Persistent Thoughts Research Articles

Gender differences in health service use for mental health reasons in community dwelling older adults with suicidal ideation

To ascertain gender-specific determinants of antidepressant and mental health (MH) service use associated with suicidal ideation. Data used in this study came from the ESA (Enquête sur la Santé des Aînés) survey carried out in 2005-2008 on a large sample of community-dwelling older adults (n = 2,004). Multivariate logistic regression analyses were carried out. The two-year prevalence of suicidal ideation was 8.4% and 20.3% had persistent suicidal thoughts at one-year follow-up. In males, the prevalence of antidepressant and MH service use in respondents with suicidal ideation reached 32.2% and 48.9%, respectively. In females, the corresponding rates were 42.6% and 65.6%. Males were less likely to consult MH services than females when their MH was judged poorly. Male respondents with higher income and education were less likely to use antidepressant and MH services. However, males using benzodiazepines were more likely than females to be dispensed an antidepressant. Among respondents with suicidal ideation, gender was not associated with service use. Younger age, however, was associated with antidepressant use. Increased promotion campaigns sensitizing men to the prodromal symptoms of depression and the need to foster access to MH care when the disorder is manageable may be needed.

Sexual Obsessions in Mental Retardation

To the Editor: Although obsessive-compulsive disorder (OCD) in mental retardation was earlier considered rare,1 recent research has sufficiently dispelled this belief. Prevalence of ritualistic behavior is reported to be 3.5% in individuals with mild to profound mental retardation2 and 40% in severe to profound mental retardation.3 In Down syndrome, prevalence of compulsive behavior ranges from 0.8%4 to 4.5%.5 Notably, much of this literature reports compulsions or rituals, and rarely have obsessions been described. We report the case of a girl with mild mental retardation with sexual obsessions. Case report. Mary, a 17-year-old girl with diagnosed mild mental retardation (IQ = 53), presented in September 2009 with 6-month history of progressively withdrawn behavior, poor personal hygiene, lack of interest in housework, irritability, and aggression directed toward her mother. There was no history of fever with rash, seizures, or medication use. Personal history revealed delayed language acquisition, though she had achieved a satisfactory level of speech before the current illness. She was able to perform activities of daily living independently and helped her mother in housework. She discontinued schooling after 5th grade due to learning difficulties. Physical examination findings were unremarkable. Mental status examination (MSE) revealed an agitated and disheveled adolescent girl displaying hostility toward her mother. No hallucinatory behavior was observed. She was hospitalized, and her liver and kidney function, blood glucose, electrolytes, and hematologic indices were found to be within normal ranges. Head computed tomography (CT) scan and electroencephalography (EEG) revealed no abnormality. A provisional diagnosis of unspecified non-organic psychotic disorder was made (ICD-10). She was prescribed risperidone 3 mg/d and trihexyphenidyl 4 mg/d, which reduced her aggression. On follow-up MSE, she was calm but was reluctant to be interviewed. She was discharged after 2 weeks. On follow-up a week later, her parents reported improvement in aggression but not in personal hygiene and interaction. This time, Mary was cooperative and admitted having repetitive, uncomfortable, and persistent thoughts of touching male genitalia for 6 months. She considered them “bad” and tried to resist them. Rarely, however, she touched her father’s genitals while he was asleep. During one such attempt she was witnessed by her mother, who reprimanded her. Though Mary never repeated the act, she developed irritability and hostility toward her mother. She disclosed that she was embarrassed to reveal these thoughts to her mother or to us during hospitalization. There were no additional obsessions, compulsions, or psychotic symptoms. Her diagnosis was revised to OCD, predominantly obsessions. Her Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 19, corresponding to moderate impairment.6 After discussion and informed consent from Mary and her parents, we discontinued risperidone and trihexyphenidyl while watching out for reemergence of behavioral problems and initiated clomipramine at 25 mg/d, which was increased to 75 mg/d over 2 weeks. Assessments were conducted independently by the authors both initially and at follow-ups. After 4 weeks, her Y-BOCS score came down to 10 and she reported substantial reduction in obsessions while her parents reported improvement in her mood, interaction, and self-care. Her Y-BOCS score was 4 at week 8, which did not change significantly on subsequent follow-ups. She remained well for the next 10 months, after which she stopped coming. Review of the literature shows that compulsive or ritualistic phenomena are the dominant presentations of OCD in mental retardation.2,3,7 This observation could be partly due to the study design whereby emphasis is on observable repetitive behavior rather than inner conflicts in diagnosing OCD2,7 and partly due to the underlying intellectual impairment, which prevents formation and expression of obsessions.7 However, the present case along with other case reports describing mixed obsessions and compulsions in mild mental retardation8,9 illustrate that some of these individuals might possess sufficient cognitive resources to form obsessions and acknowledge their unreasonableness. This report is especially noteworthy as it reports sexual obsessions as the sole presentation of OCD in mental retardation, which has not been described so far. Despite the initial diagnosis of unspecified non-organic psychosis, our patient did not exhibit hallucinations, delusions, or thought disorder throughout the course of illness. It is conceivable that risperidone, given initially, calmed her down to enable evaluation. Moreover, the fact that she responded completely to and remained well on treatment with clomipramine alone suggests that she was suffering from a primary obsessional illness rather than OCD comorbid with psychosis. Hence, careful assessment is required in patients with mental retardation for whom aggression could be secondary to underlying obsessions.

