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Tsai G, Passani LA, Slusher BS, Carter R, Baer L, Kleinman JE, Coyle JT. Abnormal excitatory neurotransmitter metabolism in schizophrenic brains. ARCHIVES OF GENERAL PSYCHIATRY 1995; 52:829-36. [PMID: 7575102 DOI: 10.1001/archpsyc.1995.03950220039008] [Citation(s) in RCA: 301] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Schizophrenia has been hypothesized to be caused by a hypofunction of glutamatergic neurons. Findings of reduced concentrations of glutamate in the cerebrospinal fluid of patients with schizophrenia and the ability of glutamate-receptor antagonists to cause psychotic symptoms lend support to this hypothesis. N-acetylaspartylglutamate (NAAG), a neuropeptide that is highly concentrated in glutamatergic neurons, antagonizes the effects of glutamate at N-methyl-D-aspartate receptors. Moreover, NAAG is cleaved to glutamate and N-acetylaspartate by a specific peptidase, N-acetyl-alpha-linked acidic dipeptidase (NAALADase). To test the glutamatergic hypothesis of schizophrenia, we studied the NAAG-related glutamatergic variables in postmortem brains from patients with schizophrenia, neuroleptic-treated controls, and normal individuals, with particular emphasis on the prefrontal cortex and hippocampus. METHOD Different regions of frozen brain tissue from three different groups (patients with schizophrenia, neuroleptic-treated controls, and normal controls) were assayed to determine levels of NAAG, N-acetylaspartate, NAALADase, and several amino acids, including aspartate and glutamate. RESULTS Our study demonstrates alterations in brain levels of aspartate, glutamate, and NAAG and in NAALADase activity. Levels of NAAG were increased and NAALADase activity and glutamate levels were decreased in the schizophrenic brains. Notably, the changes in NAAG level and NAALADase activity in schizophrenic brains were more selective than those for aspartate and glutamate. In neuroleptic-treated control brains, levels of aspartate, glutamate, and glycine were found to be increased. CONCLUSIONS The changes in levels of aspartate, glutamate, NAAG, and NAALADase are prominent in the prefrontal and hippocampal regions, where previous neuropathological studies of schizophrenic brains demonstrate consistent changes. These findings support the hypothesis that schizophrenia results from a hypofunction of certain glutamatergic neuronal systems. They also suggest that the therapeutic efficacy of neuroleptics may be related to increased glutamatergic activity.
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Baer L, Cukor P, Jenike MA, Leahy L, O'Laughlen J, Coyle JT. Pilot studies of telemedicine for patients with obsessive-compulsive disorder. Am J Psychiatry 1995; 152:1383-5. [PMID: 7653700 DOI: 10.1176/ajp.152.9.1383] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Remote video psychiatric assessment holds promise for providing expert consultation to underserved areas. The authors assessed the reliability of rating scales administered in person and over video to patients with obsessive-compulsive disorder. METHOD Rating scales for obsessive-compulsive, depressive, and anxiety symptoms were administered in person (N = 16) and by means of narrow-bandwidth video transmission over one digital telephone line (N = 10). Interrater reliability was determined for each condition; for the video interviews one rater sat at the local site in front of the videoconsulting apparatus and asked the questions, and the patient and the second rater sat at the remote site. RESULTS Reliability was excellent in both conditions, and there was no degradation in reliability when the assessment was conducted over video. CONCLUSIONS Telemedicine resulted in near-perfect interrater agreement on rating scale scores. Its use for other disorders and for more in-depth assessments should be explored.
