Preliminary investigation of objective and subjective experiences of relatives of individuals with hoarding behaviors

OBJECTIVE

Families of individuals with hoarding symptoms report substantial burden; however, there has been no investigation of potential positive experiences. The objective of this study was to examine the experiences reported by individuals with a relative with elevated hoarding symptoms using a cross-sectional design. The current investigation expands on the literature in this area by incorporating a detailed interview of experiences in conjunction with validated measures of hoarding symptomology.

METHODS

Twenty-nine adults with relatives with elevated hoarding symptoms completed self-report measures of hoarding severity for themselves and their relative and a clinician-administered assessment of their experiences with their family member with hoarding symptoms.

RESULTS

Participants endorsed significant burden across a range of areas, including permanent changes in their daily routine. The majority (93%) of participants reported at least one positive experience, with 69% endorsing companionship as a benefit of the relationship. Greater symptom severity of the relative with hoarding symptoms was associated with greater subjective burden and decreased positive experiences.

CONCLUSION

Our results add further evidence to the potential for interpersonal psychotherapy to lead to a reduction in hoarding symptomology.

Assessment and treatment of compulsive exercise in anorexia nervosa - A combined investigation of Compulsive Exercise Activity Therapy (LEAP) and Compulsive Exercise Test subscales

INTRODUCTION

Compulsive exercise is a transdiagnostic feature of eating disorders which adversely affects aspects of recovery, such as length of hospitalisation, risk of a chronic outcome, and risk of relapse. CompuLsive Exercise Activity TheraPy (LEAP) aims to reduce compulsive exercise through a cognitive behavioural approach. This study aims to investigate the effect of LEAP on compulsive exercise behaviour using subscales of the Compulsive Exercise Test (CET), a measure of exercise in individuals with eating disorders. Predictive validity of the CET's subscales and its ability to predict eating psychopathology are investigated.

METHOD

This study used data from a randomized controlled trial of LEAP (1). Linear mixed modelling was used to investigate the effect of LEAP on compulsive exercise behaviour, and the predictive ability of CET subscales on various outcomes. The CET was compared to other exercise measures to assess its superiority in predicting eating psychopathology.

RESULTS

LEAP was superior in reducing the scores of the CET's Avoidance and Rule Driven Behaviour and Exercise Rigidity subscales. All subscales made a contribution to the respective models. The CET was superior to other measures in predicting eating pathology.

CONCLUSION

The results lend credibility to LEAP's ability to reduce core parts of compulsive exercise. The CET has been found to target important aspects of compulsive exercise behaviour, and has was superior to other exercise measures in predicting eating psychopathology.

Measuring Compulsivity as a Self-Reported Multidimensional Transdiagnostic Construct: Large-Scale (N = 182,000) Validation of the Cambridge-Chicago Compulsivity Trait Scale

Compulsivity has potential transdiagnostic relevance to a range of psychiatric disorders, but it has not been well-characterized and there are few existing measures available for measuring the construct across clinical and nonclinical samples that have been validated at large population scale. We aimed to characterize the multidimensional latent structure of self-reported compulsivity in a population-based sample of British children and adults (N = 182,145) using the Cambridge-Chicago Compulsivity Trait Scale (CHI-T). Exploratory structural equation modeling provided evidence for a correlated two-factor model consisting of (a) Perfectionism and (b) Reward Drive dimensions. Evidence was obtained for discriminant validity in relation to the big five personality dimensions and acceptable test-retest reliability. The CHI-T, here validated at extremely large scale, is suitable for use in studies seeking to understand the correlates and basis of compulsivity in clinical and nonclinical participants. We provide extensive normative data to facilitate interpretation in future studies.

Relationship between self-stigma about alcohol dependence and severity of alcohol drinking and craving

BACKGROUND

The correlates and consequences of stigma surrounding alcohol use are complex. Alcohol use disorder (AUD) is typically accompanied by self-stigma, due to numerous factors, such as shame, guilt and negative stereotypes. Few studies have empirically examined the possible association between self-stigma and alcohol-related outcomes.

OBJECTIVE

To investigate the relationship between self-stigma about alcohol dependence and the severity of alcohol consumption and craving.

METHODS

In a sample of 64 participants, the majority of whom had a diagnosis of AUD (51), bivariate correlations were first conducted between Self-Stigma and Alcohol Dependence Scale (SSAD-Apply subscale) scores and Alcohol Use Disorders Identification Test (AUDIT) scores, Alcohol Timeline Follow-Back, Obsessive-Compulsive Drinking Scale (OCDS) scores and Penn Alcohol Cravings Scale scores. Based on the results, regression analyses were conducted with SSAD scores as the predictor and AUDIT and OCDS scores as the outcomes.

FINDINGS

SSAD scores positively correlated with AUDIT scores, average drinks per drinking day, number of heavy drinking days and OCDS scores (p<0.001, p=0.014, p=0.011 and p<0.001, respectively). SSAD scores were also found to be a significant predictor of AUDIT and OCDS scores (p<0.001 and p<0.001, respectively), even after controlling for demographics.

CONCLUSIONS

Higher levels of self-stigma were associated with more severe AUD, greater alcohol consumption, and more obsessive thoughts and compulsive behaviours related to alcohol.

CLINICAL IMPLICATIONS

Our results suggest that potential interventions to reduce self-stigma may lead to improved quality of life and treatment outcomes for individuals with AUD.

Conceptualising compulsivity through network analysis: A two-sample study

Compulsivity is a transdiagnostic construct crucial to understanding multiple psychiatric conditions and problematic repetitive behaviours. Despite being identified as a clinical- and research-relevant construct, there are limited insights into the internal conceptual structure of compulsivity. To provide a more nuanced understanding of compulsivity, the current study estimated the structure of compulsivity (indexed using the previously validated Cambridge-Chicago Compulsivity Trait Scale, CHI-T) among two large-scale and geographically distinct samples using the network estimation method. The samples consisted of a United Kingdom cohort (n = 122,346, 51.4% female, Mean age = 43.7, SD = 16.5, range = 9-86 years) and a South Africa cohort (n = 2674, 65.6% female, Mean age = 24.6, SD = 8.6, range = 18-65 years). Network community analysis demonstrated that compulsivity was constituted of three interrelated dimensions, namely: perfectionism, cognitive rigidity and reward drive. Further, 'Completion leads to soothing' and 'Difficulty moving from task to task' were identified as core (central nodes) to compulsivity. The dimensional structure and central nodes of compulsivity networks were consistent across the two samples. These findings facilitate the conceptualisation and measurement of compulsivity and may contribute to the early detection and treatment of compulsivity-related disorders.