Parkinson hastalığı ve delüzyonel parazitoz birlikteliği: Bir olgu sunumu / Comorbidity of Parkinson’s disease and delusional parasitosis: a case report

Delusional parasitosis is a rare psychiatric disorder in which a person has the false and persistent belief of being infested with parasites or small living creatures. Although delusional parasitosis may occur at any age, some researchers suggest an increase in frequency in the elderly, especially in women gender. The disorder usually classified as primary and secondary delusional parasitosis. The first one contains patients without a detectable cause while the secondary delusional parasitosis group is associated with general organic conditions, other psychiatric illnesses and some drugs. In this case report, we present a 57 years-old woman who has Parkinson’s disease for 15 years. Her psychiatric interview revealed her persistent thoughts about being infested by parasites. In this paper, we discussed delusional parasitosis comorbidity in Parkinson’s disease.

The role of glutamate signaling in the pathogenesis and treatment of obsessive–compulsive disorder

Obsessive–compulsive disorder (OCD) is a common and often debilitating neuropsychiatric condition characterized by persistent intrusive thoughts (obsessions), repetitive ritualistic behaviors (compulsions) and excessive anxiety. While the neurobiology and etiology of OCD has not been fully elucidated, there is growing evidence that disrupted neurotransmission of glutamate within corticalstriatal–thalamocortical (CSTC) circuitry plays a role in OCD pathogenesis. This review summarizes the findings from neuroimaging, animal model, candidate gene and treatment studies in the context of glutamate signaling dysfunction in OCD. First, studies using magnetic resonance spectroscopy are reviewed demonstrating altered glutamate concentrations in the caudate and anterior cingulate cortex of patients with OCD. Second, knockout mouse models, particularly the DLGAP3 and Sltrk5 knockout mouse models, display remarkably similar phenotypes of compulsive grooming behavior associated with glutamate signaling dysfunction. Third, candidate gene studies have identified associations between variants in glutamate system genes and OCD, particularly for SLC1A1 which has been shown to be associated with OCD in five independent studies. This converging evidence for a role of glutamate in OCD has led to the development of novel treatment strategies involving glutamatergic compounds, particularly riluzole and memantine. We conclude the review by outlining a glutamate hypothesis for OCD, which we hope will inform further research into etiology and treatment for this severe neuropsychiatric condition.