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Baer L, Jacobs DG, Cukor P, O'Laughlen J, Coyle JT, Magruder KM. Automated telephone screening survey for depression. JAMA 1995; 273:1943-4. [PMID: 7783305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To test the application of fully automated telephone screening using computerized digital voice recordings and touch-tone responses to assess symptoms of depression. DESIGN A cross-sectional study of a 2-week-long telephone survey. SETTING Toll-free telephone calls placed from home, work, or school to a central telephone/computer system at a telecommunications company in the Boston, Mass, area. PARTICIPANTS A total of 1812 participants called the system. Of these, 278 were students and faculty at a large midwestern state university, 725 were employees of a large northeastern high-technology firm, and 809 did not identify which site they were calling from. MAIN OUTCOME MEASURES The 20-question multiple-choice Zung Depression Scale was used to screen for depressive symptoms, and additional questions gathered demographic and caller satisfaction information. RESULTS No technical problems were encountered during the trial. Of 1812 callers, 1597 (88.1%) completed all questions. Of these, 412 callers (25.8%) met criteria for "moderate or marked" depression and another 194 (12.1%) met criteria for "severe or extreme" depression. The majority of callers scoring positive for depression had received no previous treatment for depression. Of callers who completed the screening questionnaire, 74.6% reported the call to have been at least "moderately" helpful. CONCLUSION Readily available low-cost technology provides a fully automated, widely accessible, and confidential method of screening for a common mental illness.
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Miguel EC, Coffey BJ, Baer L, Savage CR, Rauch SL, Jenike MA. Phenomenology of intentional repetitive behaviors in obsessive-compulsive disorder and Tourette's disorder. J Clin Psychiatry 1995; 56:246-55. [PMID: 7775367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recent evidence suggests that obsessive-compulsive disorder (OCD) and Tourette's disorder are related and have overlapping clinical features. The purpose of this study was to test the following hypotheses regarding intentional repetitive behaviors in these two disorders: (1) In OCD without comorbid Tourette's, they are preceded by cognitive phenomena and autonomic anxiety, but not sensory phenomena, and (2) in Tourette's without comorbid OCD, they are preceded by sensory phenomena, but not cognitive phenomena nor autonomic anxiety. METHOD Fifteen adult OCD outpatients without tics and 17 adult Tourette's outpatients without OCD were evaluated with a structured interview. Questions assessed cognitive, sensory, and affective experiences related to intentional repetitive behaviors. RESULTS Five of 17 Tourette's subjects were excluded because they had only unintentional or occasionally intentional tics. All OCD patients reported some cognitions preceding their intentional repetitive behaviors, whereas only 2 of 12 Tourette's patients reported cognitions. In comparison, all Tourette's patients reported sensory phenomena preceding repetitive behaviors, and none of the OCD patients reported such sensations. In addition, 13 OCD patients reported at least mild autonomic anxiety associated with their repetitive behaviors, whereas no Tourette's patients reported such symptoms. CONCLUSION Intentional repetitive behaviors in OCD differ from those in Tourette's and are associated with cognitive and autonomic phenomena. Sensory phenomena preceded intentional repetitive behaviors in Tourette's but not in OCD patients. The dimensions examined in this study (cognition, sensory phenomena, and autonomic anxiety) may represent valid clinical factors for characterization of repetitive behaviors in OCD and Tourette's.
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Baer L, Rauch SL, Ballantine HT, Martuza R, Cosgrove R, Cassem E, Giriunas I, Manzo PA, Dimino C, Jenike MA. Cingulotomy for intractable obsessive-compulsive disorder. Prospective long-term follow-up of 18 patients. ARCHIVES OF GENERAL PSYCHIATRY 1995; 52:384-92. [PMID: 7726719 DOI: 10.1001/archpsyc.1995.03950170058008] [Citation(s) in RCA: 170] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The purpose of this study was to assess prospectively long-term change in obsessive-compulsive disorder (OCD) symptoms in patients with an OCD diagnosis that was confirmed by structured interview and with documented unsuccessful trials of multiple medications and attempts at behavior therapy. METHODS We conducted an unblinded preoperative and follow-up assessment of comorbid diagnosis; OCD, depressive, and anxiety symptoms; and functional status in 18 patients who underwent cingulotomy. RESULTS At a mean follow-up of 26.8 months, five patients (28%) met conservative criteria for treatment responders, and three others (17%) were partial responders. The group improved significantly in mean functional status, and few serious adverse events were found. Improvement in OCD symptoms was strongly correlated with improvement in depressive and anxiety symptoms. CONCLUSIONS The rate of clinical improvement was consistent with a previous retrospective study in the same setting, indicating that 25% to 30% of the patients who previously were unresponsive to medication and behavioral treatments are significantly improved after cingulotomy. Cingulotomy remains a last resort treatment for severely incapacitated patients who have not responded to all other state-of-the-art pharmacological and behavioral treatments for OCD and is not to be taken lightly.