Classifying excessive exercise: Examining the relationship between compulsive exercise with obsessive-compulsive disorder symptoms and disordered eating symptoms

OBJECTIVE

There remains a lack of consensus around nosology for compulsive exercise (CE). Although widely observed in eating disorders (ED), CE shares theoretical overlap with obsessive-compulsive disorder (OCD), where exercise compulsions occur in response to obsessions. Yet, there is limited and mixed evidence of a relationship between CE with OCD. This study aims to explore the appropriate diagnostic classification of CE through examination of CE in relation to OCD, obsessional thinking, and ED symptoms.

METHOD

Two hundred and eighty one adults with mental health symptoms, dieting, and exercise behaviour completed measures of OCD, CE, and disordered eating symptoms. Regression and Receiver Operating Characteristic analyses examined relationships between dimensions of CE with OCD and ED symptoms, and the predictive ability of CE assessment for detecting threshold OCD and ED symptoms.

RESULTS

CE assessment was poor at predicting threshold OCD symptoms, probable Anorexia Nervosa, and Binge Eating Disorder and moderate at detecting probable disordered eating and Bulimia Nervosa. Associations between CE and OCD symptoms were not significant after adjustment for ED symptoms. Obsessional thinking was associated only with lack of exercise enjoyment.

CONCLUSIONS

Results indicate that excessive exercise might represent a distinct disorder, with some shared traits across CE, OCD and ED symptoms. Findings question the utility of adaptation of OCD diagnostic criteria for CE. Assessment and treatment implications are considered.

The potential relationship between loot box spending, problem gambling, and obsessive-compulsive gamers

Background and Aims

Loot boxes are digital containers of randomised rewards available in many video games. Individuals with problem gambling symptomatology spend more on loot boxes than individuals without such symptoms. This study investigated whether other psychopathological symptomatology, specifically symptoms of obsessive-compulsive behaviour and hoarding may also be associated with increased loot box spending.

Methods

In a large cross-sectional, cross-national survey (N = 1,049 after exclusions), participants recruited from Prolific, living in Aotearoa New Zealand, Australia, and the United States, provided self-reported loot box spending, obsessive-compulsive and hoarding symptomatology, problem gambling symptomatology, and consumer regret levels.

Results

There was a moderate positive relationship between loot box spending and obsessive-compulsive symptoms and hoarding. Additionally, greater purchasing of loot boxes was associated with increased consumer regret.

Discussion and Conclusion

Results identified that those with OCD and hoarding symptomatology may spend more on loot boxes than individuals without OCD and hoarding symptomatology. This information helps identify disproportionate spending to more groups of vulnerable players and may assist in helping consumers make informed choices and also aid policy discussions around the potentialities of harm.

Dyskinesia and impulsive compulsive behaviour in Parkinson's disease are not related: Insights from a study with a wearable sensor

INTRODUCTION

Previous studies have suggested an association between Impulsive Compulsive Behaviour (ICB) and dyskinesia in Parkinson's disease (PD). However, none of these studies have employed an objective home-based measure of dyskinesia.

OBJECTIVES

To evaluate in advanced PD the relationship between ICB and dyskinesia, objectively measured with a wearable device.

METHODS

In this cross-sectional study, ICB and other neuropsychiatric symptoms were assessed by means of structured clinical interview and specific screening instruments. Presence and severity of motor fluctuations and dyskinesia were rated with patient's and clinician's based rating instruments. Motor fluctuations and dyskinesia were also measured at home for 5-days using a validated wearable devise, the Parkinson's KinetiGraph™(PKG).

RESULTS

We included 89 subjects with PD (29 females, 62 ± 7 years, disease duration 10.3 ± 4.5), of whom 36 (40%) had ICB. Patients with and without ICB did not differ by presence and severity of dyskinesia measured by clinical scales and PKG. There was no association between the presence of ICB and dyskinesia in the whole sample.

CONCLUSION

Our data suggest that ICB and dyskinesia are common but unrelated disorders in advanced PD.

Problematic Internet Use in adolescents: New psychometric evidence for the Spanish short form of the Compulsive Internet Use Scale

OBJECTIVES

Problematic Internet Use (PIU) has become a worldwide problem in recent years. Among screening instruments for PIU, the Compulsive Internet Use Scale (CIUS) is perhaps the most widely used. Psychometric properties of the full CIUS are not convincing, however, and the short form (CIUS-S) has shown promising results, albeit limited to the English version, with little evidence in Spanish. Therefore, the aim of the present work was to study the psychometric properties of the CIUS-S scores in a large sample of Spanish adolescents.

METHOD

The sample consisted of 1790 participants, 816 male (45.6%), 961 female (53.7%), and 13 other (0.7%) . Mean age was 15.70 years (SD = 1.26).

RESULTS

The five-items one-dimensional model displayed appropriate goodness-of-fit indices. Strong measurement invariance model across age and partial across gender was found. Furthermore, the CIUS-S was positively associated with several indicators of poor well-being and mental health, and negatively associated with prosocial behavior, self-esteem, and feeling of belonging.

CONCLUSION

Overall, the CIUS-S scores appear reliable and valid in its Spanish version for adolescent populations, supporting its aim to detect and prevent a problem that has become a major worldwide issue in the last years.

Long-term stability in obsessive thoughts and compulsive behavior in the general population: a longitudinal study in Sweden

OBJECTIVE

Obsessive thoughts and compulsive behavior and their related disorder Obsessive-Compulsive Disorder (OCD) commonly occur in the general population. Clinical populations indicate a high level of stability, although there are few longitudinal studies in the general population. The recommended drug treatments are SSRIs/TCAs. However, there are few long-term follow up studies. The goal of this study was to 1) examine the occurrence and stability of obsessions, compulsions, and OCD in a longitudinal population-based survey, 2) investigate the use of SSRI and TCA and the potential effect on symptoms.

METHODS

A ten-year longitudinal general population in Stockholm was used (2000 and 2010, n = 5650) Obsessional washing, checking, intrusive unpleasant thoughts and the level of suffering due to these symptoms were measured by self-report. Information on use of SSRIs and TCAs by these individuals was obtained from registers. Stability was examined using contingency tables and multinomial logistic regression.

RESULTS

At baseline, 2.1, 11.7 and 11.9% reported obsessional washing, checking and intrusive thoughts. A total of 5% reported considerable suffering from these (i.e. OCD). Based on psychiatric interview only 0.4% had OCD. Ten years later a quarter of OCD cases were still classified as having OCD, one quarter reported any obsessive or compulsive symptom and half were classified as symptom-free. Treatment receipt was low and controlling for medication did not change the stability.

CONCLUSION

Obsessive thoughts and compulsive behavior are common and stable. While this group is potentially undertreated, there is no indication that those treated display a different pattern of recovery.

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

Background and aims

Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice.

Method

Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD.

Results

A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability.

