Obsessive-compulsive Patients Research Articles

Inheritance in OCD in Moslems

There is increasing evidence that obsessive-compulsive disorder (OCD) is mediated by genetic factors. Although the precise mechanism of inheritance is unclear, recent evidence has pointed towards the involvement of the serotonergic and dopaminergic systems in the disorder's development. Objectives: To examine the clinical profile of symptoms in obsessive compulsive patients and their first and second degree relatives. Subjects and Methods: This study was designed in the Institute of psychiatry, Ain Shams University Hospitals. After signing an informed consent form, all the subjects 23 patients and 19 relatives were diagnosed according to DSM-IV and Structured Clinical Interview for DSM-IV (SCID I) and General Health Questionaire for psychiatric morbidity. Severity of OCD symptoms was assessed using Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom analysis was done on four symptom factor levels and presenting symptoms. Results: Showed 15 OCD patients had positive family history of psychiatric illness. 19 of their relatives showed 11 had OCD, 6 had psychosis and 3 had depression. The most prevalent symptom in OCD patients and their relatives was washing compulsions and religious obsessions. Conclusion: Genetic factors account for most of OCD symptoms in patients diagnosed with the disorder. Environmental factors also play a role in how these symptoms are expressed by observational learning.

Commentary: Musical hallucinations: review of treatment effects.

Commentary: Musical hallucinations: review of treatment effects.

Fear conditioning in Obsessive-compulsive Disorder patients treated with sertraline: preliminary results

Fear conditioning in Obsessive-compulsive Disorder patients treated with sertraline: preliminary results

Freedom, Goodness, Power, and Belonging: The Semantics of Phobic, Obsessive-Compulsive, Eating, and Mood Disorders

Are the semantics of “freedom,” “goodness,” “power,” and “belonging” characteristic of the stories narrated in psychotherapy by individuals respectively with phobic, obsessive-compulsive, eating, and mood disorders? To verify this hypothesis, put forward by Ugazio's model of semantic polarities, the Family Semantics Grid (FSG) was applied to the transcripts of 120 individual video-recorded systemic therapy sessions, the first two sessions carried out with 60 patients with phobic (12), obsessive-compulsive (12), eating (12), and mood (12) disorders and asymptomatic patients (12) with existential problems who made up the comparison group. The results confirm the hypothesis. All but one patient were correctly assigned to their diagnostic group only by drawing on their narrated semantics. The semantics alone therefore seem capable of defining the correct diagnostic group to which each patient belongs. We suggest considering the semantics as contextual and cultural diagnostic dimensions, expressions of the bonds but also of the resources of people, and above all useful for a diagnosis aimed at fostering processes of transformation and change.

Anxiety and Phobic Disorders: Clinical Features, Diagnosis, Treatment Principles.

The group of 186 anxiety disorders patients were observed. In all them anxiety and phobic disorders were non-psychotic level, associated with acute hard emotional stress, or long term psycho-emotional stress. They include phobic disorders – 31 patients, panic disorder- 69 patients, generalized anxiety disorder-29 patients, mixed anxiety disorder-38 patients, obsessive compulsive disorder-19 patients. By the anamnesis observation was shown contributing factors to the performing anxiety and phobic disorders include mental illnesses (primarily neurotic and depressive disorders); heredity; presence of organic predisposition as perinatal, prenatal (birth asphyxia) and postnatal (cerebrocranial injury, neurological infection, acute and chronic intoxication) kinds of brain damage; personality features: anxious-hypochondriac, anancastic features; a history of neurotic and depressive disorders; psycho-emotional stress in the period preceding the disease. Clinical characteristics of various disorders are the most common for them; however, they are often shown in varying degrees of severity and may occur simultaneously (combined) or at different stages of the disease, acquiring clinical or subsyndromal forms. In clinical cases, a combination of various symptomatic complexes in the stage of independent disorders means comorbidity disorders. The main directions in the treatment of programed are the combination of pharmacotherapy and psychotherapy. Pharmacotherapy included the benzodiazepines and SSRI’s. Psychotherapy based on integrative model and included CBT and hypno-suggestive therapy. This therapy model aprobation analysis shown the high efficacy in 69% patients, middle range – in 16%, low – in 15% patients.

