Obsessive-compulsive disorders: a review of the literature

Identifying the Symptom Severity in Obsessive-Compulsive Disorder for Classification and Prediction: An Artificial Neural Network Approach

The present study is aimed at identifying the most prominent determinants of OCD along with their strength to classify the OCD patients from healthy controls. The data for this cross-sectional study were collected from 200 diagnosed OCD patients and 400 healthy controls. The respondents were selected through purposive sampling and interviewed by using the Y-BOCS scale with the addition of a factor, worth of an individual in his family. The validity and reliability of data were assessed through Cronbach's alpha and confirmatory factor analysis. Artificial Neural Network (ANN) modeling was adopted to determine threatening determinants along with their strength to predict OCD in an individual. The results of ANN modeling depicted 98% accurate classification of OCD patients from healthy controls. The most contributing factors in determining the OCD patients according to normalized importance were the contamination and cleaning (100%); symmetric and perfection (72.5%); worth of an individual in the family (71.1%); aggressive, religious, and sexual obsession (50.5%); high-risk assessment (46.0%); and somatic obsessions and checking (24.0%).

L'ocytocine dans le traitement du trouble obsessionnel: un rapport négatif à propos de deux cas

Deux patients, un homme de 43 ans et une femme de 24 ans, répondant aux critères diagnostiques du trouble obsessionnel compulsif ont été traités par ocytocine à 10 UI/jour, en intramusculaire. L'ocytocine est un nona-peptide hypophysaire dont la propriété d'altérer la mémoire est connue chez l'animal et chez l'homme. Une rémission relative du trouble obsessionnel compulsif a récemment été signalée lors d'un traitement prolongé par ocytocine intranasale. Nous n'avons, quant à nous, observé aucune amélioration des symptômes obsessionnels compulsifs (évalués selon la liste du Maudsley Hospital) durant les 15 à 20 jours de traitement. Les implications liées au mode d'administration sont discutées, de même que le rôle joué par d'éventuelles manifestations psychopathologiques survenant en cours de traitement.

Treatment of Self-Mutilation with Olanzapine

Background:

Self-mutilation or dermatitis artefacta is a facet of a much broader spectrum of factitial disease. Three nonpsychotic patients with self-mutilation are presented in this article who were successfully treated with low dose olanzapine when all other modalities of therapy had failed, including trials with numerous antidepressants and antipsychotics.

Objective:

The patients were simultaneously evaluated and treated by a dermatologist and a psychiatrist who run the psychodermatology or consultation-liaison clinic based at McMaster University. After dermatologic conditions had been excluded as a cause of the clinical findings, olanzapine was prescribed on a trial basis due to its low risk of parkinsonian side-effects and its antihistaminic properties.

Conclusions:

The excellent clinical response of the patients can be attributed to the low side-effect profile of the drug but also to the anti-impulsive effect which stems not only from antihistaminic properties but also from its anti-dopamine and serotonin-blocking action.

Obsessive-Compulsive Disorder: A Review of the Cross-Cultural Epidemiological Literature

Early clinical studies suggested that obsessive-compulsive disorder (OCD) was a rare disorder, but recent large-scale epidemiological research conducted in North America using standardized diagnostic criteria (DSM-III) report prevalence rates between 1 to 3%. A review of clinical and case reports of OCD among psychiatric population in non-Western countries reveals similar sociodemographic and clinical correlates for the disorder compared to Western findings. Epidemiological studies using translated versions of standardized diagnostic instruments and conducted in non-Western countries, report similar prevalence rates and clinical phenomenology for O CD as that found in Western settings. Methodological and measurement issues relevant to conducting valid cross- cultural psychiatric research are discussed in relationship to the diagnosis of OCD. The review concludes that OCD is generally similar in prevalence, sociodemographic characteristics and clinical features in both Western and non-Western countries for adult populations.

Influência de Estresse, Materialismo e Autoestima na Compra Compulsiva de Adolescentes

ResumoO comportamento relacionado à compra compulsiva se caracteriza por um impulso incontrolável e irracional que tende a manifestar-se quando os indivíduos vivenciam sentimentos negativos. Apesar de ser intensamente pesquisada, ainda restam dúvidas sobre os fatores influenciadores da compra compulsiva, em especial em públicos potencialmente vulneráveis, como é o caso do público adolescente. Ao considerar tal lacuna, este artigo analisa o comportamento de compra compulsiva, assim, buscando compreender os condicionantes oriundos dos níveis de autoestima, materialismo, estresse e prazer em comprar especificamente de consumidores adolescentes. A partir da revisão de literatura, foram definidas quatro hipóteses, que foram testadas a partir de dados coletados junto a uma amostra de 153 sujeitos. No teste das hipóteses, foi utilizada a técnica de regressão da família gama de modelos lineares generalizados, operacionalizados no software R. Os resultados demonstraram que fatores como estresse, materialismo e prazer em comprar influenciam o comportamento de compra compulsiva dos adolescentes, tendo-se constatado ainda que a autoestima não teve influência na compulsividade dos respondentes da pesquisa. A pesquisa inova na operacionalização dos dados e avança no conhecimento acadêmico sobre compulsividade no consumo, gerando conhecimento que pode servir para formuladores de políticas públicas e organizações sociais orientadas ao interesse do consumidor.