Discussion and conclusions

This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Compulsive Sexual Behavior Disorder should not be classified by solely relying on component/symptomatic features •

The paper by Sassover and Weinstein (2022) contributes to a timely and complex debate related to the classification of Compulsive Sexual Behavior Disorder (CSBD). The recent inclusion of CSBD as an impulse-control disorder in the ICD-11 has generated debate since a competitive view is that CSBD should rather be classified as an addictive disorder. Sassover and Weinstein (2022) reviewed existing evidence and concluded it does not support the conceptualization of CSBD as an addictive disorder. Although we agree regarding the relevance and timely nature of considering the classification of CSBD, we respectfully disagree with the position that relying on the components model of addiction (Griffiths, 2005) is the optimal approach for determining whether or not CSBD is an addictive disorder. In this commentary, we discuss potential pitfalls of relying on the components model to conceptualize CSBD as an addictive disorder and argue that considering a process-based approach is important for advancing this timely debate.

Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary

BACKGROUND

There are ongoing debates about conflicting models on how to conceptualize compulsive sexual behavior. At the heart of these discussions is the question about the sexual motivations underlying compulsive sexual behavior, as different models assume different motivations.

AIM

The aim of the present study was to understand sexual motivations underlying compulsive sexual behavior and their relation to the most prominent conceptualizations of compulsive sexual behavior (eg, compulsive sexual behavior disorder [CSBD], sex addiction).

METHODS

We used self-reported data from 2 large samples of Hungarian and German populations (N = 9814). The Sexual Motivation Scale (SexMS), a 24-item self-report measure based on self-determination theory, was used to assess a diverse set of sexual motivations. Compulsive sexual behavior was assessed with the 19-item Compulsive Sexual Behavior Disorder Scale (CSBD-19), that is based on the ICD-11 diagnostic guidelines of CSBD. We used structural equation modeling to examine the hypothesized associations between sexual motivations and compulsive sexual behavior and examined potential gender differences in these associations.

OUTCOMES

Compulsive sexual behavior was assessed in relation to a set of sexual motivations.

RESULTS

Amotivation had the strongest positive association with compulsive sexual behavior, but integrated, introjected, and intrinsic motivations were also positively related to it. Importantly, these associations did not differ for women and men, and between the 2 samples.

CLINICAL IMPLICATIONS

Future research and treatment should also consider sexual motivations that are not listed among the ICD-11 guidelines for CSBD, including high levels of sexual interest, continuing the behavior despite having little satisfaction from it and coping with sex.

STRENGTHS & LIMITATIONS

Although we used large samples of general populations in 2 Western countries, this motivational background of compulsive sexual behavior awaits replication in a clinical sample of individuals experiencing CSBD.

CONCLUSION

The identified sexual motivations underlying compulsive sexual behavior are relevant for assessing and treating patients as motivations may be integrated into psychotherapeutic interventions. Koós M, Fuss J, Klein V, et al. Sexual Motivations Underlying Compulsive Sexual Behavior in Women and Men From Germany and Hungary. J Sex Med 2022;19:170-181.

Proposed diagnostic criteria for compulsive buying-shopping disorder: A Delphi expert consensus study

BACKGROUND AND AIMS

Consensus in acknowledging compulsive buying-shopping disorder (CBSD) as a distinct diagnosis has been lacking. Before research in this area can be advanced, it is necessary to establish diagnostic criteria in order to facilitate field trials.

METHODS

The study consisted of the following phases: (1) operationalization of a broad range of potential diagnostic criteria for CBSD, (2) two iterative rounds of data collection using the Delphi method, where consensus of potential diagnostic criteria for CBSD was reached by an international expert panel, and (3) interpretation of findings taking into account the degree of certainty amongst experts regarding their responses.

RESULTS

With respect to diagnostic criteria, there was clear expert consensus about inclusion of the persistent and recurrent experience of (a) intrusive and/or irresistible urges and/or impulses and/or cravings and/or preoccupations for buying/shopping; (b) diminished control over buying/shopping; (c) excessive purchasing of items without utilizing them for their intended purposes, (d) use of buying-shopping to regulate internal states; (e) negative consequences and impairment in important areas of functioning due to buying/shopping; (f) emotional and cognitive symptoms upon cessation of excessive buying/shopping; and (g) maintenance or escalation of dysfunctional buying/shopping behaviors despite negative consequences. Furthermore, support was found for a specifier related to the presence of excessive hoarding of purchased items.

CONCLUSIONS

The proposed diagnostic criteria can be used as the basis for the development of diagnostic interviews and measures of CBSD severity.

Multifaceted impulsivity in obsessive-compulsive disorder with hoarding symptoms

OBJECTIVE

Hoarding is common in obsessive-compulsive disorder (OCD), and OCD with hoarding may have poorer prognostic features than OCD without hoarding. The aim of this study was to investigate the relationship between multifaceted impulsivity and hoarding symptoms in individuals with OCD. This relationship is important to be able to understand the psychopathological mechanisms of hoarding symptoms in OCD patients.

METHODS

The study included 136 individuals with OCD classified as OCD with high hoarding symptoms (OCDwHH, n = 41) and OCD with low/none hoarding symptoms (OCDwLH, n = 95), together with 94 healthy control subjects. All the participants completed the Hoarding Rating Scale-Interview, Barratt Impulsiveness Scale-11, Yale-Brown Obsessions and Compulsions Scale, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale.

RESULTS

The OCDwHH group had more severe anxiety (p = 0.016) and attentional impulsivity (p = 0.002) than OCDwLH. Attentional impulsivity scores were positively correlated with hoarding symptom scores (p < 0.001). Both attentional and motor impulsivity scores were positively correlated with anxiety levels (p = 0.037, p = 0.045, respectively). In partial correlation analysis, motor impulsivity was positively correlated with the severity of hoarding symptoms controlling for anxiety severity (p = 0.045). In hierarchical linear regression analysis, only attentional impulsivity predicted the severity of hoarding symptoms independently of anxiety, severity of obsessive-compulsive symptoms and motor impulsivity (β = 0.268, Adjusted R2 = 0.114, p = 0.006).

CONCLUSION

Attentional impulsivity is associated with hoarding symptoms in OCD. Future studies that reveal this relationship may contribute to treatment modalities for the OCD patients with hoarding symptoms.

Trans-diagnostic measurement of impulsivity and compulsivity: A review of self-report tools

INTRODUCTION

Impulsivity and compulsivity are important constructs, relevant to understanding behaviour in the general population, as well as in particular mental disorders (e.g. attention deficit hyperactivity disorder, obsessive-compulsive disorder). The current paper provides a narrative review of self-report impulsivity and compulsivity scales.

METHODS

A literature search was conducted using the following terms: ("impulsivity" OR "compulsivity") AND ("self-report" OR "questionnaire" OR "psychometric" OR "scale").

