Beliefs in obsessive-compulsive disorder

Several types of beliefs have been hypothesized to be associated with obsessive-compulsive disorder (OCD), including responsibility for harm, need to control thoughts, overestimates of threat, intolerance of uncertainty, and beliefs about the consequences of anxiety and capacity to cope. The present study compared 62 subjects with OCD, 45 with other anxiety disorders (AD) and 34 controls, using 3 measures of OCD-related beliefs. OCD subjects scored higher than AD and control samples on 2 general belief measures. A closer analysis of specific belief domains indicated that OCD subjects scored higher than AD and control subjects on all 6 specific belief domains (responsibility, control, estimation of threat, tolerance of uncertainty, beliefs about the consequences of anxiety, and the capacity to cope). Four of the 6 domains showed reasonable convergent and discriminant validity with measures of OCD symptoms compared to other psychopathology; anxiety and coping beliefs were the exceptions. In regression analyses, cognitive measures contributed significant explanatory power beyond mood state and worry with uncertainty predicting severity of OCD symptoms above all other belief domains. Further research on OCD-relevant belief domains in etiology, maintenance and treatment is warranted.     

Progress and therapeutic response in the obsessive-compulsive disorder

The purpose of the present work was to analyze the outcome of patients diagnosed of Obsessive Compulsive Disorder (OCD) after Hospital discharge from our Unit, focusing on therapeutical efficacy immediately after discharge and in the follow up, searching for good evolution predictors. We have studied 42 patients (26 females and 16 males) diagnosed of OCD according to ICD-9 diagnostic criteria, all patients were hospitalized during a seven years period 1981 and 1988. Therapeutical response was evaluated through a (1-4 punctuation) of a Clinical Global Impression Scale considering the changes from the moment the patient was hospitalized, the day of discharge and in the follow up (mean 4.1 years). 73.8% and 71.4% were considered as treatment "responders" the day discharged and in the follow up respectively. Through a multiple logistic regression, treatment with serotonergic drugs and insidious onset of the illness were identified as short-term treatment response predictors, while the absence of a previous obsessive personality was a long-term therapeutical response predictor. Our results show the efficacy of serotonergic drugs and the tact that the presence of a previous obsessive personality could have a prognostic value in OCD.     

Cytokine production in obsessive-compulsive disorder

Cytokine production was previously demonstrated to be reduced in untreated major affective patients. In addition, recovery from depression following clomipramine (CMI) treatment was accompanied by the restoration of interleukin-1 beta (IL-1 beta) and interleukin-3-like activity (IL-3-LA) to normal range. In the present study we assessed the in vitro production of IL-1 beta IL-2, and IL-3-LA by peripheral blood mononuclear cells (PBMC) in 11 nondepressed patients with obsessive compulsive disorder (OCD) before and after 8 weeks of CMI treatment. Results were compared with those of 11 healthy subjects. CMI treatment induced a significant improvement in OCD symptoms. No alteration was observed in cytokine production in OCD patients before treatment as compared to control subjects. Moreover, 8 weeks of drug treatment had no effect on cytokine production. In conclusion, OCD per se, as well as CMI treatment, have no effect on interleukin production as measured in this study.     

Disgust implicated in obsessive-compulsive disorder

Psychiatric classificatory systems consider obsessions and compulsions as forms of anxiety disorder. However, the neurology of diseases associated with obsessive-compulsive symptoms suggests the involvement of fronto-striatal regions likely to be involved in the mediation of the emotion of disgust, suggesting that dysfunctions of disgust should be considered alongside anxiety in the pathogenesis of obsessive-compulsive behaviours. We therefore tested recognition of facial expressions of basic emotions (including disgust) by groups of participants with obsessive-compulsive disorder (OCD) and with Gilles de la Tourette's syndrome (GTS) with an without co-present obsessive-compulsive behaviours (GTS with OCB; GTS without OCB). A group of people suffering from panic disorder and generalized anxiety were also included in the study. Both groups with obsessive-compulsive symptoms (OCD; GTS with OCB) showed impaired recognition of facial expressions of disgust. Such problems were not evident in participants with panic disorder and generalized anxiety, or for participants with GTS without obsessions or compulsions, indicating that the deficit is closely related to the presence of obsessive-compulsive symptoms. Participants with OCD were able to assign words to emotion categories without difficulty, showing that their problem with disgust is linked to a failure to recognize this emotion in others and not a comprehension or response criterion effect. Impaired recognition of disgust is consistent with the neurology of OCD and with the idea that abnormal experience of disgust may be involved in the genesis of obsessions and compulsions.     