Obsessive-Compulsive Disorder After Right Temporal-Lobe Hemorrhage

Back to table of contents Previous article Next article LettersFull AccessObsessive-Compulsive Disorder After Right Temporal-Lobe HemorrhageAbhishek Rai, MBBS, Amit Chopra, M.D., and Piyush Das, M.D.Abhishek RaiSearch for more papers by this author, MBBS, Amit ChopraSearch for more papers by this author, M.D., and Piyush DasSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe13AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Obsessive-compulsive disorder (OCD) is a psychiatric illness characterized by persistent, intrusive, and senseless thoughts (obsessions) and urges to perform repetitive behaviors (compulsions) that interfere with functioning and/or cause distress. Although OCD secondary to various neurological lesions has been described, cerebral hemorrhage has rarely been associated with OCD. We present the first reported patient; this was a 40-year-old woman who developed OCD that responded successfully to high-dose selective serotonin reuptake inhibitor (SSRI) treatment after right temporal-lobe hemorrhage.Case Report“Mrs. X” was a 40-year-old woman with a medical history significant for frontoparietal hematoma resection during infancy, centroparietal epilepsy (stable on Depakote and levetiracetam), and depression, who presented to psychiatric clinic for gradually worsening obsessions and compulsion to shop (of 7 months' duration), with onset after right temporal-lobe hemorrhage (confirmed by brain imaging). Her depression, previously well controlled on citalopram 20 mg/day, had worsened to a moderately severe depression (Patient Health Questionnaire-9/PHQ-9 Score: 15), and her mild obsessive traits had worsened to distressing obsessions and compulsions to shop, meeting DSM-IV criteria for diagnosis of OCD. The compulsive shopping significantly reduced her anxiety. Other potential causes of her presentation, including worsening of seizure disorder, psychotic disorder, impulse-control disorder, mania, and substance abuse were ruled out. Although a citalopram dose increase to 40 mg daily led to remission of her depression (PHQ-9 score: 3), she continued to endorse compulsions to shop, to the extent that she ended up calling a realtor to buy a house. A gradual increase in citalopram dosage to 80 mg/day led to a 90% improvement in her OCD symptoms, and a further increase, to 100 mg/day, resulted in complete remission at 1-year follow-up. She had regular follow-up with her neurologist in the interim, with no suggestion of worsening of her seizure disorder by high-dose citalopram.DiscussionOCD has been associated with various neurological lesions, including traumatic brain injury, tumors, and infarcts, localized mainly to the frontal cortex and basal ganglia.1 The association of OCD with temporal-lobe epilepsy (TLE) seems strong, as 10%–20% of TLE patients suffer from OCD.2 Our case suggests temporal-lobe hemorrhage as a novel putative cause of OCD. Although there is no known overt locus of neuronal degeneration in OCD, functional-imaging studies suggest an abnormal metabolic activity in orbitofrontal cortex (OFC), anterior cingulate/caudal medial prefrontal cortex, and caudate nucleus.3 The OFC–subcortical circuit, referred to as the “OCD circuit,” projects from OFC to the ventral portion of caudate nucleus. OFC receives both afferent and efferent projections from the temporal lobe,4 which may underlie temporal lobe involvement in causation of OCD. Our patient's response to high-dose SSRI is plausible, considering the fact that serotonin acts on the “OCD circuit” by modulating 5HT3 receptors predominantly present in ventral striatum.5 Besides highlighting a novel mechanism of causation of OCD, we suggest that OCD associated with temporal lobe hemorrhage may be responsive to high-dose SSRI treatment.Dept. of Psychiatry and Psychology Mayo Clinic Rochester, MNCorrespondence: das.[email protected]edu; gen.[email protected]com1. Etcharry-Bouyx F , Dubas F : Obsessive-compulsive disorders associated with focal brain lesions, in: Behaviours and Mood Disorders in Focal Brain Lesions. Edited by Bogousslavsky JCummings J. Cambridge, UK, Cambridge University Press, 2000, pp 304–326Crossref, Google Scholar2. Kaplan PW : Epilepsy and obsessive-compulsive disorder. Dial Clin Neurosci 2010; 12:241–248Medline, Google Scholar3. Graybiel A , Rauch S : Toward a neurobiology of obsessive-compulsive disorder. Neuron 2000; 28:343–347Crossref, Medline, Google Scholar4. Cummings JL : Anatomic and behavioral aspects of frontal-subcortical circuits. Ann N Y Acad Sci 1995; 769:1–13Crossref, Medline, Google Scholar5. Marsden CA : The neuropharmacology of serotonin in central nervous system, in Selective Serotonin Reuptake Inhibitors. Edited by Feighner JPBoyer WF. New York, Wiley, 1991, pp 11–35Google Scholar FiguresReferencesCited byDetailsCited by“Need to Know” or the Strong Urge to Find Names of Unique Entities in Acquired Obsessive-Compulsive DisorderCognitive and Behavioral Neurology, Vol. 32, No. 2Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 4Psychiatry and Clinical Psychopharmacology, Vol. 28, No. 3Journal of Neurotrauma, Vol. 32, No. 7Multivariate pattern analysis of DTI reveals differential white matter in individuals with obsessive‐compulsive disorder18 September 2013 | Human Brain Mapping, Vol. 35, No. 6Neuroscience & Biobehavioral Reviews, Vol. 37, No. 3 Volume 23Issue 4 Fall 2011Pages E13-E13 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

