OCD, an anxiety disorder, occurs in about 2.1 percent of the population. There may be a genetic component. An obsession is a recurring and intrusive thought (sexual urges, losing control, excessive douts such as moral or religious doubt, a need to talk or confess, a need to have things "just so", etc) while a compulsion is a recurrent conscious pattern of behavior(ie hand washing, repeating a phrase outloud or silently, praying, checking, hoarding or saving, ordering or arranging, etc) which a person is driven to perform.
About 20 percent of OCDers develop motor ticks. 70% percent develop symptoms by the age of 30.
John Hopkins is running a study for OCD nationwide and looking for subjects."Families having two or more relatives with OCD are invited to participate our study.Participants do not need to travel.
Confidentiality of all information is assured.
Participants will be compensated"
Clomipramine (Anafranil, manufactured by Ciba-Geigy)
Fluoxetine (Prozac),Fluvoxamine (Luvox), Paroxetine (Paxil).Sertraline (Zoloft), and Citalopram (Celexa), selective serotonin reuptake inhibitors (SSRIs), are commonly used for obsessive compulsive disorder, ocd. Clomipramine, nonselective SRI, is also used.
Biol Psychiatry. 2004 May 15;55(10):1041-5. :
Low level of dopaminergic D2 receptor binding in obsessive-compulsive disorder.
Denys D, van der Wee N, Janssen J, De Geus F, Westenberg HG.
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
BACKGROUND: Despite growing evidence for involvement of the dopaminergic system in obsessive-compulsive disorder (OCD), the functional anatomy of the dopaminergic system in the basal ganglia has been investigated sparsely. METHODS: Dopamine D(2) receptor binding was assessed in 10 medication-free OCD patients and 10 healthy control subjects, matched for age, gender, and handedness. The binding potential was measured with single photon emission computerized tomography (SPECT) and infusion of the D(2) receptor radiotracer [(123)I] iodobenzamide. With magnetic resonance imaging as reference, regions of interest (caudate and putamen) were delineated for each hemisphere and coregistered with the corresponding SPECT scans. RESULTS: Dopamine D(2) receptor binding in the left caudate nucleus was significantly lower in the patients with OCD than in healthy control subjects [F(1,18) = 7.0, p =.016]. In addition, an interhemispheric difference was observed in the patient sample. Both the D(2) receptor binding potential (df = 9, p =.012), and the volume (df = 9, p =.029) of the left caudate nucleus were statistically significantly reduced relative to the right caudate nucleus. CONCLUSIONS: This study provides in vivo evidence for abnormalities in the binding potential of the dopamine D(2) receptor, which suggest the direct involvement of the dopaminergic system in the pathophysiology of OCD.
Behav Res Ther. 2004 Jul;42(7):841-57. :
Effects of suppressing neutral and obsession-like thoughts in normal subjects: beyond frequency.
Belloch A, Morillo C, Gimenez A.
Department of Personality Psychology, Faculty of Psychology, University of Valencia, Avda. Blasco Ibanez 21, Valencia 46010, Spain.
Recent cognitive-behavioral theories on obsessive-compulsive disorder (OCD) show that deliberate attempts to suppress intrusive and undesirable thoughts lie at the genesis of clinical obsessions. In this paper the results of an experimental study on the suppression of neutral and obsession-like thoughts in normal subjects are presented. Eighty-seven university students performed in three experimental periods: (1) base-line monitoring, (2) experimental instruction, and (3) monitoring. For each of these periods, the frequency of the occurrence of a "white bear" thought or a personally relevant intrusive thought was registered. Half of the subjects received instructions to suppress the target-thought in period 2, and the other half were instructed to only monitor the target-thought in each of the experimental periods. Several measures were also obtained before and after the experiment: annoyance caused by the intrusion, suppression effort, subjective success, and evaluative appraisals of the target-thought. The results showed neither immediate nor delayed frequency increases of the target thought. However, evidence was found that deliberate thought suppression efforts, regardless of their content, had greater negative consequences than did non suppression. These results are discussed in relation to the recent cognitive proposals about OCD.
1: Neuropsychopharmacology. 2004 Apr;29(4):826-32. :
Amygdala volume reductions in pediatric patients with obsessive-compulsive disorder treated with paroxetine: preliminary findings.
Szeszko PR, MacMillan S, McMeniman M, Lorch E, Madden R, Ivey J, Banerjee SP, Moore GJ, Rosenberg DR.
Department of Psychiatry Research, Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
szeszko@lij.eduThe amygdala is believed to be highly relevant to the pathophysiology of obsessive-compulsive disorder (OCD) given its prominent role in fear conditioning and because it is an important target of the serotonin reuptake inhibitors (SRIs), the pharmacotherapy of choice for OCD. In the present study, we measured in vivo volumetric changes in the amygdala in pediatric patients with OCD following 16 weeks of monotherapy with the selective SRI, paroxetine hydrochloride. Amygdala volumes were computed from contiguous 1.5 mm magnetic resonance (MR) images in 11 psychotropic drug-naive patients with OCD prior to and then following treatment. Eleven healthy pediatric comparison subjects also had baseline and follow-up scans, but none of these subjects received medication. Patients demonstrated significant asymmetry of the amygdala (L>R) prior to pharmacologic intervention in contrast to healthy comparison subjects who showed no asymmetry at the time of their baseline scan. Mixed model analyses using age and total brain volume as time varying covariates indicated that left amygdala volume decreased significantly in patients following treatment. The reduction in left amygdala volume in patients correlated significantly with higher paroxetine dosage at the time of the follow-up scan and total cumulative paroxetine exposure between the scans. No significant changes in either right or left amygdala volume were evident among healthy comparison subjects from the baseline to the follow-up scan. These preliminary findings suggest that abnormal asymmetry of the amygdala may play a role in the pathogenesis of OCD and that paroxetine treatment may be associated with a reduction in amygdala volume.
J Clin Psychopharmacol. 2003 Dec;23(6):568-75. :
A double blind comparison of venlafaxine and paroxetine in obsessive-compulsive disorder.
Denys D, Van Der Wee N, Van Megen HJ, Westenberg HG.
SUMMARY: While the usefulness of clomipramine and selective serotonin reuptake inhibitors (SSRIs) in obsessive-compulsive disorder (OCD) has been established, the efficacy of serotonin-norepinephrine reuptake inhibitors remains to be determined. This report describes the first randomized double-blind comparison study of an SNRI in patients with obsessive-compulsive disorder. The current study compares the efficacy and tolerability of venlafaxine with paroxetine. One hundred and fifty patients with primary OCD according to DSM-IV criteria were randomly assigned in a 12-week double-blind trial to receive dosages titrated upward to 300 mg/d of venlafaxine (n = 75) or 60 mg/d of paroxetine (n = 75). Primary efficacy was assessed by the change from baseline on the Yale-Brown obsessive-compulsive scale (Y-BOCS). Other assessments throughout the trial included the Hamilton depression rating scale, and the Hamilton anxiety rating scale. An intent-to-treat, last-observation-carried-forward analysis demonstrated a mean decrease on the Y-BOCS of 7.2 +/- 7.5 in the venlafaxine group and of 7.8 +/- 5.4 in the paroxetine group. In both treatment groups, a responder rate (decrease > 35% on the Y-BOCS) of approximately 40% was found. There were no significant differences between venlafaxine and paroxetine with regard to response or responder rates. The incidence of adverse events for venlafaxine and paroxetine was comparable. The most common side effects for venlafaxine were somnolence, insomnia, a dry mouth, and sweating; and for paroxetine somnolence, sweating, nausea, and headache. These results show that venlafaxine was equally effective to paroxetine in treating patients with OCD. Venlafaxine may be a useful therapy for obsessive-compulsive patients, but is not superior to SSRIs.
Behav Res Ther. 2003 Nov;41(11):1311-23. :
Anxiety and selective attention in obsessive-compulsive disorder.
Cohen Y, Lachenmeyer JR, Springer C.
