Cognitive electroencephalographic potentials evoked by words as markers of the severity of the pathology and resistance to treatment in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common psychiatric illness with lifetime prevalence of 1-3% [1]. It is the fourth-most common psychiatric illness and a leading cause of disability. OCD is associated with significant impairment in functioning, quality of life and disability. If untreated, OCD is a chronic illness with a waxing and waning of symptoms. A recent meta-analysis of long-term naturalistic prospective studies demonstrated that nearly a half of patients experience remission with much higher rates of remission in Indian patients compared to those in the west [2]. Early diagnosis and appropriate treatment may improve outcomes. Despite OCD being a common mental illness, most seek treatment after several years of suffering. Those who suffer from OCD tend to be secretive about their symptoms and suffer from shame and embarrassment. Less than a third of OCD sufferers receive appropriate pharmacotherapy and even less receive evidence-based psychotherapy. Symptoms The hallmarks of OCD are presence of obsessions and compulsions. Obsessions are repetitive, unwanted, intrusive thoughts, images or urges that are mostly ego-dystonic and cause severe distress or anxiety. Compulsions (or rituals) are repetitive behaviours or mental acts that are performed in response to an obsession to reduce anxiety/distress or prevent a dreaded consequence. Obsessions and compulsions are time consuming, distressing and are often resisted unsuccessfully. Clinical manifestations of OCD are remarkably similar across cultures and geographic locations. Common obsessions and compulsions and symptom dimensions identified through factor-analytical studies are shown in Table 1. Table 1 Common symptoms of OCD

Is Compulsive Hoarding a Genetically and Neurobiologically Discrete Syndrome? Implications for Diagnostic Classification

Although standard diagnostic classifications consider obsessive-compulsive disorder (OCD) to be a single diagnostic entity, it has become clear that it is a heterogeneous disorder, with great variability in clinical presentation. This heterogeneity has complicated the interpretation of clinical, neurobiological, and genetic studies in OCD. Therefore, researchers have sought to identify clinically meaningful phenotypes that might be more homogeneous and heritable to facilitate our understanding of the etiology and pathophysiology of OCD and ultimately lead to improved treatments (1). Factor analytic studies have consistently identified four principal OCD symptom dimensions: 1) harm-related, aggressive, sexual, and religious obsessions with checking compulsions; 2) symmetry obsessions with arranging and repeating compulsions; 3) contamination obsessions with cleaning compulsions; and 4) hoarding and saving symptoms (1, 2). These symptom factors are relatively stable over time and show different patterns of genetic inheritance, age at onset, comorbidity, and treatment response (see 1 for review). Cluster analyses, which seek to identify mutually exclusive, categorical subgroups, indicate that some of these symptom factors, such as hoarding, may constitute discrete subtypes of OCD (3, 4). Hoarding is defined as the acquisition of and inability to discard items, even though they appear (to others) to have no value (5). Hoarding behavior has been observed in several neuropsychiatric disorders, including schizophrenia, dementia, eating disorders, autism, and mental retardation, as well as in non-clinical populations, but it is most commonly found in OCD (6). 30% to 40% of OCD patients report hoarding and saving symptoms (6–8), and about 10% to 15% have hoarding as their most prominent symptom factor (3, 6). Compulsive hoarding is most commonly driven by obsessional fears of losing important items that the patient believes will be needed later, distorted beliefs about the importance of possessions, excessive acquisition, and exaggerated emotional attachments to possessions (5). Compulsive hoarding and saving leads to clutter that can cover living and work spaces, rendering them unusable. Hoarding frequently causes significant impairment in social and occupational functioning. In severe cases, it can produce health risks from infestations, falls, fires, and inability to cook or eat in the home (6). In this issue of the Journal, Jack Samuels, Ph.D., et al. report results from the OCD Collaborative Genetics Study, finding “suggestive” linkage of compulsive hoarding to a marker on chromosome 14 in families with OCD. The linkage became stronger when only families with two or more family members with compulsive hoarding were tested. Compulsive hoarding is well known to run in families. Hoarding behaviors are significantly more prevalent in the relatives of hoarding OCD patients than nonhoarding OCD patients (9). In the OCD Collaborative Genetics Study, hoarding was the most strongly familial of the OCD symptom factors, with robust correlations among sibling pairs (10). Only two previous genetic studies have examined the hoarding phenotype. Lochner et al. (8) found that the met/met (L/L) genotype of the catechol O-methyltransferase val158met polymorphism on chromosome 22q11 was significantly more prevalent in Afrikaner OCD patients with

