Ketamine Infusion in a Resistant Obsessive-Compulsive Disorder Patient in Bangladesh with Severe Suicidal Ideation: A Case Report

Treatment of resistant obsessive-compulsive disorder (OCD) typically results in insufficient symptom alleviation, and even long-term medication often fails to have the intended effect. Ketamine is a potent non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Studies have shown that low-dose ketamine infusion results in a considerable reduction in obsessive-compulsive symptoms and a rapid resolution of suicidal ideation. This is a case report on the effect of intravenous ketamine infusion on a patient with resistant OCD and severe suicidal ideation. Intravenous (IV) ketamine was given once a week over consecutive three weeks with necessary precautions. Psychometric tools such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impressions Scale (CGI-S), the Beck Scale for Suicidal Ideations (BSSI), and Depression Anxiety and Stress Scale 21 (DASS-21) were applied before and after infusions. Obsessive-compulsive symptoms and suicidal severity started to decrease rapidly after the first infusion. However, after a transient improvement, these symptoms again began to increase after a stressful incident on the second day of the first infusion. All the symptoms measured by validated rating scales showed continued improvement after the following two infusions. The improvement was sustained until discharge (one week after the last infusion) and subsequent follow-up in the sixth and 12th weeks. The role of ketamine in reducing suicidal thoughts and behavior is already established. Very few studies emphasized its effectiveness in improving severe/resistant obsessive-compulsive symptoms. This pioneering work may offer scope for similar research in the relevant field.

Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder

OBJECTIVE

Orthorexia nervosa (ON) is characterized as obsessional healthy eating that results in malnutrition and/or psychosocial impairment. Yet, ON shares theoretical overlap with eating disorders (EDs), especially anorexia nervosa (AN), as well as obsessive-compulsive disorder (OCD). This study aimed to further understand ON and its overlap with related disorders by assessing the ability of ON for detecting the presence/absence of threshold ED, AN, and OCD symptoms.

METHOD

An observational survey was completed by 197 participants recruited through eating disorder, dieting, and mental health support groups. Receiver operating characteristic (ROC) curve analyses determined the predictive ability of ON symptoms (assessed by Eating Habits Questionnaire [EHQ] orthorexia nervosa [OrNe] and healthy orthorexia [HeOr] subscales, and the Orthorexia Nervosa Inventory [ONI]) for detecting disordered eating symptoms (determined by Eating Disorder Examination Questionnaire [EDE-Q] global cut-scores), probable AN (determined by EDE-Q cut-scores and body mass index [BMI] <18.5), and OCD symptoms and obsessional thinking (assessed by the Revised Obsessive-Compulsive Inventory [OCI-R]).

RESULTS

Results showed both the ONI and EHQ OrNe measures are able to adequately predict ED symptoms and AN; however, both were poor to moderate at detecting OCD symptoms and obsessional thinking. Healthy orthorexia was poor to moderate at detecting outcomes.

DISCUSSION

These results suggest that ON, as it is currently operationalized, may be more closely related to EDs than OCD, and that ON may represent a subtype of AN. Results also support healthy orthorexia as a distinct construct to ON. While results are limited by the lack of definitive ON diagnostic criteria, findings suggest that treatments developed for EDs might be most suited to ON.

PUBLIC SIGNIFICANCE

ON has been proposed as a psychiatric disorder, and it shares theoretical overlap with several existing disorders. This study adopts a novel approach to assessing and exploring the overlap of ON with EDs, AN and OCD. Results suggest that ON shares more overlap with EDs and might best be understood as a subtype of EDs or AN.

Obsessive-Compulsive Disorder (OCD): A Comprehensive Review of Diagnosis, Comorbidities, and Treatment Approaches

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder widely recognized for its recurrent obsessions and compulsions, which may cause severe impairment worldwide. This review explores the difficulties in diagnosing OCD, its comorbidities, and its treatment approaches. Psychiatry and neuroscience face noteworthy obstacles in treating OCD, which is frequently misdiagnosed and inadequately addressed. This illness, which causes upsetting symptoms that interfere with day-to-day living, affects not only adults but also children and adolescents to a great extent. Despite the availability of multiple therapy methods, such as pharmacological and psychological approaches, many patients exhibit resistance, emphasizing the necessity for alternative therapies. OCD and other psychiatric conditions like bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder substantially overlap, highlighting the complexity of mental health diagnoses. Furthermore, its comorbidity with these diseases further highlights OCD's intricacy. Several therapy considerations have been mentioned, such as using larger dosages of medications and combining different therapeutic approaches. Their association suggests possible common pathogenic pathways between OCD and other psychiatric illnesses. The review concludes that, given the significant number of people who still struggle with chronic symptoms, new treatment techniques and ongoing research are necessary, even in the face of improvements in the understanding and treatment of OCD.

What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations

The Diagnostic and Statistical Manual 5th ed. defines obsessions in obsessive-compulsive disorder (OCD) as frequent, persistent, intrusive, unwanted thoughts that provoke anxiety and distress and lead to attempts to neutralize them with either thoughts or actions. However, no systematic review has yet evaluated characteristics that are specific to obsessions occurring in OCD. The aim of the current systematic review and meta-analysis was to investigate the specific features of obsessions occurring in OCD by comparing them to both obsessionally and non-obsessionally-themed intrusions in non-clinical and other clinical populations. Based on a registered protocol, 832 records were found, of which 15 were included in the systematic review and meta-analysis, with a total of 1891 participants. Obsessionally-themed intrusions that occur among those with OCD caused more distress, guilt, negative emotion and interference as compared to similarly-themed intrusions that occur within the general population. The distinction between obsessionally-themed intrusions among those with OCD as compared to those occurring in anxiety and depressive disorder primarily revolves around a higher level of persistence, pervasiveness and distress associated with their occurrence. Further, unacceptability, uncontrollability, ego-dystonicity, alienness, guilt, the form of the intrusion, association with the self and lack of any basis in reality also differentiates between obsessions and intrusions occurring in other disorders. Obsessions share many characteristics with thoughts occurring in other disorders and can be distinguished using a combination of characteristics specific to individual disorders.

Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients

INTRODUCTION

Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile.

OBJECTIVES

The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients.

METHODS

This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight.

RESULTS

Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation.

CONCLUSION

Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.