Role of serotonin in obsessive-compulsive disorder

BACKGROUND: Serotonin may play a role in the pathophysiology of obsessive-compulsive disorder (OCD) because of the anti-obsessional effect of selective serotonin reuptake inhibitors (SSRIs). METHOD: The literature is reviewed on knowledge of the role of serotonergic neurons in brain function, studies on monoamine metabolites in cerebrospinal fluid (CSF), various stress neuropeptides, neuroendocrine and behavioural challenge after administration of direct and indirect serotomimetic compounds, and neuroanatomical data on brain circuits organising behaviour. RESULTS: In most of the OCD cases analysed, CSF 5-hydroxyindoleacetic acid and homovanillic acid concentrations do not significantly differ from age-corrected controls. However, a relationship appears to exist between pre-treatment levels of these metabolites and clinical response to drugs acting on the serotonin transporter. Abnormalities in CSF arginine vasopressin, corticotropin-releasing hormone, oxytocin and somatostatin levels have been reported in OCD. Long-term treatment with high-doses of clomipramine, fluvoxamine, and fluoxetine tend to correct these neuropeptide abnormalities. CONCLUSIONS: We hypothesise that continuous treatment with SSRIs alters serotonin turnover and neuropeptide expression patterns in OCD-entertaining functional forebrain/midbrain circuits.     

Pharmacotherapy for obsessive-compulsive disorder

BACKGROUND: Pharmacotherapy for obsessive-compulsive disorder (OCD) was seldom beneficial before clomipramine, a potent selective serotonin reuptake inhibitor (SSRI), became available. Subsequent progress in pharmacotherapy for OCD has increased the possibility of effective treatment for most sufferers. METHOD: Randomised controlled trials of pharmacotherapy for OCD were reviewed, as well as reports of beneficial pharmacotherapy found in open trials and case reports. RESULTS: SSRIs are well-tolerated by patients with OCD, even in large doses. Proserotonergic augmentation is seldom helpful but antipsychotic augmentations seem beneficial for many OCD patients with comorbid tics. CONCLUSIONS: Potent SSRIs are the pharmacotherapy of choice for OCD, with a more limited role reserved for monoamine oxidase inhibitors. If one SSRI is ineffective, others may be beneficial. Non-drug therapies are also important in OCD: behaviour therapy is frequently helpful but infrequently available and neurosurgery is sometimes helpful when all other treatments have failed.     

Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder

BACKGROUND: Neuroimaging studies provide strong evidence that the pathophysiology of obsessive-compulsive disorder (OCD) involves abnormal functioning along specific frontal-subcortical brain circuits. METHOD: A literature search was carried out for all brain imaging studies of patients with OCD. We also reviewed the basic science literature on the functional neuroanatomy of cortico-basal ganglia circuits, and integrated this information with neuroimaging data in OCD to formulate a theoretical model of brain mediation of OCD symptoms and response to treatment. RESULTS: At least a subgroup of patients with OCD may have abnormal basal ganglia development. Functional neuroimaging studies indicate that OCD symptoms are associated with increased activity in orbitofrontal cortex, caudate nucleus, thalamus and anterior cingulate gyrus. CONCLUSIONS: OCD symptoms are mediated by hyperactivity in orbitofrontal-subcortical circuits, perhaps due to an imbalance of tone between direct and indirect striato-pallidal pathways. We present a model which describes how frontal-subcortical brain circuitry may mediate OCD symptomatology, and suggest a hypothesis for how successful treatments may ameliorate symptoms, via their effects on circuit activity.     

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.     

Comparison of clinical characteristics in obsessive-compulsive disorder and body dysmorphic disorder

Recent research has suggested that body dysmorphic disorder (BDD) is part of the spectrum of obsessive-compulsive disorders. In order to determine the extent of similarity for psychopathology measures, patients diagnosed with BDD were compared to a group of patients diagnosed with obsessive-compulsive disorder (OCD) on obsessionality, compulsivity, overvalued ideas, depression, and anxiety. Results indicate that BDD patients are similar to OCD patients for measures of obsessionality and compulsivity when BDD symptoms are assessed as such. BDD and OCD patients were also similar for measures of depression, and state and trait anxiety. OCD patients had higher levels of anxiety when measuring common physical symptoms associated with this affective reaction. BDD patients had higher levels of overvalued ideas, but fewer obsessive and compulsive symptoms. Overall, the results suggest that BDD is a variant of OCD, with special considerations given to degree of belief conviction (overvalued ideas.     

