Contamination Obsessions Research Articles

P01-145 - Disgust sensitivity predicts obsessive-compulsive disorder symptoms above and beyond anxiety sensitivity and negative affectivity

Introduction and aimsBoth anxiety sensitivity (AS) and negative affect (NA) are significant general predictors of anxiety disorders, including the obsessive-compulsive disorder (OCD; Taylor, 1999). Recently, our group reported preliminary findings suggesting that disgust sensitivity was able to predict OCD symptoms, particularly contamination obsessions and washing compulsions, when controlling for AS and NA (Sandín et al., 2008). The present study examines whether disgust domains of the Cuestionario de Sensibilidad al Asco (CSA) [Disgust Sensitivity Questionnaire] predict obsessive-compulsive symptoms above and beyond AS and NA.MethodA sample of undergraduates completed the CSA (see Valiente et al.), the Padua Inventory-Whasington State University Revision (Burns et al., 1996), the Anxiety Sensitivity Index-3 (Taylor et al., 2007; Sandín et al., 2007), and the Positive and Negative Affect Schedule (Watson et al., 1988, Sandín et al., 1999).ResultsHierarchic regression analysis revealed that CSA was a better predictor of contamination obsessions and washing compulsions than anxiety sensitivity and negative affect. Also, CSA domains predicted differentially each obsessive-compulsive dimension.ConclusionsContamination-based OCD symptoms appears to be particularly associated to disgust sensitivity, specially with the CSA dimension of hygiene (it includes items such as “Seeing someone spit”, Touching the clothes of a beggar or homeless”). Assuming that contamination-based OCD is a very prevalent type of OCD, future studies on implication of this dimension in its development and/or maintenance is warranted.

Obsessive–compulsive disorder: a new risk factor for Alzheimer disease?

We describe a case of a 75-year-old woman referred to the Memory Clinic of the neurological Department of Charles Nicolle Hospital, Tunis, for cognitive decline and behavioral disturbances. Her past medical history was marked by severe obsessive-compulsive disorder (OCD) with contamination obsessions and washing compulsions. She has a family history for OCD and/or of dementia in 15 members. Clinical features, along with neuropsychological findings and Brain imaging were in favor of Alzheimer disease (AD). The present report is the first family study reporting the possible association of OCD and AD. The glutamatergic dysfunction may be a common pathophysiology of OCD and AD explaining this association.

Cognitive and Clinical Characteristics of Sexual and Religious Obsessions.

Sexual and religious obsessions are often grouped together as unacceptable thoughts, symptoms of obsessive-compulsive disorder hypothesized to be maintained by maladaptive beliefs about the importance and control of thoughts. Although there is empirical justification for this typology, there are several reasons to suspect that sexual and religious obsessions may differ with respect to associated obsessional beliefs and personality traits. In this study, we examined the associations between sexual and religious obsessions (separately) and (a) putatively obsessional cognitive styles, especially beliefs about the importance and control of thoughts, and responsibility, (b) obsessive-compulsive personality traits, and (c) schizotypal personality traits. Whereas sexual obsessions were predicted only by increased beliefs about the importance and control of thoughts, and contamination obsessions were predicted only by inflated responsibility appraisals and threat estimation, religious obsessions were independently predicted by both of these constructs. In addition, only religious obsessions were related to self-reported obsessive-compulsive personality traits. Researchers and clinicians should be cognizant of potentially important distinctions between sexual and religious obsessions, and the possibility that scrupulous OCD shares processes with both autogenous and reactive presentations.