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Rauch SL, Baer L, Cosgrove GR, Jenike MA. Neurosurgical treatment of Tourette's syndrome: a critical review. Compr Psychiatry 1995; 36:141-56. [PMID: 7758300 DOI: 10.1016/s0010-440x(95)90109-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Some patients with Tourette's syndrome (TS) remain disabled despite conventional treatment. Recently, neurosurgical procedures have been reported to be potentially effective interventions for such intractable cases. Clinicians are now being asked to make recommendations to patients about these candidate operations. This review explores the reported experience with neurosurgical treatment of TS to assess critically the evidence regarding risks and benefits. Toward that end, the rationale for the various procedures and the relevant neuroanatomy are outlined and recommendations for patient selection and management of future cases are discussed. We reviewed all available published reports on this subject and two unpublished cases, totaling 36 patients. Although a variety of operations have been used to treat TS, there is limited evidence pertaining to the risks or benefits of any surgical procedure. Neurosurgical treatment of TS remains experimental, since there is only anecdotal experience with these operations. Furthermore, there is no compelling evidence that any neurosurgical procedure is superior to all others. If these experimental neurosurgeries are to continue, guidelines should be developed regarding patient and operation selection, and interdisciplinary assessment committees should implement such guidelines at institutions where these operations are performed. Moreover, future cases should be prospectively studied using contemporary technologies to assess lesion placement and size and validated clinical instruments to characterize patients and assess outcome, including adverse effects.
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Rauch SL, Savage CR, Alpert NM, Miguel EC, Baer L, Breiter HC, Fischman AJ, Manzo PA, Moretti C, Jenike MA. A positron emission tomographic study of simple phobic symptom provocation. ARCHIVES OF GENERAL PSYCHIATRY 1995; 52:20-8. [PMID: 7811159 DOI: 10.1001/archpsyc.1995.03950130020003] [Citation(s) in RCA: 216] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The goal of this study was to determine the mediating neuroanatomy of simple phobic symptoms. METHODS Positron emission tomography and oxygen 15 were used to measure normalized regional cerebral blood flow in seven subjects with simple phobia during control and provoked states. Stereotactic transformation and statistical parametric mapping techniques were employed to determine the locations of significant activation. RESULTS Statistical parametric maps demonstrated significant increases in normalized regional blood flow for the symptomatic state compared with the control state in the anterior cingulate cortex, the insular cortex, the anterior temporal cortex, the somatosensory cortex, the posterior medial orbitofrontal cortex, and the thalamus. CONCLUSIONS The results suggest that anxiety associated with the simple phobic symptomatic state is mediated by paralimbic structures. Moreover, activation of somatosensory cortex may reflect tactile imagery as one component of the phobic symptomatic condition.
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O'Sullivan RL, Keuthen NJ, Hayday CF, Ricciardi JN, Buttolph ML, Jenike MA, Baer L. The Massachusetts General Hospital (MGH) Hairpulling Scale: 2. reliability and validity. PSYCHOTHERAPY AND PSYCHOSOMATICS 1995; 64:146-8. [PMID: 8657845 DOI: 10.1159/000289004] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Assessment of symptom severity and change in chronic hairpulling has been limited by the absence of a psychometrically validated clinical rating scale. The Massachusetts General Hospital Hairpulling Scale demonstrated test-retest reliability, convergent and divergent validity, and sensitivity to change in hairpulling symptoms.