RESULTS

25 impulsive and 11 compulsive scales were identified, which varied considerably in psychometric properties, convenience, and validity. For impulsivity, the most commonly used scales were the BIS and the UPPS-P, whilst for compulsivity, the Padua Inventory was commonly used. The majority of compulsivity scales measured OCD symptoms (obsessions and compulsions) rather than being trans-diagnostic or specific to compulsivity (as opposed to obsessions). Scales capable of overcoming these limitations were highlighted.

DISCUSSION

This review provides clarity regarding relative advantages and disadvantages of different scales relevant to the measurement of impulsivity and compulsivity in many contexts. Areas for further research and refinement are highlighted.

Desire thinking as a predictor of compulsive sexual behaviour in adolescents: Evidence from a cross-cultural validation of the Hebrew version of the Desire Thinking Questionnaire

BACKGROUND

Desire thinking is a voluntary cognitive process that involves the perseverative focus on memories, images and information related to a desired target. The aim of the present study was to validate the Hebrew version of the Desire Thinking Questionnaire (DTQ; Caselli & Spada, 2011) in a sample of adolescents and to investigate its relationship with measures of thought suppression, impulsivity and individual-based compulsive sexual behaviour.

METHODS

In Study 1, a convenience sample of 718 adolescents completed the newly translated Desire Thinking Questionnaire in Hebrew (DTQ-H) and results were subjected to an Exploratory Factor Analysis (EFA). In Study 2, a convenience sample of 379 adolescents completed a battery of questionnaires including the DTQ-H. A Confirmatory Factors Analysis was performed on the DTQ-H and validity was ascertained by correlating with other measures.

RESULTS

In Study 1, a 9-item two-factor structure was identified. A 6-item two-factor structure was confirmed in Study 2. Results also indicated that the DTQ-H has acceptable levels of reliability, and good concurrent and incremental validity in predicting compulsive sexual behaviour.

CONCLUSIONS

The 6-item DTQ-H appears to be a reliable and valid measure of desire thinking and may be used also on adolescents - an understudied population.

Hypothesis: Compulsive hoarding as an atavism

In this hypothesis paper, we propose that hoarding disorder may be an ancestral mammalian behavior, possibly hard-wired but dormant in present-day humans, that can be activated by traumatic experiences. To support this claim, we describe hoarding in ancestral mammals and provide examples of recurrence of traits, or atavisms, in humans and other mammals, highlighting its implications for neuropsychiatric diseases. We highlight the potential of using shrews as animal models for hoarding behavior and, considering the current knowledge on the molecular underpinnings of the disorder, we also point to limitations of the proposed connection.

The transdiagnostic structure of mental effort avoidance

The law of least mental effort states that, everything else being equal, the brain tries to minimize mental effort expenditure during task performance by avoiding decisions that require greater cognitive demands. Prior studies have shown associations between disruptions in effort expenditure and specific psychiatric illnesses (e.g., schizophrenia and depression) or clinically-related symptoms and traits (e.g., anhedonia and apathy), yet no research has explored this issue transdiagnostically. Specifically, this research has largely focused on a single diagnostic category, symptom, or trait. However, abnormalities in effort expression could be related to several different psychiatrically-relevant constructs that cut across diagnostic boundaries. Therefore, we examined the relationship between avoidance of mental effort and a diverse set of clinically-related symptoms and traits, and transdiagnostic latent factors in a large sample (n = 811). Only lack of perseverance, a dimension of impulsiveness, was associated with increased avoidance of mental effort. In contrast, several constructs were associated with less mental effort avoidance, including positive urgency, distress intolerance, obsessive-compulsive symptoms, disordered eating, and a factor consisting of compulsive behavior and intrusive thoughts. These findings demonstrate that deviations from normative effort expenditure are associated with a number of constructs that are common to several forms of psychiatric illness.

Inflexible daily behaviour is associated with the ability to control an automatic reaction in autism spectrum disorder

Inflexible behaviours in people with autism spectrum disorder (ASD) broadly obstruct social communication. Meanwhile, flexibility implicates cognitive control to resolve socially conflicting situations; however, it remains unclear how people with ASD behave in the face of these conflicts in this respect. We used the ultimatum game (UG) and the implicit-association test (IAT) to examine goal-directed/economic flexibility, both of which involve conflict and cognitive control. In addition, we used the Detail and Flexibility Questionnaire (DFlex) to measure inflexible everyday behaviour with diminished cognitive control and attention shifting. We observed the decreased flexibility in participants with ASD (DFlex and IAT); further, their IAT scores positively correlated with DFlex. However, in the UG, contrary to our prediction, participants with ASD accepted unfair offers more frequently than TD. These results suggest that assessing the automatic/attention processing level with the IAT could be a useful approach to study behavioural flexibility among ASD compared with the UG, which might comprise multiple response strategies besides economic rationality. Overall, the severity of inflexible daily behaviours in people with ASD may be associated with a reduced flexible attitude at an automatic level, altered attention processing and decreased cognitive control.

Can we predict development of impulsive-compulsive behaviours in Parkinson's disease?

OBJECTIVE

To determine clinical and structural imaging predictors of impulsive-compulsive behaviour (ICB) in de novo Parkinson's disease (PD).

METHODS

From a cohort of 1116 subjects from the Parkinson's Progression Marker Initiative database, we created a subcohort of 42 de novo PD without ICB at baseline with available 3T MRI and who developed ICB during follow-up. PD-ICB were matched for age, gender and disease duration to 42 patients with PD without ICB over follow-up (PD-no-ICB) and 42 healthy controls (HCs). Baseline demographic and clinical predictors of ICB were analysed. For the longitudinal neuroimaging analysis, we selected 27 patients with PD-ICB with available neuroimaging after ICB onset, who were matched with 32 PD-no-ICB and 35 HCs. Baseline and longitudinal structural differences were compared using voxel-based morphometry and voxel-based quantification.

RESULTS

People who went on to develop ICB had more severe anxiety, worse autonomic and global cognitive functions and were more likely to have rapid eye movement sleep behaviour disorder. Logistic regression confirmed that worse autonomic and cognitive functions were predictors of ICB. We could not find any morphological feature on baseline MRI that predicted later onset of ICB. When comparing PD groups at follow-up, a small region of increased atrophy in the anterior limb of the left internal capsule adjacent to the head of the left caudate nucleus was found in PD-ICB, but not surviving correction for multiple comparisons.

CONCLUSIONS

Worse autonomic and cognitive functions predict development of ICB at the time of PD diagnosis. Structural imaging fails to identify morphological features associated with the development of ICB.