School of Psychology, Fairleigh Dickinson University, 1000 River Road, Teaneck, NJ, USA
Recently, there has been increasing evidence for information-processing deficits in individuals with obsessive-compulsive disorder (OCD). While impairments in selective attention have been identified to be central to the symptomatology of OCD, the role that situational anxiety plays in attentional processes has not been fully explored. Previous research findings were limited to tasks containing anxiety-relevant materials, only permitting for the evaluation of the impact of anxiety on simultaneous cognitive processing. Furthermore, it has not yet been determined whether the impact of anxiety is limited to selective attention or is indicative of a more general cognitive impairment. This study was designed to examine the role that situational anxiety plays in selective attention impairments. OCD participants and controls were presented with an anxiety producing statement and a neutral statement, followed by the Stroop Task. Results indicated that situational anxiety plays a significant role in the performance of tasks that require selective attention in OCD. A significant deterioration was detected in performance on selective attention tasks for the OCD participants after confronting anxiety-provoking scenarios, as compared to neutral scenarios. Anxiety did not impair performance on simple reading tasks. Possible explanations are discussed
: Int J Neuropsychopharmacol. 2003 Oct 31 [Epub ahead of print].:
Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study.
Hollander E, Rossi NB, Sood E, Pallanti S.
Department of Psychiatry, The Mount Sinai School of Medicine, New York, NY, USA.
This double-blind, placebo-controlled trial was performed to determine the efficacy and tolerability of 8 wk of risperidone augmentation of serotonin reuptake inhibitor (SRI) treatment in adult subjects with treatment-resistant obsessive-compulsive disorder (OCD) (failure of at least two SRI trials). Sixteen adult treatment-resistant OCD patients were randomly assigned to augmentation with 8 wk of either risperidone (n=10) (0.5-3.0 mg/d) or placebo (n=6) following at least 12 wk of SRI treatment. Four patients on risperidone (40%) and none (0%) on placebo were responders with both a Clinical Global Impression - Improvement (CGI-I) score of 1 or 2 and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decrease >/=25%. Risperidone was generally well tolerated: there were 3 dropouts, 1 on risperidone and 2 on placebo. Better Y-BOCS insight score at baseline significantly correlated with a greater CGI-I score at endpoint on risperidone augmentation. Risperidone may be an effective and well-tolerated augmentation strategy in treatment-resistant OCD subjects, but larger sample size studies are required to demonstrate this
Psychiatry Res. 2003 Oct 30;124(2):87-103. :
Brain reactivity to specific symptom provocation indicates prospective therapeutic outcome in OCD.
Hendler T, Goshen E, Tzila Zwas S, Sasson Y, Gal G, Zohar J.
Psychiatry Department, Chaim Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel.
talma@tasmc.health.gov.il
A pertinent question in biological psychiatry is what differentiates responders and non-responders to pharmacological treatment. One possibility is that individual differences in the symptomatic spectrum as well as in the underlying biology of the disorder lead to the known 40% failure in pharmacological treatment. Our study aimed to maximize individual brain markers of obsessive-compulsive disorder (OCD) by applying single photon emission computed tomography (SPECT) during a provoked symptomatic state prior to and following treatment. Four brain SPECT scans were obtained from 26 OCD patients prior to and at 6 months of sertraline treatment. At each time point, two SPECT scans were performed in a counterbalanced order of two specific states; one a symptom-provoking condition and the other a relaxed condition. At 6 months of treatment, patients were divided into responders and non-responders according to a predetermined clinical criterion. Prospective responders showed significantly lower brain perfusion in the dorsal-caudal anterior cingulum and higher brain perfusion in the right caudate, when compared to non-responders, only during symptom provocation. When pre- and post-treatment scans during symptom provocation were compared, only responders showed significant change in brain response: increased perfusion in the left anterior temporal cortex and prefrontal cortex at 6 months' treatment. These findings suggest that obtaining functional brain imaging during specific symptom provocation emphasizes individual differences in brain reactivity. Thus can indicate prospective responders to symptom-related treatment in OCD and mark the relevant brain regions for effective response to treatment.
Clin Psychopharmacol. 2003 Oct;23(5):448-50. :
Lack of efficacy of low doses of quetiapine addition in refractory obsessive-compulsive disorder.
Sevincok L, Topuz A.
Department of Psychiatry, Adnan Menderes University, Aydin, Turkey.
isevincok@hotmail.com
BACKGROUND: Some studies have shown that low dose of neuroleptic addition to ongoing antiobsessive treatment might be effective in treatment resistant obsessive-compulsive disorder (OCD). The primary purpose of this study was to evaluate the efficacy of low-dose quetiapine in clomipramine and serotonin reuptake inhibitor-refractory obsessive-compulsive disorder patients. METHOD: Eight obsessive-compulsive disorder patients who were resistant to treatment after 2 or more inadequate trials with clomipramine or serotonin reuptake inhibitor were admitted to the study. The patients were administrated on open trial of quetiapine at daily dose of 150 mg. Treatment response was assessed using the Yale-Brown Compulsive Scale and the Clinical Global Impressions Scale. RESULTS: Only 2 patients were partial responders, with Yale-Brown Compulsive Scale score decreases of 28% and 29%. CONCLUSION: The results of this preliminary open trial suggest that low dose of quetiapine may not be effective in treatment-resistant obsessive-compulsive disorder patients. Larger placebo-controlled trials are needed to investigate the clinical efficacy of quetiapine addition at low doses to antiobsessive treatment in treatment-refractory obsessive-compulsive disorder
Behav Res Ther. 2003 Sep;41(9):1029-41. :
Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series.
Gershuny BS, Baer L, Radomsky AS, Wilson KA, Jenike MA.
Harvard Medical School and Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA 02129, USA.
gershuny@psych.mgh.harvard.edu
Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.
J Clin Exp Neuropsychol. 2003 Sep;25(6):842-51. :
Relation of neurological soft signs to nonverbal memory performance in obsessive-compulsive disorder.
Mataix-Cols D, Alonso P, Hernandez R, Deckersbach T, Savage CR, Manuel Menchon J, Vallejo J.
Department of Psychological Medicine, GKT School of Medicine and Institute of Psychiatry, London, UK.
d.mataix@iop.kcl.ac.uk
Few studies have examined the relation between neurological soft signs (NSS) and neuropsychological performance in Obsessive-Compulsive Disorder (OCD). Thirty outpatients with primary OCD and 30 matched normal controls were administered the Cambridge Neurological Inventory and the Rey-Osterrieth Complex Figure Test (RCFT). A series of multiple regression models tested the relationship between NSS and performance on the RCFT. Patients presented significantly more neurological soft signs than controls on both sides of the body, and were impaired on the free recall and organization scores of the RCFT. Nonverbal memory deficits in OCD were predicted independently by organizational strategies during the copy condition of the RCFT, and neurological soft signs. There might be at least two variables independently mediating nonverbal memory deficits in OCD: (1) a cognitive organization and planning component, and (2) a complex motor regulatory component
"Behav Res Ther 2003 May;41(5):529-40 : "Previous
research suggests that individuals with OCD use maladaptive strategies to control
their unpleasant thoughts (Behav Res Ther (1977) 35, 775). These include worry
and self-punishment strategies. In the present study we replicated and extended
the previous findings by comparing thought control strategies used by patients
with OCD to strategies used by anxious and non-anxious control participants.
We also examined changes in thought control strategies for OCD patients who
underwent cognitive-behavioral therapy. Compared to controls, OCD patients reported
more frequent use of worry and punishment strategies, and less frequent use
of distraction. Following successful treatment, OCD patients evidenced increased
use of distraction and decreased use of punishment. Findings are discussed in
terms of the cognitive model of OCD.
Compr Psychiatry 2003 May-Jun;44(3):256-61 :
The relation of psychogenic excoriation with psychiatric disorders: A comparative study.
cAlikusu C, Yucel B, Polat A, Baykal C.
Psychogenic excoriation (PE), characterized by excessive scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV disorder. It is a chronic disorder with a high rate of psychiatric comorbidity. The purpose of this study was to compare patients diagnosed with PE and patients with another dermatological disease in terms of comorbid psychiatric disorders. Thirty-one consecutive subjects were recruited from an outpatient dermatology clinic. The control group was composed of 31 patients with chronic urticaria. All subjects were interviewed using the Structured Clinical Interview for DSM-III-R (SCID-I), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HARS), and Yale-Brown Obsession and Compulsion Scale (Y-BOCS) and also completed a semistructured questionnaire. Current major depressive syndrome was the most common psychiatric disorder in the PE group. There was a statistically significant difference between the two groups in terms of current major depressive syndrome (PE group 58.1%, control group 6.5%, P<.01). In the PE group, 45.2% of subjects were diagnosed with obsessive compulsive disorder (OCD), while the rate of OCD was only 3.7% in the control group (P <.01). The PE group scored significantly higher on the BDI, HARS, and Y-BOCS. The results of this study point to the close relationship of PE to depression and OCD
J Clin Psychiatry 2003 May;64(5):546-550 ":
Venlafaxine in Treatment-Resistant Obsessive-Compulsive Disorder.