Psychometric properties of a daily obsessive-compulsive symptom scale for ecological momentary assessment

Despite growing interest in ecological momentary assessment (EMA) in psychopathology and clinical observation of day-to-day fluctuations in obsessive-compulsive disorder (OCD) symptoms, there is not a standardized EMA measure of such symptoms that can guide systematic research. In the absence of such a measure, prior EMA research in OCD has utilized heterogeneous approaches to sampling momentary and daily OCD symptoms, which limits the ability to compare results between studies. The present study sought to examine the psychometric properties of a daily OCD symptom (d-OCS) measure that assesses common OCD symptom themes (e.g., contamination, checking, intrusive thoughts) in a sample of adults with OCD (n = 20), psychiatric controls (n = 27), and healthy controls (n = 27). Participants completed the d-OCS 3 times per day for 1 week. The d-OCS distinguished those with OCD from psychiatric controls and healthy controls. The d-OCS demonstrated good internal consistency, adequate test-retest reliability, and good convergent validity. These findings offer initial psychometric support for the use of the d-OCS in EMA research examining day-to-day fluctuations in symptoms of OCD. Additional investigation is needed to examine the discriminant validity of the d-OCS and generalize these findings to more diverse samples.

The Seeking Proxies for Internal States (SPIS) Model of OCD - A Comprehensive Review of Current Findings and Implications for Future Directions

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) explains symptoms of OCD as stemming from attenuated access to internal states, which is compensated for by using proxies, which are indices of these states that are more discernible or less ambiguous. Internal states in the SPIS model are subjective states that are not accessible to others, encompassing physiological states, motivations, preferences, memories, and emotions. Compensatory proxies in OCD include fixed rules and rituals as well as seeking and relying on external information. In the present review, we outline the SPIS model and describe its basic tenets. We then use the SPIS conceptualization to explain two pivotal OCD-related phenomena - obsessive doubt and compulsive rituals. Next, we provide a detailed overview of current empirical evidence supporting the SPIS in several domains, including physiological states, emotions, sense of understanding, decision-making, and sense of agency. We conclude by discussing possible neural correlates of the difficulty in accessing internal states, focusing on the anterior insular cortex (AIC) and highlighting potential clinical implications of the model to the treatment of OCD.

Obsessional intrusive thoughts in children: An interview based study

OBJECTIVES

We aimed to investigate the experience of obsessional intrusive thoughts (OITs) in a sample of children aged 8 to 10 years old and to test the main tenets of the cognitive model of OCD. Specifically, we assessed: (1) the prevalence of OITs experienced by young children; (2) their frequency and content; (3) the emotions they evoke; (4) the reasons why they are upsetting; (5) how they are appraised (6) and what control strategies they use.

METHODS

Forty-nine children (28 girls, 21 boys; mean age 9.1 years) from the community completed two self-report questionnaires assessing anxiety and obsessive-compulsive symptoms. Children were interviewed using the Children's Anxious Thoughts Interview, which assessed their experiences of OITs.

RESULTS

From the 49 participants, 71.43% reported having experienced at least one OIT. The most frequent contents related to harm and doubt. Of the total sample, 28.6% reported having experienced one OIT recently with at least moderate frequency; these participants reported higher anxiety and obsessive-compulsive interference, described feeling nervous and anxious when experiencing their OIT, and rated their OIT as highly important and distracting. The most frequently reported control strategies were cognitive - suppression, distraction and thought replacement.

CONCLUSIONS

Almost two thirds of community children reported experiencing OITs. The findings from this study provide preliminary support for the application of the cognitive model of OCD in children. Subtle differences from previous research with adults are discussed.

COVID-19-related intrusive thoughts and associated ritualistic behaviors

This study evaluated COVID-19-related intrusive thoughts and associated ritualistic behaviors (CITRB). From March to May 2020, 1,118 Chinese high school students, college students, psychiatric outpatients, and community members completed a survey assessing CITRB, generalized anxiety, depression, somatization, obsessive-compulsive symptoms, and pandemic-related disruptions. Overall, participants reported mild to moderate CITRB, although certain thoughts/behaviors were more frequently endorsed, such as repeatedly telling others to take precautions against COVID-19 and checking COVID-19-related news. Being male, younger, a health-care worker, or in isolation/quarantine was associated with CITRB severity in community members. Obsessive-compulsive symptom severity, depression, somatic symptoms, and anxiety were associated with CITRB severity, although only obsessive-compulsive symptoms were uniquely associated with CITRB. This study provided evidence for the construct of CITRB, which may help mental health providers identify the nature and sources of COVID-19-related distress for some individuals as well as serve as a framework for evaluating obsessive-compulsive symptoms specific to large-scale crises.

Do all obsessions contradict personal values to the same degree? A pilot investigation

Although much is known about how intrusive thoughts become obsessions, the factors that determine which particular thoughts do so is not. The degree to which intrusions are personally significant may be such a determinant. Obsessive-compulsive disorder (OCD) is heterogeneous; thus, it is possible that contradictions of personal values may play a varying role in the development of obsessions depending on which OCD symptoms manifest and may change differentially following treatment. Archival data were examined. Patients with a diagnosis of OCD (N = 62) reported their most upsetting obsession and the degree to which it violated values both pre- and postparticipation in group cognitive-behavioral therapy for OCD. At pretreatment, contradiction ratings differed across symptom domains, such that participants with primary symptoms of obsessions/checking exhibited contradiction ratings that were significantly greater than did participants with other primary symptoms. Contradiction ratings did not change posttreatment. Implications for the conceptualization of OCD are discussed.

Use of Selective Alternative Therapies for Treatment of OCD

About 40% of the people with the obsessive-compulsive-disorder do not experience the desired outcome after the existing treatment, and its several side effects were reported. This systematic review was conducted to evaluate the efficacy and tolerability of alternative drugs and assess the possibility of their use as treatment options for obsessive-compulsive-disorder. The Scientific databases PubMed, Science Direct, Google Scholar, Cochrane, Directory of Open Access Journals, MedRxiv and BioRxiv, were searched from inception to March 2022, using appropriate search strategies for each drug and following the Prisma guidelines 2020. Studies were selected according to the already set criteria and assessed for bias. Data were extracted, and descriptive and continuous data were analyzed and presented as frequency/percentage and mean. A total of 16 observational and interventional studies were included for data extraction. The studies focused on four drugs, Psilocybin (n=4), Cannabis (n=7), Nicotine (n=3), and Morphine (n=2), that were used to test out their effect on OCD symptoms. Overall, the majority of the studies showed promising results by documenting a reduction in Y-BOCS scores. However, few subjects, specifically those using nicotine or Cannabis, did not affect their condition or self-reported worsening symptoms. Few side effects were also noticed. This systematic review found that the drugs mostly showed a positive response. All Psilocybin and morphine users, 88.2% and 74.1% of the nicotine and Cannabis users, respectively, reported experiencing the positive effect of these drugs, indicating that these drugs have the potential to be used in the management of OCD. However, further research is required in this arena to thoroughly understand the mechanism of action by which these drugs produce their therapeutic effect. Policies to destigmatize and encourage clinical trials with these drugs are crucial for exploring the use of these drugs as a treatment option for OCD.