Individual-Based Compulsive Sexual Behavior Scale: Its Development and Importance in Examining Compulsive Sexual Behavior

Compulsive sexual behavior comprises individual-based (e.g., sexual fantasies, compulsive sexual thoughts, masturbation) and partnered (e.g., interpersonal sexual conquests, repeated infidelity) facets. Most instruments for assessing compulsive sexual behavior, however, focus less on the individual-based facet and specifically on fantasies and compulsive thoughts. In the current research, we developed and validated an individual-based compulsive sexual behavior scale (I-CSB). In Study 1 (N = 492), the factorial structure of the I-CSB was examined. In Study 2 (N = 406), we assessed I-CSB's convergent validity. In Study 3 (N = 112), we examined whether the I-CSB differentiates between individuals who suffer from compulsive sexual behavior and those who do not. Results revealed a four-factor structure for individual-based compulsive sexual behavior that is associated with an intense inner conflict regarding sexuality (high arousal contrasting with high sexual anxiety), and that accounts for approximately 75% of the differences between people with compulsive sexual behavior and controls. Results are discussed in light of the need for a broader understanding of compulsive sexual behavior.

Association of Rigid-Compulsive Behavior with Functional Constipation in Autism Spectrum Disorder

Based upon checklist data from the Autism Speaks Autism Treatment Network, we hypothesized that functional constipation (FC) would be associated with rigid-compulsive behavior in children with autism spectrum disorder (ASD). We used the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III to assess FC symptoms in 108 children with ASD. As hypothesized, FC was associated with parent ratings on the Repetitive Behavior Scales-Revised (RBS-R) Compulsive, Ritualistic, and Sameness subscales in the overall population. Of note, FC was less common in children who were not taking medications that target behavior or treat FC. In the medication-free children, rigid-compulsive behavior was not significantly associated with FC. More research is needed to understand the mechanisms underlying these associations.

Latent class analysis of gambling subtypes and impulsive/compulsive associations: Time to rethink diagnostic boundaries for gambling disorder?

Background

Gambling disorder has been associated with cognitive dysfunction and impaired quality of life. The current definition of non-pathological, problem, and pathological types of gambling is based on total symptom scores, which may overlook nuanced underlying presentations of gambling symptoms. The aims of the current study were (i) to identify subtypes of gambling in young adults, using latent class analysis, based on individual responses from the Structured Clinical Interview for Gambling Disorder (SCI-GD); and (ii) to explore relationships between these gambling subtypes, and clinical/cognitive measures.

Methods

Total 582 non-treatment seeking young adults were recruited from two US cities, on the basis of gambling five or more times per year. Participants undertook clinical and neurocognitive assessment, including stop-signal, decision-making, and set-shifting tasks. Data from individual items of the Structured Clinical Interview for Gambling Disorder (SCI-GD) were entered into latent class analysis. Optimal number of classes representing gambling subtypes was identified using Bayesian Information Criterion and differences between them were explored using multivariate analysis of variance.

Results

Three subtypes of gambling were identified, termed recreational gamblers (60.2% of the sample; reference group), problem gamblers (29.2%), and pathological gamblers (10.5%). Common quality of life impairment, elevated Barratt Impulsivity scores, occurrence of mainstream mental disorders, having a first degree relative with an addiction, and impaired decision-making were evident in both problem and pathological gambling groups. The diagnostic item ‘chasing losses’ most discriminated recreational from problem gamblers, while endorsement of ‘social, financial, or occupational losses due to gambling’ most discriminated pathological gambling from both other groups. Significantly higher rates of impulse control disorders occurred in the pathological group, versus the problem group, who in turn showed significantly higher rates than the reference group. The pathological group also had higher set-shifting errors and nicotine consumption.

Conclusions

Even problem gamblers who had a relatively low total SCI-PG scores (mean endorsement of two items) exhibited impaired quality of life, objective cognitive impairment on decision-making, and occurrence of other mental disorders that did not differ significantly from those seen in the pathological gamblers. Furthermore, problem/pathological gambling was associated with other impulse control disorders, but not increased alcohol use. Groups differed on quality of life when classified using the data-driven approach, but not when classified using DSM cut-offs. Thus, the current DSM-5 approach will fail to discriminate a significant fraction of patients with biologically plausible, functionally impairing illness, and may not be ideal in terms of diagnostic classification. Cognitive distortions related to ‘chasing losses’ represent a particularly important candidate treatment target for early intervention.

•

Current classification of gambling pathology relies on total number of criteria met for gambling disorder (DSM-5)

•

This approach can be seen as somewhat arbitrary and may overlook meaningful gambling subtypes

•

Latent class analysis (LCA) was used to identify candidate subtypes of gambling in 582 gamblers.

•

Compared to the reference class, both problem gamblers and gambling disorder classes showed relatively impaired quality of life, and more psychiatric morbidity.

•

Both problem gamblers and gambling disorder classes also showed higher impulsivity scores and impaired decision-making.

•

LCA classification was sensitive to group quality of life differences, whereas DSM-5 classification was not.

Further Psychometric Evaluation of the Child Disgust Scale

This study evaluated the psychometric properties of the Child Disgust Scale (CDS) among 457 youth (ages 8-17, M = 14.77 ± 1.98 years) initiating residential treatment for obsessive-compulsive disorder and anxiety disorders. Confirmatory factor analysis supported a bifactor model with two distinct factors of Disgust Avoidance and Disgust Affect, in addition to an overall General Disgust factor. Strong internal consistency was observed for the CDS total and factor scores. In addition, CDS scores demonstrated generally modest and positive correlations with child-reported obsessive-compulsive and anxiety symptoms, weaker correlations with parent-reported anxiety and child-rated impairment, and non-significant correlations with parent-rated impairment. Findings suggest that the CDS displays strong psychometric properties and is developmentally appropriate for use in pediatric clinical populations with obsessive-compulsive and anxiety disorders.

Marble burying as compulsive behaviors in male and female mice

Marble burying is considered an, albeit controversial, animal model of the compulsive like behaviors of obsessive-compulsive disorder (OCD). Hallmark features of OCD patients are similarities and, more prominent, differences from anxiety disorders, e.g., the absence of sex differences and resistance to spontaneous remission. We report an experiment on marble burying by male and female C57/BL6/N mice. Animals were administered either the classic anxiolytic drug, diazepam, that targets the GABA receptor or a "pure" inhibitor of the serotonin transporter, escitalopram, that has been reported to be particularly effective in OCD. A burying paradigm that more precisely mimics the human condition was used, e.g., testing in the home environment, chronic drug exposure and acknowledging individual differences by pre-selecting for high marble burying. Results were that there were no sex differences in groups treated with drugs or in control mice. Both diazepam and escitalopram decreased numbers of marbles buried compared to vehicle-only controls in the absence of correlated changes in anxiety. Diazepam, however, was more effective than escitalopram in suppressing MB. The conclusion is that along with serotonin, GABA is involved in regulating compulsive behaviors. The marble burying paradigm may prove more useful for pharmacological drugs tests of impulsivity or attention deficit because of the involvement of serotonin and GABA in both disorders.