Epidemiology of obsessive compulsive disorder at high school students in Edirne city center

Epidemiology of obsessive compulsive disorder at high school students in Edirne city center Objective: To investigate the prevalence of OCD among high school students in Edirne city center, to determine sociodemographic features of OCD, and to determine frequency of OCD symptoms. Methods: The study was conducted with 9th, 10th, and 11th grade high school students in the Edirne city center. The frequency of OCD among the entire population was accepted on 3% in the calculation of sample size and 3107 students among 8037 province-wide students were enrolled to the study with a 0.6% tolerance and a 95% confidence level. The sample was selected from province-wide high schools using stratified sampling by weighing according to gender and the number of students. The sociodemographic data form and the Maudsley Obsessive-Compulsive Inventory (MOCI), which will be filled out by the participant, and the Composite International Diagnostic Interview (CIDI) and two subscales of the CIDI concerning major depression (MD) and generalized anxiety disorder (GAD), which were filled out by the interviewer, were used. In the study, conducted together with a biostatistician, 117 students who had a MOCI score of ≥ 25 were enrolled into the next stage of the assessment with respect to the normal distribution. Thus, the students who were eligible for assessment of OCD were also diagnostically-assessed in terms of co-morbid GAD and MD by the CIDI. Results: A total of 40 students were diagnosed with OCD, and the point prevalence of OCD was found to be 1.4%. Sociodemographic features of the cases were not statistically significantly different compared to the control group included students selected from the 2856 students, except 117 students who had a MOCI score of ≥ 25, obtained after dividing into equal intervals. Contamination obsessions and control compulsions were most frequently encountered (40% and 22.5%, respectively), and the frequency of co-morbid MD and GAD were 47.5% and 5%, respectively. Conclusion: In the present study, the sociodemographic features were different from the literature and the results were not statistically different compared to the control group. Puberty is a sensitive period that has different features from other age groups. Therefore, difficulties of working with such an age group were also observed in the present study. It is suggested that there is a need for more informative studies for a better understanding of psychiatric disorders in the population, particularly in adolescence.

Variants in estrogen receptor alpha gene are associated with phenotypical expression of obsessive-compulsive disorder

Compelling data from animal and clinical studies suggest that sex steroids may play a role in the etiopathology of obsessive-compulsive disorder (OCD). The aim of this study was to investigate whether variants in estrogen receptor genes ESR1 and ESR2 may contribute to the genetic susceptibility to OCD, through a case-control association study using an extensive linkage disequilibrium-mapping approach. Twenty tag single-nucleotide polymorphisms (tagSNPs) covering the ESR2 region and nine tagSNPS from regions of ESR1 reported to be related to transcriptional control were genotyped in 229 OCD patients and 279 controls. SNP association and haplotype analysis were performed. The association of these genes and OCD subphenotypes was tested, considering early-onset OCD, comorbid tic and affective disorders, and OCD symptom dimensions. No significant difference in the distribution of alleles or genotypes was detected between controls and OCD subjects. Nevertheless, on analyzing OCD subphenotypes, SNP rs34535804 in ESR1 and a five SNPs haplotype, located at the 5' end of intron 1 of ESR1, were associated with the presence of contamination obsessions and cleaning compulsions. Specifically, carriers of the ACCCG haplotype, a combination of functional alleles related to higher ER alpha expression, showed a reduced risk of suffering from these symptoms. Our results suggest that the ESR1 gene may contribute to the genetic vulnerability to certain OCD manifestations. The dissection of OCD into more homogeneous subphenotypes may well help to identify susceptibility genes for the disorder.

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Cognitive Bias to Symptom and Obsessive Belief Threat Cues in Obsessive-Compulsive Disorder

The current study examined the extent to which patients with obsessive compulsive disorder (OCD) demonstrate cognitive biases to OCD symptom or inflated responsibility threat cues. Participants with either primary contamination-washing or doubting/harming-checking OCD, non-OCD anxiety disorders, and student controls completed a primed lexical decision task. Following either neutral or OCD-threat priming conditions, participants made lexical decisions regarding different sets of word stimuli: nonwords, OCD symptoms, OCD inflated responsibility, and depression. Following the OCD primes, the primary contamination-washing symptom subgroup showed increased interference on OCD symptom words compared with the harming symptom and student groups. The primary contamination-washing subgroup also showed increased interference on responsibility words compared with the harming, non-OCD anxious and student groups. However, subsidiary analyses comparing patients with contamination obsessions with and without associated fears of harming others through the spreading of contaminants, demonstrated that it was the latter group that evidenced cognitive biases to responsibility threat cues. These results are considered in relation to cognitive models of OCD.