How does thought-action fusion relate to responsibility attitudes and thought suppression to aggravate the obsessive-compulsive symptoms?

BACKGROUND

Comprehensive cognitive theories of obsessive compulsive disorder (OCD) propose that clinical obsessions and compulsions arise from specific sorts of dysfunctional beliefs and appraisals, such as inflated sense of responsibility, thought-action fusion (TAF), and thought suppression.

AIMS

The present study aimed to examine the mediator roles of responsibility and thought suppression between TAF and obsessive-compulsive symptoms. Specifically, it aimed to explore the relative effects of TAF factors (i.e. morality and likelihood) on inflated sense of responsibility and on thought suppression to increase the obsessive qualities of intrusions.

METHOD

Two hundred and eighty-three Turkish undergraduate students completed a battery of measures on responsibility, thought suppression, TAF, OC symptoms, and depression.

RESULTS

A series of hierarchical regression analyses, where depressive symptoms were controlled for, indicated that TAF-morality and TAF-likelihood follow different paths toward OC symptoms. Although TAF-morality associated with inflated sense of responsibility, TAF-likelihood associated with thought suppression efforts, and in turn these factors increased OC symptoms.

CONCLUSIONS

These findings provide support for the critical role of sense of responsibility and thought suppression between the relationship of TAF and OC symptoms. Findings were discussed in line with the literature.

Cognitive behavioral therapy of obsessive-compulsive disorder

Until the mid-1960s, obsessive-compulsive disorder (OCD) was considered to be treatment-resistant, as both psychodynamic psychotherapy and medication had been unsuccessful in significantly reducing OCD symptoms. The first real breakthrough came in 1966 with the introduction of exposure and ritual prevention. This paper will discuss the cognitive behavioral conceptualizations that influenced the development of cognitive behavioral treatments for OCD. There will be a brief discussion of the use of psychodynamic psychotherapy and early behavioral therapy, neither of which produced successful outcomes with OCD. The main part of the paper will be devoted to current cognitive behavioral therapy (CBT) with an emphasis on variants of exposure and ritual or response prevention (EX/RP) treatments, the therapy that has shown the most empirical evidence of its efficacy.

Hypnotically facilitated treatment of obsessive-compulsive disorder: can it be evidence-based?

There are extensive evidence-based guidelines for the treatment of Obsessive-Compulsive Disorder (OCD) with medication, behavior therapy, and cognitive therapy. Nevertheless, there remain a significant percentage of patients whose symptoms are more or less refractory to standardized treatments. This situation could be rooted in the phenotypic heterogeneity of the disorder as well as in its high rates of comorbid psychopathology. Studies have also found OCD to be associated with higher levels of dissociation. This paper examines what may be needed to establish evidence-based hypnotically facilitated therapies for treatment-resistant OCD. It provides an introduction to the complexity of the treatment issues surrounding OCD and considers both possibilities for and obstacles to setting up an evidence-base for using hypnotically facilitated psychotherapies for its treatment.

Child psychoanalysis and obsessive-compulsive symptoms: the treatment of a ten-year-old boy

Obsessive-compulsive symptoms have long held interest for psychoanalysts. Currently, pharmacological and behavioral treatments are commonly viewed as the standard of care, and psychoanalytic clinicians are often uncertain of how best to approach these patients. The successful two-year psychoanalytic treatment of a ten-year-old boy with obsessivecompulsive disorder, who remained symptom-free eight years after termination, is reported. While this is but a single case, its outcome implies that for some patients psychoanalysis may be the treatment of choice.

Posttraumatic obsessive-compulsive disorder: a three-factor model

This paper presents a three-factor causal model of obsessive-compulsive disorder (OCD), which posits that exposure to long-term traumatic stress generates an inordinate degree of anxiety during the psychological development of the premorbid OCD child. In response to these conditions the child evolves a distinct cognitive style characterized by exaggerated threat appraisal and magical beliefs, and experiences alterations in brain metabolism. An entire functional brain system (a basal ganglia-orbitofrontal circuit) enters into a state of enhanced responsiveness following exposure to protracted threat. Over time the threshold for stimulation is dramatically lowered, resulting in a hypersensitivity to cues that signify potential harm. Individuals adapt to this hypersensitivity through a variety of strategies, which constitute OCD.