Should compulsive sexual behavior be considered an addiction?

AIMS

To review the evidence base for classifying compulsive sexual behavior (CSB) as a non-substance or 'behavioral' addiction.

METHODS

Data from multiple domains (e.g. epidemiological, phenomenological, clinical, biological) are reviewed and considered with respect to data from substance and gambling addictions.

RESULTS

Overlapping features exist between CSB and substance use disorders. Common neurotransmitter systems may contribute to CSB and substance use disorders, and recent neuroimaging studies highlight similarities relating to craving and attentional biases. Similar pharmacological and psychotherapeutic treatments may be applicable to CSB and substance addictions, although considerable gaps in knowledge currently exist.

CONCLUSIONS

Despite the growing body of research linking compulsive sexual behavior (CSB) to substance addictions, significant gaps in understanding continue to complicate classification of CSB as an addiction.

COMPULS: design of a multicenter phenotypic, cognitive, genetic, and magnetic resonance imaging study in children with compulsive syndromes

BACKGROUND

Compulsivity, the closely linked trait impulsivity and addictive behaviour are associated with several neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive compulsive disorder (OCD). All three disorders show impaired fronto-striatal functioning, which may be related to altered glutamatergic signalling. Genetic factors are also thought to play an important role in the aetiology of compulsivity-related disorders.

METHODS

The COMPULS study is a multi-center study designed to investigate the relationship between the traits compulsivity, impulsivity, and, to a lesser extent, addictive behaviour within and across the neurodevelopmental disorders ADHD, ASD, and OCD. This will be done at the phenotypic, cognitive, neural, and genetic level. In total, 240 participants will take part in COMPULS across four different sites in Europe. Data collection will include diagnostic interviews, behavioural questionnaires, cognitive measures, structural, functional and spectral neuroimaging, and genome-wide genetic information.

DISCUSSION

The COMPULS study will offer the unique opportunity to investigate several key aspects of compulsivity across a large cohort of ADHD, ASD and OCD patients.

Is athletic really ideal? An examination of the mediating role of body dissatisfaction in predicting disordered eating and compulsive exercise

BACKGROUND

Investigations into female body image have suggested that rather than thinness, preference is now being given to a female "athletic ideal" characterised by a toned abdomen, firmer lower body and muscular upper body. This study sought to investigate a) whether greater internalization of the athletic-ideal is associated with higher body dissatisfaction, dieting, bulimic symptoms and compulsive exercise, and b) whether body dissatisfaction mediates the relationship between athletic-ideal internalization and the disordered eating and exercise behaviours of dieting, bulimic symptoms and compulsive exercise.

METHODS

Participants were 388 females aged between 17 and 35years. Participants completed a battery of questionnaires measuring athletic-ideal internalization, body dissatisfaction, dieting, compulsive exercise and bulimic symptoms.

RESULTS

Athletic-ideal internalization was not found to be associated with body dissatisfaction, but was found to predict dieting, bulimic symptoms and compulsive exercise directly. Body dissatisfaction did not mediate the relationship between athletic-ideal internalization and any of the disordered eating and exercise behaviours.

LIMITATIONS

The study was limited by its cross sectional design which precluded conclusions being drawn about the direction of causality and temporal associations.

CONCLUSIONS

Athletic-ideal internalization, while not associated with body dissatisfaction, was associated with a range of disordered eating and exercise behaviours. Results from the study suggest that the female athletic-ideal is an equally unrealistic and problematic ideal for women to strive towards.

Characteristics and correlates of stealing in college students

BACKGROUND

Stealing is a fairly common behaviour among young adults. Understanding the potential associations and characteristics of individuals who steal may help educational institutions, health services and young people themselves resolve difficulties before the behaviour impacts on their academic performance and health.

AIMS

We aim to test the hypothesis that desires to steal among students would be associated with worse academic achievements and higher rates of mood and impulse control disorders.

METHODS

One thousand eight hundred and five students completed the College Student Computer User Survey online and were included in this analysis at a large Midwestern United States University. Responders were grouped according to self-reported stealing urges and behaviours and were compared on measures of psychosocial function, mental health disorders and impulsivity.

RESULTS

Urges to steal were associated with worse depressive symptoms, higher levels of perceived stress and a number of psychiatric disorders including bipolar disorder and multiple disorders of impulse control (kleptomania, compulsive sexual behaviour, skin picking, trichotillomania and compulsive buying). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND/OR FUTURE RESEARCH: These following data indicate that stealing for many college students may be considered within a spectrum of impulsive behaviours. • Illegal behaviours among students point to mental health difficulties among them. • Our findings may provide clinicians, researchers and health professionals with a clearer picture of a range of impulsive behaviours among college students and promote treatment for this group. • Our findings could also inform preventative approaches to impulsive problems in young adults.

Sexual Compulsivity Scale, Compulsive Sexual Behavior Inventory, and Hypersexual Disorder Screening Inventory: Translation, Adaptation, and Validation for Use in Brazil

Epidemiological, behavioral, and clinical data on sexual compulsivity in Brazil are very limited. This study sought to adapt and validate the Sexual Compulsivity Scale (SCS), the 22-item version of the Compulsive Sexual Behavior Inventory (CSBI-22), and the Hypersexual Disorder Screening Inventory (HDSI) for use in Brazil. A total of 153 participants underwent psychiatric assessment and completed self-reported measures. The adaptation process of the instruments from English to Portuguese followed the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The reliability and validity of the HDSI criteria were evaluated and the construct validity of all measures was examined. For the SCS and HDSI, factor analysis revealed one factor for each measure. For the CSBI-22, four factors were retained although we only calculated the scores of two factors (control and violence). All scores had good internal consistency (alpha >.75), presented high temporal stability (>.76), discriminated between patients and controls, and presented strong (ρ > .81) correlations with the Sexual Addiction Screening Test (except for the violence domain = .40) and moderate correlations with the Impulsive Sensation Seeking domain of the Zuckerman Kuhlman Personality Questionnaire (ρ between .43 and .55). The sensitivity of the HDSI was 71.93 % and the specificity was 100 %. All measures showed very good psychometric properties. The SCS, the HDSI, and the control domain of the CSBI-22 seemed to measure theoretically similar constructs, as they were highly correlated (ρ > .85). The findings support the conceptualization of hypersexuality as a cluster of problematic symptoms that are highly consistent across a variety of measures.

In the wake of a possible mistake: Security motivation, checking behavior, and OCD

BACKGROUND AND OBJECTIVES

In previous experiments, OCD washers did not differ significantly from controls in their initial level of activation in response to the potential threat of contamination; however, they were less able to reduce their activation by engaging in hand-washing, suggesting that the key problem in OCD is a faulty stopping mechanism. The main objectives of the present experiments were to develop a similar experimental paradigm for investigating checking behavior, and to use it to test the hypothesis that a faulty stopping mechanism also underlies OCD checking.