Obsessive-Compulsive Disorder After Right Temporal-Lobe Hemorrhage

Back to table of contents Previous article Next article LettersFull AccessObsessive-Compulsive Disorder After Right Temporal-Lobe HemorrhageAbhishek Rai, MBBS, Amit Chopra, M.D., and Piyush Das, M.D.Abhishek RaiSearch for more papers by this author, MBBS, Amit ChopraSearch for more papers by this author, M.D., and Piyush DasSearch for more papers by this author, M.D.Published Online:1 Oct 2011https://doi.org/10.1176/jnp.23.4.jnpe13AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Obsessive-compulsive disorder (OCD) is a psychiatric illness characterized by persistent, intrusive, and senseless thoughts (obsessions) and urges to perform repetitive behaviors (compulsions) that interfere with functioning and/or cause distress. Although OCD secondary to various neurological lesions has been described, cerebral hemorrhage has rarely been associated with OCD. We present the first reported patient; this was a 40-year-old woman who developed OCD that responded successfully to high-dose selective serotonin reuptake inhibitor (SSRI) treatment after right temporal-lobe hemorrhage.Case Report“Mrs. X” was a 40-year-old woman with a medical history significant for frontoparietal hematoma resection during infancy, centroparietal epilepsy (stable on Depakote and levetiracetam), and depression, who presented to psychiatric clinic for gradually worsening obsessions and compulsion to shop (of 7 months' duration), with onset after right temporal-lobe hemorrhage (confirmed by brain imaging). Her depression, previously well controlled on citalopram 20 mg/day, had worsened to a moderately severe depression (Patient Health Questionnaire-9/PHQ-9 Score: 15), and her mild obsessive traits had worsened to distressing obsessions and compulsions to shop, meeting DSM-IV criteria for diagnosis of OCD. The compulsive shopping significantly reduced her anxiety. Other potential causes of her presentation, including worsening of seizure disorder, psychotic disorder, impulse-control disorder, mania, and substance abuse were ruled out. Although a citalopram dose increase to 40 mg daily led to remission of her depression (PHQ-9 score: 3), she continued to endorse compulsions to shop, to the extent that she ended up calling a realtor to buy a house. A gradual increase in citalopram dosage to 80 mg/day led to a 90% improvement in her OCD symptoms, and a further increase, to 100 mg/day, resulted in complete remission at 1-year follow-up. She had regular follow-up with her neurologist in the interim, with no suggestion of worsening of her seizure disorder by high-dose citalopram.DiscussionOCD has been associated with various neurological lesions, including traumatic brain injury, tumors, and infarcts, localized mainly to the frontal cortex and basal ganglia.1 The association of OCD with temporal-lobe epilepsy (TLE) seems strong, as 10%–20% of TLE patients suffer from OCD.2 Our case suggests temporal-lobe hemorrhage as a novel putative cause of OCD. Although there is no known overt locus of neuronal degeneration in OCD, functional-imaging studies suggest an abnormal metabolic activity in orbitofrontal cortex (OFC), anterior cingulate/caudal medial prefrontal cortex, and caudate nucleus.3 The OFC–subcortical circuit, referred to as the “OCD circuit,” projects from OFC to the ventral portion of caudate nucleus. OFC receives both afferent and efferent projections from the temporal lobe,4 which may underlie temporal lobe involvement in causation of OCD. Our patient's response to high-dose SSRI is plausible, considering the fact that serotonin acts on the “OCD circuit” by modulating 5HT3 receptors predominantly present in ventral striatum.5 Besides highlighting a novel mechanism of causation of OCD, we suggest that OCD associated with temporal lobe hemorrhage may be responsive to high-dose SSRI treatment.Dept. of Psychiatry and Psychology Mayo Clinic Rochester, MNCorrespondence: das.[email protected]edu; gen.[email protected]com1. Etcharry-Bouyx F , Dubas F : Obsessive-compulsive disorders associated with focal brain lesions, in: Behaviours and Mood Disorders in Focal Brain Lesions. Edited by Bogousslavsky JCummings J. Cambridge, UK, Cambridge University Press, 2000, pp 304–326Crossref, Google Scholar2. Kaplan PW : Epilepsy and obsessive-compulsive disorder. Dial Clin Neurosci 2010; 12:241–248Medline, Google Scholar3. Graybiel A , Rauch S : Toward a neurobiology of obsessive-compulsive disorder. Neuron 2000; 28:343–347Crossref, Medline, Google Scholar4. Cummings JL : Anatomic and behavioral aspects of frontal-subcortical circuits. Ann N Y Acad Sci 1995; 769:1–13Crossref, Medline, Google Scholar5. Marsden CA : The neuropharmacology of serotonin in central nervous system, in Selective Serotonin Reuptake Inhibitors. Edited by Feighner JPBoyer WF. New York, Wiley, 1991, pp 11–35Google Scholar FiguresReferencesCited byDetailsCited By“Need to Know” or the Strong Urge to Find Names of Unique Entities in Acquired Obsessive-Compulsive DisorderCognitive and Behavioral Neurology, Vol. 32, No. 2Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 4Psychiatry and Clinical Psychopharmacology, Vol. 28, No. 3Journal of Neurotrauma, Vol. 32, No. 7Multivariate pattern analysis of DTI reveals differential white matter in individuals with obsessive‐compulsive disorder18 September 2013 | Human Brain Mapping, Vol. 35, No. 6Neuroscience & Biobehavioral Reviews, Vol. 37, No. 3 Volume 23Issue 4 Fall 2011Pages E13-E13 Metrics PDF download History Published online 1 October 2011 Published in print 1 October 2011

