Recurrent Thoughts Research Articles

Psychogenic seizures in obsessive-compulsive disorder with poor insight: A case report

Psychogenic seizures or psychogenic nonepileptic seizures occur in various mental disorders. Obsessive-compulsive symptoms can also imitate epileptic partial seizures, but detailed observations of this phenomenon are rare in the literature. A girl of 13 years was referred to the Department of Child Psychiatry because of sudden falls that had occurred during a 1-year period, mainly at school. She had been diagnosed previously as having epilepsy or conversion seizures. After a fall, she demonstrated no response for periods up to 10 minutes, postictal somnolence had occasionally been observed. From the age of 10 years, the patient was reported to have had intrusive recurrent thoughts about dirt and contamination and had also demonstrated some signs of separation anxiety disorder. She was diagnosed as having obsessive-compulsive disorder with poor insight. The chronic falling disappeared completely when behavioral therapy was begun, but the girl still exhibits obsession and separation anxiety.

The performance of DSM-III-R major depression criteria in the diagnosis of bipolar mixed states

Two hundred thirty-seven (237) manic patients diagnosed by DSM-III-R criteria as either purely manic (204) or mixed bipolar (33) were reviewed for analysis of the diagnostic performance of the DSM-III-R criteria required to diagnose the mixed bipolar state. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic efficiency of each of the 9 DSM-III-R criteria for major depression in this cohort. As predicted, four of the major depression criteria had low diagnostic utility, with PPV's less than 0.3. Those items were: weight change; sleep disturbance; psychomotor change; and diminished ability to think or concentrate or indecisiveness. Four symptoms: anhedonia, fatigue, feelings of worthlessness or guilt, and recurrent thoughts of death or suicidal ideation had acceptable utility for the diagnosis of mixed states.

A Thousand Frightening Fantasies: Understanding and Healing Scrupulosity and Obsessive Compulsive Disorder

William Van Ornum, a professor of psychology at Marist College in New York, has written this book for persons who suffer from scrupulosity, a spectrum of symptoms expressive of obsessive-compulsive disorder (OCD) that tends to affect individuals with religious affiliations, especially, but not exclusively, Roman Catholics and Orthodox Jews. The focus of their obsessions—recurrent, anxietyprovoking, intrusive, and inappropriate thoughts—and their compulsions—driven, repetitive behaviors to counteract the obsessions—are usually the beliefs, rituals, and behaviors that reinforce or express the tenets of the religion. Until the mid 1980s, OCD was generally perceived as rare and poorly responsive to treatment. With the advent of large-scale epidemiological studies and more precise diagnostic criteria, a far greater number of the population have been identified as suffering from OCD, with perhaps a lifetime prevalence of 2% to 3%. Many individuals with symptoms may not recognize it as a known disorder or seek professional evaluation or

The phenomenology of obsessive-compulsive disorder

Obsessive-compulsive symptoms have been described by British, French, and German authors. While different clinical aspects were emphasized by different authors, it was recognized during the second half of the last century that obsessive-compulsive symptoms have cognitive, volitional and emotional facts: the patient experiences recurrent and persistent thoughts, impulses, or images as forced upon him or her, recognizes the content as unreasonable and is markedly distressed by it. Once delineated, defined and named, the obsessive-compulsive syndrome was described in a number of clinical studies with the main result of an astonishing homogeneity of content and form across culture, time and space. Symptoms fluctuate in severity and may change in content over time. In most cases, the content regards dirt and contamination, while aggression, religion, and sex also play a noticeable role. Patients spend a lot of time either yielding to, or fighting the thoughts and behaviors. As obsessive-compulsive disorder is defined differently from obsessivecompulsive personality disorder and, of course, from delusional disorder, clinical comorbidity and transitional phenomena are now subject to empirical investigations. The marked homogeneity of the symptoms suggests that obsessive compulsive symptoms are deeply rooted in human nature.

Suicidal behavior in schizophrenia and its relationship to awareness of illness.