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Okin RL, Borus JF, Baer L, Jones AL. Long-term outcome of state hospital patients discharged into structured community residential settings. Psychiatr Serv 1995; 46:73-8. [PMID: 7895127 DOI: 10.1176/ps.46.1.73] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This longitudinal study examined various dimensions of the lives of patients with chronic mental illness immediately before and again several years after their discharge from a state hospital into well-staffed structured community residential settings. METHODS Fifty-three patients with chronic mental illness and long histories of hospitalization were evaluated shortly before their state hospital discharge using a comprehensive structured assessment of nine dimensions of functioning and symptomatology. A follow-up assessment was undertaken a mean of 7.5 years after discharge into four structured group home settings. RESULTS At follow-up, 57 percent of the patients continued to live in structured community residential settings, 28 percent had moved on to independent living, and 16 percent had returned to an institutional setting. Fifty-five percent needed hospital readmission, but the total sample spent only 11 percent of the time after discharge in the hospital. At follow-up, patients showed significant improvements in cognitive and social functioning, and 94 percent expressed a preference for life in the community. CONCLUSIONS Many patients discharged to structured community residential settings seem to prefer them to the state hospital, are able to graduate to independent settings, and show improvement in important dimensions of functioning after several years in the community. Other dimensions seem resistant to change despite the structure and support afforded by residential settings.
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Keuthen NJ, O'Sullivan RL, Ricciardi JN, Shera D, Savage CR, Borgmann AS, Jenike MA, Baer L. The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. development and factor analyses. PSYCHOTHERAPY AND PSYCHOSOMATICS 1995; 64:141-5. [PMID: 8657844 DOI: 10.1159/000289003] [Citation(s) in RCA: 241] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We developed the MGH Hairpulling Scale to provide a brief, self-report instrument for assessing repetitive hairpulling. Seven individual items, rated for severity from 0 to 4, assess urges to pull, actual pulling, perceived control, and associated distress. We administered the scale to 119 consecutive patients with chronic hairpulling. Statistical analyses indicate that the seven items form a homogenous scale for the measurement of severity in this disorder.
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Baer L, Ricciardi J, Keuthen N, Pettit AR, Buttolph ML, Otto M, Minichiello W, Jenike MA. Discontinuing obsessive-compulsive disorder medication with behavior therapy. Am J Psychiatry 1994; 151:1842. [PMID: 7977900 DOI: 10.1176/ajp.151.12.1842a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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O'Rourke DA, Wurtman JJ, Wurtman RJ, Tsay R, Gleason R, Baer L, Jenike MA. Aberrant snacking patterns and eating disorders in patients with obsessive compulsive disorder. J Clin Psychiatry 1994; 55:445-7. [PMID: 7961522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Appetitive symptoms, particularly carbohydrate craving, have been shown to occur in patients whose conditions responded to treatment with drugs that enhance serotonin-mediated neurotransmission. This suggested that patients with obsessive compulsive disorder (OCD) who also frequently respond to serotonergic drugs also might have similar distributions of appetitive and eating patterns. METHOD A survey study of 170 OCD patients and 920 controls was conducted using a questionnaire that inquired about snacking behavior, including food preference, mood changes after eating, and previous diagnosis of eating disorders. The frequency responses in the two groups were tested for statistical significance. RESULTS Significant differences were found between the OCD and control groups with respect to the reported incidence of eating disorders, snacking patterns, and mood response to food. CONCLUSION This finding of different snacking patterns in OCD mirrors that found in other disorders that have been shown to be responsive to serotonergic drugs. The high incidence of carbohydrate snacking among OCD patients compared with the control group provides additional evidence that brain serotonin may be involved in this disorder.