Hollander E, Friedberg J, Wasserman S, Allen A, Birnbaum M, Koran LM.
Department of Psychiatry, Compulsive, Impulsive, and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, N.Y. (Drs. Hollander, Wasserman, and Allen and Mss. Friedberg and Birnbaum), and the OCD Clinic, Department of Psychiatry, Stanford University Medical Center, Stanford, Calif. (Dr. Koran).
BACKGROUND: While selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment of obsessive-compulsive disorder (OCD), approximately 40% of patients fail to respond to SSRIs. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that might be effective in the treatment of OCD, even among those who have failed previous SSRI trials. METHOD: Thirty-nine patients who met DSM-IV criteria for OCD, including 29 who were resistant to prior SRI treatment trials, were treated with venlafaxine in an open, naturalistic fashion. Improvement was assessed using the Clinical Global Impressions-Improvement scale. RESULTS: Of 39 patients treated with venlafaxine, 27 (69.2%) were rated as sustained treatment responders. Of the 29 patients who did not respond to 1 or more previous SRI trials, 22 (75.9%) were rated as having sustained response to treatment. Mean dose of venlafaxine was 232.2 mg/day (range, 37.5-375 mg/day), and it was generally well tolerated. CONCLUSION: Venlafaxine may be beneficial to individuals with OCD, including those who have not responded to prior SSRI trials. However, these findings must be interpreted with caution, as the study is limited by its open, retrospective nature and its inclusion of patients with comorbid diagnoses and patients on concomitant medications. Prospective, controlled trials with a more homogeneous patient population are needed to replicate these preliminary findings.
Am J Psychiatry 2003 Mar;160(3):522-32 :
Differential brain metabolic predictors of response to paroxetine in obsessive-compulsive disorder versus major depression.
Saxena S, Brody AL, Ho ML, Zohrabi N, Maidment KM, Baxter LR Jr.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
ssaxena@mednet.ucla.edu
OBJECTIVE: Serotonin reuptake inhibitor (SRI) medications are effective in the treatment of both major depressive disorder and obsessive-compulsive disorder (OCD), but it is unknown whether the neural substrates of treatment response for the two disorders are the same or different. The authors sought to identify pretreatment cerebral glucose metabolic markers of responsiveness to SRI treatment in patients with OCD versus major depressive disorder and to determine whether the pretreatment patterns associated with improvement of OCD symptoms were the same as or different from those associated with improvement of major depressive disorder symptoms. METHOD: [(18)F]Fluorodeoxyglucose positron emission tomography was used to measure cerebral glucose metabolism in 27 patients with OCD alone, 27 with major depressive disorder alone, and 17 with concurrent OCD and major depressive disorder, who were all then treated with 30-60 mg/day of paroxetine for 8-12 weeks. Correlations were calculated between pretreatment regional metabolism and pre- to posttreatment changes in the severity of OCD symptoms, depressive symptoms, and overall functioning. RESULTS: While improvement of OCD symptoms was significantly correlated with higher pretreatment glucose metabolism in the right caudate nucleus (partial r=-0.53), improvement of major depressive disorder symptoms was significantly correlated with lower pretreatment metabolism in the amygdala (partial r=0.71) and thalamus (partial r=0.34) and with higher pretreatment metabolism in the medial prefrontal cortex and rostral anterior cingulate gyrus (Talairach coordinates: x=0, y=62, z=10) (z=2.91). CONCLUSIONS: These findings suggest that, although both OCD and major depressive disorder respond to SRIs, the two syndromes have different neurobiological substrates for response. Elevated activity in the right caudate may be a marker of responsiveness to antiobsessional treatment, while lower right amygdala activity and higher midline prefrontal activity may be required for response of depressive symptoms to treatment.
Acta Psychiatr Scand 2003 Apr;107(4):275-82 : OBJECTIVE: Investigation of deep brain stimulation (DBS) as a last-resort treatment alternative to capsulotomy in treatment-refractory obsessive-compulsive disorder (OCD). METHOD: Prospective single-case based design with evaluation of DBS impact on emotions, behaviour, personality traits and executive function in three patients with OCD. RESULTS: Two patients experienced sustained improvement of OCD symptoms with DBS. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) dropped 12 points and 23 points to baseline and Y-BOCS self-rating scale (Y-BOCS-SRS) and Profile of Mood States (POMS) for depression and tension decreased with increasing stimulation amplitude. Total Maladjustment Score on the Brief Psychiatric Rating Scale reduced with 44 and 59% to baseline. Reduction in psychopathology was sustained under continuous stimulation. No deleterious impact of DBS on neuropsychological testing or personality traits measured on a self-rated personality inventory was detected. CONCLUSION: These preliminary findings demonstrate that DBS may have important therapeutic benefits on psychopathology in OCD. No harmful side-effects were detected during follow-up (33/33/39 months, respectively).
World J Biol Psychiatry 2002 Oct;3(4):171-99
:
World Federation of Societies of Biological Psychiatry (WFSBP)
guidelines for the pharmacological treatment of anxiety,
obsessive-compulsive and posttraumatic stress disorders.
Bandelow B, Zohar J, Hollander E, Kasper S, Moller HJ;
World
Federation of Societies of Biological Psychiatry Task Force on Treatment
Guidelines for Anxiety, Obsessive-Compulsive and Posttraumatic Stress
Disorders.
Department of Psychiatry and Psychotherapy, University of Gottingen,
Germany.
bbandel@gwdg.deIn this report, recommendations for the pharmacological treatment of anxiety
and obsessive-compulsive disorders are presented, based on available
randomized, placebo- or comparator-controlled clinical studies. Selective
serotonin reuptake inhibitors (SSRIs) are the first-line treatment for panic
disorder. Tri2-cyclic antidepressants (TCAs) are equally effective, but they
are less well tolerated than the SSRIs. In treatment-resistant cases,
benzodiazepines like alprazolam may be used when the patient does not have a
history of dependency and tolerance. Due to possible serious side effects and
interactions with other drugs and food components, the irreversible monamine
oxidase inhibitor (MAOI) phenelzine should be used only when first-line drugs
have failed. In generalised anxiety disorder, venlafaxine and SSRIs can be
recommended, while buspirone and imipramine may be alternatives. For social
phobia, SSRIs are recommended for the first line, and MAOIs, moclobemide
and benzodiazepines as second line.
Obsessive-compulsive disorder is best
treated with SSRIs or clomipramine.
J Clin Psychiatry 2002 Aug;63(8):700-3
:
Quetiapine addition to serotonin reputake inhibitor treatment in
patients with treatment-refractory obsessive-compulsive
disorder: an open-label study.
Denys D, van Megen H, Westenberg H.
Department of Psychiatry, University Medical Center, Utrecht, The
Netherlands.
D.A.J.P.denys@azu.nlOBJECTIVE: Although patients with obsessive-compulsive disorder (OCD)
benefit from treatment with serotonin reuptake inhibitors (SRIs), it is
estimated that 40% to 60% of the patients remain unimproved. The objective of
this study was to examine whether addition of the atypical antipsychotic
quetiapine to SRIs is useful for patients with OCD who do not respond to SRI
monotherapy. METHOD: Ten patients with OCD (DSM-IV criteria) who had not
responded to at least 3 previous treatments with an SRI at maximum dose and
duration were assigned to receive quetiapine in addition to an SRI for 8 weeks.
Treatment response was assessed using the Yale-Brown Obessive-Compulsive
Scale (YBOCS). RESULTS: Seven of 10 patients responded to the quetiapine
addition. The mean +/- SD baseline YBOCS score of 31.4 +/- 7.8 dropped to a
mean of 20.8 +/- 8.4 at endpoint with a mean reduction of 35.4%.