Dental management of the patient with obsessive-compulsive disorder

Individuals with obsessive-compulsive disorder frequently manifest bizarre behaviors that contribute to the oral disease development. The medications used to manage the disorder can cause profound xerostomia and compound the magnitude of oral pathology. The patient's behavioral alterations and drug therapy might require dental treatment modifications.

Intravenous chlorimipramine therapy in obsessive-compulsive disorder

A brief summary of the etiological factors and pharmacological approaches to therapy of obsessive-compulsive disorder is given. Evidence for the serotonergic hypothesis is reviewed. Three case reports of patients with severe OCD who had not responded to traditional chemotherapeutic approaches and electroconvulsive therapy are presented. All three responded to a series of 14 intravenous chlorimipramine infusions with a maximum dose of 350 mgms per infusion. The technique of infusion therapy and possible mechanisms of action are discussed. It is concluded that OCD is no longer accepted as a rare disorder and that effective treatment exists. For patients who do not respond to oral chlorimipramine, the treatment of choice, intravenous chlorimipramine is suggested as a viable alternative.

Obsessive-compulsive symptoms in childhood inflammatory bowel disease and cystic fibrosis

The Leyton Obsessional Inventory-Child Version was administered to 33 children with Crohn's disease, 11 with ulcerative colitis, and 46 with cystic fibrosis. Subjects with ulcerative colitis scored significantly higher on total number of obsessional symptoms and degree of resistance to symptoms than subjects with Crohn's disease. Scores of subjects with cystic fibrosis were intermediate between those of the ulcerative colitis and Crohn's disease groups. However, neither the ulcerative colitis group nor the Crohn's disease group differed significantly from the cystic fibrosis group that were statistically significant. Duration of illness was negatively correlated with symptoms in Crohn's disease and ulcerative colitis. The results suggest that obsessive-compulsive symptoms are not specific to Crohn's disease or ulcerative colitis and that obsessive-compulsive symptoms in pediatric chronic illness may be secondary to the demands of the illness.

Hospitalization of obsessive-compulsive patients: the "forgotten" factor in the behavior therapy literature

The role of hospitalization in the treatment of obsessive-compulsive patients has been neglected to a great extent in the behavior therapy literature. For this reason existing therapeutic programs, as described and evaluated in the literature, are briefly reviewed with regard to the use of a hospital setting in the course of treatment. The advantages and limitations of both inpatient and outpatient treatment are discussed. Finally, a few guidelines are offered to decide which patients may require admission to an inpatient psychiatric setting.

Obsessive-compulsive disorder: psychobiological approaches to diagnosis, treatment, and pathophysiology

The diagnosis, treatment, and pathophysiology of obsessive-compulsive disorder (OCD) were examined in a series of studies utilizing psychobiological approaches. Putative biological markers previously reported in depression were studied in this disorder and revealed that on some measures [Dexamethasone Suppression Test and rapid eye movement (REM) latency on sleep electroencephalogram (EEG)], OCD patients resemble those with major depressive disorder (MDD), whereas on others [REM density, platelet serotonin uptake, probably platelet 3H-imipramine binding, and 5-hydroxy-indoleacetic acid (5-HIAA) in cerebral spinal fluid (CSF)] they do not. The relationship between OCD and MDD was further explored in a double-blind, randomized crossover study designed to compare the antiobsessional effects of two tricyclic antidepressants, clomipramine (CMI) and desipramine (DMI), in a nondepressed cohort of OCD patients. CMI was found to have significant antiobsessional effects in this group, whereas in the same patients, DMI lacked therapeutic effects. These results suggest that not all antidepressants are antiobsessive and that some property of CMI, such as its potent serotonergic effects, may be of pathophysiological relevance for OCD. The role of serotonin in this disorder was then tested using the pharmacological challenge strategy. A novel serotonin postsynaptic receptor (5HT-1) agonist, m-chlorophenylpiperazine (m-CPP), was administered orally (0.5 mg/kg) under double-blind, placebo-controlled conditions to OCD patients and controls. In addition, a serotonergic receptor antagonist, metergoline (4 mg), was given to a subset of OCD patients. Relative to healthy volunteers, the OCD patients became significantly more anxious, depressed, and dysphoric after m-CPP administration. Moreover, in the OCD patients, obsessive-compulsive symptoms increased markedly after m-CPP and decreased significantly following metergoline administration. These results demonstrate that agents that bind to the 5HT-1 receptor can acutely affect the symptoms of OCD patients. The striking behavioral effects of these direct postsynaptic receptor ligands and the relative specificity of clomipramine as an antiobsessional agent suggest that serotonergic neurons may play a role in the pathophysiology, as well as mediating the pharmacological reduction, of obsessional symptoms.