Suicidal behavior is prevalent in individuals with schizophrenia. Although a relationship between greater awareness of illness and suicidal behavior has been posited, the question has not been systematically studied. The purpose of this study was to examine the relationship between suicidal behavior and various aspects of insight in 218 patients with schizophrenia. Patients who were participating in the DSM-IV field trial for schizophrenia were assessed with the Scale to Assess Unawareness of Mental Disorder and an instrument that was developed for the field trial study that measured multiple aspects of psychopathology, including suicidal behavior. The prevalence of suicidal thoughts and behavior found in this study was consistent with previous published reports. Schizophrenia patients with recurrent suicidal thoughts and behavior were generally more aware of their negative symptoms and delusions than were nonsuicidal patients. Contrary to expectations, general awareness of having a mental disorder did not predict suicidal behavior. The notion that insight may be associated with greater suicidality was partially supported.

The Neurobiology of Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts and repetitive ritualistic actions. Although symptoms have long been considered symbolic expressions of unconscious issues, recent neuroscientific research has increasingly strengthened a conceptualization of OCD as a neuropsychiatric disorder. Thus, significant advances have been made in understanding both the neurochemical and the neuroanatomical underpinnings of OCD. Ongoing research of particular interest includes investigation of the neuroethology, neuroimmunology, and genetics of OCD. From a clinical perspective, research on OCD has resulted in increased recognition and more effective treatment of the condition, and has shed light on a range of other disorders with overlapping phenomenology. Of even broader interest, the study of OCD allows new insights on general questions in the study of brain-mind interrelationships. NEUROSCIENTIST 2:300-305, 1996

Passages: Three Poems at Thorn Portal

Passages: Three Poems at Thorn Portal

Obsessive–Compulsive Disorder

Within the past decade the field of psychiatry has rediscovered the neuropsychiatric syndrome of obsessive-compulsive disorder (OCD). Although excellently described over 150 years ago, for many years OCD was thought to be rare, untreatable, and to arise from hidden psychodynamic conflicts. All of these earlier ideas now appear to be wrong. Occurring in approximately 2% of adults, OCD consists of recurrent intrusive thoughts (obsessions) or senseless repetitive actions (compulsions). Although the aetiology of OCD remains unclear, recent neuro-imaging studies implicate the basal ganglia and frontal cortex as crucial structures in the pathogenesis of OCD. Genetic studies demonstrate a clear genetic component to OCD and an interesting link with chronic motor tics and the Gilles de la Tourette Syndrome. Although a true cure for the disorder remains elusive, most OCD symptoms respond well to treatment with 5HT reuptake inhibitors. The phenomenology and aetiology of OCD will be reviewed, with particular emphasis placed on the proper pharmacological treatment of this sometimes crippling disorder.

The assessment and management of obsessive‐compulsive disorder

This article describes obsessive-compulsive disorder (OCD) and discusses its diagnosis and its management by behavioural therapy combined with antidepressant medication. Patients with OCD experience recurrent distressing thoughts which may lead them to avoid certain situations and to carry out protective rituals. Behavioural treatment is considered specific. The therapist establishes a relationship with the patient by which he or she can be motivated to cease the thoughts and the avoidance and ritual behaviour. The patient's family can play an important role in the therapy. The treatment is usually easier if the patient can accept taking clomipramine. Patients who, despite severe symptoms, are able to carry out their normal activities usually respond well to treatment. Those who cannot tolerate stress and have had to cease most of their normal activities usually do not respond well and require supportive therapy.

Obsessive-compulsive disorder. How primary care physicians can help.

Obsessive-compulsive disorder is common but not always recognized and treated. Obsessions are recurrent undesirable thoughts or images; compulsions are recurrent undesirable actions. Behavior psychotherapy can be very helpful in controlling compulsions, whereas clomipramine (Anafranil) or fluoxetine (Prozac) therapy can relieve both obsessions and compulsions. Given an understanding of the disorder and its treatment, primary care physicians can, in most cases, effectively diagnose and manage this debilitating condition. Those who do not wish to initiate treatment should refer patients to a mental health professional, as should those who attempt treatment but meet with an unresponsive case.