CONCLUSION: This is the first study to show that treatment-refractory OCD
patients may benefit from addition of quetiapine to ongoing SRI therapy.
Harv Rev Psychiatry 2002 May-Jun;10(3):127-37
:
Pharmacological management of obsessive-compulsive disorder: a
review for clinicians.
McDonough M, Kennedy N.
Maudsley Hospital, Denmark Hill, London, England.
sbpmdm@iop.kcl.ac.ukObsessive-compulsive disorder (OCD) has been treated pharmacologically with
drugs that enhance availability of the neurotransmitter serotonin. This review
summarizes the available literature on the pharmacological treatments of OCD.
Numerous randomized controlled trials have attested to the efficacy of
serotonin-reuptake inhibitors (SRIs) in treating this disorder, although a
coherent model of serotonin dysfunction in OCD has not been established.
Meta-analyses of randomized controlled trials have found better results with
clomipramine than with other SRIs, but comparative studies have so far not
replicated this finding. Aspects of the methodology in these studies that might
explain this discrepancy are considered. Tolerability, side effects, dosing, and
safety during pregnancy of the SRIs are discussed. Treatment of OCD with
poor insight and of OCD comorbid with a tic disorder, augmentation strategies,
and management of partial response to SRIs are reviewed. Finally, the available
interventions for refractory OCD are considered.
J Affect Disord 2002 Feb;68(1):59-65
:
Does SSRI augmentation with antidepressants that influence
noradrenergic function resolve depression in obsessive-compulsive
disorder?
Mancini C, Van Ameringen M, Farvolden P.
Anxiety Disorders Clinic, McMaster University Medical Centre, Hamilton
Health Sciences Corporation, McMaster Site, 1200 Main Street West,
Hamilton, Ontario, Canada L8N 3Z5.
mancini@fhs.mcmaster.caBACKGROUND: Obsessive compulsive disorder (OCD) often coexists with
major depressive disorder (MDD). Serotonergic antidepressant medications
have emerged as the treatment of choice for both OCD and MDD. In the usual
course of events, both the patient's OCD and depressive symptoms improve in
parallel following initiation of serotonin reuptake inhibitor (SRI) treatment for
OCD. However, such is not always the case. We report here on a series of ten
patients whose OCD but not depression improved following a trial of SRI
therapy. METHOD: Ten patients with OCD and comorbid MDD who
experienced a worsening or exacerbation of depressive symptoms while being
maintained on an adequate dose of SRI therapy were treated using a
combination of SRIs and agents with effects on noradrenergic reuptake.
Response to treatment was based on clinician-ratings of severity and
improvement of OCD and MDD (CGI-S and CGI-I). RESULTS: Following
augmentation, nine of the ten patients had a significant improvement/resolution
of their MDD, with little further change in the severity of their OCD.
LIMITATIONS: Inferences from the results of this study are limited by the
lack of a control group, the small sample size, and the use of nonstandardized
ratings as measures of symptom severity. CONCLUSIONS: These results are of
practical significance to clinicians insofar as they suggest a possible guideline
to clinicians treating depression in OCD with SSRIs without success.
Can J Psychiatry 2001 May;46(4):356-8
:
Olanzapine augmentation of serotonin uptake inhibitors in
obsessive-compulsive disorder: an open study.
Francobandiera G.
Department of Psychiatry, Center for Treatment of Anxiety Disorders,
Morbegno, Italy.
giofran@katamail.comOBJECTIVE: This study evaluates the clinical response to olanzapine used in
association with selective serotonin reuptake inhibitors (SSRIs) or
clomipramine in treatment-resistant obsessive-compulsive disorder (OCD).
METHODS: We describe the cases of 9 patients with serotonin uptake
inhibitor-resistant OCD who were given an open-label adjunctive treatment of
olanzapine for a minimum of 6 weeks. The response was assessed by using the
Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global
Impression Scale (CGI). RESULTS: Six patients showed improvement of
symptoms after the augmentation with olanzapine. One patient (treated with
clomipramine) discontinued olanzapine due to side effects, and another 2 did not
respond. CONCLUSION: Olanzapine augmentation of SSRIs in treating OCD
showed a good (two-thirds) response rate, and it could therefore be considered
as a treatment option when conventional therapies have failed.
Psychopharmacology (Berl) 2003 Feb 13; [epub ahead of
print]
:
Age differences in the sensitivity to clomipramine in an animal
model of obsessive-compulsive disorder.
Fernandez-Guasti A, Ulloa RE, Nicolini H.
Departamento de Farmacobiologia, Centro de Investigacion y Estudios
Avanzados, Calz. De los Tenorios 235, Col. Granjas Coapa, 14330, Mexico D.F.,
Mexico.RATIONALE. Subtypes of obsessive-compulsive disorder (OCD) related to age
could determine differential response to treatment. OBJECTIVES. To explore
possible age differences in the effect of clomipramine in an animal model of
OCD....CONCLUSIONS. The present data shows important age differences in the
effect of clomipramine in a model of OCD. Such differences could be relevant
for the age variations in the response to treatment in clinical practice.
Am J Psychiatry 2003 Feb;160(2):242-7
:
Childhood obsessive-compulsive personality traits in adult women
with eating disorders: defining a broader eating disorder
phenotype.
Anderluh MB, Tchanturia K, Rabe-Hesketh S, Treasure J.OBJECTIVE: The authors retrospectively examined a spectrum of childhood
traits that reflect obsessive-compulsive personality in adult women with eating
disorders and assessed the predictive value of the traits for the development of
eating disorders. METHOD: In a case-control design, 44 women with anorexia
nervosa, 28 women with bulimia nervosa, and 28 healthy female comparison
subjects were assessed with an interview instrument that asked them to recall
whether they had experienced various types of childhood behavior suggesting
traits associated with obsessive-compulsive personality. The subjects also
completed a self-report inventory of obsessive-compulsive disorder (OCD)
symptoms. RESULTS: Childhood obsessive-compulsive personality traits showed
a high predictive value for development of eating disorders, with the estimated
odds ratio for eating disorders increasing by a factor of 6.9 for every
additional trait present. Subjects with eating disorders who reported
perfectionism and rigidity in childhood had significantly higher rates of
obsessive-compulsive personality disorder and OCD comorbidity later in life,
compared with eating disorder subjects who did not report those traits.
CONCLUSIONS: Childhood traits reflecting obsessive-compulsive personality
appear to be important risk factors for the development of eating disorders
and may represent markers of a broader phenotype for a specific subgroup of
patients with anorexia nervosa.
Am J Med Genet 2003 Apr 1;118A(1):25-8
:
Cytogenetic analysis of obsessive-compulsive disorder (OCD):
Identification of a FRAXE fragile site.
Wang Q, Gu Y, Ferguson JM, Chen Q, Boatwright S, Gardiner J, Below
C, Espinosa J, Nelson DL, Shaffer LG.
Center for Molecular Genetics, Department of Molecular Cardiology, Lerner
Research Institute, Center for Cardiovascular Genetics, Department of
Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.Obsessive-compulsive disorder (OCD) is a chronic psychiatric disease
characterized by recurrent obsessions, compulsions, or both. The prevalence
rate of OCD is 2.1% in the general population. Here we report cytogenetic
analysis of 26 patients affected with OCD. In one male patient (OCD-K33), we
identified a fragile X chromosome by cytogenetic analysis with 21% of cells
demonstrating a fragile site at Xq27-q28. Polymerase chain reaction (PCR) and
Southern blot analysis demonstrated that the molecular basis of the OCD-K33
fragile X chromosome was expansion of the CCG repeat at FRAXE. The number
of the expanded repeats was estimated to be more than 300 copies, qualifying
it as a full FRAXE mutation. Further analysis of the family members of
OCD-K33 revealed another member with a full FRAXE mutation (630-1,200
copies of the CCG repeat), who had the clinical phenotype of speech impairment,
and two other members with normal phenotypes and no FRAXE expansion. The
two FRAXE expansions lead to complete methylation at the CCG repeat. The
co-segregation of the full FRAXE mutation with apparent neurologic disorders
in the same family provides further support to the notion that FRAXE is a
genetic neurologic condition. Our findings expand the spectrum of clinical
phenotypes associated with FRAXE mutations. Copyright 2003 Wiley-Liss, Inc.