Treatment of Obsessive-Compulsive Disorder in a Mentally Challenged Adult

Sir: Obsessive-compulsive disorder (OCD) as a comorbidity was earlier considered to be very unusual among mentally retarded individuals.1,2 However, current literature review reveals that OCD does occur at rates at least proportional to the general population but often remains undetected and untreated among individuals with developmental disabilities.3 Herein, we describe the case of a patient with mild mental retardation and OCD, who responded to behavioral therapy. Case report. Ms. A, an 18-year-old woman, presented to our hospital in November 2007 with an insidious onset, 6-month duration of illness characterized by repetitive acts such as cleaning; ritualized bathing, urination, and defecation; excessive need for symmetry in daily activities; and avoidance of morning duties. Nonperformance of proxy compulsions would make the patient aggressive. A structured assessment was conducted at baseline and at subsequent follow-ups. The Mini-International Neuropsychiatric Interview,4 Wechsler Adult Intelligence Scale-Performance Scale (Indian adaptation),5 Yale-Brown Obsessive Compulsive Scale Symptom Checklist,6,7 and a semi-structured clinical interview revealed that she had OCD, an intelligence quotient of 58 (mild mental retardation), contamination obsessions, and cleaning/washing compulsions. The details of the assessments are given in Table 1. Table 1 Assessment Scores of a Mentally Challenged Woman With OCD Treated With Escitalopram and Behavioral Therapy She was started on treatment with escitalopram 10 mg/day, which was increased to 20 mg over a period of 2 weeks. Differential positive reinforcement and performance-feedback procedures were initiated after family members were psychoeducated. By using differential positive reinforcement, exposure and response prevention was conducted. Initially, the patient received 20 sessions of inpatient behavior therapy on a daily basis and, later, 7 sessions on an outpatient basis. Follow-up assessment at week 12 (see Table 1) revealed that Ms. A was mildly ill on the OCD severity rating scale and on the Clinical Global Impressions-Severity of Illness scale. The patient's parents also reported 90% improvement in her symptoms. This patient with mild mental retardation and OCD responded to escitalopram and behavior therapy. The improvements attained at week 4 included a 33% decrease (based on a clinical significance formula11) in severity of symptoms; clinically significant reduction in proxy compulsions; and a 50% overall improvement of symptoms, which was reported by the patient's parents and was visible on the Clinical Global Impressions-Improvement scale. Another important issue that requires attention is the substantial decrease in OCD symptom severity and proxy compulsions, which occurred within the first 2 weeks of treatment. This improvement at week 4 (within the initial few weeks) would be attributed primarily to behavior therapy and not to serotonin reuptake inhibitor (SRI) medication, as it is well known that an SRI would take at least 8 weeks to demonstrate its benefits. This case report assumes importance in the light of the paucity of studies reporting effectiveness of differential reinforcement procedures in causing clinically significant reduction in obsessional rituals in individuals with mental retardation. Physicians should keep in mind the effectiveness of differential reinforcement procedures in mildly mentally retarded patients who have OCD. C. J. Maikandaan, M.B.B.S. Nitin Anand, M.A., M.Phil. Suresh Bada Math, M.D., D.N.B., P.G.D.M.L.E. Y. C. Janardhan Reddy, D.P.M., M.D. National Institute of Mental Health and Neuro Sciences, Bangalore, India

The impact of trauma and post-traumatic stress disorder on the treatment response of patients with obsessive-compulsive disorder

