Phenomenological questions about obsession and delusion

[The concept of insight in patients with obsessive-compulsive disorder]

OBJECTIVE

To update clinicians regarding the existence of a putative subtype of obsessive-compulsive disorder based on poor insight.

METHOD

Opinionative review based on studies indexed in the PubMed and PsychINFO databases, identified by means of the keywords 'obsessive-compulsive disorder' AND 'insight' OR 'ego-syntonic', and published between 1966 and October 2009. The results were analyzed according to the approach adopted, i.e. a categorical or dimensional view of insight in obsessive-compulsive disorder.

RESULTS

The review of recent studies led us to identify some issues that cast doubts over the existence of a clear-cut poor insight subtype of obsessive-compulsive disorder. These issues include 1) an extremely variable prevalence of poor insight obsessive-compulsive disorder in categorical studies, 2) a significant degree of homogeneity in the phenotypical findings (i.e. greater severity) associated with lower levels of insight in obsessive-compulsive disorder in both categorical and dimensional studies and, 3) a lack of studies investigating zones of rarity between poor and good insight obsessive-compulsive disorder.

CONCLUSION

Although a categorical approach to the insight issue in obsessive-compulsive disorder is still important in clinical settings, where decision-making is often a critical issue, a dimensional approach seems to reflect levels of impairment in these patients more reliably.

Misunderstanding psychopathology as medical semiology: an epistemological enquiry

In our everyday clinical experience we encounter significant problems directly related to the instability of psychopathological concepts. In order to trace the origin of this inconsistency, the nature of these concepts will be explored in their historical development. They will be compared to those pertaining to medical semiology, paying special attention to the specific nature of the 'object' each of them refers to. While concepts belonging to medical semiology refer to natural objects and retain their meaning independently of the patient's context, psychopathological concepts refer to fragments of experience, which lose their significance if detached from their contextual horizon. The instability of psychopathological concepts is a consequence of the misunderstanding of psychopathology as medical semiology. As an alternative to this view, it will be argued that psychopathology represents an active and never-ending process aimed at the creation of intelligibility.

Obsessive-compulsive disorder: admission patterns and diagnostic stability. A case-register study

All first-time admissions from 1970 to 1986 with obsessive-compulsive neurosis (OCD) (ICD-8 diagnosis number 300.39) or obsessive-compulsive personality disorder (OCPD) (ICD-8 diagnosis number 301.49) were analyzed based on an extract from the nationwide Psychiatric Case Register in Denmark. All patients with secondary diagnoses other than neurotic disorders or personality disorders (including "neuroses characterogenes") were excluded from the study. A total of 284 patients were first-time admitted with a main diagnosis of OCD during the period. The sex ratio was 0.67 (males/females). A total of 126 were first-time admitted with a diagnosis of OCPD, with a sex ratio of 1.18 (males/females). Seventy-seven percent of the readmitted patients with a first-time diagnosis of OCD kept a diagnosis within the "emotional spectrum" at the last admission. About half kept OCD as a main diagnosis, whereas only 15% shifted to a severe psychiatric diagnosis such as schizophrenia or manic-depressive psychosis. Of the readmitted patients with OCPD, 13% later developed a diagnosis of manic-depressive psychosis.

Obsessive-compulsive disorder in children and adolescents. A review of the literature

The literature on obsessive-compulsive disorder (OCD) in children and adolescents is reviewed. On the basis of the epidemiological data it is concluded that OCD is far more common among children and adolescents than was previously believed. However, good epidemiological studies in other parts of the world than the US are still needed. Follow-up studies of the course of OCD with a childhood onset are still very few in number. Recent studies show that OCD is a disabling disorder for many of the patients, also in adult life, but that a considerable proportion of the patients seems to "recover" from their obsessions and compulsions in adulthood. There are indications that treatment response in childhood, parental psychopathology, and severity of the OCD migh predict the outcome. The biological aspects of OCD are reviewed. The serotonin transmitter system seems to be involved in the pathogenesis of adult as well as childhood OCD. Additionally, most studies demonstrate a high degree of neuropsychological and neurological deficits in children with OCD. Comorbidity in childhood, and the concept of OCD spectrum disorders are presented. Childhood OCD seems to be associated with depression, eating disorders, anxiety disorders, and empathy disorder, whereas there seems to be no convincing relation between OCD and schizophrenia.