Am J Psychiatry 2003 Mar;160(3):522-32
:
Differential brain metabolic predictors of response to paroxetine
in obsessive-compulsive disorder versus major depression.
Saxena S, Brody AL, Ho ML, Zohrabi N, Maidment KM, Baxter LR Jr.OBJECTIVE: Serotonin reuptake inhibitor (SRI) medications are effective in
the treatment of both major depressive disorder and obsessive-compulsive
disorder (OCD), but it is unknown whether the neural substrates of treatment
response for the two disorders are the same or different. The authors sought to
identify pretreatment cerebral glucose metabolic markers of responsiveness to
SRI treatment in patients with OCD versus major depressive disorder and to
determine whether the pretreatment patterns associated with improvement of
OCD symptoms were the same as or different from those associated with
improvement of major depressive disorder symptoms. METHOD:
[(18)F]Fluorodeoxyglucose positron emission tomography was used to measure
cerebral glucose metabolism in 27 patients with OCD alone, 27 with major
depressive disorder alone, and 17 with concurrent OCD and major depressive
disorder, who were all then treated with 30-60 mg/day of paroxetine for 8-12
weeks. Correlations were calculated between pretreatment regional metabolism
and pre- to posttreatment changes in the severity of OCD symptoms, depressive
symptoms, and overall functioning. RESULTS: While improvement of OCD
symptoms was significantly correlated with higher pretreatment glucose
metabolism in the right caudate nucleus (partial r=-0.53), improvement of major
depressive disorder symptoms was significantly correlated with lower
pretreatment metabolism in the amygdala (partial r=0.71) and thalamus (partial
r=0.34) and with higher pretreatment metabolism in the medial prefrontal
cortex and rostral anterior cingulate gyrus (Talairach coordinates: x=0, y=62,
z=10) (z=2.91). CONCLUSIONS: These findings suggest that, although both
OCD and major depressive disorder respond to SRIs, the two syndromes have
different neurobiological substrates for response. Elevated activity in the right
caudate may be a marker of responsiveness to antiobsessional treatment, while
lower right amygdala activity and higher midline prefrontal activity may be
required for response of depressive symptoms to treatment
Schizophr Res 2003 Apr 1;60(2-3):191-8
:
Morphometric abnormality of the insula in schizophrenia: a
comparison with obsessive-compulsive disorder and normal control
using MRI.
Kim JJ, Youn T, Lee JM, Kim IY, Kim SI, Kwon JS.
BK21 Life Science and Neuroscience Institute-MRC, Seoul National University,
Seoul, South KoreaThe insula is increasingly the subject of great interest in psychiatric disorders
of neurodevelopmental origin because of its anatomical location, wide
interconnectivity, and variety of functions. This study explores the possible
morphometric change of the insula in schizophrenia and obsessive-compulsive
disorder (OCD), and its potential relationship to clinical symptoms. The insula
was traced on all coronal slices of magnetic resonance images of three age- and
sex-matched diagnostic groups, which consisted of 21 patients with
schizophrenia, 21 patients with OCD and 21 normal volunteers. The volumetric
measures of the insula were compared among the three groups, and their
relationships to the symptom severity were investigated. Volumetric reduction
of the left insula was observed in the schizophrenia group, but not in the OCD
group. These results confirm the involvement of deficient insular function in the
pathophysiology of schizophrenia.
: Behav Res Ther 2003 Mar;41(3):285-99
:
An examination of the cognitive processes involved in childhood
obsessive-compulsive disorder.
Barrett PM, Healy LJ.
School of Applied Psychology, Mount Gravatt Campus, 4111, QLD, AustraliaThe cognitive theory of obsessive-compulsive disorder (OCD) is the most widely
accepted account of the aetiology and maintenance of this disorder in adults.
This paper investigated whether cognitive processes were evident in a sample of
children with a primary diagnosis of OCD. Using an idiographic approach, as
proposed by the Obsessive-Compulsive Cognitions Working Group, this paper
assessed cognitive appraisals of responsibility, probability, severity,
thought-action fusion, self-doubt and cognitive control. Ratings of these
cognitive appraisals were obtained across a sample of children with OCD, and
were compared with ratings from a clinical control group of anxious children
and a non-clinic control group. It was hypothesised that consistent with the
cognitive theory of OCD, children in the OCD group would display higher
estimations of these cognitive processes in comparison to anxious and non-clinic
children. Results of this investigation provide preliminary support for a
cognitive conceptualisation of OCD during childhood. OCD children reported
significantly higher ratings of responsibility, severity, thought action fusion and
less cognitive control in comparison to non-clinic children. OCD children could
also be clearly differentiated from anxious children on ratings of cognitive
control. Implications of this investigation are discussed and directions for
future research are highlighted.
Clin Psychol Rev 2003 Feb;23(1):95-117
:
Neuropsychology of obsessive-compulsive disorder: a review and
treatment implications.
Greisberg S, McKay D.
Department of Psychology, Fordham University, 441 East Fordham Road,
10458-5198, Bronx, NY, USAThe existing literature examining neuropsychological features of
obsessive-compulsive disorder (OCD) is reviewed. The accumulated research
points to a deficit in organizational strategies in general, suggesting problems in
executive functioning. The available research is inconsistent in identifying
memory deficits in OCD. However, memory problems are most evident when
tests are used that require an implicit organizational strategy. While the
majority of the research reviewed involves adult samples, there is emerging
evidence that these deficits are present in children as well. It is suggested here
that the interaction between organizational strategy deficits and the effort to
recall unstructured information contributes to doubting, an important feature
of OCD. Implications of this body of research for behavior therapy are
considered.
J Clin Psychiatry 2003 Feb;64(2):152-5
:
How common is obsessive-compulsive disorder in a dermatology
outpatient clinic?
Fineberg NA, O'Doherty C, Rajagopal S, Reddy K, Banks A, Gale TM.
Hertfordshire Partnership, NHS Trust, London, UK.
kim.fox@hpt.nhs.ukBACKGROUND: This study was prompted by reports suggesting a high
prevalence of unrecognized obsessive-compulsive disorder (OCD) in the
dermatology clinic. METHOD: 92 consecutive dermatology referrals were
screened for DSM-IV OCD using the Mini-International Neuropsychiatric
Inverview (MINI), the Yale-Brown Obsessive Compulsive Scale (YBOCS), and
the 5-item screening questionnaire from the International Council on OCD.
Illness severity was rated on the YBOCS, and symptom profiles and
dermatologic diagnoses were established for screen-positive cases. RESULTS:
18 patients (20%) qualified for a DSM-IV diagnosis of OCD, of whom 17 were
previously undiagnosed. The range and type of OCD symptoms covered the
normal clinical spectrum. Most patients had more than 1 symptom, and among
obsessions (including somatic obsessions), checking, washing, and symmetry were
common. The mean total YBOCS score was 16/40 (SD = 7.2), indicating
moderate OCD, and 40% of the positive cases scored 16 or higher. Dermatologic
diagnoses were various and did not seem to bear a direct relationship with the
OCD. CONCLUSION: These results suggest that there is a high prevalence of
clinically relevant OCD in the dermatology clinic. This is an area that merits
attention with regard to better recognition and treatment for OCD sufferers.
Neuropsychopharmacology 2003 Feb;28(2):402-12
:
Synergistic Action of 5-HT(2A) Antagonists and Selective
Serotonin Reuptake Inhibitors in Neuropsychiatric Disorders.
Marek GJ, Carpenter LL, McDougle CJ, Price LH.Recently, the addition of drugs with prominent 5-HT(2) receptor antagonist
properties (risperidone, olanzapine, mirtazapine, and mianserin) to selective
serotonin reuptake inhibitors (SSRIs) has been shown to enhance therapeutic
responses in patients with major depression and treatment-refractory
obsessive-compulsive disorder (OCD). These 5-HT(2) antagonists may also be
effective in ameliorating some symptoms associated with autism and other
pervasive developmental disorders (PDDs). At the doses used, these drugs would
be expected to saturate 5-HT(2A) receptors. These findings suggest that the
simultaneous blockade of 5-HT(2A) receptors and activation of an unknown
constellation of other 5-HT receptors indirectly as a result of 5-HT uptake
inhibition might have greater therapeutic efficacy than either action alone.