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

A dysfunction of the fronto-striatal loop has been associated with obsessive-compulsive disorder (OCD). Functional imaging studies suggest that reversal learning is affected by deficits in fronto-striatal brain areas and thus should be impaired in patients with OCD. The authors compared patients with OCD and healthy comparison subjects on a reversal learning task. Correlation analyses and group comparisons showing prolonged reaction times of different response parameters are associated with increasing severity of compulsions. The reversal learning task has been shown to be associated with ventral fronto-striatal brain activation by functional magnetic resonance imaging (fMRI) in healthy comparison subjects. The purpose of this article is to suggest that the reversal learning task can be used as a neuropsychiatric measurement of the ventral fronto-striatal dysfunction in OCD.

Although standard diagnostic classifications consider obsessive-compulsive disorder (OCD) to be a single diagnostic entity, it has become clear that it is a heterogeneous disorder, with great variability in clinical presentation. This heterogeneity has complicated the interpretation of clinical, neurobiological, and genetic studies in OCD. Therefore, researchers have sought to identify clinically meaningful phenotypes that might be more homogeneous and heritable to facilitate our understanding of the etiology and pathophysiology of OCD and ultimately lead to improved treatments (1). Factor analytic studies have consistently identified four principal OCD symptom dimensions: 1) harm-related, aggressive, sexual, and religious obsessions with checking compulsions; 2) symmetry obsessions with arranging and repeating compulsions; 3) contamination obsessions with cleaning compulsions; and 4) hoarding and saving symptoms (1, 2). These symptom factors are relatively stable over time and show different patterns of genetic inheritance, age at onset, comorbidity, and treatment response (see 1 for review). Cluster analyses, which seek to identify mutually exclusive, categorical subgroups, indicate that some of these symptom factors, such as hoarding, may constitute discrete subtypes of OCD (3, 4). Hoarding is defined as the acquisition of and inability to discard items, even though they appear (to others) to have no value (5). Hoarding behavior has been observed in several neuropsychiatric disorders, including schizophrenia, dementia, eating disorders, autism, and mental retardation, as well as in non-clinical populations, but it is most commonly found in OCD (6). 30% to 40% of OCD patients report hoarding and saving symptoms (6–8), and about 10% to 15% have hoarding as their most prominent symptom factor (3, 6). Compulsive hoarding is most commonly driven by obsessional fears of losing important items that the patient believes will be needed later, distorted beliefs about the importance of possessions, excessive acquisition, and exaggerated emotional attachments to possessions (5). Compulsive hoarding and saving leads to clutter that can cover living and work spaces, rendering them unusable. Hoarding frequently causes significant impairment in social and occupational functioning. In severe cases, it can produce health risks from infestations, falls, fires, and inability to cook or eat in the home (6). In this issue of the Journal, Jack Samuels, Ph.D., et al. report results from the OCD Collaborative Genetics Study, finding “suggestive” linkage of compulsive hoarding to a marker on chromosome 14 in families with OCD. The linkage became stronger when only families with two or more family members with compulsive hoarding were tested. Compulsive hoarding is well known to run in families. Hoarding behaviors are significantly more prevalent in the relatives of hoarding OCD patients than nonhoarding OCD patients (9). In the OCD Collaborative Genetics Study, hoarding was the most strongly familial of the OCD symptom factors, with robust correlations among sibling pairs (10). Only two previous genetic studies have examined the hoarding phenotype. Lochner et al. (8) found that the met/met (L/L) genotype of the catechol O-methyltransferase val158met polymorphism on chromosome 22q11 was significantly more prevalent in Afrikaner OCD patients with