The Effect of Self‐Control on Attentional Bias for Alcohol Cues in Male Heavy Drinkers1

Attentional bias for alcohol cues increases craving and subsequent alcohol consumption. Override processes can be used to disengage attention from alcohol cues. This requires self‐control and implies that depletion of self‐control would impair the ability to disengage attention from alcohol cues. This study examined the effect of self‐control on attentional bias among male heavy drinkers. To manipulate self‐control resources, an expression control task was used. Attentional bias was measured with a visual probe task. The Obsessive Compulsive Drinking Scale (OCDS; Anton, Moak, & Latham, 1996) assessed the urge to drink and persistent thoughts about alcohol. The results suggest that participants who scored relatively high on the OCDS showed more attentional bias after controlled emotional expression, compared to free emotional expression.

Neurobiology of Addiction

Neurobiology of Addiction

Executive Functions Evaluation through Evoked Potentials among Children with Obsessive-Compulsive Disorder

pychological and pedagogical survey Abstract Introduction: Obsessive-compulsive disorder [OCD] is characterized by repetitive, disturbing obsessions and/or compulsions. Obsessions are thoughts, images or feelings which are unwanted, persistent and recurrent. Compulsions are repetitive and ritual motor acts which are performed to decrease the anxiety level caused by repetitive obsessions. The onset of the OCD is typically during adolescence or early adulthood. Its prevalence among children is from 1% to 3% and it appears to be more present among boys than girls. Nowadays, the most effective way to treat OCD is to combine psychopharmacological with cognitive-behavioral treatment strategies. In the past decades researchers were more involved in investigating the role of the executive functions [EF] in psychiatric disorders. Aim of the study: to investigate EF among children with OCD by using Event Related Potentials (ERPs) on the Go/NoGo tasks. Subjects and methods: The sample is comprised of 20 children from both genders, between seven and 14 years of age [M=10,33±1,83], all diagnosed with OCD. Psychological evaluation was performed with Child Behavior Check List, Kohs cubes for assessment of the intellectual capacities, Beck Depression Inventory, The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Stroop Color Word Test and Wisconsin Card Sorting Test. Neuropsychological evaluation was performed with the Visual Continuous Performance Test [VCPT] from which the Event Related Potentials [ERP] components were extracted. Results: There is a clear presence of obsessions and/or compulsions, absence of symptoms of depression, presence of perseverative errors and mild difficulties in mental flexibility. The ERP results cannot be understood as a disturbance of the EF in a direct sense, rather than as a disturbed normal functioning caused by the high anxiety level. Conclusion: There is no significant clinical manifestation of cognitive dysfunction among children with OCD in the early stage of the disorder, but it could be expected the same one to be appearing in the later stages of the disorder. Key words: obsessive-compulsive disorder, executive functions, children (ProQuest: ... denotes non-USASCII text omitted.) Introduction Until recently, obsessive-compulsive disorder [OCD] was considered a rare condition, especially in childhood. Obsessions are thoughts, images or feelings which are unwanted, persistent and recurrent. Compulsions are motor acts which are stereotyped, ritual and repetitive. Certain compulsion is a consequence of a certain obsession with a goal to neutralize the anxiety which is in the background. Like adults, children are also not free from experiencing worries, fears and doubts about their everyday life. But when these stressful situations become very powerful and cannot be stopped or overcome, and start to disturbe the everyday functioning, academic achievements and peer relations, a disorder is present. The most frequent obsessions among children are fear of dirt and germs, excessive need for order and symmetry, fixations on urination and defecation, persistent thoughts fulfilled with aggressive or sexual context that are and unmoral, feeling that something bad will happen to a close member of their family or themselves, etc. On the other hand, most frequent compulsions among children are frequent hand washing, ordering or counting objects, rechecking finished actions, word repetition, coughing, rituals before bed time, etc. When the child will resist carrying out the compulsions, anxiety usually increases. Adult patients generally recognize that the obsessions and compulsions are excessive and irrational but in children this is not the case. The majority of the patients with OCD experience both obsessions and compulsions. Around 25% of adult patients experience only obsession and 5% only compulsions (1). …