Animal studies have suggested that activation of 5-HT(1A) and 5-HT(2C)
receptors may counteract the effects of activating 5-HT(2A) receptors.
Additional 5-HT receptors, such as the 5-HT(1B/1D/5/7) receptors, may
similarly counteract the effects of 5-HT(2A) receptor activation. These
clinical and preclinical observations suggest that the combination of highly
selective 5-HT(2A) antagonists and SSRIs, as well as strategies to combine
high-potency 5-HT(2A) receptor and 5-HT transporter blockade in a single
compound, offer the potential for therapeutic advances in a number of
neuropsychiatric disorders.Neuropsychopharmacology (2003) 28, 402-412.
doi:10.1038/sj.npp.1300057
Psychiatry Res 2003 Jan 25;117(1):11-6
:
Obsessive-compulsive behaviors in parents of multiplex autism
families.
Hollander E, King A, Delaney K, Smith CJ, Silverman JM.
Department of Psychiatry and Seaver Autism Research Center, Box 1230,
Mount Sinai School of Medicine, One Gustave L. Levy Place, 10029-6574, New
York, NY, USAParents of autistic probands with high and low rates of repetitive behaviors
were compared for rates of obsessive-compulsive traits and disorder. The rate
of repetitive behaviors was assessed using the Autism Diagnostic
Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex
families. Obsessive-compulsive disorder (OCD) in parents was determined by
direct interview using a parental history questionnaire, with screening for
obsessive-compulsive traits using the Yale-Brown Obsessive-Compulsive Scale
checklist. Children who had high total scores on the repetitive behavior domain
of the ADI-R were significantly more likely to have one or both parents with
obsessive-compulsive traits or disorder compared with children who had low
total scores on this domain. Children with high scores on D1/D2 of the ADI-R
(narrow restricted interests and rituals) were significantly more likely to have
one or both parents with OCD, especially fathers, than those with low D1/D2.
The occurrence of obsessive-compulsive traits or disorder in parents of autistic
children in multiplex families is significantly more likely if autistic children
have a high occurrence of repetitive behaviors. Dichotomizing autistic probands
by severity and type of repetitive behaviors (circumscribed interests and
compulsive rituals) may yield more homogenous groups, which could be helpful in
genetic linkage studies.
Psychiatry Res 2003 Jan 20;122(1):37-47
:
Neural correlates of clinical symptoms and cognitive dysfunctions
in obsessive-compulsive disorder.
Kwon JS, Kim JJ, Lee DW, Lee JS, Lee DS, Kim MS, Lyoo IK, Cho MJ,
Lee MC
.
BK 21 Human Life Sciences, Seoul National University College of Medicine, 28
Yongon-dong, Chongno-gu, 110-744, Seoul, South KoreaAlthough results from neuropsychological and neuroimaging studies have
postulated the involvement of the frontal lobe and the subcortical brain regions
in the pathophysiology of obsessive-compulsive disorder (OCD), neuroimaging
studies have provided little evidence that cognitive abnormalities in patients
with OCD are related to dysfunctions in these areas. This study was designed to
determine whether the clinical features and cognitive deficits of OCD might be
taken to reflect frontal-subcortical dysfunction. Fourteen patients with OCD
and 14 case-matched normal subjects completed clinical and cognitive
evaluation, including four sets of neuropsychological tests that assessed the
executive functions and visual memory. Cerebral glucose metabolic rates were
measured by using positron emission tomography (PET) with
18F-fluorodeoxyglucose. Behavioral and PET data were analyzed using
statistical parametric mapping for group differences and behavioral-metabolic
correlates. The right orbitofrontal cortex showed increased metabolic activity
and the left parieto-occipital junction showed decreased metabolic activity in
patients. Metabolism in the right hippocampus, the left putamen and the right
parietal region was associated with the severity of obsessive-compulsive
symptoms. Correlations between metabolic rates and neuropsychological test
scores in the prefrontal cortex and the putamen occurred only in the patient
group. These results suggest that patients with OCD have distinct features of
brain metabolic activities for performing cognitive tasks as well as presenting
obsessive-compulsive symptoms. In particular, the frontal-subcortical circuits
might mediate not only symptomatic expression but also cognitive expression in
patients with OCD.
Behav Res Ther 2003 Jan;41(1):11-29
:
Two different types of obsession: autogenous obsessions and
reactive obsessions.
Lee HJ, Kwon SM.
Department of Psychology, Seoul National University, San 56-1, Sillim-Dong,
Kwanak-Gu, Seoul 151 742, South Korea.
hjlee75@chollian.netWe propose that obsessions are categorized into two subtypes, i.e. autogenous
obsessions and reactive obsessions, which are different in terms of
identifiability of their evoking stimuli, subjective experiences, contents, and
subsequent cognitive processes. Autogenous obsessions tend to come abruptly
into consciousness without identifiable evoking stimuli, which are perceived as
ego-dystonic and aversive enough to be repelled, and include sexual, aggressive,
and immoral thoughts or impulses. On the other hand, reactive obsessions are
evoked by identifiable external stimuli, which are perceived as relatively
realistic and rational enough to do something toward the stimuli, and include
thoughts about contamination, mistake, accident, asymmetry, loss, etc. Through
three empirical studies, we confirmed the differences between the two types of
obsessional intrusion in their frequency, subjective experiences, subsequent
appraisal and control strategy. In particular, autogenous obsessions led to high
appraisal on 'control over thought' and 'importance of thought' and frequent
use of 'avoidant control strategies', while reactive obsessions linked with high
appraisal on 'responsibility' and frequent use of 'confrontational control
strategies'. These findings are expected to provide a basis for classifying and
explaining the heterogeneous phenomena of obsessive-compulsive disorder.
Behav Res Ther 2003 Jan;41(1):97-103
:
How to suppress obsessive thoughts.
Rassin E, Diepstraten P
.
Faculty of Social Sciences (Institute of Psychology), Erasmus University, PO
Box 1738, 3000 DR Rotterdam, The Netherlands.
rassin@fsw.eur.nlThought suppression (i.e. consciously trying to avoid certain thoughts from
entering consciousness) has been argued to be an inadequate strategy in case of
unwanted intrusions. That is, thought suppression seems to result in more rather
than less intrusions. Although this experimental finding has been explained in
terms of failing attempts to distract oneself from the target thought, the White
Bear Suppression Inventory (WBSI; a scale that measures chronic thought
suppression tendencies) does not address the means by which respondents try to
suppress unwanted thoughts. To examine which strategies of mental control
people use to suppress unwanted thoughts, obsessive-compulsive disorder
patients (N=47) completed the WBSI, the Thought Control Questionnaire, and
two measures of psychopathology. Results suggest that the crucial mechanism in
thought suppression may not be distraction, but self-punishment.
Int Clin Psychopharmacol 2003 Jan;18(1):29-33
:
Effect of a pharmacological intervention on quality of life in
patients with obsessive-compulsive disorder.
Tenney NH, Denys DA, Van Megen HJ, Glas G, Westenberg HG.
Department of Psychiatry, University Medical Centre, Utrecht.Patients with obsessive-compulsive disorder (OCD) not only suffer from
obsessive-compulsive symptoms, but also the disorder is associated with
aberrant social functioning and a diminished quality of life (QoL). Although
studies concerning the effect of treatment interventions on symptoms are
common, studies with regard to the effect of treatment interventions on QoL
are scarce. We examined the effect of a pharmacological intervention on QoL in
150 patients with OCD. Furthermore, we studied whether two different drugs,
venlafaxine and paroxetine, differed in their effect on QoL. Finally, we
examined whether any found improvement in QoL was related to improvement in
symptoms and/or the baseline self-directedness score, which is one of the
character dimensions of the psychobiological model of Cloninger. We
demonstrated that QoL, as assessed with the Lancashire Quality of Life Profile,
improved
following pharmacological intervention, for which paroxetine and
venlafaxine appeared to be equally effective. Furthermore, neither
improvement in symptoms, nor baseline self-directedness, was associated with
the improvement in QoL.
Int Clin Psychopharmacol 2003 Jan;18(1):23-8
:
Antipsychotic augmentation for treatment resistant
obsessive-compulsive disorder: what if antipsychotic is
discontinued?