Right-deviating prismatic adaptation reduces obsessions in a community sample

Background and aims

Patients with obsessive-compulsive (OC) disorder are impaired in disengaging attention from negative valence stimuli and show an attentional bias toward the right space. This pattern in OC disorder is similar to the impaired disengagement of attention from stimuli in the ipsilesional space as a consequence of a right-hemispheric cerebral lesion in patients with neglect, suggesting a right hemispheric dysfunction in patients with OC disorder. The attentional impairment in patients with neglect is reduced by a visuomotor procedure, such as prismatic adaptation (PA) with right-deviating lenses. Thus, here, we explored whether right-deviating PA is also effective in reducing OC psychological symptoms.

Methods

Participants with a high rate of OC symptoms completed self-report measures of such symptoms before and after right- or left-deviating PA.

Results

Right-deviating PA, and not left-deviating PA, reduced OC symptoms more prominently on obsessions than compulsions.

Conclusion

Results support the idea that right-deviating PA might be considered an effective technique to modulate OC symptoms. This has implications for theories about the underlying mechanisms of OC symptoms and the consideration of PA as a complementary procedure to psychological treatments.

The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample

BACKGROUND

Although obsessive-compulsive (OC) symptoms are common in the perinatal period, measures to comprehensively assess their presence, frequency, interference and severity are lacking. The Perinatal Obsessive-Compulsive Scale (POCS) is the only self-report questionnaire with context-specific items. It includes items to assess perinatal-specific obsessions and compulsions, a severity scale and an interference scale.

OBJECTIVES

(1) to analyze the validity and reliability of the Portuguese version of the POCS; (2) to find Obsessive-Compulsive Disorder (OCD) prevalence in postpartum and determine the POCS cut-off scores and its accuracy (sensitivity, specificity and predictive values) in screening for OCD according to DSM-5 criteria; (3) to describe the prevalence, content, severity, interference and onset of OC symptoms in the postpartum.

METHODS

212 women in postpartum filled in a booklet, including the POCS Portuguese preliminary version, the Perinatal Anxiety Screening Scale and the Postpartum Depression Screening Scale; they were interviewed with the Diagnostic Interview for Psychological Distress-Postpartum.

RESULTS

Confirmatory Factor Analysis revealed that POCS presented acceptable fit indexes (χ²/df = 2.2971; CFI= 0.9319; GFI = 0.8574; TLI = 0.9127; RMSEA = 0.860, p < 0.001). The Cronbach's alphas were all > 0.800. The POCS cut-off point that maximized the Youden Index (J = 0.86, 95% CI [0.94-0.99]) was 20, corresponding to an Area Under the Curve of 0.970 (p < 0.001; Standard Error = 0.031; 95% CI: 0.937 to 0.988). The prevalence of postpartum OCD was 3.30%. The severity of thoughts and behaviors was moderate to severe for approximately 15% of women. For thirty-five percent of women, the onset of symptoms was in the first three months postpartum.

CONCLUSIONS

The Portuguese version of POCS has good validity, reliability and accuracy and may be considered ready for use in both clinic and research fields. POCS provides specific information regarding symptoms and individual patterns experienced by each woman, which allows normalization, destigmatization and personalized intervention.

Antiseizure medication-induced obsessive-compulsive disorder and tic disorder: a pragmatic review

INTRODUCTION

With a lifetime prevalence of 2.3%, obsessive compulsive disorder is a chronic, disabling condition that is associated with significant social and occupational impairment. Up to 30% of individuals with obsessive-compulsive disorder have a lifetime diagnosis of tic disorders. Antiseizure medication is increasingly used for a variety of physical and psychiatric illnesses. Clarification of the relationship between these symptoms/disorders and use of antiseizure medication is critically important for diagnostic and treatment purposes.

AREAS COVERED

Studies on antiseizure-induced obsessive-compulsive disorder and tic disorders are reviewed. The literature search strategy identified 89 articles. Twenty-nine articles were included in the final results. Of these, 24 are case reports or case studies, 2 cross-sectional studies, 1 chart review, 1 population-based case-control study and 1 observational prospective study assessing lamotrigine, levetiracetam, topiramate, zonisamide, and carbamazepine.

EXPERT OPINION

This study highlighted the temporal relationship of antiseizure medication use and onset of obsessive-compulsive symptoms and tics. Monitoring for medication-induced obsessive compulsions or tics should be undertaken when prescribing antiseizure medication for treatment of mood disorders or epilepsy. Further research identifying the causal relationship between antiseizure medication and de novo onset of obsessive-compulsive symptoms, obsessive-compulsive disorder and tic disorder is required.

Obsessive-Compulsive Disorder and Schizophrenia: Conceptualization, Assessment and Cognitive Behavioral Treatment

There is little doubt that schizophrenia (SZ) and obsessive-compulsive disorder (OCD) are among the most severe disorders to impact humanity. They are both common, significantly disabling and have the tendency to strike during critical developmental periods in a young person's life. Schizophrenia affects approximately 1% of the global population and OCD has a lifetime prevalence of between 2% and 3% in the general population. The comorbidities in both SZ and OCD are common and frequently diagnosed, and research has generally found that comorbidities are associated with conditions that are more complex to diagnose and treat, and often result in less favorable prognoses. We review the research that has taken place regarding the co-occurrence of SZ and OCD, discuss it's theoretical conceptulization and clinical differentiation and diagnosis. We then propose recommendations for the best practice of cognitive behavioral therapy in this difficult population, as well as areas that need exploration for future research.

Impaired test performance yet spared neurocognitive functioning in individuals with obsessive-compulsive disorder: the role of performance mediators

INTRODUCTION

Although most studies report neurocognitive deficits in patients with obsessive-compulsive disorder (OCD), important exceptions exist, highlighting the possible role of mediators (e.g., poor motivation). This study investigated neurocognitive functioning and potential influences affecting performance in OCD.

METHODS

Forty-three participants (13 OCD patients, 30 healthy controls) were assessed using a battery of neurocognitive tests. During the assessment, the examiner completed the Impact on Performance Scale (IPS) which measures variables that may impact neurocognitive performance.

RESULTS

Pooled neurocognitive performance was lower in OCD patients versus healthy controls at a moderate effect size. Patients performed more poorly on the IPS, particularly the Well-Being During Assessment subscale. Performance differences across the two groups were attenuated to a non-significant small-to-medium effect when the IPS was entered as a covariate. A total of 34% of patients showed scores greater than one standard deviation below the mean compared to 9.63% in healthy individuals. Yet, when a conservative impairment criterion (≥2 standard deviations below the mean) was applied, less than 10% of patients displayed deficits.

