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PubMed1981

Obsessive-compulsive behavior: an overview of four psychological frameworks.

Four frameworks for understanding obsessive-compulsive behavior have been presented. It is apparent that there is no single, simple basis for obsessive-compulsive symptomatology. Obsessions and compulsions are manifestations of different psychological processes and may exist in conjunction with many types of mental illness in addition to those presented. With increased knowledge about the dynamics of obsessions and compulsions, the mental health professional will achieve a greater understanding of the client who expresses himself through these symptoms.

Cognition↗
PubMed1984

Cocaine abuse and its treatment.

Increasing numbers of individuals with a diagnosis of cocaine abuse (DSM-III, 305.6) are seeking medical and psychiatric care. The majority of users inhale the drug in powdered form, as cocaine is rapidly absorbed by mucous membranes. The patterns of use resemble those for the use of alcohol and marijuana: recreational, intensified, circumstantial, and compulsive. When cocaine is taken intravenously or by freebasing, individuals are much more vulnerable to developing a compulsive pattern of use that could lead to an organic delusional syndrome. Cocaine causes systemic effects that are similar to those of amphetamine, but they have a much shorter duration of action. Blood pressure, heart rate, feelings of "pleasantness" and "stimulation" are increased, and hunger is decreased. Acute tolerance may develop over hours of continuous use, but it disappears after a short period of abstinence (overnight). In psychomotor testing, performance that is impaired by fatigue is restored to baseline levels. Users like cocaine because they feel more alert, energetic, sociable, and sensual. However, these positive feelings are commonly followed by anxiety, depression, irritability, fatigue, and craving more cocaine. Chronic intoxication is always associated with adverse psychosocial sequelae. Treatment initially must be directed toward the patient's stopping all use of cocaine, employing strategies such as contingency contracts, urinalysis, family intervention, the assignment of financial control to others, or hospitalization. Several psychopharmacologic agents are helpful as an adjunct to a comprehensive treatment plan. Overdoses of cocaine are treated by diazepam and propranolol. Antidepressant medications, both TCAs and MAOIs, often help relieve the symptoms of depression that emerge when chronic use of cocaine is discontinued. Classical and operant conditioning contribute to craving for the drug and opportunities to extinguish these factors are valuable in preventing relapse. Compulsive users often have an Axis II diagnosis of borderline or narcissistic personality disorder, which require long-term psychodynamic psychotherapy.

Antidepressive Agents↗
PubMed2002

Comorbid psychiatric disorders in late life depression.

In late life depression, common comorbid psychiatric disorders are alcohol use, anxiety, and personality disorders. Elderly depressed patients are three to four times more likely to have an alcohol use disorder compared with nondepressed elderly subjects, with a prevalence of 15%-30% in patients with late life major depression. While the presence of a comorbid alcohol use disorder may worsen the prognosis for geriatric depression, limited data suggest that successful treatment of depression combined with reducing alcohol use leads to the best possible outcomes. Most studies show that the overall prevalence of anxiety disorders, particularly panic disorder and obsessive-compulsive disorder, is low in geriatric depression, but generalized anxiety disorder may not be uncommon. It remains unclear if the presence of a comorbid anxiety disorder impacts on the treatment and prognosis of late life major depression. Personality disorders occur in 10%-30% of patients with late life major depression or dysthymic disorder, particularly in patients with early onset depressive illness. Cluster C disorders, including the avoidant, dependent, and obsessive-compulsive subtypes predominate, while Cluster B diagnoses, including borderline, narcissistic, histrionic and antisocial, are rare. Overall, the research database on comorbid psychiatric disorders in major and nonmajor late life depression is relatively sparse. Since comorbid psychiatric disorders affect clinical course and prognosis, and may worsen long-term disability in late life depression, considerably more research in this field is needed.

Aged↗
PubMed2003

[Obsessive-compulsive disorders in children and adolescents--a review].