Maina G, Albert U, Ziero S, Bogetto F.The aim of the present study was to retrospectively review the charts of
obsessive-compulsive disorder (OCD) patients who responded to the addition of
an antipsychotic to the seroronin reuptake inhibitor (SRI), and who
subsequently discontinued the antipsychotic, in order to evaluate whether
antipsychotic discontinuation resulted in a relapse of the disorder. Charts of
patients with a principal diagnosis of OCD (DSM-IV) treated with
pharmacotherapy were reviewed in order to select patients who: (i) did not
respond to a trial with a first-line drug (clomipramine or a selective SRI); (ii)
received an antipsychotic at low doses (haloperidol, pimozide, risperidone or
olanzapine) in order to potentiate the SRI; (iii) responded to this augmentation
strategy; and (iv) discontinued the antipsychotic drug for any reason while
continuing the SRI at the same dose. Relapse was defined as a worsening of
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score >/= 35% with
respect to last evaluation before antipsychotic discontinuation or, for patients
with a Y-BOCS < 16 at the end of the combination period, as a Y-BOCS total
score >/= 16 at any time after antipsychotic discontinuation. According to our
definition of relapse, 15 patients out of 18 (83.3%) relapsed after
antipsychotic discontinuation, with a mean worsening of symptoms of 6.6 +/- 1.7
points in the Y-BOCS total score. Thirteen patients out of the 15 who relapsed
did so by week 8 after discontinuation. Two subjects relapsed at the end of the
1-year study. Although retrospective, our study provides initial evidence that
antipsychotic augmentation has to be maintained for patients who respond to
this strategy, because the vast majority of subjects who discontinue the
antipsychotic relapse within 2 months.
J Anxiety Disord 2003;17(2):233-42
:
Intolerance of uncertainty in obsessive-compulsive disorder.
Tolin DF, Abramowitz JS, Brigidi BD, Foa EB.
Anxiety Disorders Center, The Institute of Living, University of Connecticut,
200 Retreat Avenue, 06106, Hartford, CT, USAPathological doubt, a prominent feature of obsessive-compulsive disorder
(OCD), may be related to difficulty tolerating ambiguous or uncertain
situations. This is thought to be particularly true of those patients with
checking compulsions. Intolerance of uncertainty (IU) has been studied
extensively within the domains of worry and generalized anxiety; however, it
has received relatively little empirical attention in OCD patients. We
administered the Intolerance of Uncertainty Scale [Personality and Individual
Differences 17 (1994) 791] to 55 clinic patients with OCD, 43 of whom had
checking compulsions, and 14 nonanxious controls. OC checkers showed greater
IU than did OC noncheckers and NACs. The latter two groups did not differ
from each other. Furthermore, both repeating and checking rituals were
associated with IU. Pathological doubt may be understood not only in terms of
knowledge-based constructs, but also patients' emotional reaction to feelings of
uncertainty. We discuss the implications for increasing tolerance via
cognitive-behavioral therapy.
World J Biol Psychiatry 2003 Jan;4(1):30-4
:
A double-blind, placebo-controlled trial of clonazepam in
obsessive-compulsive disorder.
Hollander E, Kaplan A, Stahl SM
Eric Hollander M.D.
, Department, of Psychiatry, Box 1230, Mount Sinai School
of Medicine, One Gustave L. Levy Place, New York, USA.
eric.hollander@mssm.eduSelective serotonin reuptake inhibitors (SSRIs) are currently the first-line
pharmacological agents in treating obsessive-compulsive disorder (OCD).
Appropriate treatment for OCD also involves cognitive behavioural therapy
(CBT), including exposure and response prevention. As there is a time delay in
seeing full therapeutic response, and not all patients tolerate SSRIs, there
remains an unmet need for additional treatment approaches in OCD. In addition,
most responders report only a partial reduction in symptoms. Clonazepam has
demonstrated effectiveness in several preliminary reports in treating OCD.
Twenty-seven patients with OCD were entered into a 10 week, double-blind,
parallel design trial of clonazepam vs. placebo. Overall, only 3 out of 25
patients who had >/= 1 rating on clonazepam/placebo were judged to be
treatment responders, by scoring a 1 (very much improved) or 2 (much
improved) on the CGI improvement scale. Responders included 2 of 9 in the
placebo group and 1 of 16 in the clonazepam group. No significant difference
was found between clonazepam and placebo groups on responder/non responder
status (Chi(2 )=1.39, df =1,24, p=0.238), nor on change in YBOCS, Ham-A,
Ham-D or NIMH scales from beginning to last evaluation carried forward.
These findings suggest that clonazepam is not effective as monotherapy in
treating OCD. Its effectiveness in specific subgroups of OCD patients with
co-morbid anxiety disorders or as an augmentation strategy added to SSRIs
remains to be determined.
J Am Acad Child Adolesc Psychiatry 2002
Dec;41(12):1431-8
:
Fluoxetine in children and adolescents with OCD: a
placebo-controlled trial.
Liebowitz MR, Turner SM, Piacentini J, Beidel DC, Clarvit SR, Davies
SO, Graae F, Jaffer M, Lin SH, Sallee FR, Schmidt AB, Simpson HB.
New York State Psychiatric Institute, Department of Psychiatry, Columbia
University, New York 10032, USA.OBJECTIVE: To examine the safety and efficacy of fluoxetine in child and
adolescent obsessive-compulsive disorder (OCD). METHOD: Between 1991 and
1998, 43 patients were randomly assigned to fluoxetine or placebo for 8 weeks.
Dosing was fixed for the first 6 weeks (up to 60 mg/day) and then could be
increased to 80 mg/day. Responders entered an 8-week maintenance phase. The
primary outcome measures were the Children's Yale-Brown Obsessive
Compulsive Scale (CY-BOCS) and the Clinical Global Impression-Improvement
(CGI-I) scale. Analyses were done on the intent-to-treat sample. RESULTS:
Fluoxetine patients (n = 21) had significantly lower CY-BOCS scores than
placebo patients (n = 22) after 16 (but not 8) weeks. Fluoxetine responders (n =
11) had significantly lower CY-BOCS scores than placebo responders (n = 7)
after an additional 8 weeks of treatment. After 16 weeks, 57% of fluoxetine
(versus 27% of placebo) patients were much or very much improved on the
CGI-I scale (p <.05). No patient terminated the study because of adverse
medication effects. CONCLUSION: Fluoxetine was well tolerated and
effective for the treatment of child and adolescent OCD, but fluoxetine's full
effect took more than 8 weeks to develop.
J Clin Psychiatry 2002 Dec;63(12):1106-12
:
Comorbidity of obsessive-compulsive disorder and depression:
prevalence, symptom severity, and treatment effect.
Overbeek T, Schruers K, Vermetten E, Griez E.
Department of Psychiatry and Neuropsychology, Maastricht University, and the
Academic Anxiety Center, Psychiatric Hospital Vijverdal, Maastricht, The
Netherlands.
thea.overbeek@skynet.beBACKGROUND: The goal of this study was to investigate the co-occurrence of
depressive disorders in obsessive-compulsive disorder (OCD) and the effect of
these disorders on combined pharmacologic and behavioral treatment for OCD.
METHOD: A retrospective chart analysis was performed on baseline ratings of
120 OCD patients and posttreatment ratings of 72 of these patients. For
depressive symptoms, the Montgomery-Asberg Depression Rating Scale and the
Self-Rating Depression Scale were applied; for obsessive-compulsive symptoms,
the Yale-Brown Obsessive Compulsive Scale and the Maudsley Obsessive
Compulsive Inventory were used; and for general anxiety symptoms, the
Self-Rating Anxiety Scale, the Clinical Anxiety Scale, and the State-Trait
Anxiety Inventory were given. RESULTS: One third of the OCD patients in our
sample were found to be depressed. Symptom severity on OCD symptoms at
baseline did not differ between depressed and nondepressed OCD patients; on
general anxiety symptoms, the comorbid group was more severely affected. Both
depressed and nondepressed OCD patients responded well to treatment, as
reflected in assessments for depressive, obsessive-compulsive, and general
anxiety symptoms. However, comorbid depression had a negative effect on
treatment: depressed OCD patients showed less improvement than nondepressed
OCD patients on most scales. CONCLUSION: Depression frequently
accompanies OCD and appears to affect treatment outcome negatively. While
both groups of patients improved with combination treatment, the OCD-alone
group had more improvement than the group that had comorbid depression.