Cerebellum Involvement in Obsessive-Compulsive Disorder related Brain Network Model

Conventional obsessive-compulsive disorder related brain network model relies mainly on cortico-striato-thalamo-cortical areas. However, recent findings consistently point cerebellar structural and functional differences in obsessive-compulsive disorder patients compared to healthy controls. Here we briefly reviewed these studies and argued that cerebellum should be involved in obsessive-compulsive disorder related brain network model for a better understanding of the nature of this disorder.

Association of Metacognitive Beliefs, Obsessive Beliefs and Symptom Severity With Quality of Life in Obsessive–Compulsive Patients

The aim of this study was to evaluate the association of obsessive beliefs, obsessive–compulsive disorder severity and metacognitive beliefs to the quality of life in patients with obsessive–compulsive disorder (OCD). Sixty one adults with a principal diagnosis of OCD were recruited for the study. Participants were assessed by trained clinicians using an unstructured clinical interview, the Obsessive Beliefs Questionnaire, the Yale–Brown Obsessive–Compulsive Scale, the Metacognitive Beliefs Questionnaire and the WHO Quality of Life Questionnaire. Data were analyzed using Pearson's of correlation coefficients and multiple regression analyses. Findings indicate that obsessive beliefs, severity total OCD and metacognitive beliefs were associated with total quality of life scores. Regression analysis revealed that while OCD total severity explained 40.1% of the variance in total quality of life, obsessive beliefs (perfectionism/certainty domain) and metacognitions (cognitive self-consciousness and negative beliefs about thoughts in general) explained an additional 13.7%, 7.7% and 5.4% of the variance in QoL. Findings indicate that the metacognitive beliefs associated with OCD symptom severity are different from that associated with quality of life. The implications are that metacognitive therapy aimed at symptom reduction may not necessarily result in improved QoL in OCD patients.

Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review.

BackgroundObsessive-compulsive disorder is one of the most disabling of all psychiatric illnesses. Despite available pharmacological and psychotherapeutic treatments about 10% of patients remain severely affected and are considered treatment-refractory. For some of these patients deep brain stimulation offers an appropriate treatment method. The scope of this article is to review the published data and to compare different target structures and their effectiveness.MethodsPubMed search, last update June 2013, was conducted using the terms “deep brain stimulation” and “obsessive compulsive disorder”.ResultsIn total 25 studies were found that reported five deep brain stimulation target structures to treat obsessive-compulsive disorder: the anterior limb of the internal capsule (five studies including 14 patients), nucleus accumbens (eight studies including 37 patients), ventral capsule/ventral striatum (four studies including 29 patients), subthalamic nucleus (five studies including 23 patients) and inferior thalamic peduncle (two studies including 6 patients). Despite the anatomical diversity, deep brain stimulation treatment results in similar response rates for the first four target structures. Inferior thalamic peduncle deep brain stimulation results in higher response rates but these results have to be interpreted with caution due to a very small number of cases. Procedure and device related adverse events are relatively low, as well as stimulation or therapy related side effects. Most stimulation related side effects are transient and decline after stimulation parameters have been changed.ConclusionDeep brain stimulation in treatment-refractory obsessive-compulsive disorder seems to be a relatively safe and promising treatment option. However, based on these studies no superior target structure could be identified. More research is needed to better understand mechanisms of action and response predictors that may help to develop a more personalized approach for these severely affected obsessive compulsive patients.

Obsessive-compulsive disorder patients with washing symptoms show a specific brain network when confronted with aggressive, sexual, and disgusting stimuli

Psychoanalytic theories of obsessive-compulsive disorder (OCD) suggest that underlying conflicts about aggression or sexuality drive a variety of obsessive-compulsive behaviors. This study aimed to explore the possible neural correlates of these processes in OCD patients in response to emotion-evoking stimulus material. A total of 15 unmedicated OCD patients primarily with washing symptoms and 15 healthy control participants underwent functional magnetic resonance imaging analysis while confronted with neutral pictures and emotion-evoking pictures (aggression, disgust, water, sexuality). The choice of the stimuli explicitly took into account the psychoanalytical model of OCD. While viewing aggressive pictures compared to neutral stimuli, OCD patients demonstrated greater activation than controls in the right frontal gyrus, posterior cingulate cortex, insula, claustrum, and in parietal areas of the left hemisphere. In the disgust condition OCD patients demonstrated greater activation than controls in right frontal gyrus, right precentral gyrus, and in left inferior parietal lobule. These results furnish evidence that OCD patients with washing symptoms show a different pattern of processing of aggressive and disgusting stimuli at the brain level. The implicated networks involved suggest that OCD patients have a more self-referential response than in healthy controls. Focusing on the processing of specific negative emotions may help in the enhancement of psychotherapy for OCD.