Why do some people ruminate more or less than others? The role of Emotional Intelligence ability

Emotional Intelligence (EI) has been defined as an ability to evaluate, perceive and express emotions, use emotions to facilitate thought, analyse and understand emotions, and manage and regulate emotions. The emotional elaboration ability is considered a crucial skill for EI, because of its role on the individual well-being. Individuals differ in adopting more or less successful emotion elaboration strategies. Among the many strategies, mental rumination is conceptualized as being characterized by persistent thoughts which intrude into the consciousness in a repetitive way. As a consequence, individual differences in mental rumination may be related to differences in EI abilities. The aim of the present study was to investigate the relationship between mental rumination and EI abilities. More specifically, Study 1 (N = 150) investigated this association with respect to the emotional valence of an emotionally inducing event (positive vs. negative). Study 2 (N = 88) explored the impact of EI on the mental rumination processes both immediately after an emotional event and over time. Results, jointly considered, supported the idea that people with a higher level of managing emotions ability had reduced frequency of mental rumination, independent of the valence of the emotional event and retention delay.

Individual differences in biological stress responses moderate the contribution of early peer victimization to subsequent depressive symptoms.

Some children who are exposed to early peer victimization become depressed, whereas others are resilient. Understanding individual differences in responses to early adversity, such as victimization, is critical for developing both comprehensive theoretical models and effective interventions. This study examined whether individual differences in biological stress responses (i.e., activation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system) moderated the contribution of peer victimization to depressive symptoms across a 1-year period. Children (N = 132; M age = 9.46 years, SD = 0.33) completed measures of peer victimization and depressive symptoms, and rated their ruminative responses (i.e., persistent thoughts about negative task-related emotion and experiences) to a laboratory-based social challenge task involving two conflict-of-interests situations with an unfamiliar peer. Children's saliva was collected prior to, and following, participation in the task, and was later assayed for cortisol and alpha amylase [sAA]. Victimization interacted with levels of cortisol measured in anticipation of the task to predict task-related rumination and depressive symptoms 1 year later, adjusting for initial symptoms. Specifically, victimization served as a risk factor for rumination and depressive symptoms in children with heightened but not dampened anticipatory cortisol; yet, heightened anticipatory cortisol was protective against rumination and depressive symptoms in low-victimized children. Victimization also predicted subsequent depressive symptoms in girls with high sAA reactivity across the task. This study advances contemporary theory and research by implicating individual variation in biological stress responses as one determinant of sensitivity to the mental health effects of early adversity.

Suicide in patients treated for obsessive–compulsive disorder: A prospective follow-up study

Background To describe the occurrence of persistent suicidal ideation and suicide attempts in a sample of obsessive–compulsive patients followed-up prospectively during 1 to 6 years, and to determine the existence of predictors of suicide behavior. Method Two hundred and eighteen outpatients with DSM-IV OCD, recruited from a specialized OCD Unit in Barcelona, Spain, between February 1998 and December 2007, were included in the study. Suicide ideation was assessed by item 3 of the Hamilton Depression Rating Scale. Suicide attempts were evaluated by the Beck Suicide Intent Scale. Patients with and without persistent suicidal thoughts and suicide attempters and non-attempters were compared on sociodemographic and clinical variables. A Cox proportional hazards regression analysis was used to estimate potential predictors of suicide. Results Patients completed a mean follow-up period of treatment of 4.1 years (SD: 1.7; range: 1–6 years). During this period, eighteen patients (8.2%) reported persistent suicidal ideation, two patients (0.91%) committed suicide and 11 (5.0%) attempted suicide. Being unmarried, presenting higher basal scores in the HDRS, current or previous history of affective disorders and symmetry/ordering obsessions were independently associated with suicidal behaviors. Limitations Patients were recruited from a specialized OCD clinic and received exhaustive treatment. Influence of variables including social support, life events, hopelessness and substance abuse/dependence was not assessed. Conclusions Suicide behavior is not a highly common phenomenon in OCD, but it should not be disregarded, especially in unmarried patients, with comorbid depression and symmetry/ordering obsessions and compulsions, who appear to be at a greater risk for suicide acts.