CONCLUSIONS

Neurocognitive impairment in OCD is likely exaggerated. In addition to considering important mediators researchers should report the percentage of participants displaying performance deficits rather than mean group differences alone; the latter obscures the high percentage of patients without impairment and thus may unduly foster stigma in this population.

The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive-compulsive disorder sample

Cognitive models of obsessive-compulsive disorder (OCD) posit the relevance of the self in OCD, although the nature of this association is still unclear. We aimed to explore actual and feared selves and its association with obsessions and intrusions in a group of OCD patients. A group of 58 patients with OCD identified their most upsetting obsession and intrusion (non-clinical obsession) experienced in the past 3 months. These cognitions were classified as either moral-based or autogenous (obsessions n = 32; intrusions n = 26) or non-moral-based or reactive, depending on their content. Next, patients described their actual self and their feared self, that is, the person they feared being or becoming, and whether they believed these descriptions were associated with their obsessions/intrusions. Results indicate that individuals with OCD described themselves as insecure, anxious and fearful, but also as good and nice. They particularly feared a selfish, aggressive, bad, liar, coward, insecure and arrogant self. Two-thirds of the patients believed that their obsessions said something about their actual self (65.52%) and that their obsessions brought them closer to the person they do not want to be (62.06%). A third of patients believed their intrusions said something about their actual self (actual self: 30.35%; feared self: 25%), which was a significantly lower percentage than for obsessions. These associations existed independent from the content of the obsession and/or intrusion, although patients with obsessions with moral-based contents more often tended to believe that their obsessions brought them closer to the person they do not want to be. Results suggest the relevance of the real and feared selves in the maintenance of obsessions.

The impact of the coronavirus (COVID-19) pandemic on the development of obsessive-compulsive symptoms in Saudi Arabia

Objectives:

To explore the impact of the COVID-19 pandemic on the development of obsessive-compulsive disorder (OCD) symptoms and its correlation with the level of perceived stress among the Saudi population.

Methods:

In July 2020, a cross-sectional survey of 2909 participants in Saudi Arabia during the outbreak was conducted to collect data related to sociodemographic characteristics and scores on the Brief Obsessive-Compulsive Scale (BOCS) and Perceived Stress Scale (PSS).

Results:

Most participants were female (73.9%) with a university level of education or higher (81%). The prevalence of new-onset obsessions was 57.8%, compulsions 45.9%, and moderate/high perceived stress 72.4%. New-onset dirt, germs, and virus obsessions were significantly higher among 40-49 age group, employees, housewives, students, quarantine discipliners, and those who spent 20 or more days in quarantine. New-onset hand-washing compulsions were significantly higher among the 30-49 age group. A significantly higher level of perceived stress was reported among those in the 18-29 age group, females, singles, participants with no children, students, non-smokers, those who were unemployed, living with families, diagnosed with a psychiatric disorder, living in the northern region, quarantine discipliners, and those who spent 60 or more days in quarantine.

Conclusion:

This study revealed a significantly higher prevalence of high perceived stress in respondents with new-onset OCD contamination symptoms during the COVID-19 pandemic. This implies that a biodisaster is associated with high psychological morbidity.

Brooding Over the Closet: Differentiating Sexual Orientation Rumination and Sexual Orientation Obsessions

Two concepts that describe repetitive thoughts regarding an individual's sexual orientation-sexual orientation rumination and sexual orientation obsessions-have been introduced into the research literature. Despite the fact that these concepts have similarities, important distinctions exist with regard to their theoretical underpinnings, development, and catalyst of stress. As these concepts have never been teased apart in the research literature, understanding how these concepts are similar and different is particularly important. To this end, the present overview synthesizes the current literature regarding these concepts with the purpose of providing a decisional framework for differentiating sexual orientation rumination and sexual orientation obsessions and suggesting areas of future research.

Cognitive Tic-Like Phenomena in Gilles de la Tourette Syndrome

Coprolalia and echophenomena repeated in the patients’ mind (CTPh—cognitive tic-like phenomena) have been rarely recognized as part of Gilles de la Tourette syndrome (GTS) symptomatology and their assignment to tics, OCD or other psychopathologies has not been settled. The aim of the paper was to assess the incidence and clinical associations of CTPh in GTS, and to establish if CTPh belong to the tic spectrum. We performed a prospective, one-registration study on a cohort of 227 consecutive patients with GTS. CTPh were diagnosed during the interview and defined as brief, sudden, involuntary thoughts that had corresponding complex vocal tics. CTPh occurred at some point in the lives of 34 (15.0%) patients. The median age at onset of CTPh was 14.5 years (IQR: 10.5–17.5). CTPh were found more frequently in adults, with the most frequent onset in adolescence (44.1%). Four mental phenomena resembling tics were recognized: echolalia (n = 17), coprolalia (n = 16), palilalia (n = 13) and repeating of words in the mind (n = 7). The older the age of patients, the more severe tics, and anxiety disorder significantly correlated with CTPh. CTPh may be considered as a part of tic spectrum with a substantial impact of anxiety disorder. CTPh are a late and age-related symptom of GTS.

Depiction of Obsessive-Compulsive Disorder in YouTube videos

Videos on obsessive-compulsive disorder (OCD) are widely available on YouTube. Individuals with OCD and their caregivers would likely watch these videos to understand this disorder. Videos presenting the information related to symptomatology and available treatment accurately and in an easy-to-understand manner would benefit the patients and the caregivers. On the other hand, inaccurate information may create confusion. Given this, the present research is aimed at analyzing the content, accuracy, and appropriateness of the YouTube videos on OCD. The quality of the YouTube videos on OCD, in terms of accuracy of the information provided, was assessed. Out of 330 videos, resulting from various search terms, 82 were found to be suitable for analysis. The videos were assessed for the accuracy of presented content on clinical symptoms, biological underpinnings, and treatment (pharmacological and non-pharmacological) as well as their educational utility. Majority of the videos provided accurate description of obsessions (82.9%) and compulsions (74.4%) and 21.9% of the videos mentioned biological underpinnings of OCD. Treatment options, both pharmacotherapy and psychotherapy, were mentioned in 32.71% and 41.5% of the videos, respectively. Overall, 69.5% of the videos had useful educational utility. Findings have been discussed in terms of their practical utility.

Is context a crucial factor in distinguishing between intrusions and obsessions in patients with obsessive-compulsive disorder?

OBJECTIVE

Some cognitive models of obsessive-compulsive disorder (OCD) posit that intrusions exist on a continuum with obsessions; others consider that they may be unrelated phenomena that differ in the context where they occur. We aimed to examine and compare, at two different moments, the context of the occurrence of intrusions and obsessions.

METHOD

Sixty-eight patients with OCD completed an interview appraising their most upsetting obsession and intrusion.