Relationship of obsessive-compulsive personality to obsessive-compulsive disorder: a review of the literature

The nature of the relationship between obsessive-compulsive personality and obsessive-compulsive disorder has been the subject of considerable debate. The present article dealt with clinical opinion and reviewed empirical data bearing on this issue. It was concluded that, although the two clinical entities bear a surface similarity in terms of shared behavioral features and defenses, obsessive-compulsive personality is neither a necessary nor sufficient factor in the development of obsessive-compulsive disorder, though the latter appears to be more frequently associated with premorbid obsessive-compulsive personality patterns than with other personality patterns. Suggestions for future research study are made.

Intranasal oxytocin in obsessive-compulsive disorder

A 55-year patient with obsessive-compulsive disorder showed clear improvement during 4 weeks of treatment with intranasal oxytocin compared to 4 weeks of intranasal placebo. This improvement was concurrent with the development of severe memory disturbances, supporting the amnestic properties of the peptide. However, the patient also developed psychotic symptoms and a marked decrease in plasma sodium and osmolality, which may have masked the obsessive symptomatology. This case highlights the need for careful monitoring in long-term oxytocin therapy.

Obsessional symptomatology and adverse mood states

Patients suffering from obsessional neurosis without other psychiatric diagnosis were examined with reference to the association of the mood disorders of depression, anxiety, and outwardly and inwardly directed irritability. All mood disorders were common, and many occurred together in individual patients, but anxiety was the most prevelant. Inwardly directed irritability was significantly related to the overall severity of obsessions, and to the degree of handicap or interference in everyday life experienced by the patient.

Sociodemographic variables in obsessive compulsive neurosis in India

A retrospective analysis was carried out about sociodemographic data in 412 patients who had received a diagnosis of Obsessive Compulsive Neurosis in the period 1975 to 1984. The patterns which emerged have been discussed. There was a bimodal age of onset in females, the second peak occurring at 35-40 years. Students and housewives were the two largest groups observed.

Obsessive-compulsive adolescents and their parents: a psychometric study

The present study examined obsessive personality traits and achievement expectations of parents with an obsessive-compulsive adolescent. The Leyton Obsessional Inventory (LOI) and rating scales of occupational and educational aspirations and expectations were administered to both parents and the adolescent of 12 families with an obsessional adolescent and 10 families having an anxious, nonobsessional son or daughter. The parents' LOI scores were similar in the two groups, though higher than normal adults on the trait and resistance scales. The obsessional adolescents perceived their parents to hold significantly higher career demands for them than the anxious adolescents.

Clomipramine treatment of repetitive behavior

The paper describes an informal, open trial of the effect of clomipramine on 8 patients with repetitive behaviors which were not part of a classical obsessive-compulsive neurosis. Six chronic schizophrenics had obsessions, compulsions and rituals in addition to their schizophrenic symptoms. Four of the six showed reduction in the repetitive behavior with clomipramine. Two cases in which the target symptom and overall clinical picture had little in common with obsessive compulsive neurosis, are reported in detail. Both improved with clomipramine. It is suggested that clomipramine may be useful in the treatment of a broad range of psychiatric disorders characterized by repetitive mental or behavioural phenomena, but which do not fulfill criteria for obsessive-compulsive neurosis.

The use of intravenous chlorimipramine in the treatment of obsessive compulsive disorder

Obsessional disorder has always remained a difficult illness for psychiatrists to treat with response to therapy, both psychotherapy and chemotherapy, being low. A review of the traditional approaches to the treatment of obsessional disorder is done, including a brief review of the literature on intravenous chlorimipramine. Five case histories of patients with previously non-responsive obsessional disorder are summarized. All five cases were treated in hospital with a series of infusions of intravenous chlorimipramine. The drug and route of administration was extremely well tolerated with rapid and dramatic relief of obsessional symptoms as well as improvement of mood in all cases. The theoretical action of chlorimipramine is discussed as well as possible reasons why the intravenous route appears to be superior to the oral form.

Behavioral treatment of obsessive-compulsive disorders: current status

Behavioral treatment of obsessive-compulsive disorders ranks among the most widely used and widely studied approaches to these problems. Next to sociopathy these disorders have traditionally been regarded as constituting one of the most difficult classes of psychological problems to treat; certainly they present an exceptionally low rate of success. By contrast with the usual insight psychotherapy, behavior therapy usually focuses on the symptoms alone, with little attention to any underlying intrapsychic or environmental conditions that presumably maintain the symptom. Behavior therapy ignores, in short, the total personality or lifestyle. This symptom specificity of treatment has rendered behavioral approaches subject to criticism from practitioners of more traditional approaches. In more recent years, newer techniques and strategies of behavior therapy have rendered some of those criticisms obsolete. A trend toward consideration of other symptoms and the individual's environment has also been noted.