Remorse and Guilt in Obsessive-Compulsive Disorder

Remorse and guilt are common phenomena among patients suffering from obsessive compulsive disorder. Such individuals are troubled by recurrent intrusive thoughts that they have knowingly or unknowmgly harmed others, and such private events appear to serve as antecedents to certain compulsive rituals centered around acts related to undoing and checking. Clinical research in behavior therapy which focuses upon such psychotherapy patients is described, along with procedural guidelines for their effective treatment.

Assumptive Worlds and the Stress of Traumatic Events: Applications of the Schema Construct

Work on the psychological aftermath of traumatic events suggests that people ordinarily operate on the basis of unchallenged, unquestioned assumptions about themselves and the world. A heuristic model specifying the content of people's assumptive worlds is proposed. The schema construct in social cognition is used to explore the role of these basic assumptions following traumatic events. A major coping task confronting victims is a cognitive one, that of assimilating their experience and/or changing their basic schemas about themselves and their world. Various seemingly inappropriate coping strategies, including self-blame, denial, and intrusive, recurrent thoughts, are discussed from the perspective of facilitating the victim's cognitive coping task. A scale for measuring basic assumptions is presented, as is a study comparing the assumptive worlds of people who did or did not experience particular traumatic events in the past. Results showed that assumptions about the benevolence of the impersonal world, chance, and self-worth differed across the two populations. Findings suggest that people's assumptive worlds are affected by traumatic events, and the impact on basic assumptions is still apparent years after the negative event. Further research directions suggested by work on schemas are briefly discussed.

Etiology and treatment of childhood depression: A biopsychological perspective

Depression in children has become a well-accepted entity today, 1–6 but its existence was denied by even experienced clinicians a generation ago. It is a disorder with diverse physical manifestations. These include disturbances of appetite, abnormalities in body weight, and multiple somatic complaints, such as headaches and vague abdominal 7 and chest pains. 8 The Diagnostic and Statistical Manual of Mental Disorders (3rd ed), (DSM-III), 9 describes the criteria for a diagnosis of major depressive disorder as follows: a dysphoric mood or pervasive loss of interest or pleasure, plus four of the following eight symptoms: (1) changes in appetite or weight, (2) sleep difficulty, (3) loss of energy, (4) psychomotor agitation or retardation, (5) loss of interest or pleasure in usual activities, (6) feelings of self-reproach or guilt, (7) complaints or evidence of diminished ability to concentrate or think, and (8) recurrent thoughts of death or suicide. Although no distinction is made among children, adolescents, and adults concerning the essential features of depressive disorders, the text of DSM-III does describe differences in associated features for different age groups. Affective disorders are classified as either primary or secondary, 10 depending on whether or not the individual had a preexisting psychiatric disorder. 11 Carlson and Cantwell 5 have recently shown that this dichotomy may also be a useful one for childhood depression. Another familiar classification employs the unipolar—bipolar dichotomy. 12,13 The endogenous-reactive classification offers a third, albeit controversial, view of categorizing depressive disorders. 11 Malmquist's 14 classification of depression has as its basis an association with organic disease, deprivation syndrome, difficulty with individuation, latency type, or adolescent types. Currently, affective disorders are considered to comprise a heterogenous group in adults. All of the preceding classification schemes have some 15–26 degree of validation behind them from family studies, natural history studies, biologic correlates, and responses to various types of treatment. In this paper, we discuss the etiology and treatment of childhood depression from both biologic and psychologic perspectives.

Reentry. I. Adjustment issues facing the Vietnam returnee.

With little systematic study or intervention, 3 million Vietnam veterans have returned to the United States in the last ten years. Sixtyfour Vietnam combat returnees, completing their military obligations at a stateside Army post, were interviewed during their initial months of return. Common adjustment issues described by both adjusting and maladjusting veterans included (1)<i>military issues</i>of adjusting to changes in military mission, group support, and leadership; (2)<i>family issues</i>of adjusting to changes in family dynamics and to discrepancies between the fantasied and real homecoming; (3)<i>social issues</i>of adjusting to one's participation in an unpopular war and to increased racial polarization; and (4)<i>emotional issues</i>of adjusting to changes in temperament, to recurrent thoughts and feelings about the Vietnam experience, and, for some, to changes in drug use patterns.