RESULTS

At their onset, the obsessions/intrusions were associated with experiencing negative emotional states and life events, and they were more likely to appear in "inappropriate" contexts. The context of the obsessions/intrusions differed the last time they were experienced. Autogenous obsessions/intrusions occurred more frequently in contexts with an indirect link.

CONCLUSIONS

The context distinguishes between intrusions and obsessions, not when they emerge, but when the obsession is already established. The results support that there is a continuum or progression from intrusions to obsessions.

The diagnosis of severe obsessions in the setting of kratom withdrawal and treatment with lorazepam: Case report

Commercially available Kratom (Mitragyna speciosa) is a dietary supplement that has gained popularity in the United States for its psychoactive effects and potential medicative properties as an opioid receptor agonist. Likewise, sudden discontinuation may be accompanied by an opioid-like withdrawal. We present the first case in the literature of the withdrawal manifesting in disturbing obsessive thoughts after the substance was used as an opioid replacement treatment by our patient, as well as the first case where lorazepam is utilized for mitigation of these thoughts.

Pain and Psychological Distress: Effect of Microvascular Decompression on Sleep Disorders and Obsessions in Trigeminal Neuralgia

Objective  This study was aimed to investigate the effects of microvascular decompression (MVD) on sleep disorders and obsessions in trigeminal neuralgia. Methods  Clinical data from 115 patients with trigeminal neuralgia treated with MVD from August 1, 2017 to May 31, 2018 at Jining First People's Hospital were analyzed retrospectively. The preoperative and postoperative risk factors for sleep disorders and obsessions, as well as the effects of MVD on sleep disorders and obsessions, were examined. Results  In 115 patients, there were significant differences in preoperative sleep disorders associated with sex, monthly household income, pain in multiple branches, visual analog scale (VAS) score, and Self-Rating Depression Scale (SDS) score ( p  < 0.05). Preoperative obsessions were significantly different according to age, gender, pain in multiple branches, monthly household income, VAS score, and Self-Rating Anxiety Scale (SAS) score groups ( p  < 0.05). A 1-year recurrence was positively correlated with sleep disturbance (odds ratio = 3.829) and obsessions (odds ratio = 4.507). In addition, the results revealed a negative correlation between the manipulation of trigeminal neuralgia and postoperative sleep disorders ( B  ≥ 1.043). Moreover, there was a significant difference in sleep disorders and obsessions before and 1 year after MVD ( p  < 0.05). Conclusion  For patients with trigeminal neuralgia, pain caused by sleep and obsession disorders should be examined early to identify an effective solution. Moreover, MVD, as a first treatment, is valuable for improving the physiological and psychological prognosis of patients.

A Psycho-Behavioral Perspective on Modelling Obsessive-Compulsive Disorder (OCD) in Animals: The Role of Context

Obsessive-compulsive disorder is a heterogeneous and debilitating condition, characterized by intrusive thoughts and compulsive repetition. Animal models of OCD are important tools that have the potential to contribute significantly to our understanding of the condition. Although there is consensus that pre-clinical models are valuable in elucidating the underlying neurobiology in psychiatric disorders, the current paper attempts to prompt ideas on how interpretation of animal behavior can be expanded upon to more effectively converge with the human disorder. Successful outcomes in psychopharmacology involve rational design and synthesis of novel compounds and their testing in well-designed animal models. As part of a special journal issue on OCD, this paper will 1) review the psychobehavioral aspects of OCD that are of importance on how the above ideas can be articulated, 2) briefly elaborate on general issues that are important for the development of animal models of OCD, with a particular focus on the role and importance of context, 3) propose why translational progress may often be less than ideal, 4) highlight some of the significant contributions afforded by animal models to advance understanding, and 5) conclude by identifying novel behavioral constructs for future investigations that may contribute to the face, predictive and construct validity of OCD animal models. We base these targets on an integrative approach to face and construct validity, and note that the issue of treatment-resistance in the clinical context should receive attention in current animal models of OCD.

Predictors of acute outcomes for intensive residential treatment of obsessive-compulsive disorder

For those who suffer with chronic and disruptive obsessive-compulsive disorder (OCD), who have not been sufficiently helped by outpatient treatments or medications, intensive residential treatment (IRT) is often the next best treatment option. To date, research of the predictors of treatment outcome in IRT for OCD are mixed and sometimes contradictory. Additionally, although comorbidity is common for patients in this setting, the inclusion of comorbidity as a potential predictor of outcome has been mostly lacking in research to date. The current study aimed to address these issues by utilizing optimal indices of treatment outcomes, while incorporating comorbidity into our analyses, in order to identify the predictors of treatment outcomes in the IRT for OCD setting. To this end, we analysed outcome data from 379 patients receiving IRT for OCD at the Rogers Memorial OCD Center between August 2012, and December 2017. Results indicated that the most important predictor of treatment outcome was obsession severity at admission. Specifically, higher obsession severity at admission predicted poorer treatment outcomes at discharge. Clinical implications and suggestions for future research were discussed in the manuscript.

Obsessions Across Two Cultures: A Comparison of Belgian and Turkish Non-clinical Samples

There is a growing interest in the role of culture in Obsessive-Compulsive Disorder, yet cultural studies to date have suffered from methodological limitations and lack a clear theoretical framework. In the current study, we adopted a rigorous methodological approach, and a clear cultural psychological framework. We compared the structure and frequency of obsessions in non-clinical samples (N = 706) from Belgium, a Western culture, and Turkey, a non-Western cultural context. Obsessions were measured by a newly compiled instrument that included a broad range of obsessions. Cross-cultural equivalence of the structure of obsessions was assessed both in the pooled data, and in each culture separately. At an abstract level, we found a two-factor structure that was cross-culturally invariant, and that fit both cultures equally well. These two types of obsessions each corresponded with a different model of agency. Compared to the Turkish sample, the Belgian sample reported more obsessions that can be understood from a disjoint (independent) model of agency as frequently found in Western cultures, whereas the Turkish sample, compared to their Belgian counterparts, reported more obsessions that can be tied to a conjoint (shared) model of agency as frequently found in non-Western cultural contexts. Differences in the prevalent types of obsessions were systematic and interpretable, therefore. In addition to the cross-culturally equivalent two-factor structure, we found culture-specific factor solutions; these solutions point to cultural differences in the experience of obsessions that have yet to be fully understood. In the Discussion, we outline future directions of the research on culture and obsessions.