Exploring types of interference between work and non-work: using a diary study approach

Studies of work and family issues have used predominately between-subject cross-sectional designs. While some researchers have called for more longitudinal studies, others have suggested that a more strategic way forward for the field is the use of daily diary studies (Frone, Russell, & Cooper, 1992). This study explores different types of interference between work and non-work domains, using a diary study methodology. This study consisted of a two-week diary study among 12 Irish employees. Analysis involved a two-step procedure involving both content analysis and interpretative phenomenological analysis (IPA). Results indicated that while individuals reported strain-based and time-based interference, evidence was also found of interference concerning persistent and intrusive thoughts. Despite some limitations to the study, this paper demonstrates that diary studies represent an opportunity for researchers to explore work and non-work experiences in a sensitive and ecologically valid way.

Multiple rare SAPAP3 missense variants in trichotillomania and OCD

Multiple rare SAPAP3 missense variants in trichotillomania and OCD

Persistent Pain Biases Item Response on the Geriatric Depression Scale (GDS): Preliminary Evidence for Validity of the GDS-PAIN

Differential item functioning (DIF) assesses the consistency of items on a metric across clinical samples in relation to the attribute being measured. We hypothesized that in older adults with persistent pain, items of the Geriatric Depression Scale (GDS) would evidence DIF based on presence or intensity of pain. Unidimensionality was determined by factor and item analyses. DIF was tested using Rasch Modeling. We then evaluated the psychometric properties of a revised GDS (GDS-PAIN), comprised of items that did not evidence DIF. PATIENT AND SETTINGS: A total of 677 community dwelling older adults (age 65-91) participating in observational or treatment studies of low back or knee pain who endorsed at least moderate pain for at least 3 months. A total of 201 pain-free controls were included in the analysis. Ten of the 30 items displayed significant DIF. These items were: 1) dropping activities and interests; 2) bothered by persistent thoughts; 3) often get fidgety and restless; 4) prefer to stay home; 5) do not feel full of energy; 6) do not enjoy getting up in the morning; 7) mind is not as clear as it was, 8) feel life is empty; 9) feel more problems with memory; and 10) do not find life very exciting. The modified GDS-PAIN scale did not adversely affect the psychometric properties of the scale. The performance of the GDS is affected by pain. When unstable items are removed, the revised GDS (GDS-PAIN) appears to be psychometrically stable and maintains both internal consistency and similar correlation values with a measure of pain as the original scale.

Suicidal behaviour and associated risk factors among opioid‐dependent individuals: a case–control study

To examine suicidal behaviour and the associated risk factors among opioid-dependent cases and non-opioid-dependent controls. Case-control study. Sydney, Australia. A total of 726 opioid-dependent cases and 399 non-opioid-dependent controls, matched on age, sex and employment status. Cases had significantly higher life-time prevalence of suicidal thoughts (66% versus 55%), suicide attempts (31% versus 20%) and multiple attempts (19% versus 11%) compared to controls. Cases were significantly more likely to indicate a severe intent to die (63% versus 43%). Both cases and controls who had attempted suicide were significantly more likely than others to suffer from substance use and psychological disorders, as well as childhood maltreatment. Risk factors which predicted suicide attempts were the same among cases and controls, including screening positive for borderline personality disorder, post-traumatic stress disorder and persistent suicidal thoughts. Although controls had elevated levels of suicidal behaviour compared to those seen in general population surveys, the prevalence of suicidal behaviour among cases was still much higher. Although opioid dependence was related to suicidal behaviour, it did not make a unique contribution to the risk of suicide attempts over and above the other risk factors identified.

Cortico-striatal synaptic defects and OCD-like behaviours in Sapap3-mutant mice

Obsessive-compulsive disorder (OCD) is an anxiety-spectrum disorder characterized by persistent intrusive thoughts (obsessions) and repetitive actions (compulsions). Dysfunction of cortico-striato-thalamo-cortical circuitry is implicated in OCD, although the underlying pathogenic mechanisms are unknown. SAP90/PSD95-associated protein 3 (SAPAP3; also known as DLGAP3) is a postsynaptic scaffolding protein at excitatory synapses that is highly expressed in the striatum. Here we show that mice with genetic deletion of Sapap3 exhibit increased anxiety and compulsive grooming behaviour leading to facial hair loss and skin lesions; both behaviours are alleviated by a selective serotonin reuptake inhibitor. Electrophysiological, structural and biochemical studies of Sapap3-mutant mice reveal defects in cortico-striatal synapses. Furthermore, lentiviral-mediated selective expression of Sapap3 in the striatum rescues the synaptic and behavioural defects of Sapap3-mutant mice. These findings demonstrate a critical role for SAPAP3 at cortico-striatal synapses and emphasize the importance of cortico-striatal circuitry in OCD-like behaviours.