White matter structural alterations in pediatric obsessive-compulsive disorder: relation to symptom dimensions.

The aims of this study were to identify gray matter (GM) and white matter (WM) volume abnormalities in pediatric obsessive-compulsive patients, to examine their relationship between these abnormalities and the severity of disorder, and to explore whether they could be explained by the different symptom dimensions. 62 child and adolescent OCD patients (11-18years old) and 46 healthy subjects of the same gender and similar age and estimated intellectual quotient were assessed by means of psychopathological scales and magnetic resonance imaging (MRI). Axial three-dimensional T1-weighted images were obtained in a 3T scanner and analyzed using optimized voxel-based morphometry (VBM). Compared with healthy controls, OCD patients showed lower white matter (WM) volume in the left dorsolateral and cingulate regions involving the superior and middle frontal gyri and anterior cingulate gyrus (t=4.35, p=0.049 FWE (family wise error)-corrected). There was no significant correlation between WM and the severity of obsessive-compulsive symptomatology. There were no regions with lower gray matter (GM) volume in OCD patients than in controls. Compared with healthy controls, only the "harm/checking" OCD dimension showed a cluster with a near significant decrease in WM volume in the right superior temporal gyrus extending into the insula (t=5.61, p=.056 FWE-corrected). The evidence suggests that abnormalities in the dorsolateral prefrontal cortex, anterior cingulate cortex, temporal and limbic regions play a central role in the pathophysiology of OCD. Moreover, regional brain volumes in OCD may vary depending on specific OCD symptom dimensions, indicating the clinical heterogeneity of the condition.

Do antidepressant-induced manic episodes in obsessive-compulsive disorder patients represent the clinical expression of an underlying bipolarity?

Do antidepressant-induced manic episodes in obsessive-compulsive disorder patients represent the clinical expression of an underlying bipolarity?

Exposición virtual como herramienta para el tratamiento del trastorno obsesivo compulsivo

El trastorno obsesivo compulsivo afecta al 2.6% de la población en México y es un una problemática que afecta severamente la calidad de vida de las personas que lo padecen, siendo clasificado por la OMS como la décima causa de discapacidad en el mundo, por lo que es un problema de salud que necesita atención por parte de los profesionales de la salud. Existen estudios sobre diversos tratamientos para este trastorno, entre ellos se encuentran el tratamiento de exposición y prevención de respuesta y el tratamiento cognitivo. El tratamiento puede ser percibido como aversivo y entre el 25 y el 35 por ciento de los pacientes abandonan el tratamiento debido a la ansiedad que experimentan por la exposición, el Laboratorio de Enseñanza Virtual y Ciberpsicología presenta un tratamiento basado en realidad virtual para poder exponer de forma controlada y menos aversiva a los pacientes obsesivo-compulsivos, el tratamiento se basa en la exposición y prevención de respuesta pero dando la facilidad al terapeuta de poder graduar de mejor forma los estímulos y la posibilidad de poder replicar los eventos la cantidad de veces que sea necesario. Por otra parte al paciente le permite exponerse en un ambiente virtual que le puede parecer seguro y que le permitirá hacer la exposición de forma gradual y menos aversiva. Los ambientes virtuales creados para dicho propósito son lugares contextualizados a la cultura mexicana y que están relacionados con la vida cotidiana del paciente para ayudar a éste a mejorar su calidad de vida así como reducir la evitación y ansiedad experimentada.

Executive functions and memory in autogenous and reactive subtype of obsessive-compulsive disorder patients

There are concurrently with different results of studies about cognitive functions of Obsessive-Compulsive Disorder (OCD), impairment in non-verbal memory and executive functioning in OCD, has shown consistent results in several studies. In this study, 62 OCD patients and 40 healthy controls were participated. Firstly, cognitive functions of OCD group and healthy control group were compared in terms of scores in Stroop Test, Wisconsin Cart Sorting Test (WCST), Auditory Consonant Trigram Test (ACTT), Controlled Word Association Test (CWAT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test (DST). And then, two patient groups of OCD patients (patients with autogenous obsessions and patients with reactive obsessions) were compared in terms of the scores of same tests, with a hypothesis that claims, cognitive functions of patients with autogenous obsessions, who shown schizotypal personality features and thought disorder in higher ratio, will show more impairment than cognitive functions of patients with reactive obsessions. Significant impairment was found in OCD patients in terms of Stroop test and WCST scores when compared to scores of healthy controls. There was no difference pointed out between cognitive functions of patients with autogenous obsessions and reactive obsessions. Due to limited number of patients with autogenous obsessions in current study, any future research with greater sample size will be helpful to explain the cognitive functions in OCD with autogenous and reactive obsessions.

