and marital status. There was a higher rate of lifetime and current BDD in subjects with atypical depression than in those with non-atypical depression (14.4% compared to 5.1%; chi2 = 6.63; P = 0.01: 11.6% vs. 4.1%; chi2 = 7.02; P = 0.02). Subjects with BDD also had higher rates of social phobia, any eating disorder, and any somatoform disorder but not obsessive compulsive disorder. They also had higher rates of avoidant, histrionic, and dependent personality disorders. LIMITATIONS: As we did not specifically examine bipolar spectrum conditions, the present study cannot address to what extent BDD is comorbid with Bipolar-II disorder. CONCLUSIONS: BDD is frequently comorbid with major depression, is associated with an earlier age of onset of depression and longer duration of depressive episodes, and is found more frequently with atypical than non-atypical depression.

Adolescent↗
PubMed1998

Evidence for linkage disequilibrium between serotonin transporter protein gene (SLC6A4) and obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is characterized by recurrent and intrusive thoughts that are distressing (obsessions) and/or repetitive behaviors or mental acts that the person feels driven to perform (compulsions). OCD has a partly genetic basis. For treatment of OCD, potent serotonin reuptake inhibitor (SRI) drugs (clomipramine (Anafranil), fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil)), which act on the serotonin transporter protein, are uniquely efficacious. A polymorphism in the promoter region of the gene (SLC6A4) encoding this protein, was recently reported to affect protein expression and to be associated with measures of anxiety and depression and with autism (using a family-controlled transmission disequilibrium test (TDT) design). SLC6A4 therefore has strong a priori support for potentially influencing risk for OCD: the protein it encodes is a medication target; a polymorphism in the gene affects function; and that polymorphism has been shown to be associated with behavioral phenotypes. We used the TDT with a set of 34 European-American family trios, 30 unrelated and four drawn from an extended pedigree, to test for linkage disequilibrium between OCD and alleles at the SLC6A4 promoter polymorphic locus. Of 35 heterozygous parents, 24 transmitted the 'l' SLC6A4 allele and 11 transmitted the 's' allele (chi 2 TDT = 4.83; P < 0.03). Considering only the 13 SRI drug nonresponders, there were 13 heterozygous parents, of whom 10 transmitted the 'l' allele and three the 's' allele (chi 2 TDT = 3.77; P < 0.052). These data provide preliminary support for association and linkage disequilibrium between the SLC6A4 'l' allele and OCD.

Adolescent↗
PubMed1985

[Pleiotropic tics and early disorders of ego development].

The long-term inpatient psychotherapeutic treatment of a 10-year-old girl with pleiotropic tics, aggressive behavior and a conduct disorder is described. The symptoms were present in the context of a compulsive-depressive personality development. The positive course of treatment is interpreted from a psychoanalytic perspective.

Child↗
PubMed2006

The validity of Cloninger's psychobiological model versus the five-factor model to predict DSM-IV personality disorders in a heterogeneous psychiatric sample: domain facet and residualized facet descriptions.

The validity of Cloninger's psychobiological model and the Five-Factor Model of personality to predict DSM-IV personality disorders was examined in a psychiatric in-patient sample of 130 individuals. Patients completed Dutch authorized versions of the TCI (Cloninger, Svrakic, & Przybeck, 1993) and the NEO PI-R (Costa & McCrae, 1992) and were also administered the ADP-IV (Schotte & De Doncker, 1994), a Dutch self-report questionnaire to assess Axis-II disorders. No personality-descriptive model proved to be superior in explaining personality disorder symptoms at the higher-order level: the TCI dimensions better explained the Obsessive-Compulsive and the Narcissistic disorders, whereas the FFM accounted for more variance of the Avoidant disorder. However, differences were apparent at the lower-order level with the NEO facets out performing the TCI subscales for six to four personality disorders. FFM facet-level predictions of Widiger, Trull, Clarkin, Sanderson, and Costa (2002) were partially confirmed, with substantially better results using residualized facet scores. A set of TCI subscale personality disorder relationships is suggested.