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Breiter HC, Filipek PA, Kennedy DN, Baer L, Pitcher DA, Olivares MJ, Renshaw PF, Caviness VS. Retrocallosal white matter abnormalities in patients with obsessive-compulsive disorder. ARCHIVES OF GENERAL PSYCHIATRY 1994; 51:663-4. [PMID: 8042915 DOI: 10.1001/archpsyc.1994.03950080075010] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Brown HD, Kosslyn SM, Breiter HC, Baer L, Jenike MA. Can patients with obsessive-compulsive disorder discriminate between percepts and mental images? A signal detection analysis. JOURNAL OF ABNORMAL PSYCHOLOGY 1994; 103:445-54. [PMID: 7930043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Signal detection analysis was used to test three hypotheses for repetitive thoughts and behaviors characteristic of obsessive-compulsive disorder (OCD). Patients might have (a) low sensitivity for the difference between having seen something or having imagined seeing it, (b) a high criterion for this discrimination, or (c) difficulty associating context with information in memory. Subjects judged viewed words or imagined words and later indicated which were actually seen. Patients with OCD discriminated seen from imaged words significantly better than normal control subjects, as evidenced by higher d' scores on a recognition memory task. Groups did not differ in response criterion, beta, used to decide whether words had been seen or imaged. Implications for the study of OCD from an information-processing perspective are discussed.
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90
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Miguel EC, Pereira RM, Pereira CA, Baer L, Gomes RE, de Sá LC, Hirsch R, de Barros NG, de Navarro JM, Gentil V. Psychiatric manifestations of systemic lupus erythematosus: clinical features, symptoms, and signs of central nervous system activity in 43 patients. Medicine (Baltimore) 1994; 73:224-32. [PMID: 8041245 DOI: 10.1097/00005792-199407000-00005] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Forty-three female inpatients with active systemic lupus erythematosus (SLE) were studied by a multidisciplinary team to answer the following research questions: 1) What are the features of the psychopathology in patients with active SLE? and 2) In these patients, what is the relationship between psychiatric disorders and symptoms and signs suggesting activity of SLE in the CNS? Our a priori hypothesis was that, in patients with active SLE, those with psychiatric manifestations would have more symptoms and signs of CNS activity than those without psychiatric manifestations. Psychiatric evaluation consisted of standardized psychiatric instruments and diagnostic criteria. The assessment of SLE systemic and central nervous system (CNS) activity consisted of rheumatologic, neurologic, and ophthalmologic evaluations; serum and cerebral spinal fluid (CSF) analysis; brain computerized tomography (CT); and electroencephalogram (EEG). Twenty-seven patients (63%) presented psychiatric symptoms (Psychiatric Group), and 16 (37%) patients presented no current psychiatric diagnosis (Nonpsychiatric Group). These groups were compared in terms of the above variables. Depressive syndrome was the most frequent diagnosis (44%) followed by delirium (7%) and dementia (5%). Psychiatric symptoms were associated with subjective cognitive impairment (85%) and neurologic abnormality (85%). Widened cortical sulci was the most frequent CT alteration and was equally common in both groups. No statistical difference was found between the 2 groups regarding their general clinical evaluation, serum and CSF exams, or EEG alterations. To determine whether the severity of psychiatric symptoms was related to CNS activity, we divided the 27 patients with psychiatric manifestations into 2 groups: the Major Group--18 patients with major psychopathology, and the Minor Group--9 patients with mild depressive syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Holzer JC, Goodman WK, McDougle CJ, Baer L, Boyarsky BK, Leckman JF, Price LH. Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients. Br J Psychiatry 1994; 164:469-73. [PMID: 8038934 DOI: 10.1192/bjp.164.4.469] [Citation(s) in RCA: 145] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The phenomenological features of 35 obsessive-compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.