Contents: Preface. Part I: Clinical Subtypes and Spectrum. E. Hollander, C.M. Wong, Spectrum, Boundary, and Subtyping Issues: Implications for Treatment-Refractory Obsessive-Compulsive Disorder. K.A. Phillips, Connection Between Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. J.F. Leckman, C.J. McDougle, D.L. Pauls, B.S. Peterson, D.E. Grice, R.A. King, L. Scahill, L.H. Price, S.A. Rasmussen, Tic-Related Versus Non-Tic-Related Obsessive-Compulsive Disorder. M.J. Byerly, W.K. Goodman, C. Cuadros, Comorbid Schizophrenia: Implications for Treatment of Obsessive-Compulsive Disorder. Part II: Pathophysiology and Etiology. G.L. Hanna, Clinical and Family-Genetic Studies of Childhood Obsessive-Compulsive Disorder. R.J. McNally, Information-Processing Abnormalities in Obsessive-Compulsive Disorder. P. van Oppen, P.M.G. Emmelkamp, Issues in Cognitive Treatment of Obsessive-Compulsive Disorder. S.L. Rauch, C.R. Savage, Investigating Cortico-Striatal Pathophysiology in Obsessive-Compulsive Disorders: Procedural Learning and Imaging Probes. Part III: Assessment. U. Feske, D.L. Chambless, A Review of Assessment Measures for Obsessive-Compulsive Disorder. S.W. Kim, Measuring Outcome in Drug Trials of Obsessive-Compulsive Disorder. Part IV: Cognitive-Behavioral Treatments. P.M. Salkovskis, C. Richards, E. Forrester, Psychological Treatment of Refractory Obsessive-Compulsive Disorder and Related Problems. C.A. Pollard, Inpatient Treatment of Refractory Obsessive-Compulsive Disorder. F.A. Neziroglu, K.P. Stevens, B. Liquori, J.A. Yaryura-Tobias, Cognitive and Behavioral Treatment of Obsessive-Compulsive Spectrum Disorders. G. Steketee, N.J. Henninger, C.A. Pollard, Predicting Treatment Outcome for Obsessive-Compulsive Disorder: Effects of Comorbidity. Part V: Drug and Other Somatic Treatments. T.A. Pigott, S. Seay, Pharmacotherapy of Obsessive-Compulsive Disorder: Overview and Treatment-Refractory Strategies. I. Iancu, P.N. Dannon, M. Lustig, Y. Sasson, J. Zohar, Preferential Efficacy of Serotonergic Medication in Obsessive-Compulsive Disorder: From Practice to Theory. J. DeVeaugh-Geiss, R. Katz, Clomipramine in the Treatment of Obsessive-Compulsive Disorder. W.K. Goodman, H.E. Ward, A. Kablinger, T.K. Murphy, Biological Approaches to Treatment-Resistant Obsessive-Compulsive Disorder. C.J. McDougle, C.N. Epperson, L.H. Price, The Role of Neuroleptics in Treatment-Refractory Obsessive-Compulsive Disorder. B.A. Fallon, M.R. Liebowitz, Intravenous Clomipramine for Obsessive-Compulsive Disorder. W.A. Hewlett, Benzodiazepines in the Treatment of Obsessive-Compulsive Disorder. M.V. Rudorfer, Electroconvulsive Therapy in Treatment-Refractory Obsessive-Compulsive Disorder. M.A. Jenike, Neurosurgical Treatment of Obsessive-Compulsive Disorder. Part VI: Combined Treatment. D.A. Speigel, Combined Drug and Behavioral Treatments for Obsessive-Compulsive Disorder: Early Findings. M.J. Kozak, M.R. Liebowitz, E.B. Foa, Cognitive Behavior Therapy and Pharmacotherapy for Obsessive-Compulsive Disorder: The NIMH-Sponsored Collaborative Study. Part VII: Mechanisms of Action. S. Rachman, R. Shafran, The Mechanisms of Behavioral Treatment and the Problem of Therapeutic Failures. P. Blier, R. Bergeron, G. Pineyro, M. El Mansari, Understanding the Mechanism of Action of Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder: A Step Toward More Effective Treatments? L.R. Baxter, Jr., R.F. Ackermann, N.R. Swerdlow, A. Brody, S. Saxena, J.M. Schwartz, J.M. Gregoritch, P. Stoessel, M.E. Phelps, Specific Brain System Mediation of Obsessive-Compulsive Disorder Responsive to Either Medication or Behavior Therapy.