Few case series studies have addressed the issue of treatment response in patients with obsessive-compulsive disorder (OCD) and comorbid post-traumatic stress disorder (PTSD), and there are no prospective studies addressing response to conventional treatment in OCD patients with a history of trauma (HT). The present study aimed to investigate, prospectively, the impact of HT or PTSD on two systematic, first-line treatments for OCD. Two hundred and nineteen non-treatment-resistant OCD outpatients were treated with either group cognitive-behavioral therapy (GCBT n = 147) or monotherapy with a selective serotonin reuptake inhibitor (SSRI n = 72). Presence of HT and PTSD were assessed at intake, as part of a broader clinical and demographical baseline characterization of the sample. Severity and types of OCD symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Dimensional YBOCS (DYBOCS), respectively. Depression and anxiety symptoms were measured with the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Both treatments had 12-week duration. Treatment response was considered as a categorical [35% or greater reduction in baseline YBOCS scores plus a Clinical Global Impression-Improvement rating of better (2) or much better (1)] and continuous variable (absolute number reduction in baseline YBOCS scores). Treatment response was compared between the OCD + HT group versus the OCD without HT group and between the OCD + PTSD group versus the OCD without PTSD group. Parametric and non-parametric tests were used when indicated. Data on HT and PTSD were available for 215 subjects. Thirty-eight subjects (17.67% of the whole sample) had a positive HT (OCD + HT group) and 22 subjects (57.89% of the OCD + HT group and 10.23% of the whole sample) met full DSM-IV criteria for PTSD. The OCD + HT and OCD without HT groups presented similar response to GCBT (60% of responders in the first group and 63% of responders in the second group, p = 1.00). Regarding SSRI treatment, the difference between the response of the OCD + HT (47.4%) and OCD without HT (22.2%) groups was marginally significant (p = 0.07). In addition, the OCD + PTSD group presented a greater treatment response than the OCD without PTSD group when treatment response was considered as a continuous variable (p = 0.01). The age when the first trauma occurred had no impact on treatment response. In terms of specific OCD symptom dimensions, as measured by the DYBOCS, OCD treatment fostered greater reductions for the OCD + PTSD group than for the OCD without PTSD group in the scores of contamination obsessions and cleaning compulsions, collecting and hoarding and miscellaneous obsessions and related compulsions (including illness concerns and mental rituals, among others). The OCD + PTSD group also presented a greater reduction in anxiety scores than the OCD without PTSD group (p = 0.003). The presence of HT or PTSD was not related to a poorer treatment response in this sample of non-treatment-resistant OCD patients. Unexpectedly, OCD patients with PTSD presented a greater magnitude of response when compared with OCD without PTSD patients in specific OCD symptom dimensions. Future studies are needed to clarify if trauma and PTSD have a more significant impact on the onset and clinical expression of OCD than on the conventional treatment for this condition, and whether OCD stemming from trauma would constitute a subtype of OCD with a distinct response to conventional treatment.

Cognitive Therapy for Obsessive-Compulsive Disorder: a Case Example

Cognitive therapy for OCD is an empirically validated alternative to the more widely used and validated behavioral therapy for OCD. The cognitive approach is based on the premise that belief systems contribute importantly to the development and maintenance of all types of OCD. By identifying and challenging maladaptive thoughts, beliefs, and core beliefs, patients can improve significantly and maintain their gains over time. This approach is demonstrated in detail with the case of Caroline, a 51-year-old woman with contamination obsessions.

Psychopharmacology of pediatric obsessive-compulsive disorder: three case reports

We present the treatment of three very young preschool patients (four- to five-year old) with obsessive-compulsive disorder (OCD). Two of the patients had severe ego-dystonic obsessions with sexual, aggressive, religious themes and forbidden thoughts, while the other one had contamination obsession and cleaning compulsions. Physical and neurological examination and laboratory work-up did not reveal any abnormalities. The symptoms resolved after sertaline monotherapy up to 50 mg/day and sertraline plus risperidone 0.5 mg/day (two cases) treatment. There is very limited data on the treatment of such young pediatric population of patients with OCD and, especially, the safety of using such psychotropic drugs in this special population.