OBJECTIVE: Presented is a review of the literature on the medium- and long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence. METHODS: Using the data bank MEDLINE, relevant studies published since 1983 were investigated. Older studies were included if their results complemented those of recent studies. RESULTS: Follow-up studies point to a rather unfavorable course of childhood OCD. At the time of follow-up investigations, 30% to 70% of the patients still suffered from obsessive-compulsive symptoms or had a diagnosis of OCD. Other clinical disorders were diagnosed in 20% to 95% of them. One to two thirds of former patients had received at least one diagnosis of a personality disorder. Multicomorbidity was common. Impairment of the patients' psychosocial adjustment especially affected relationships and sexuality. Most of the variables examined in childhood or adolescence had no significant predictive power as to the course of obsessive-compulsive disorders. CONCLUSIONS: Differences between the results of the follow-up studies can partly be explained by the different study designs employed. Results on the course of childhood OCD point to the high stability of the disorder and the accompanying rate of comorbidity. This has to be taken into account in the diagnosis (supplementary diagnosis of comorbid disorders and family diagnostics) and therapy of childhood OCD (offering long-term therapeutic advice and booster sessions, treatment of comorbid disorder, inclusion of the family).

Adolescent↗
PubMed1998

Suggestions for a framework for an empirically based classification of personality disorder.

BACKGROUND: The classification of personality disorder is one of the least satisfactory sections of contemporary psychiatric classification. Fundamental problems with current classifications include extensive diagnostic overlap, limited evidence of validity, and poor empirical support. METHODS: Conceptual analysis and the results of empirical studies are used to propose a framework for organizing an empirically based classification. RESULTS: First, personality disorder is a form of mental disorder and, therefore, should be classified as a single diagnostic entity on Axis I along with other mental disorders. A preliminary definition of personality disorder as a tripartite failure involving the self system, kinship relationships, and societal relationships is proposed. The evidence suggests that this definition can be translated into a reliable set of items. Second, the diagnosis of personality disorder should be separated from the assessment of clinically relevant personality traits. Given the consistent evidential support for a dimensional model of personality disorder, it is suggested that personality be coded on a set of trait dimensions selected to provide a systematic representation of the domain of behaviours represented by current diagnostic concepts. Third, given that personality traits are hierarchically organized, it is suggested that an axis for coding personality include basic or lower-order dimensions as the primary level of assessment and a few higher-order patterns to summarize information for some purposes. CONCLUSION: A preliminary list of 16 basic dispositional traits is proposed to describe the more specific components of personality disorder based, in part, on the convergence of evidence across studies: anxiousness, affective lability, callousness, cognitive dysregulation, compulsivity, conduct problems, insecure attachment, intimacy avoidance, narcissism, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, submissiveness, and suspiciousness. Three higher-order patterns were proposed: emotional dysregulation, dissocial behaviour, and inhibitedness, which may occur independently or in combination.

Diagnosis, Differential↗
PubMed2004

Treatment of obsessive-compulsive disorder in patients who have comorbid major depression.

Many patients who have obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses such as mood, anxiety, and personality disorders. The presence of severe depression, and major depressive disorder per se, impedes response to treatment for OCD that uses the best available treatments. In this article, the comorbidity data in OCD are reviewed, then the relationship between depression and OCD treatment outcome is reviewed. Next, the derivation and implementation of a treatment program specifically for depressed OCD patients are illustrated with a case example. The article closes with a discussion of implications and directions gleaned from this single case study.

Adult↗
PubMed1983

Agoraphobia, compulsive behaviours and behaviour completion mechanisms.