Adolescent↗
PubMed2000

Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD): a 12-week open trial.

A few studies have tried antipsychotic augmentation in obsessive-compulsive disorder (OCD) patients who are non-responders to selective serotonin reuptake inhibitors. The aim of this study was to investigate the efficacy and tolerability of olanzapine addition to fluvoxamine-refractory OCD patients and to assess if a comorbid chronic tic disorder or a concomitant schizotypal personality disorder was associated with response. Twenty-three OCD non-responders to a 6-month, open-label trial with fluvoxamine (300 mg/day) entered a 3-month open-label trial of augmentation with olanzapine (5 mg/day). OC symptom change was measured with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale. Differences between responders and non-responders were assessed with regard to age, sex, duration of illness, baseline Y-BOCS score, and comorbidity with chronic tic disorders or schizotypal personality disorder. A significant decrease of mean Y-BOCS score between pre- and post-treatment (26. 8+/-3.0 vs. 18.9+/-5.9) was found at endpoint. Ten patients (43.5%) were rated as responders. The most common side effects were mild to moderate weight gain and sedation. In our sample, three patients (13. 04%) had a chronic motor tic disorder, and four (17.39%) had a codiagnosis of schizotypal personality disorder. Concomitant schizotypal personality disorder was the only factor significantly associated with response. It appears that augmentation of olanzapine in fluvoxamine-refractory OCD may be effective in a large number of patients, including those with comorbid schizotypal personality disorder.

Adolescent↗
PubMed1995

[Ambulatory behavior therapy in obsessive-compulsive disorders].

The term Obsessive Compulsive Disorder (OCD) is a label for a variety of syndromes with changing symptom configurations and different intraindividual as well as interactional functions. They are among the most difficult to treat psychiatric disorders. Heterogeneous variables affecting personal development in family, school, and peer-group, as well as genetic or brain organic variables contribute to the development of obsessions and compulsions. In more than 50% of patients with OCD we find one or more of the following disturbances before the outbreak of the disorder: low self-esteem; social deficits; increased anxiety level with increased, latent aggressiveness; striving for 100% security. Behaviour therapy today is the "treatment of choice" for OCD--both in respect of direct symptom reduction as well as the treatment of "causes", co-morbidity and risk factors. Additionally to the use of highly standardised "symptom techniques" individualized, multimodal treatment is necessary in the more severely disturbed patients. Long-term follow-up results show 50-80% success--probably depending on variations in the study samples regarding the type of obsessions and compulsions, the degree of developmental deficits before the occurrence of OCD, actual co-morbidity, and professional as well as private life conditions. Whether and to what degree additional psychotropic medication can enhance the efficacy of behaviour therapy, and whether the high relapse rates of 70% after discontinuation of previously successful drug treatment can be reduced by concomitant or subsequent behaviour therapy, cannot be safely concluded from the currently available studies. Are the non-responders in each of these treatments the responders of the non-responders in the alternative treatment mode?

Ambulatory Care↗
PubMed1987

Motor, behavioral and pharmacologic findings in Tourette's syndrome.

We studied 112 patients with Tourette's syndrome (TS); the male-to-female ratio was 3.8, the mean age of onset was 7.3 years, and the average duration of symptoms prior to the initial evaluation was 15.2 years. Seventy-nine percent of the patients had at least one family member with motor or vocal tics, and an additional 10 percent had a family member with marked obsessive-compulsive behavior. Simple motor tics occurred as the presenting symptom in about one-third of patients; one-third had multiple motor tics at the onset, and another third started with vocal tics. During the course of the illness all patients developed multifocal motor tics and 86 percent had vocal tics. Verbal and mental coprolalia was present in 44 percent of the patients. Copropraxia was seen in 19 percent of patients, and both coprolalia and copropraxia were more frequent among the males than expected. Attentional deficit disorder was diagnosed in 36 percent of the patients and 32 percent had obsessive-compulsive personality. Sleep disturbances were reported by 62 percent of the patients and polysomnographs in 34 patients showed motor and vocal tics during all stage of sleep, sleep apnea, abnormal arousal pattern, and other sleep disturbances. Patients with mild symptoms improved with clonidine or clonazepam, but those with more advanced disorder required fluphenazine, pimozide, haloperidol or tetrabenazine.