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Abstract
Histories of childhood trauma have been reported previously in bulimic subjects but no study to date has assessed how these experiences may affect response to fluoxetine. Thirty outpatient subjects in a placebo-controlled trial of 60 mg of fluoxetine for the treatment of bulimia nervosa completed the Dissociative Experiences Scale and a self-report instrument assessing trauma. Response to treatment was measured with the Hamilton Depression Scale-17 (HAMD-17), the CGI, the PGI, and the change in number of binges per day. Subjects taking fluoxetine with histories of physical abuse showed a significantly greater drop in HAMD-17 scores than those without such histories. No relationship between a reported history of abuse and the response of binging to fluoxetine was found. A history of abuse does not appear to predict the response of binging to fluoxetine but may predict a greater response of nonspecific symptoms like depression.
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Minichiello WE, O'Sullivan RL, Osgood-Hynes D, Baer L. Trichotillomania: clinical aspects and treatment strategies. Harv Rev Psychiatry 1994; 1:336-44. [PMID: 9384868 DOI: 10.3109/10673229409017100] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Trichotillomania is a disorder of compulsive hair pulling that often results in alopecia. The clinical features include the pulling of hair from the scalp, eyebrows, and eyelashes, sometimes symmetrically; pubic and other bodily hair may also be plucked. The disorder is present in 0.6% of college students. The majority of sufferers who seek treatment are female, with usual age of onset between 11 and 16 years. Trichotillomania can occur in a wide variety of psychiatric disorders, and patients with the condition may be more likely to have a lifetime diagnosis of depression or an anxiety, eating, or substance abuse disorder. Although empirically derived treatment guidelines are still lacking, the current literature suggests that behavior therapy and pharmacotherapy are the most efficacious treatments for adult trichotillomania. Controlled trials with pharmacotherapy (clomipramine) have shown significant reductions in hair pulling over the short term. Controlled investigations of behavior therapy have not been conducted, but several treatment series suggest efficacy. At least three reports also suggest that behavior therapy and pharmacotherapy bring some improvement in childhood trichotillomania, although this has not been empirically studied. A case illustrating the combination of behavior therapy techniques and pharmacotherapy in the treatment of trichotillomania is presented.
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Baer L. Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. J Clin Psychiatry 1994; 55 Suppl:18-23. [PMID: 8077163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite advances in our understanding of the pathology and genetics of obsessive compulsive disorder (OCD) and in our ability to successfully treat patients with medications and behavioral psychotherapy, the identification of homogeneous subgroups of patients with OCD has remained elusive. Once identified, such subgroups may be found related to treatment response, biological markers, or genetic transmission of OCD. To clarify identification of symptom subtypes, my colleagues and I administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist to 107 patients with OCD and applied principal components analysis (e.g., factor analysis) to these data. We then examined the correlations between these factor scores and the presence of comorbid tic and personality disorders, which are thought to be related to OCD. We found that three factors, which we named "symmetry/hoarding," "contamination/cleaning," and "pure obsessions," best explained the symptoms of the Y-BOCS Symptom Checklist. Only the first factor was significantly related to comorbid obsessive compulsive personality disorder or to a lifetime history of Tourette's syndrome or chronic tic disorder. Implications of these findings regarding possible clinical utility are discussed.
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Orloff LM, Battle MA, Baer L, Ivanjack L, Pettit AR, Buttolph ML, Jenike MA. Long-term follow-up of 85 patients with obsessive-compulsive disorder. Am J Psychiatry 1994; 151:441-2. [PMID: 8109659 DOI: 10.1176/ajp.151.3.441] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this study, long-term outcome for patients with obsessive-compulsive disorder treated with serotonin reuptake inhibitor medications was examined. The records of 85 patients who had first been evaluated at least 1 year previously (the mean follow-up period was 773 days) were reviewed. Information was collected on age at onset of symptoms, time since first evaluation, and scores on several scales measuring symptom severity, including the Yale-Brown Obsessive Compulsive Scale. Comparison of these baseline data with Yale-Brown scale scores at the most recent follow-up visit showed that 74 (87%) of the patients had responded to treatment. No predictors of improvement were found.