Conscientiousness and obsessive-compulsive personality disorder.

A dimensional perspective on personality disorder hypothesizes that the current diagnostic categories represent maladaptive variants of general personality traits. However, a fundamental foundation of this viewpoint is that dimensional models can adequately account for the pathology currently described by these categories. While most of the personality disorders have well established links to dimensional models that buttress this hypothesis, obsessive–compulsive personality disorder (OCPD) has obtained only inconsistent support. The current study administered multiple measures of 1) conscientiousness-related personality traits, 2) DSM–IV OCPD, and 3) specific components of OCPD (e.g., compulsivity and perfectionism) to a sample of 536 undergraduates who were oversampled for elevated OCPD scores. Six existing measures of conscientiousness-related personality traits converged strongly with each other supporting their assessment of a common trait. These measures of conscientiousness correlated highly with scales assessing specific components of OCPD, but obtained variable relationships with measures of DSM–IV OCPD. More specifically, there were differences within the conscientiousness instruments such that those designed to assess general personality functioning had small to medium relationships with OCPD, but those assessing more maladaptive variants obtained large effect sizes. These findings support the view that OCPD does represent a maladaptive variant of normal-range conscientiousness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Body dysmorphic disorder as an obsessive-compulsive spectrum disorder

Considerable evidence supports consideration of body dysmorphic disorder (BDD) and obsessive-compulsive disorder as related disorders. BDD may share common phenomenological and neurobiological features with OGD and other disorders characterized by repetitive thoughts and behaviors and mediated by serotonin dysfunction. Within this substrate, specific psychological and sociological factors may shape the specific BDD syndrome. Further research incorporating dimensional models of these disorders, may delineate specific similarities and differences.     

Clinical features distinguishing patients with Tourette's syndrome and obsessive-compulsive disorder from patients with obsessive-compulsive disorder without tics

OBJECTIVE: It is not clear whether obsessive-compulsive disorder (OCD) in the context of Tourette's syndrome (TS) is the same as that disorder found in patients with OCD alone. This study evaluated the severity and characteristics of the obsessive-compulsive symptoms in adult patients with OCD and TS compared to adult patients with OCD alone. METHOD: Thirteen subjects with both DSM-III-R TS and OCD and 13 subjects with OCD alone were recruited. Obsessive-compulsive severity was determined by using the Yale-Brown Obsessive Compulsive Scale. The Tourette Syndrome Association Unified Tic Rating Scale was administered to determine tic severity, and the adult version of the Attention Deficit and Hyperactivity Checklist was used to detect a history of childhood attention-deficit hyperactivity disorder (ADHD). RESULTS: Subjects with OCD alone had very few obsessions and compulsions that were not also experienced by subjects with both TS and OCD. In contrast, subjects with TS and OCD were significantly more likely to report obsessions involving nonviolent images, excessive concern with appearance, and need for symmetry. Touching, blinking or staring, and counting compulsions were also significantly more common in this group. Eight subjects with OCD and TS had a childhood history of ADHD, compared to none of the pure OCD subjects. CONCLUSION: There are subtle but definite differences in symptomatology of subjects with pure OCD compared to those with OCD and TS consistent with putative differences in pathophysiology between the 2 groups, i.e., abnormalities in the serotonergic system in OCD patients and serotonergic and dopaminergic abnormalities in those with OCD and TS. These observations may be consistent with genetic heterogeneity within both OCD and TS.     

Cognitive frontal lobe dysfunction in obsessive-compulsive disorder

BACKGROUND: There is evidence that dysfunction within associative frontostriatal circuits represents a feature of obsessive-compulsive disorder (OCD). Previous neuropsychologic studies have yielded diverging results, which may in part be explained by differences in the selection of subjects and methods. The present study focused on the question of cognitive frontal lobe performance in OCD. METHODS: Twenty-nine unmedicated OCD patients were compared to a double-size control group of normal subjects matched individually for age, sex, and intelligence. A series of 12 neuropsychologic tests was applied, most of which are thought to be sensitive to different aspects of cognitive frontal lobe function. RESULTS: OCD patients were unimpaired at tests of abstraction, problem solving, set-shifting, response inhibition, active memory search, and choice reaction speed. Deficits of approximately one standard deviation were observed at timed tests of verbal and nonverbal fluency, attentional processing, and weight sorting. CONCLUSIONS: OCD patients exhibited selective deficits in tasks involving controlled attentional processing and self-guided, spontaneous behavior. We discuss a link between this neuropsychologic profile and dysfunctioning within the anterior cingulate, but not the dorsolateral prefrontal circuit.     