Prevalence and clinical characteristics of obsessive-compulsive disorder and obsessive compulsive symptoms in Afrikaner schizophrenia and schizoaffective disorder patients

There is evidence of variation in the prevalence of co-morbid obsessive-compulsive disorder in schizophrenia amongst ethnic groups. This study evaluated the lifetime prevalence and clinical characteristics of obsessive-compulsive disorder (OCD)/ obsessive-compulsive symptoms (OCS) in Afrikaner schizophrenic and schizoaffective disorder patients. An ongoing genetic study of schizophrenia is currently being conducted on the Afrikaner founder population. In this cohort of 400 subjects from the original genetic study, we identified 53 subjects with schizophrenia or schizoaffective disorder and co-morbid OCD/OCS (study group). They were matched for gender and age of onset of illness with 59 subjects who do not have OCD/OCS (control group). The diagnostic instrument used in this cohort is the Diagnostic Interview for Genetic Studies (DIGS) version 2, which has been translated into Afrikaans. In addition to the DIGS, information for the relevant clinical characteristics reported in this study was also drawn from a detailed narrative chronological summary report and clinical files. A checklist was completed. The prevalence of co-morbid OCD/OCS amongst 400 subjects with schizophrenia or schizoaffective disorder was 13.2% [n=53] of which 40 were male and 13 female patients. The prevalence of OCD was 10.7% and OCS was 2.5%. Contamination obsessions [n=17] were the most common type of obsession reported, followed by religious obsessions [n=8]. The most prevalent compulsions were repetitive rituals [n=32] followed by checking behaviour [n=22]. Onset of psychotic symptoms was found to be insidious in 86.8% of the study group compared to 24.6% of the control group (p<0.0001). Second-generation antipsychotic use was found to be statistically more prevalent in the study group (77.4%), compared to the control group (45.8%) (p=0.0008). 73% of the study group experienced depressive symptoms compared to 50.8% of the control group. Both groups were found to have a similar incidence of suicidal thoughts and suicide attempts. Substance abuse amongst the control group was significantly higher (35.9%) compared to the study group (19.2%) (p <0.05). Cannabis was most commonly abused in both groups, followed by alcohol. The prevalence rate of 13.2% of co-morbid OCD/OCS in Afrikaner schizophrenia and schizoaffective disorder patients differs from findings in other ethnic groups, suggesting the possible role of genetic and cultural factors in the prevalence of co-morbid OCD/OCS. Second-generation antipsychotic use amongst schizophrenia and schizoaffective disorder patients with co-morbid OCD/OCS was found to be significantly higher than in those without co-morbid OCD/OCS. Clinical characteristics of Afrikaner schizophrenics and schizoaffective disorder patients with and without co-morbid OCD/OCS are the same, both groups were associated with significant psychopathology and a poor prognosis.

Real persons' experience of contamination obsession: Hypothese from a Strausian analysis

&lt;p&gt;The last two decades have witnessed a growing interest in the relation between philosophy, psychiatry and psychology (PP&amp;amp;P), to the extent that their kinship is now widely recognised. Erwin Straus* was a forerunner in this field. As one of the central scholars of the phenomenological approach to psychology and psychiatry in the 20th century, he acutely confronts the major thinkers of classic philosophy as well as his contemporaries. Through a profound reflection on philosophers (mainly Aristotle, Descartes, Husserl, Freud, Heidegger, Merleau-Ponty) and an engaged dialogue with the most important psychiatrists in his time (such as Binswanger and Minkowski), Straus came to elaborate an original theory whose fundamental basis is the phenomenological recognition of the inconsistency of Cartesian philosophy, of ‘experimental’ psychology (as originally described by Pavlov) and of psychoanalysis.&lt;/p&gt;