Prediction of treatment resistance in obsessive compulsive disorder patients based on EEG complexity as a biomarker

Neurological Soft Signs in Schizophrenia Patients With Obsessive-Compulsive Disorder

To explore the features of events-related potentials (ERP) component N400 in generalized anxiety disorder (GAD) versus obsessive compulsive disorder (OCD) patients and understand the cognitive pattern and processing characteristic for Chinese characters. ERP component N400 was recorded by Guangzhou Runjie WJ-1 ERP apparatus. And 41 GAD patients, 69 OCD patients and 58 normal controls (NC) were tested by the Chinese idioms ending with matching (congruent) or mismatching (incongruent) words. (1) Latencies: Significant differences were found of N400 latencies in ending words with the same pronunciation but different forms and meanings (NC: (377 ± 40) ms, OCD: (395 ± 43) ms, GAD: (396 ± 43) ms, congruent; NC: (415 ± 32) ms, OCD: (429 ± 35) ms, GAD: (430 ± 36) ms, incongruent), ending words with the same meaning but different pronunciations and forms (NC: (411 ± 32) ms, OCD: (424 ± 40) ms, GAD: (433 ± 39) ms, incongruent), ending words with different pronunciations, forms and meanings (NC: (399 ± 47) ms, OCD: (427 ± 53) ms, GAD: (434 ± 42) ms, congruent; NC: (442 ± 36) ms, OCD: (465 ± 35) ms, GAD: (474 ± 35) ms, incongruent) (P < 0.05 - 0.01). Compared with NC, the N400 latencies were prolonged in GAD and OCD patients. Compared with OCD patients, the GAD patients also showed prolonged N400 latencies in ending words with different pronunciations, forms and meanings (incongruent situation). (2) Significant differences were found of N400 amplitudes in ending words with the same pronunciation but different forms and meanings (NC: (9 ± 5) µV, OCD: (6 ± 5) µV, GAD: (6 ± 5) µV, congruent; NC: (11 ± 6) µV, OCD: (5 ± 4) µV, GAD: (6 ± 4) µV, incongruent), ending words with similar forms but different pronunciations and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (7 ± 5) µV, congruent; NC: (14 ± 6) µV, OCD: (6 ± 5) µV, GAD: (9 ± 7) µV, incongruent), ending words with different pronunciations, forms and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (5 ± 3) µV, congruent; NC: (14 ± 6) µV, OCD: (9 ± 7) µV, GAD: (9 ± 7) µV, incongruent) (P < 0.05 - 0.01). Compared with NC, N400 amplitudes decreased in GAD and OCD patients respectively. Compared with OCD patients, the GAD patients also showed elevated N400 amplitudes in ending words with similar forms but different pronunciations and meanings (congruent). The cognitive and emotional problems in GAD and OCD may be measured by N400 elicited by Chinese idioms. Notable N400 priming effects can be found in Chinese idioms.