METHODS

Participants sorted pills under the guise of beta testing a new medication system and then were given suggestions of the possibility of having made mistakes with potentially serious consequences. Later, participants engaged in a 90-s checking period and an unlimited period of checking. At baseline and three other times during the experiment, security motivation was measured with respiratory sinus arrhythmia (RSA) and subjective ratings of confidence. Experiment 1 established the parameters of the paradigm in non-patient participants, and Experiment 2 contrasted OCD checkers with OCD washers and non-patients.

RESULTS

Results for both subjective and physiological measures of security motivation closely replicated previous findings for washing behavior. Groups did not differ significantly in initial activation, but the OCD checkers were unable to reduce their activation by engaging in period of checking that was ample for returning controls to baseline.

LIMITATIONS

The sample size for the patient groups was modest.

CONCLUSIONS

These results lend further support to the security-motivation theory of OCD.

A study on the relationship between compulsive exercise, depression and anxiety

BACKGROUND AND AIMS

Exercise and physical activity are beneficial both physically and psychologically but a few individuals use exercise excessively resulting in physical and even psychological damage. There is evidence for bi-directional relationship between exercise with depression and anxiety showing that exercise can reduce anxiety and depression, whereas a lack of exercise is associated with higher levels of anxiety and depression.

METHODS

This study used questionnaires assessing compulsive exercise, anxiety and depression among 20 professional regular exercisers and 51 recreational regular exercisers.

RESULTS

Results showed that ratings of compulsive exercise were associated with ratings of anxiety and depression among individuals who exercise for professional and recreational purpose. Secondly, individuals who exercise for professional purpose were more depressed than individuals who exercise for recreational purpose, but did not exhibit higher trait anxiety ratings. Thirdly, individuals who exercise for recreational purpose showed an association between ratings of compulsive exercise and depression but not with ratings of trait anxiety.

DISCUSSION

Individuals who exercise for professional and recreational purpose may use it as a means for alleviating depression and anxiety although this small sample of recreational and professional sportsmen showed clinical levels of anxiety and depression that may require further clinical treatment.

Third International Congress on Epilepsy, Brain, and Mind: Part 2

Epilepsy is both a disease of the brain and the mind. Here, we present the second of two papers with extended summaries of selected presentations of the Third International Congress on Epilepsy, Brain and Mind (April 3-5, 2014; Brno, Czech Republic). Humanistic, biologic, and therapeutic aspects of epilepsy, particularly those related to the mind, were discussed. The extended summaries provide current overviews of epilepsy, cognitive impairment, and treatment, including brain functional connectivity and functional organization; juvenile myoclonic epilepsy; cognitive problems in newly diagnosed epilepsy; SUDEP including studies on prevention and involvement of the serotoninergic system; aggression and antiepileptic drugs; body, mind, and brain, including pain, orientation, the "self-location", Gourmand syndrome, and obesity; euphoria, obsessions, and compulsions; and circumstantiality and psychiatric comorbidities.

Cannabinoid Hyperemesis Syndrome During Pregnancy: A Case Report

BACKGROUND

Cannabinoid hyperemesis syndrome (CHS) is a syndrome characterized by chronic marijuana use, cyclic vomiting, and compulsive bathing. Given the similarities this syndrome shares with hyperemesis gravidarum, it is likely that this is a highly underdiagnosed syndrome. We present a case of severe nausea and vomiting during pregnancy that met the criteria for CHS.

CASE

This case outlines the course of recurrent nausea and vomiting due to cannabinoid hyperemesis in a pregnant patient and illustrates the similarities between hyperemesis gravidarum and CHS and the value of obtaining a complete history that includes the use of marijuana.

CONCLUSION

Recognition of this syndrome will aid in patient care, lessen the economic burden of an extensive workup, and hopefully lessen provider frustration with diagnosis and treatment of a common and underdiagnosed entity.

[Kleptomania and compulsive buying]

Kleptomania and compulsive buying are important clinical problems. However there is no established treatment for these problems in Japan yet. In this article, we review the available clinical treatments for kleptomania and compulsive buying in Japan. Kleptomania and compulsive buying can be explained by the conditioning theory. These behaviors are reinforced by positive consequences. In particular, the problem behaviors of kleptomania arise because of arousal and tension and are reinforced by the relaxed feeling that follows. Therefore, kleptomania is treated by systematic desensitization. However, it is important that interventions such as cognitive behavioral therapy, which increase subjective adaptation. be used in combination to treat and control such behaviors.

Clinically related or predictive factors and impacts on long-term treatment outcomes of involvement behaviors in patients with obsessive-compulsive disorder

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) frequently exhibit involvement behaviors (IBs) in which they accommodate their caregivers to their OCD symptoms by 1) asking them for reassurance, 2) forcing them to participate in their rituals, or 3) forcing them to assist in avoidance according to the patients' rules or demands. Such behaviors correspond to those of their caregivers, and are referred to as family accommodation (FA).

METHODS

We performed multifactorial comparisons between 256 OCD patients with and without IBs in order to examine the clinical characteristics and long-term treatment outcomes of OCD patients with IBs. A multiple logistic regression analysis was also performed to identify the related and predictive factors of IBs.

RESULTS

A total of 108 out of the 256 OCD patients examined (42%) were determined to exhibit IBs. OCD patients with IBs were differentially characterized by demographic and phenomenological characteristics (e.g. female predominance and poorer insight), more severe psychopathological features (e.g. lower GAFS, higher anxiety, or a depressive status), and poorer treatment outcomes. Furthermore, the predictive factors of IBs such as being female, having a higher compulsive score, and lower GAFS were identified by logistic analyses and structural equation modeling.

CONCLUSION

The presence of IBs correlated with the severe clinical features, treatment refractoriness, and poorer long-term outcome of OCD. The severity of compulsions, being female, and lower GAFS were identified as predictive factors for the presence of IBs. Similar to FA, these findings appear to support the effectiveness of early identification and family-focused intervention in the treatment of OCD patients with IBs.

Variations in symptom prevalence and clinical correlates in younger versus older youth with obsessive-compulsive disorder

Few studies have examined the phenomenology of obsessive-compulsive disorder (OCD) in younger children. A sample of 292 treatment seeking youth with a primary diagnosis of OCD was divided into the young child (3-9 years old) and older child (10-18 years old) groups. Overall OCD severity did not differ between groups. However, older youth demonstrated stronger intensity of obsessive and compulsive symptoms, while younger children were rated as having less resistance and control of compulsions. Older youth exhibited increased occurrence of comorbid depression, and an increased occurrence of sexual, magical thinking, and somatic obsessions, as well as, checking, counting and magical thinking compulsions. Conversely, the group of younger children exhibited significantly poorer insight, increased incidence of hoarding compulsions, higher rates of comorbid attention deficit/hyperactivity disorder, disruptive behavior, and parent-rated anxiety, and more frequently exhibited hoarding compulsions. These differences suggest domains to consider when screening for OCD among younger/older pediatric cohorts.