Predictors and Moderators of Cognitive and Behavioral Therapy Outcomes for OCD: A Patient-Level Mega-Analysis of Eight Sites

Cognitive (CT) and behavioral treatments (BT) for OCD are efficacious separately and in combination. Tailoring treatment to patient-level predictors and moderators of outcome has the potential to improve outcomes. The present study combined data from eight treatment clinics to examine the benefits of BT (n = 125), CT (n = 108), and CBT (n = 126), and study predictors across all treatments and moderators of outcome by treatment type. All three methods led to large benefits for OCD and depression symptoms. Residual gain scores for OCD symptoms were marginally smaller for BT compared to treatments containing CT. For depression, significantly more gains were evident for CBT than BT, and CT did not differ from either. Significantly fewer BT participants (36%) achieved clinically significant improvement compared to CT (56%), and this was marginally evident for CBT (48%). For all treatments combined, no predictors were identified in residual gain analyses, but clinically improved patients had lower baseline depression and stronger beliefs about responsibility/threat and importance/control of thoughts. Moderator analyses indicated that higher baseline scores on depression adversely affected outcomes for BT but not CT or CBT, and lower OCD severity and more education were associated with positive outcomes for CT only. A trend was evident for higher responsibility/threat beliefs to moderate clinical improvement outcomes for those receiving cognitive (CT and CBT), but not behavioral (BT) treatment. Medication status and comorbidity did not predict or moderate outcomes. Findings are discussed in light of models underlying behavioral and cognitive treatments for OCD.

If it is absurd, then why do you do it? The richer the obsessional experience, the more compelling the compulsion

Mounting evidence suggests that obsessive intrusions are often accompanied and amplified by perceptual experiences of different modalities (e.g., feeling dirt on one's skin while experiencing intrusive thoughts about contamination). Pilot studies conducted online with individuals endorsing mild obsessive-compulsive symptoms have linked the co-occurrence of perceptual experiences and obsessions to the severity of subsequent compulsive behaviour as well as low insight. However, it is presently unclear whether sensory experiences accompany all types of obsessional thoughts or are restricted to certain preoccupations (e.g., contamination and aggression). The present study examined a clinical inpatient and outpatient sample with a formally diagnosed obsessive-compulsive disorder (N = 34). Perceptual properties of intrusive thoughts were assessed with the Sensory Properties of Obsessions Questionnaire. The prevalence of perception-laden obsessive thoughts was comparable with prior studies (73.5%), but the intensity was significantly greater. No association was observed between perceptual experiences and expert-rated insight. However, the severity of perception-laden obsessions predicted the frequency of and impairment associated with compulsive behaviour. This was particularly strong for obsessions about contamination. The present study confirms the high prevalence and clinical relevance of perceptual experiences that accompany obsessions and further challenges the traditional trichotomy splitting mental phenomena into thoughts, intrusions, and hallucinations.

Differences in clinical intrusive thoughts between obsessive-compulsive disorder, generalized anxiety disorder, and hypochondria

Differences and similarities between intrusive thoughts typical of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive-compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire-Transdiagnostic Version (Romero-Sanchiz, Nogueira-Arjona, Godoy-Ávila, Gavino-Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.

Differences between autogenous and reactive obsessions in terms of metacognitions and automatic thoughts

BACKGROUND

Obsessive compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions have been classified as autogenous obsessions and reactive obsessions on the basis of the cognitive theory of Lee and Kwon. The aim of this study was to investigate the differences between autogenous groups (AG) and reactive groups (RG) in terms of metacognition and automatic thoughts, for the purpose of investigating the differences of cognitive appraisals.

METHODS

One hundred and thirty-three patients diagnosed with OCD were included in the study as the patient group. A control group was formed of 133 age, gender and education-matched healthy individuals. The OCD group patients were separated into subgroups according to the primary obsessions. The sociodemographic data, and the Yale-Brown Obsessive Compulsive Scale, Metacognition Questionnaire-30 (MCQ-30), Automatic Thoughts Questionnaire (ATQ), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores of the AG, RG, and control groups were compared.

RESULTS

The MCQ-30 (total) and the subscales of MCQ-30 and ATQ scale points were seen to be significantly higher in the AG than in the RG and significantly higher in the RG than in the control group. In the reactive obsession group, the predictive variables of the ATQ points were determined to be MCQ-30 (total), BDI and BAI. In the autogenous obsession group, the predictive variables of the ATQ points were determined to be BDI and BAI.

CONCLUSION

In the current study, differences were determined between the AG and the RG in respect of metacognitions and automatic thoughts. In light of these results, the recommended grouping can be considered useful in the identification of OCD sub-types. There is a need for further studies to identify more homogenous sub-types of OCD. Future multi-centered studies of sub-typing with larger samples using more specific instruments to sub-type and dimensional evaluation will be useful for detailed evaluation and better understanding of the subject.

Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions

BACKGROUND

Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions.

MATERIALS AND METHODS

Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12-16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up.

RESULTS

Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively.

CONCLUSIONS

Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted.

Assessing Sexual Orientation-Related Obsessions and Compulsions in Italian Heterosexual Individuals: Development and Validation of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS)

Sexual Orientation-Obsessive-Compulsive Disorder (SO-OCD) is characterized by intrusive thoughts, images, and urges related to one's sexual orientation, and by consequent avoidance, reassurance seeking, and overt and covert compulsions. Currently there is no short self-report measure that assesses SO-OCD symptoms. The current article describes two studies that develop and evaluate the first version of the Sexual Orientation Obsessive-Compulsive Scale (SO-OCS), a 14-item Italian self-report measure targeted towards heterosexual individuals. In Study 1, the SO-OCS was developed and refined through item analysis and exploratory factor analysis from an initial pool of 33 items administered to 732 Italian nonclinical participants. The SO-OCS showed a unidimensional structure and an acceptable internal consistency. In Study 2, the factor structure, internal consistency, temporal stability, construct and criterion validity, and diagnostic sensitivity of the SO-OCS were investigated in three samples of Italian participants (294 from the general population, 52 OCD patients who reported sexual orientation-related symptoms or concerns as a primary complaint, and 51 OCD patients who did not report these symptoms as primary complaint). The SO-OCS was again found to have a unidimensional structure and good internal consistency, as well as to exhibit strong construct validity. Specifically, the SO-OCS showed an excellent criterion validity and diagnostic sensitivity, as it successfully discriminated between those with SO-OCD and all other groups of participants. Finally, evidence of temporal stability of the SO-OCS in a nonclinical subsample was found. The SO-OCS holds promise as a measure of SO-OCD symptoms in heterosexual individuals.

Psychiatric Morbidity and Correlates in Postpartum Women in a Tertiary Care Hospital

BACKGROUND

A range of psychological disorders occur in women in the postpartum period apart from the traditional blues, postpartum depression and psychosis. These include obsession of infanticide, PTSD, morbid preoccupations regarding child birth and disorders of mother-infant relationships, though they are under emphasized.

METHODS

it is a cross-sectional study conducted in the tertiary maternity care hospital. A total of 152 study subjects were interviewed on MINI (Mini International Neuropsychiatric Inventory) and GAF (Global Assessment of Functioning) within 2 weeks after delivery.