Comparison of Meta-Cognitive Beliefs with Regard to Depressed, Obsessive-Compulsive and Normal Individuals

The main purpose of the present study was to investigate and compare the meta-cognitive beliefs of three groups consisting of depressed, obsessive-compulsive and normal individuals. This expost facto study was carried out on 174 individuals (58 depressed, 58 obsessive-compulsive, and 58 normal). The depressed and obsessive-compulsive patients were selected from psychological clinics in central and southern Tehran using purposive sampling. The normal group was randomly selected from the staff of the related clinics. Participants completed three questionnaires including the Beck Depression Inventory-II (BDI-II), the Maudsley Obsessive-Compulsive Inventory (MOCI), and the Meta-CognitionsQuestionnaire-30 (MCQ-30). The MANOVA test was used to analyze the statistical data. There were significant differences between the mean scores with regard to the meta-cognitive beliefs in normal individuals and in patients with depression or obsessive-compulsive disorders. Furthermore, with regard to cognitive confidence and cognitive self-consciousness subscales, there were significant differences between depressed and obsessive-compulsive patients. The mean scores of these two subscales were higher in obsessive-compulsive patient, in comparison with depressed individuals. There was no significant difference between the depressed and obsessive-compulsive groups regarding the three subscales of positive beliefs about worry, uncontrollability and need to control thoughts.

Cognitive functioning in medication-free obsessive-compulsive patients treated with cognitive-behavioural therapy

So far it is still uncertain whether neuropsychological test results in obsessive-compulsive disorder (OCD) change after CBT and whether neuropsychological and clinical variables predict response to CBT. 60 medication-free patients hospitalised for severe OCD were treated with CBT including exposure and response prevention (ERP). Pre- and Post-treatment patients completed a cognitive test battery covering a broad range of neuropsychological and clinical variables. The Yale Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess symptom severity. A healthy control group matched for age, gender, intelligence and education completed the same neuropsychological test battery, with similar test–retest intervals as the patients. Analyses showed significantly worse cognitive functioning in patients compared to healthy controls before treatment on many measures. After CBT patients had significantly improved test results regarding speed of information processing, verbal fluency, visuo-constructive functions and set shifting ability while controls did not perform better at the second testing. None of the neuropsychological and clinical variables assessed was significantly correlated with treatment outcome. These results indicate that cognitive dysfunctions in OCD are in part state-dependent and reversible after treatment. Moreover, our results suggest that CBT is successful even in those patients who exhibit cognitive dysfunctions and who are severely affected at the beginning of treatment.

1739 – Obsessive symptoms onset ay childbirth

Obsessive compulsive disorder (OCD) is relatively more frequent in pregnancy (third trimester) -3,5%- and post partum - 4 to 9%. Puerperium is at risk for onset of OC disorder and OC personality disorder. Most common obsession are contamination (75%), aggressive (33.3%), and symmetry/exactness (33.3%), and the most common compulsions are cleaning/ washing (66.7%) and checking (58.3%). OC personality disorder is a risk factor for post partum onset of OCD. We selected women during their admission for delivery (n = 61) and analyzed: sociodemographically and through administration of EPDS, BDI, BAI, WHOQOL and SCID II (comparing Obsessive-Compulsive patients [OC=32] with negative patients [NEG=11]). Time of recruitment: 2 weeks Labor: Emergency cesarian OC (21,4%) vn NEG (10,3%) Previous treatment: OC (outpatient department+ private psychiatrist+ psychologist) 11,1% vs NEG 0%; only Psychologist OC 16,7% vs NEG 6,3% Past drug intake: Antidepressant OC 11,1% vs NEG 0% Miscarriage: OC (22,2%) vs NEG (31,3%) Previous Oestroprogestinic intake : OC (66,7%) vs NEG (81,3%) Complication during pregnancy: OC (38,9%) vs NEG (21,9%) Whoqol psychological: OC (22,05) vs NEG (23,66) p = 0,46; environment: OC (28,32) vs NEG (31,09) p=0,015; physical: OC (23,37) vs NEG (26,72) p=0,011 BAI: OC (14,58) vs NEG (5,75) p=0,0005 BDI: OC (5,63) vs NEG (1,72) p< 0,0001 The groups clearly differ. From a test analysis we can underline that OC feels less confident in their environment and perceives less Physical wellness. BAI and BDI are statistically different, even if OC scores small level of anxiety or depression.