[Movement disorders is psychiatric diseases]

Movement disorders are common in psychiatry. The movement disorder can either be the symptom of a psychiatric disorder, can share a common aetiological factor with it, or can be the consequence of psychopharmacological therapy. Most common features include tic, stereotypy, compulsion, akathisia, dyskinesias, tremor, hypokinesia and disturbances of posture and gait. We discuss characteristics and clinical importance of these features. Movement disorders are frequently present in mood disorders, anxiety disorders, schizophrenia, catatonia, Tourette-disorder and psychogenic movement disorder, leading to differential-diagnostic and therapeutical difficulties in everyday practice. Movement disorders due to psychopharmacotherapy can be classified as early-onset, late-onset and tardive. Frequent psychiatric comorbidity is found in primary movement disorders, such as Parkinson's disease, Wilson's disease, Huntington's disease, diffuse Lewy-body disorder. Complex neuropsychiatric approach is effective concerning overlapping clinical features and spectrums of disorders in terms of movement disorders and psychiatric diseases.

Compulsive versifying after treatment of transient epileptic amnesia

Compulsive production of verse is an unusual form of hypergraphia that has been reported mainly in patients with right temporal lobe seizures. We present a patient with transient epileptic amnesia and a left temporal seizure focus, who developed isolated compulsive versifying, producing multiple rhyming poems, following seizure cessation induced by lamotrigine. Functional neuroimaging studies in the healthy brain implicate left frontotemporal areas in generating novel verbal output and rhyme, while dysregulation of neocortical and limbic regions occurs in temporal lobe epilepsy. This case complements previous observations of emergence of altered behavior with reduced seizure frequency in patients with temporal lobe epilepsy. Such cases suggest that reduced seizure frequency has the potential not only to stabilize or improve memory function, but also to trigger complex, specific behavioral alterations.

Two types of impairments in OCD: obsessions, as problems of thought suppression; compulsions, as behavioral-executive impairment

Impairments in executive functioning have been identified as an underlying cause of Obsessive-Compulsive Disorder (OCD). Obsessive patients attempt to suppress certain unwanted thoughts through a mechanism that Wegner referred to as 'chronic thought suppression', whereas compulsive patients are unable to inhibit their rituals. We tested 51 OCD patients using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the White Bear Suppression Inventory (WBSI) and the Dysexecutive Questionnaire (DEX). Executive functions were tested using a cognitive test battery. We found that the total WBSI score was correlated with the Y-BOCS obsessive score but not with the Y-BOCS compulsive score. A stronger correlation was observed between the Y-BOCS obsessive score and the 'unwanted intrusive thoughts' factor based on Blumberg's 3-factor model of the WBSI. The total WBSI score was not correlated with the cognitive test results. The DEX score was significantly correlated with the Y-BOCS compulsive score; however, no correlation was found between the DEX score and the Y-BOCS obsessive score. A stronger correlation was observed between the Y-BOCS compulsive score and the 'inhibition' component of the DEX score, as defined by Burgess's 5-factor model. The DEX scores were correlated with cognitive test results measuring attention, cognitive flexibility and inhibitory processes. We conclude that obsessions indicate a failure of cognitive inhibition but do not involve significant impairment of executive functions, whereas compulsions indicate ineffective behavior inhibition and impaired executive functions.

Validation of the questionnaire for impulsive-compulsive disorders in Parkinson's disease (QUIP) and the QUIP-rating scale in a German speaking sample

Impulsive-compulsive disorders are frequent in patients with Parkinson’s disease (PD). Recently, a screening questionnaire and rating scale were developed for these disorders: the questionnaire for impulsive-compulsive disorders (QUIP) and QUIP-rating scale (QUIP-RS). We assessed the validity of these instruments in the German language in order to reevaluate the benefit and to obtain German screening tools in clinical practice. A convenience sample of 156 patients was assessed in Kiel and Vienna. The patients filled out the QUIP-current, the QUIP-anytime and the QUIP-RS. We validated the questionnaires against a gold standard diagnosis via receiver operating characteristic curves and determined optimal cut-off scores for the instruments. Excluding walkabout, which was not shown to be valid, sensitivities ranged from 60–92 % for the QUIP-current, 68–91 % for the QUIP-anytime, and 73–100 % for the QUIP-RS. Specificities were >71 % for QUIP-current, >69 % for QUIP-anytime and >62 % for QUIP-RS. With its very good sensitivities, the QUIP-RS is a valid instrument to assess impulsive-compulsive disorders and makes an early detection of behavioral disorders in PD possible. The QUIP-anytime was also shown to be a valid screening instrument. Both are expected to prove useful in scientific and clinical practice.

A phenotypic structure and neural correlates of compulsive behaviors in adolescents

BACKGROUND

A compulsivity spectrum has been hypothesized to exist across Obsessive-Compulsive disorder (OCD), Eating Disorders (ED), substance abuse (SA) and binge-drinking (BD). The objective was to examine the validity of this compulsivity spectrum, and differentiate it from an externalizing behaviors dimension, but also to look at hypothesized personality and neural correlates.

METHOD

A community-sample of adolescents (N=1938; mean age 14.5 years), and their parents were recruited via high-schools in 8 European study sites. Data on adolescents' psychiatric symptoms, DSM diagnoses (DAWBA) and substance use behaviors (AUDIT and ESPAD) were collected through adolescent- and parent-reported questionnaires and interviews. The phenotypic structure of compulsive behaviors was then tested using structural equation modeling. The model was validated using personality variables (NEO-FFI and TCI), and Voxel-Based Morphometry (VBM) analysis.

RESULTS

Compulsivity symptoms best fit a higher-order two factor model, with ED and OCD loading onto a compulsivity factor, and BD and SA loading onto an externalizing factor, composed also of ADHD and conduct disorder symptoms. The compulsivity construct correlated with neuroticism (r=0.638; p ≤ 0.001), conscientiousness (r=0.171; p ≤ 0.001), and brain gray matter volume in left and right orbitofrontal cortex, right ventral striatum and right dorsolateral prefrontal cortex. The externalizing factor correlated with extraversion (r=0.201; p ≤ 0.001), novelty-seeking (r=0.451; p ≤ 0.001), and negatively with gray matter volume in the left inferior and middle frontal gyri.

CONCLUSIONS

Results suggest that a compulsivity spectrum exists in an adolescent, preclinical sample and accounts for variance in both OCD and ED, but not substance-related behaviors, and can be differentiated from an externalizing spectrum.