RESULTS

The psychiatric morbidity was seen in 67 (44%) of the study subjects. About 26% of subjects had Depressive disorder NOS. Obsessive harm to the child, Panic disorder, Social phobia were the other disorders identified. There were no cases of Mania, Bipolar disorder, psychosis, post traumatic stress disorder or substance use disorder diagnosed across the sample. The Global Assessment of Functioning (GAF) score averaged 87.8. Statistically significant association was seen to be present between psychiatric illness and number of previous still births and dead children before this delivery (P = 0.045).

CONCLUSIONS

The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Social phobia identified as a common association is a new finding and needs further replication. It needs a larger sample with a prospective assessment to generalize the findings of our study.

Methylphenidate-induced obsessive-compulsive symptoms: A case report and review of literature

Literature on the association of methylphenidate and obsessive-compulsive symptoms (OCS) is sparse. This report discusses a case of a 14-year-old boy, who developed OCS (in the form of need for symmetry, obsessive doubts; compulsive symptoms included the need to order/arrange articles and repeated checking behavior), within 10 days of starting methylphenidate at the dose of 15 mg/day. Stoppage of methylphenidate led to amelioration of OCS over 2 weeks. The case description suggests that whenever a child on stimulants presents with new-onset OCS, association of OCS with stimulants must be suspected before considering an independent diagnosis of comorbid OCS/obsessive-compulsive disorder.

Handwriting Tics in Tourette's Syndrome: A Single Center Study

Tourette's syndrome (TS) is a neurodevelopmental disorder typically defined by multiple motor tics and at least one sound tic, beginning in childhood or in adolescence. Handwriting is one of the most impaired school activities for TS patients because of the presence of tics that hamper learning processes. In this paper, we present a case of handwriting tics in a TS patient highlighting the main features.

The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms

BACKGROUND

Obsessive beliefs account for substantial (but not all) obsessive-compulsive (OC) symptoms. Intolerance of internal experiences (IIE), which encompasses the constructs of experiential avoidance (EA) and distress tolerance (DT), refers to difficulty managing unwanted thoughts, emotions, and other internal states, and might add to current explanatory models. Although IIE appears to be conceptually relevant to obsessive-compulsive (OC) symptoms, scant research has examined this relationship empirically.

AIM

The present study examined the relative contributions of EA and DT as predictors of OC symptom dimensions.

METHOD

A nonclinical sample (n = 496) completed self-report questionnaires measuring general distress, EA, DT and OC symptom dimensions.

RESULTS

All variables of interest were significantly (all ps ≤ .001) correlated with one another, such that higher general distress, higher EA, and lower DT were associated with greater OC symptom severity for all symptom dimensions; however, only EA independently predicted obsessional symptoms, but not other OC symptom dimensions.

CONCLUSIONS

One's willingness to endure (i.e. EA), rather than their ability to tolerate (i.e. DT) unpleasant internal experiences best predicts obsessional symptoms (i.e. obsessing) above and beyond general distress. Potential implications for understanding, assessing, and treating OC symptoms are discussed.

Open-label study of duloxetine for the treatment of obsessive-compulsive disorder

BACKGROUND

This study sought to investigate the efficacy of duloxetine for the treatment of obsessive-compulsive disorder (DSM-IV).

METHODS

Twenty individuals were enrolled in a 17-week, open-label trial of duloxetine at Massachusetts General Hospital. Data were collected between March 2007 and September 2012. Study measures assessing obsessive-compulsive disorder symptoms, quality of life, depression, and anxiety were administered at baseline and weeks 1, 5, 9, 13, and 17. The primary outcome measures were the Yale-Brown Obsessive Compulsive Scale and Clinical Global Improvement scale.

RESULTS

For the 12 study completers, pre- and posttreatment analyses revealed significant improvements (P<.05) on clinician- and self-rated measures of obsessive-compulsive disorder symptoms and quality of life. Among the 12 completers, more than one-half (n=7) satisfied full medication response criteria. Intention-to-treat analyses (n=20) showed similar improvements (P<.05) on primary and secondary study outcome measures.

CONCLUSION

The results of this study suggest that duloxetine may provide a significant reduction in symptoms for patients with obsessive-compulsive disorder. ClinicalTrials.gov NCT00464698; http://clinicaltrials.gov/ct2/show/NCT00464698?term=NCT00464698&rank=1.

Brief dynamic psychotherapy in a case of obsessive compulsive disorder

A 57 years old married, retired official of Indian Railway service presented with two months complaints of recurrent fears of circulation of a duplicate CD of one of his presentations in an international conference, recurrent thoughts that the years of winning medals during his tenure in Indian Railways service were misrepresented in the records as early years. He recognized these fears as irrational, intrusive causing irritability and extreme anxiety, as he felt an urge to go and check the records, and feared it would cause humiliation. A diagnosis of obsessive compulsive disorder predominantly obsessions were made. Patient refused medication and a keen interest to receive insight. Patient had strong ego functions, stable heterosexual partnership, was open to interpretations and therapeutic contract of ten sessions of David Malan's school of brief dynamic therapy was initiated. Unconscious therapeutic alliance dominated over resistance. Displacement, isolation of affect and undoing were the neurotic defenses interpreted by the therapist. Therapeutic focus was relief of obsessions occurred by 9(th) session and therapy was successfully terminated.

The sense of incompleteness as a motivator of obsessive-compulsive symptoms: an empirical analysis of concepts and correlates

Contemporary models of obsessive-compulsive disorder emphasize the importance of harm avoidance (HA) and related dysfunctional beliefs as motivators of obsessive-compulsive (OC) symptoms. Recently, there has been a resurgence of interest in Janet's (1908) concept of incompleteness (INC) as another potentially important motivator. Contemporary investigators define INC as the sense that one's actions, intentions, or experiences have not been properly achieved. Janet defined INC more broadly to include alexithymia, depersonalization, derealization, and impaired psychological mindedness. We conducted two studies to address four issues: (a) the clinical correlates of INC; (b) whether INC and HA are distinguishable constructs; (c) whether INC predicts OC symptoms after controlling for HA; and (d) the relative merits of broad versus narrow conceptualizations of INC. Study 1 was a meta-analysis of the clinical correlates of narrowly defined INC (16 studies, N=5,940). INC was correlated with all types of OC symptoms, and was more strongly correlated with OC symptoms than with general distress. Study 2 (N=534 nonclinical participants) showed that (a) INC and HA were strongly correlated but factor analytically distinguishable; (b) INC statistically predicted all types of OC symptoms even after controlling for HA; and (c) narrow INC was most strongly correlated with OC symptoms whereas broad INC was most strongly correlated with general distress. Although the findings are limited by being correlational in nature, they support the hypothesis that INC, especially in its narrow form, is a motivator of OC symptoms.