Concerns regarding study of obsessive-compulsive disorder in dogs

Thromboembolism is rarely considered in discussions of the complications of blunt chest trauma. The few cases of thromboembolism that have been reported in this setting have occurred in association with significant myocardial damage. A previously fit 23 year old woman was admitted to the intensive care unit following a road traffic accident. A day later, left atrial thrombus was demonstrated by transoesophageal echocardiography in the absence of any other evidence of important myocardial injury. Anticoagulation with heparin was cautiously introduced in spite of her extensive injuries, and there were no consequent bleeding complications. At hospital discharge on day 18 she was entirely well. Full anticoagulation with warfarin was continued for a further eight weeks at which time follow up transoesophageal echocardiography showed complete resolution of the thrombus.     

Examining the evidence for anxiety-related cognitive biases in obsessive-compulsive disorder

In light of current concerns about the diagnostic classification of obsessive-compulsive disorder (OCD), this article critically examines recent experimental research on anxiety-related cognitive biases in OCD in order to determine whether it provides grounds for OCD's differentiation from other anxiety disorders. This small body of work is found to be fraught with defects, anomalies, and inconsistencies. These findings contrast dramatically with the robust results obtained with other clinical anxiety disorders. When biases are in evidence it tends to be with a select group of subjects, that is, those with contamination concerns. It is suggested that only this subtype of OCD, or some core characteristic underlying it, may be associated with cognitive tendencies comparable to those found in other anxiety disorders (i.e., biases at the attentional level associated with the emotional tone, or content, of information). Cognitive tendencies in other subtypes likely require different explanatory frameworks. This review provides evidence for the partial uniqueness of OCD from other anxiety disorders.     

Recurrent obsessive-compulsive disorder associated with pregnancy and childbirth

A 77-year-old woman presented with unilateral ocular pain, exophthalmos, vascular tinnitus, and chemosis several weeks after a minor closed head injury. Cerebral angiography showed a carotid-cavernous sinus fistula. One week later the patients's symptoms abruptly ceased. A brief discussion of the presentation and management of these fistulas is presented.     

The dynamics of protection and exposure in the development of obsessive-compulsive disorder.

This article considers the development of obsessional thinking in relation to the protective function provided by the early interpersonal environment. In particular, it explores the idea that the seed of obsessional thinking lies in the child's adaptation to and survival in an environment that either provides an overly strong shield against the world or one where the child is left highly exposed to the world. At the two extremes of shielding, where there is a less than or more than needed mediation of the external world, the child is at greater risk of developing a sense of an endangered relationship to the world. The main point here is that the malign omnipotence of obsessional thoughts grows within an environment whose capacity to balance exposing the child to the world and protecting him from that same world is skewed or where the child is unable to avail of the defensive shield as a means of safeguarding him from feelings of personal omnipotent destructiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary approaches to pharmacotherapy in Tourette''s syndrome and obsessive-compulsive disorder

Considerable research on minority health has examined whether members of a minority group experience more rapid health declines than the White majority when both groups reach later life. Researchers have sought to determine if being both old and a member of a minority creates a double disadvantage to health. The primary purpose of this research is to test the double jeopardy to health hypothesis among Black and White Americans using data from a 15-year panel study of adults: National Health and Nutrition Examination Survey I: Epidemiological Follow-up Study (NHEFS). African Americans have poorer health at all three times on a variety of health status measures, but no evidence for double jeopardy was uncovered. There were important racial differences for change in health status but Black Americans of all ages -- including Black older adults -- suffered from growing disability and more negative ratings of health. Black adults are more likely to develop serious illness, and their ratings of health decline more rapidly than is the case for White respondents. While there is little support for the double jeopardy hypothesis as originally stated, there is overwhelming evidence to show that the health of Black Americans of all ages declines at a faster rate. The formulation of the double jeopardy hypothesis is critiqued on several points: ontogenetic fallacy, attribution of discrimination, and selective mortality.