1692 – Obsessive-compulsive-bipolar disorder comorbidity: a case report

Anxiety disorders have been historically described as a feature of Bipolar Disorder (BD), and Obsessive-compulsive-bipolar disorder (OCBD) comorbidity has been referred in literature. A survey reports that 55,8% of obsessive-compulsive patients may develop BD in their lifetime. Another survey estimates it at 21%. Mania in Obsessive-Compulsive Disorder (OCD) can occur either as an independent comorbidity or as a result of an antidepressant-induced switch in a patient in anti-OCD drugs. The aim of this poster is to describe and discuss some aspects of this psychiatric comorbidity, with emphasis on its diagnosis and management, based on a case report. This case report describes a 38-years-old married male with 5 years history of OCD treated with an antidepressant, admitted at our psychiatric ward due to a manic episode. Its management and therapeutic approach are described. A baseline of “neurosis” (versus “psychosis”) in some BD presentations has emerged from recent scientific evidence, which prompts its better understanding. As a complex comorbidity, OCBD represents a diagnostic and therapeutic challenge implying further systematic exploration.

Neuropsychological deficits in drug naïve, non-depressed obsessive-compulsive disorder patients

There are several studies that compared neuropsychological performance of OCD patients with healthy controls. However, there are hardly any studies which have used drug-naïve as well as non-depressed OCD subjects in their studies. The present study compared eighteen drug-naïve non-depressed OCD patients with similar number of age, education and sex matched healthy controls on neuropsychological tests. The tests used are block design, object assembly, Visuospatial Working Memory Test, Verbal Working Memory Test, Complex Figure Test, Stroop Test and Wisconsin Card Sorting Test. In addition to usual significance testing, Effect Sizes were calculated. In addition, correlation was done between neuropsychological test variables and clinical variables. The results did not show any significant correlation between any of the clinical variables and neuropsychological test variables. On the other hand, patients showed significant deficits mainly in executive functions and organizational strategy with respect to visuospatial functions. The observed deficits can be attributed to both dorsolateral prefrontal cortex and orbitofrontal cortex involvement.

Managing Obsessive Thoughts During Brief Exposure: An Experimental Study Comparing Mindfulness-Based Strategies and Distraction in Obsessive–Compulsive Disorder

In mindful meditation, negative thoughts such as obsessive thoughts are observed simply as mental events that come and go, rather than as accurate reflections of reality. This experimental study tested the efficacy of a mindfulness-based instruction compared to distraction during brief exposure to obsessive thoughts in obsessive–compulsive patients. Thirty patients diagnosed with obsessive–compulsive disorder were asked to listen to their own obsessive thoughts through headphones during three time phases: at baseline, during an experimental condition and during a return to baseline. During the experimental condition, they were instructed to deal with their obsessive thoughts using either a mindfulness-based strategy or a distraction strategy (random allocation). Results showed that a mindfulness-based strategy reduced anxiety and urge to neutralize from first to second baseline, whereas a distraction strategy did not. Data offer initial evidence that using mindfulness-based metaphors during brief exposure with obsessive thoughts may be a useful alternative to distraction.

Religiosity, Magical Ideation, and Paranormal Beliefs in Anxiety Disorders and Obsessive-Compulsive Disorder

The relation between religiosity/spirituality (R/S), personal beliefs, and mental health has been extensively studied. However, concerning anxiety disorders (ADs), empirical evidence is scarce. This study investigated the differences in R/S and magical/paranormal ideation among obsessive-compulsive disorder patients (OCD; n = 49), patients with other ADs (n = 36), and healthy controls (HCs; n = 35). Our results suggest negative religious coping as being the only parameter showing significantly higher scores in OCD and AD participants in comparison with HCs. Negative religious coping reflects negative functional expressions of R/S in stressful situations. Logistic regression also suggested negative religious coping as the strongest predictor of group affiliation to the nonhealthy group. Further results show no significant differences between other R/S, magical, and paranormal ideation traits among groups. This study underlines an important role of negative religious coping in ADs yet does not clearly indicate a specific causality. Religious-sensitive treatment targeting cognitive aspects of negative religious coping are discussed.