Adolescent↗
PubMed2004

Psychological correlates of comorbid gambling in psychiatric outpatients: a pilot study.

This study compared psychiatric outpatients with and without lifetime gambling problems on clinical disorder and personality disorder scales, and the relationship of these scales with involvement in gambling. One hundred and sixty-two adults (females = 112) in an urban, outpatient psychiatric setting completed the South Oaks Gambling Screen (SOGS; Lesieur, H. R., Blume, S. B. (1987). The south oaks gambling screen (SOGS): a new instrument for the identification of pathological gamblers. Am. J. Psychiatry 144(9):1184-1188) and the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, T. (1987). Manual for the MCMI-II: 2nd Edition. Minneapolis, MN: National Computer Systems, Inc.) after their initial psychiatric evaluation in 1999. Avoidant and compulsive personality features were significantly related to gambling problem status. The Self-Defeating and Dysthymic Disorder scales were positively associated with gambling involvement. The Alcohol Dependence scale was predictive of gambling involvement for males only. Findings are somewhat consistent with the literature examining comorbidity in pathological gamblers seeking treatment, although no association was found with antisocial personality disorder.

Adult↗
PubMed1984

Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances.

The nature of the relationship between 'panic disorder', agoraphobia and general anxiety disorder remains open. The aetiological theories which have tried to link them with the aid of biological and psychological concepts fail to take account of conflicting observations. 'Panic' attacks are not confined to agoraphobic and related disorders, being indistinguishable from the attacks of acute anxiety and phobic aversion manifest in a wide range of anxiety and affective disorders. There is continuity and discontinuity in the evolution of agoraphobia; those affected differ in respect of a range of premorbid features from patients with other disorders and control subjects. These variables include family history, life development, trait anxiety and other personality characteristics including introversion, neuroticism and probably emotional dependence on others. Not all the claims made on behalf of the efficacy of pharmacological treatment on the one hand and behavioural therapies on the other are substantiated. The success achieved by behavioural treatment appear to endure over some years. But the residual disabilities and defects that follow all forms of treatment and the problems posed by patient selection and high drop-out rates have received insufficient attention. Aetiological theories of agoraphobia and related conditions have been advanced along biomedical, psychological and psychodynamic lines. Some evidence supports each kind of theory. But none is wholly consistent with the findings regarding its phenomenology and evolution. Recent biological investigations have led to the formulation of hypotheses in relation to anticipatory and chronic anxiety in terms of changes in synaptic connections, enhancement of transmitter release as well as alterations in molecular configuration and regulation of gene expression. It would be premature to conclude that these findings can provide a unitary conceptual framework for the explanation of human anxiety disorders. The psychological, behavioural and psychodynamic aspects of this group of disorders should all continue to receive due attention both in clinical management and scientific investigation.

Adolescent↗
PubMed1986

The dilemma of Howard Hughes: paradoxical behavior in compulsive disorders.

The history of Howard Hughes illustrates an unusual variant or end state of obsessive-compulsive neurosis in which a germ phobia coincides with the deliberate avoidance of cleaning and neglect of personal hygiene. We have reported on three patients who share similar symptomatology. In these cases, the coincidence of personal filthiness and a germ phobia appear paradoxical.

Adult↗
PubMed1991

Compulsive procrastination: some self-reported characteristics.

In Sample 1, 46 procrastinators compared with 52 nonprocrastinators claimed lower self-esteem, greater public self-consciousness and social anxiety, and a stronger tendency toward self-handicapping. In Sample 2, 48 procrastinators compared with 54 nonprocrastinators reported a weaker tendency toward seeking self-identity information but a stronger tendency toward a diffuse-identity style, yet there were no significant differences in verbal and abstract thinking abilities. Further research must provide evidence for persistent procrastination as a personality disorder that includes anxiety, avoidance, and a fear of evaluation of ability.

Adult↗