Obsessive-compulsive disorder in youth with and without a chronic tic disorder

The goal of this study was to discriminate subtypes of pediatric obsessive-compulsive disorder (OCD) among youth with and without a comorbid tic disorder. Seventy-four youth (M(age)=9.7+/-2.3 years) with a principal diagnosis of OCD, with (n=46) or without (n=28) a comorbid tic disorder, were assessed with a semi-structured diagnostic interview and the Children's Yale Brown Obsessive-Compulsive Scale (CY-BOCS). The CY-BOCS Symptom Checklist was used to categorize obsessions and compulsions. Group differences were analyzed by t tests, chi(2), and discriminant function analyses. Results suggested that subjects without tics had significantly more contamination obsessions, sexual obsessions, and counting compulsions than youth with comorbid tics. Generally speaking, however, youth with and without tics had similar symptom presentations. These data suggest that pediatric OCD patients with and without comorbid tics may have some aspects of symptom presentation that differ, but generally have more OCD symptoms in common than different. Implications of these findings on clinical presentation and treatment efficacy are highlighted.

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

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

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

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

&lt;i&gt;Wilson's disease&lt;/i&gt; presenting as isolated obsessive-compulsive disorder

Wilson's disease (WD) is a genetic neurodegenerative disorder; it exhibits wide heterogeneity in symptoms and usually presents with liver disease and/ or neuropsychiatric manifestations. The common neurological manifestations observed are dysarthria, gait disturbance, dystonia, rigidity, tremor, dysphagia and chorea. The frequent psychiatric manifestations reported are personality and mood changes, depression, phobias, cognitive impairment, psychosis, anxiety, compulsive and impulsive behavior. Isolated obsessive-compulsive disorder (OCD) is a rare presentation of WD. Reported herein is a case of a 17-year-old boy with isolated OCD. He presented to the psychiatrist with symptoms of contamination obsessions and washing compulsions, along with compulsion of repeated feet tapping and was treated with adequate doses of fluoxetine for 6 months but did not improve. Later on, he was diagnosed as a case of WD and showed improvement with chelating and behavior therapy. This implies the importance of the occurrence of isolated psychological symptoms in WD.

Acute dystonia after initial doses of ziprasidone: A case report

We present the case of an 18-year-old man, who was admitted with an obsessive compulsive disorder (OCD) since 17 years old. He had symmetry and contamination obsessions and cleaning compulsions, and had been treated with fluoxetine 40 mg/day for 2 months. The patient was not taking additional psychotropic medication. We made ziprasidone augmentation to the treatment. First day, ziprasidone 40 mg bid was applied. Four hours after the evening dose, the patient complained about distress. He demonstrated a notable torticollis and dystonic posture to his left side. Intramuscular biperiden lactate (5 mg) was given, and dystonic symptoms resolved within 30 min. Ziprasidone is a new atypical antipsychotic with reported low potential for extrapyramidal side effects. To our knowledge, acute dsytonic reaction with initial doses of ziprasidone in adult has not been reported yet. This case report describes a male patient with OCD developed acute dystonia shortly after initial doses (80 mg/day) of ziprasidone and discusses precautions in antipsychotic use.

Sexual pleasure in women with obsessive-compulsive disorder?

Background Although patients with OCD have reported sexual dissatisfaction frequently, controlled studies are sparse. This study compared subjective appreciation of sexuality and sexual functioning between OCD patients and healthy subjects and controlled for the influence of medication or OCD subtypes on sexual functioning and satisfaction. Methods Self-report questionnaires were sent to 350 female outpatients with OCD and 101 questionnaires were completed. Results OCD patients reported significantly more sexual disgust ( t = 4.48, p < 0.001), less sexual desire ( t = 5.52, p < 0.001), sexual arousal ( t = 4.28, p < 0.001), and satisfying orgasms ( t = 4.94, p < 0.001), than controls. Neither medication nor OCD phenotypes did affect outcome. Limitations A self-report questionnaire and relatively low response-rate (29%) could have biased the results and the sample was limited to women so results might not be generalisable to men. Conclusions Female patients with OCD report low sexual pleasure, high sexual disgust and diminished sexual functioning, which are not only attributed to medication or contamination obsessions. In the future, clinicians should explicitly ask for sexual function in the assessment of patients with OCD.