Utility of the concept of minor depressive disorder: Evidence from a large rural community sample in a developing country setting

Background Evidence on the utility of the minor depressive disorder diagnostic construct in rural communities and developing countries is scarce. Aim To assess the utility and validity of definitive minor depressive disorder in Ethiopia by determining its impact and sociodemographic correlates. Methods Assessment of 68,378 adults, aged 15–49 years, living in a largely rural district in Ethiopia using the Composite International Diagnostic Interview. Results The lifetime prevalence of minor depressive disorder was 2.2% (95% CI = 2.1%, 2.3%). Age, marital status, education and unemployment independently predicted minor depressive disorder. Over 80% of cases used health services, 55.1% experienced persistent thoughts of death and 14.6% attempted suicide. Limitation Findings are based on lifetime estimates. Conclusions Minor depressive disorder is an important public health problem in rural Ethiopia, as shown by the associated high health service use and risk behaviour. Sociodemographic correlates suggest aetiological continuity with major depression. Thus our findings extend the clinical and public health utility of this diagnostic construct to rural community and developing country settings.

Romantic Love, Hypomania, and Sleep Pattern in Adolescents

Purpose To examine the impact of early-stage intense romantic love on sleep, daytime functioning and self-worth, adolescents in early-stage intense romantic love were compared to controls. In adolescence, falling in love is an important prerequisite for acquiring psychosocial and psychosexual skills. Early-stage intense romantic love involves physiological, cognitive, emotional, and behavioral dimensions: increased arousal, persistent thoughts for the beloved person, feelings of overwhelming joy, and efforts to sustain proximity to the person loved are prominent features of adolescents in a state of intense romantic love. The stage is comparable to a hypomanic-like state. However, no research has addressed this issue. Furthermore, no data are available with respect to sleep and sleep-related dimensions such as mood. Method One hundred seven adolescents (mean age: 17.98 years ± 1.33) took part in the study; 60 of them indicated they had recently fallen in love and experienced intense romantic love, 47 had a longer-lasting relationship or were singles. Following a screening interview for psychiatric disorders, participants completed questionnaires related to hypomania and sleep habits. Additionally, they completed a sleep log for seven consecutive nights. Results Compared to controls, adolescents in early-stage intense romantic love had increased scores on a hypomania scale, and recorded increased positive mood states in the mornings and in the evenings. These adolescents also recorded fewer hours of sleep with increased subjective sleep quality, lowered daytime sleepiness, and heightened concentration during the day. Conclusions In adolescence, early-stage intense romantic love is comparable to a hypomanic state. This state is also reflected in altered sleep patterns, mood, and daytime functioning. Consequently, to not bias data in research with adolescents, current stage of love should be taken into account.

Management of treatment-resistant obsessive-compulsive disorder: An update on therapeutic strategies

<b>Background: </b> Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by recurrent, persistent thoughts and/or repetitive compulsive behaviors that cause anxiety or distress, are time-consuming, and cause significant socio-occupational dysfunction. Although OCD can be alleviated with pharmacological and behavioral treatments, up to 40-60% of patients do not have a satisfactory outcome. This paper aims to review the operational definitions and management of treatment-resistant OCD. <b> Materials and Methods:</b> A computerized search on Pubmed carried from 1980 to April 2006 led to the summarization of the results. <b> Results:</b> There are several strategies to manage treatment-resistant OCD. To start with, it is necessary to define it and differentiate it from other comorbid psychiatric disorders. Adequate trials of selective serotonin reuptake inhibitors (SSRIs), including clomipramine, at the maximum recommended dosages for at least 12 weeks needs to be tried, along with cognitive behavioral therapy (CBT), before trying out other modalities of treatment, which include ECT, rTMS, and neurosurgery. <b> Conclusion:</b> OCD has various clinical and therapeutic implications as it has a chronic course. Unless diagnosed and treated in an effective manner, it carries the risk of becoming resistant to treatment. This paper attempts to present an algorithm of management that can be followed in treatment-resistant OCD. It also emphasizes the need to maximize the effect of each course of treatment before moving on to the next step of management.