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Savage CR, Weilburg JB, Duffy FH, Baer L, Shera DM, Jenike MA. Low-level sensory processing in obsessive-compulsive disorder: an evoked potential study. Biol Psychiatry 1994; 35:247-52. [PMID: 8186329 DOI: 10.1016/0006-3223(94)91255-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study used visual and auditory evoked potentials (VEP and AEP) to study low-level sensory processing in a group of 15 unmedicated subjects with obsessive-compulsive disorder (OCD) and 30 age-matched, gender-matched, and handedness-matched normal controls. EPs were recorded to flash (VEP) and binaural click (AEP) stimulation. OCD subjects were found to have significantly shorter latencies on N1 and P2 of the AEP, and no differences were found in the VEP. Results indicate abnormal information processing states in OCD during low-level auditory processing, but not during low-level visual processing. Neural generators of the VEP and AEP are briefly reviewed and results are discussed in relation to current neurobiological models of OCD.
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Rauch SL, Jenike MA, Alpert NM, Baer L, Breiter HC, Savage CR, Fischman AJ. Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. ARCHIVES OF GENERAL PSYCHIATRY 1994; 51:62-70. [PMID: 8279930 DOI: 10.1001/archpsyc.1994.03950010062008] [Citation(s) in RCA: 511] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The study was designed to determine the mediating neuroanatomy of obsessive-compulsive disorder (OCD). METHODS The short half-life tracer oxygen 15-labeled carbon dioxide was used to allow for repeated positron emission tomographic determinations of regional cerebral blood flow on each of eight patients with OCD during a resting and a provoked (symptomatic) state. RESULTS Individually tailored provocative stimuli were successful in provoking OCD symptoms, in comparison with paired innocuous stimuli, as measured by self-report on OCD analogue scales (P = .002). Omnibus subtraction images demonstrated a statistically significant increase in relative regional cerebral blood flow during the OCD symptomatic state vs the resting state in right caudate nucleus (P < .006), left anterior cingulate cortex (P < .045), and bilateral orbitofrontal cortex (P < .008); increases in the left thalamus approached but did not reach statistical significance (P = .07). CONCLUSIONS These findings are consistent with results of previous functional neuroimaging studies and contemporary neurocircuitry models of OCD. The data further implicate orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex in the pathophysiology of OCD and in mediating OCD symptoms.
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Baer L, Rauch SL, Jenike MA, Cassem NH, Ballantine HT, Manzo PA, Martuza RL. Cingulotomy in a case of concomitant obsessive-compulsive disorder and Tourette's syndrome. ARCHIVES OF GENERAL PSYCHIATRY 1994; 51:73-4. [PMID: 8279932 DOI: 10.1001/archpsyc.1994.03950010073013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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99
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Baer L, Brown-Beasley MW, Sorce J, Henriques AI. Computer-assisted telephone administration of a structured interview for obsessive-compulsive disorder. Am J Psychiatry 1993; 150:1737-8. [PMID: 8214187 DOI: 10.1176/ajp.150.11.1737] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A computer-assisted telephone system using digitized human speech was developed to administer two rating scales for obsessive-compulsive disorder. For 18 patients, scores derived with this system agreed well with scores from human administration of the scales by telephone and paper-and-pencil scales returned by mail. This approach provides reliable, low-cost, and instantaneous data acquisition.
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100
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Baer L. Behavior therapy for obsessive compulsive disorder in the office-based practice. J Clin Psychiatry 1993; 54 Suppl:10-5; discussion 30. [PMID: 8331097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The article provides guidance for the clinician in applying scientifically proven behavior therapy techniques for obsessive compulsive disorder. Rationale for considering behavior therapy for all patients with OCD is presented, along with guidelines for determining an adequate trial of this approach and for predicting if a particular patient is likely to benefit.
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