Background: This research seeks to make a comparison between executive functions of the obsessive compulsive disorder (OCD) patients, with poor and high insight levels and normal people. Materials and Methods: In this casual comparative study, 22 OCD patients with high insight level, 5 OCD patients with poor insight level (based on YBOCS’ 11th item score) and 23 normal subjects were selected using convenience sampling technique. The subjects were evaluated using two groups of clinical and neuropsychiatric instruments. The clinical instruments included Y-BOCS, BDI-II and GHQ-12. The executive functions were assessed using the Tower of London test, the Stroop and the Wisconsin Card Sorting tests. Results: The obtained results showed a significant difference between OCD patients and normal people in a number of executive functions. However, comparison between OCD patients with high and poor insight levels showed no significant difference in the executive functions variables. Conclusion: Executive functions (EF) may contribute to the psychopathology of OCD. Therefore examining EF can play an important role in assessment and treatment of OCD.

Treatment of obsessive-compulsive disorder has focused almost exclusively on symptom reduction; however, deficits in social functioning and quality of life of individuals with this disorder may contribute more to their "burden," suffering, and disability. To gauge the significance of social dysfunction and quality of life of persons with obsessive-compulsive disorder (OCD), we made comparisons with a group of persons with schizophrenia matched for age and gender. Thirty-one patients with OCD participating in a partial hospital treatment program were compared with 68 schizophrenic outpatients participating in a day rehabilitation program. The Independent Living Skills Survey (ILSS) and Lehman Quality of Life Scale (QOL) were administered before and after treatment for both cohorts. QOL scores were significantly lower for the OCD patients both before and after treatment, but improved significantly during treatment. OCD and schizophrenic patients had similar scores on almost every domain of the ILSS at pretreatment. The OCD patients improved significantly on many of the domains of social and independent living skills as a result of treatment and acquired significantly greater skills by post-treatment than did their counterparts with schizophrenia; however, the performance of social and independent living skills by OCD patients remained less than satisfactory even in domains where they improved. In the areas of job and leisure skills, there were significant group-by-time interactions. We concluded that patients with severe OCD and patients with schizophrenia are equally socially impaired. However, OCD patients experience greater significant functional improvement with multimodal treatment.

In order to investigate attentional processing of emotional information in obsessive-compulsive disorder (OCD), 14 patients with OCD and 28 normal control (NC) subjects were asked to name the background colors of anxiety-relevant, compulsion-relevant, positive and neutral words (an emotional Stroop color-naming test). The stimulus words were presented subliminally, and supraliminally. The time of subliminal presentation for each subject was determined in advance by the lexical decision task. In the subliminal condition, the delay for anxiety- and compulsion-relevant words, when compared with neutral words, was greater in OCD patients, while no difference was found in NC subjects. In the supraliminal condition, no delay was found for both OCD patients and NC subjects. In other words, OCD patients were more sensitive to threat information when it could not be identified with consciousness. Moreover, the present study compared checking OCD with cleaning OCD in the attentional processing of emotional information. As a result, it was found that checking OCD patients responded more slowly in naming the background color of subliminal emotional words than cleaning OCD patients. The results indicate that OCD patients, especially with checking compulsion, may have a deficit in automatic processing of threat information.

When a patient presents with both psychotic and obsessive-compulsive symptoms, the clinician is faced with a differential diagnosis that includes comorbid schizophrenia and obsessive-compulsive disorder (OCD), OCD with poor insight, and schizophrenia with antipsychotic-induced obsessive-compulsive symptoms. If the psychotic symptoms are subthresh-old or attenuated in form, the individual may have OCD and putative prodromal schizophrenia. The authors present a case to outline a strategy for differentiating among these possible diagnoses and for optimizing treatment.

Les interventions basées sur la pleine conscience dans le trouble obsessionnel compulsif : mécanismes d’action et présentation d’une étude pilote