Anxiety is identified with a state of high arousal. Agoraphobia is differentiated from specific phobias which are inherent responses to situations which threatened primitive man. In agoraphobia, attacks of high arousal are produced by situations which delay ongoing activity. It is hypothesised that such delays produce arousal by activating behaviour completion mechanisms. Evidence is reviewed which indicates desensitization has a lasting effect in agoraphobia but not in specific phobias. It is suggested that desensitization reduces the arousal produced by behaviour completion mechanisms. Aversive therapy in homosexuality reduces the subjects' drive to carry out compulsive sexual behaviours but does not alter sexual orientation. It is suggested that compulsive sexual behaviours are not activated by primary sexual drives but by behaviour completion mechanisms which are also responsible for other compulsive behaviours. Aversive therapy acts by reducing the arousal produced by the behaviour completion mechanisms. As both aversive therapy and desensitization reduce such arousal, desensitization should be able to replace aversive therapy in the treatment of compulsive behaviours.

Agoraphobia↗
PubMed1995

DSM-III-R Axis I and II disorders in agoraphobic inpatients with and without panic disorder before and after psychosocial treatment.

Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder (n = 18) who were participants in an inpatient behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2-year posttreatment follow-up. At pretreatment, there were statistical trends for more of the panic with agoraphobia patients to have obsessive-compulsive disorder and alcohol abuse/dependence, and for more of the agoraphobia without panic patients to have generalized anxiety disorder and avoidant personality disorder. There was also a trend for more of the panic with agoraphobia patients to have met criteria for major depression during the 2-year follow-up period.

Adult↗
PubMed1987

Obsessive-compulsive symptoms in panic disorder.

Previous reports have noted an increased prevalence of obsessive-compulsive symptoms in patients with panic disorder. The authors found a prevalence of obsessive-compulsive symptoms in 19 (27%) of 70 patients with panic disorder. Compared to a subgroup of 25 patients with classic features of panic disorder and no obsessive-compulsive symptoms, the subgroup with obsessive-compulsive symptoms had an earlier onset of illness, were more likely to have personal and family histories of major depression and substance abuse, and showed a poorer outcome after treatment.

Adult↗
PubMed2004

[Bulimia nervosa and obesity. Clinical and psycho-social features, and intervention].

In this article, the authors deal with clinical and psycho-social aspects as well as treatment measures for nervous bulimia, overeating attacks and obesity. By studying these disorders, we have been able to notice the existence of common psycho-pathological characteristics. Impulsive behavior, more or less compulsive eating habits, and the presence of certain personality traits are different from nervous anorexia according to our study. However, our manner of viewing these disorders consists of considering nervous bulimia and overeating attacks as being clear psychiatric entities, while obesity can be a consequence, or not as seen in the majority of cases, of a psychiatric disorder, although there always exists a special weakness which causes one to suffer from these disorders and there exists a need for psychological support to complement a nutritional treatment program.

Bulimia↗
PubMed2002

Pharmacotherapy of anxious disorders.

The present paper is a review of the treatment of anxious disorders by the current pharmaceutical medications; a short epidemiological survey is given for anxious disorders including: general anxiety disorder, panic disorder, obsessive compulsive disorder, social anxiety and post-traumatic stress disorder. For all these disorders there are proposals of treatment built on literature data mainly on meta-analysis as well on personal experience.

Anti-Anxiety Agents↗
PubMed2002

Impulse control disorders and depression.

This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).

Adult↗
PubMed1992

Factorial structure of traits delineating personality disorders in clinical and general population samples.

Categorical and dimensional models for classifying personality disorders were evaluated by comparing the structure of personality pathology in a clinical sample (n = 158) with the structure in a general population sample (n = 274). Subjects completed 100 personality scales. Separate factor analyses revealed similar structures in the 2 samples. An underlying structure in a combined sample showed limited agreement with the concepts of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). Fifteen factors were retained: Generalized Distress, Rejection, Restricted Expression, Compulsivity, Stimulus Seeking, Insecure Attachment, Diffidence, Intimacy Problems, Oppositionality, Interpersonal Disesteem, Conduct Problems, Cognitive Dysfunction, Affective Reactivity, Narcissism, and Social Apprehensiveness. The results are consistent with a dimensional representation of personality disorder.

Adult↗