: J Clin Psychiatry 2002 Dec;63(12):1129-34
:
Obsessive-compulsive-bipolar comorbidity: a systematic
exploration of clinical features and treatment
outcome.
Perugi G, Toni C, Frare F, Travierso MC, Hantouche E, Akiskal HS.
Department of Psychiatry, University of Pisa, Pisa, Italy.
gperugi@psico.med.unipi.itBACKGROUND: Notwithstanding the emerging literature on comorbidity
between obsessive-compulsive disorder (OCD) and bipolar disorder, relatively
few systematic data exist on the clinical characteristics of this interface and
its treatment. The aim of the present study is to address this challenge as it
appears in a setting of routine clinical practice. METHOD: The sample
comprised 68 patients with comorbid DSM-IV diagnoses of OCD and major
depressive episode admitted and treated at the day-hospital in the Department
of Psychiatry at the University of Pisa (Pisa, Italy) during a 3-year period
(January 1995-December 1998). Thirty-eight patients (55.8%) showed lifetime
comorbid bipolar disorder (12 [31.6%] bipolar I and 26 [68.4%] bipolar II).
Diagnoses and clinical features were collected by means of structured
(Structured Clinical Interview for DSM-IV) and semistructured interviews
(OCD-Interview). Assessments of drug treatments, clinical outcome, and
adverse effects were made prospectively as part of routine clinical care
throughout the course of their day-hospitalization. RESULTS: In contrast with
non-bipolar OCD patients, OCD-bipolar patients showed a more episodic course
with a greater number of concurrent major depressive episodes. They reported
a significantly higher rate of sexual obsessions and significantly lower rate of
ordering rituals. Furthermore, they reported more frequent current
comorbidity with panic disorder-agoraphobia and abuse of different substances
(alcohol, sedatives, nicotine, and coffee). Drug treatment with clomipramine and,
to a lesser extent, with selective serotonin reuptake inhibitors was associated
with hypomanic switches in OCD-bipolar patients, especially in those not
concomitantly treated with mood stabilizers. A combination of multiple mood
stabilizers was necessary in 16 OCD-bipolar patients (42.1%) and a
combination of mood stabilizers with atypical antipsychotics was required in 4
cases (10.5%). OCD-bipolar patients tended to show a less positive outcome for
mood symptomatology and general functioning. Three patients required
hospitalization for severe mixed episode. CONCLUSION: In a tertiary care
center, comorbidity between OCD and bipolar disorder is a significant clinical
problem affecting a large number of patients and has a substantial impact on
the clinical characteristics and treatment outcome of both disorders.
J Clin Psychiatry 2002 Nov;63(11):1004-9
:
Venlafaxine versus clomipramine in the treatment of
obsessive-compulsive disorder: a preliminary single-blind,
12-week, controlled study.
Albert U, Aguglia E, Maina G, Bogetto F.
Anxiety and Mood Disorders Unit, Department of Neurosciences, University of
Turin, Italy.BACKGROUND: The objective of this study was to investigate, in a single-blind
manner over a period of 12 weeks, the efficacy and tolerability of venlafaxine
versus clomipramine in the treatment of obsessive-compulsive disorder (OCD).
METHOD: Patients with a DSM-IV diagnosis of OCD and a Yale-Brown
Obsessive Compulsive Scale (YBOCS) score >/= 16 were randomly assigned to
receive venlafaxine, 225 to 350 mg/day (26 patients), or clomipramine, 150 to
225 mg/day (47 patients), for 12 weeks, with dosage adjustments according to
tolerability and response to treatment. All patients were medication-free from
at least 2 months prior to study enrollment. Efficacy measures were the YBOCS
and the Clinical Global Impressions scale (CGI), which were completed at
baseline and every 4 weeks.We defined responders as patients who had an
improvement from baseline in YBOCS score of >/= 35% and a CGI score
Jpn J Pharmacol 2002 Oct;90(2):197-200
:
Effect of YM992, a Novel Antidepressant With Selective
Serotonin Re-uptake Inhibitory and 5-HT(2A) Receptor
Antagonistic Activity, on a Marble-Burying Behavior Test as an
Obsessive-Compulsive Disorder Model.
Takeuchi H, Yatsugi S, Yamaguchi T.
Neuroscience Research, Pharmacology Laboratories, Institute for Drug
Discovery Research, Yamanouchi Pharmaceutical Co., Ltd.YM992 ((S)-2-[[(7-fluoroindan-4-yl)oxy]methyl]morpholine)
monohydrochloride is a novel antidepressant with selective serotonin
(5-hydroxytryptamine, 5-HT) re-uptake inhibition and 5-HT(2A) receptor
antagonistic activity. The effects of YM992 and two selective 5-HT re-uptake
inhibitors (SSRIs) were studied in a marble-burying behavior test as a model
of an obsessive-compulsive disorder (OCD) in mice at doses of 5, 10 and 15
mg/kg, i.p. YM992 and fluoxetine significantly inhibited marble-burying
behavior at a dose of 15 mg/kg (i.p.) without affecting spontaneous locomotor
activities. Citalopram also significantly inhibited the behavior at doses of 5, 10
and 15 mg/kg (i.p.) without affecting spontaneous locomotor activities. These
results suggest that YM992, as well as SSRIs, may exhibit anti-OCD activity
in addition to an antidepressive effect in clinical use.
Int Clin Psychopharmacol 2001 Nov;16(6):357-61
:
Predictors of response to pharmacotherapy with citalopram in
obsessive-compulsive disorder.
Stein DJ, Montgomery SA, Kasper S, Tanghoj P.
Department of Psychiatry, University of Stellebosch, Tygerberg, Cape Town,
South Africa.Although serotonin reuptake inhibitors (SRIs) are the medications of choice in
the treatment of obsessive-compulsive disorder (OCD), only 50-60% of
patients respond to a single trial of any of these agents. Improved knowledge of
the predictors of response to treatment may have important clinical
implications. Data from a large randomized placebo-controlled trial of
citalopram in OCD was analysed using logistic regression to determine
predictors of response. Demographic (age, sex), clinical (OCD severity and
duration, depression severity, prior treatment) and trial variables (citalopram
dose, treatment duration) were included. Subjects with longer duration of OCD,
more severe OCD symptoms or previous selective SRI use were less likely to be
responders in the citalopram trial. In contrast, subjects who received adequate
medication doses for sufficient periods of time in the citalopram trial were
more likely to be responders. Despite greater awareness of OCD in recent
years, there is evidence that the disorder continues to be underdiagnosed and
undertreated. The data here emphasize the crucial importance of early
diagnosis and treatment of OCD, and of pharmacotherapy with appropriate dose
and duration.
: J Clin Psychopharmacol 2002 Oct;22(5):461-7
:
Risperidone-induced obsessive-compulsive symptoms: a series of
six cases.
Alevizos B, Lykouras L, Zervas IM, Christodoulou GN.
Department of Psychiatry, University of Athens, Eginition Hospital, Greece.
gnchrist@compulink.grRisperidone is a novel and atypical agent with a dual antagonistic effect on
5-HT and D receptors. Open-label reports and one controlled study suggest
that risperidone addition is effective in patients with obsessive-compulsive
disorder refractory to treatment with serotonin reuptake inhibitors. However,
risperidone has also been implicated in the production or exacerbation of
obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases;
psychotic depression, one case) in which risperidone was effective in the
treatment of the psychotic symptoms but produced obsessive-compulsive
symptoms (four cases) or caused exacerbation of previous obsessive-compulsive
symptoms (two cases). In all but one case, obsessive-compulsive symptoms
emerged shortly after initiation of risperidone treatment with a dose above 3
mg/day. The mechanisms and risk factors for risperidone and other atypical
antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as
yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be
dose-dependent and are probably produced by serotoninergic-dopaminergic
imbalance. Close monitoring of the patients receiving risperidone, especially
those vulnerable to the development of obsessive-compulsive symptoms, may be
of value. Gradual escalation and low final dose may be helpful.(2) (2)