Obsessive compulsive symptoms in individuals at clinical risk for psychosis: association with depressive symptoms and suicidal ideation

Obsessive-compulsive symptoms, particularly aggressive obsessions, are prevalent in schizophrenia patients and associated with other symptom severity, suicidal ideation and functional impairment. In a psychosis-risk cohort, obsessive-compulsive diagnosis and symptoms were assessed in terms of prevalence and content, and for associations with clinical measures. Obsessive-compulsive symptoms were prevalent in the CHR cohort, as was suicidal ideation. The presence and severity of aggressive obsessions were associated with depression, suicidal ideation and social impairment. The high prevalence of aggressive obsessions and associated suicidal ideation in a clinical high risk cohort, and their relationship to depression, is relevant for risk assessment and treatment strategies.

Psychometric evaluation of the thought-action fusion scale in a large clinical sample

This study examined the psychometric properties of the 19-item Thought-Action Fusion (TAF) Scale, a measure of maladaptive cognitive intrusions, in a large clinical sample (N = 700). An exploratory factor analysis (n = 300) yielded two interpretable factors: TAF Moral (TAF-M) and TAF Likelihood (TAF-L). A confirmatory bifactor analysis was conducted on the second portion of the sample (n = 400) to account for possible sources of item covariance using a general TAF factor (subsuming TAF-M) alongside the TAF-L domain-specific factor. The bifactor model provided an acceptable fit to the sample data. Results indicated that global TAF was more strongly associated with a measure of obsessive-compulsiveness than measures of general worry and depression, and the TAF-L dimension was more strongly related to obsessive-compulsiveness than depression. Overall, results support the bifactor structure of the TAF in a clinical sample and its close relationship to its neighboring obsessive-compulsiveness construct.

Myth of the pure obsessional type in obsessive--compulsive disorder

BACKGROUND

Several studies have identified discrete symptom dimensions in obsessive-compulsive disorder (OCD), derived from factor analyses of the individual items or symptom categories of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC). This study aims to extend previous work on the relationship between obsessions and compulsions by specifically including mental compulsions and reassurance-seeking. Because these compulsions have traditionally been omitted from prior factor analytic studies, their association to what have been called "pure obsessions" may have been overlooked.

METHOD

Participants (N = 201) were recruited from two multi-site randomized clinical treatment trials for OCD. The YBOCS-SC was used to assess OCD symptoms, as it includes a comprehensive list of obsessions and compulsions, arranged by content category. Each category was given a score based on whether symptoms were present and if the symptom was a primary target of clinical concern, and a factor analysis was conducted. Mental compulsions and reassurance-seeking were considered separate categories for the analysis.

RESULTS

Using an orthogonal geomin rotation of 16 YBOCS-SC categories/items, we found a five-factor solution that explained 67% of the total variance. Inspection of items that composed each factor suggests five familiar constructs, with mental compulsions and reassurance-seeking included with sexual, aggressive, and religious obsessions (unacceptable/taboo thoughts).

CONCLUSIONS

This study suggests that the concept of the "pure obsessional" (e.g., patients with unacceptable/taboo thoughts yet no compulsions) may be a misnomer, as these obsessions were factorially associated with mental compulsions and reassurance-seeking in these samples. These findings may have implications for DSM-5 diagnostic criteria.

Latent class analysis of the Yale-Brown Obsessive-Compulsive Scale symptoms in obsessive-compulsive disorder

OBJECTIVE

Obsessive-compulsive disorder (OCD) is phenomenologically heterogeneous, and findings of underlying structure classification based on symptom grouping have been ambiguous to date. Variable-centered approaches, primarily factor analysis, have been used to identify homogeneous groups of symptoms; but person-centered latent methods have seen little use. This study was designed to uncover sets of homogeneous groupings within 1611 individuals with OCD based on symptoms.

METHOD

Latent class analysis models using 61 obsessive-compulsive symptoms collected from the Yale-Brown Obsessive-Compulsive Scale were fit. Relationships between latent class membership and treatment response, sex, symptom severity, and comorbid tic disorders were tested for relationship to class membership.

RESULTS

Latent class analysis models of best fit yielded 3 classes. Classes differed only in frequency of symptom endorsement. Classes with higher symptom endorsement were associated with earlier age of onset, being male, higher Yale-Brown Obsessive-Compulsive Scale symptom severity scores, and comorbid tic disorders. There were no differences in treatment response between classes.

CONCLUSIONS

These results provide support for the validity of a single underlying latent OCD construct, in addition to the distinct symptom factors identified previously via factor analyses.

Complex obsessive compulsive and impulsive symptoms in Tourette's syndrome

Obsessive compulsive and impulsive symptoms are prevalent in patients with Tourette's Syndrome (TS) and well recognized as part of the TS spectrum. However, some complex obsessive compulsive and impulsive behaviors may be mistaken for other symptoms, such as complex tics or psychotic behavior. In addition, the overlap between tics, compulsions, and impulsive actions can make them impossible to discern from each other. Yet, the proper recognition of these symptoms is critical in optimizing treatment outcome in TS patients. This paper will review complex obsessive compulsive and impulsive behaviors that may occur in patients with TS and discuss implications for diagnosis and treatment.

Obsessive-compulsive disorder and anorexia nervosa in a high school athlete: a case report

OBJECTIVE

To describe the case of a basketball and track athlete who presented with both anorexia nervosa and obsessive- compulsive disorder (OCD).

BACKGROUND

OCD is a psychiatric condition known to appear with significant frequency among those with anorexia. Although treatable with drug and behavioral therapy, it must be specifically sought because some of its symptoms are similar to those of anorexia nervosa.

DIFFERENTIAL DIAGNOSIS

Obsessive-compulsive disorder, anxiety disorder.

TREATMENT

Behavioral therapy involves exposure to the obsessive fears without allowing the patient to ritualize. This is best used in combination with drugs that selectively block the reuptake of serotonin in the brain.

UNIQUENESS

Anorexia nervosa is notoriously difficult to treat. In our patient, anorexic symptoms all but disappeared along with the OCD in a matter of weeks, once treatment of the OCD began. Lengthy treatment for anorexia alone had been unsuccessful.

CONCLUSIONS

OCD occurs frequently in patients with anorexia, and successful treatment requires that both conditions be specifically identified and managed. Athletic trainers may be the first to recognize key signs and symptoms of this illness; by referring the individual for psychiatric evaluation, they can be instrumental in helping the patient to obtain appropriate treatment.

Isolated musical obsessions

Musical obsessions are rare in both clinical practice and literature. A case is presented of a musical obsession which had the additional unique characteristics of acute onset, marked severity, and occurrence as an isolated symptom.