Compulsive Severity Research Articles

Increased Plasma Nesfatin-1 Levels in Patients with Obsessive Compulsive Disorder

ABSTRACTObjective: To determine and compare the plasma nesfatin-1 (a satiety peptide) levels of patients with obsessive compulsive disorder (OCD) and healthy control subjects.Method: Plasma nesfatin-1 levels of 31 patients with OCD (18 females, 13 males) and 28 healthy control subjects (16 females and 12 males) similar to the study group in terms of weight, age, and gender were measured in this study. Severity of obsessions and compulsions both in OCD patients and control subjects were determined by using Yale-Brown Obsessive Compulsive Scale (Y-BOCS). ELISA method was used to measure plasma nesfatin-1 levels.Results: Median plasma nesfatin-1 levels in patients with OCD and healthy control subjects were 4.61 ng/ml (min-max: 1.28-8.11) and 2.0 ng/ml (min-max: 0.11-4.98) respectively. The observed difference in plasma nesfatin-1 levels between two groups was statistically significant (p<0.001). No statistically significant correlation was observed between Y-BOCS scores and plasma nesfatin-1 levels either in...

Predictors of Parental Accommodation in Pediatric Obsessive-Compulsive Disorder: Findings from the Pediatric Obsessive-Compulsive Disorder Treatment Study (POTS) Trial

Few studies have examined predictors of parental accommodation (assessed with the Family Accommodation Scale-Parent Report) among families of children with obsessive-compulsive disorder (OCD). No studies have examined this phenomenon using empirically derived subscales of the Family Accommodation Scale-Parent Report (i.e., Caregiver Involvement, Avoidance of Triggers). Ninety-six youths (and their families) were included in the present study. Parents were asked to complete the Family Accommodation Scale-Parent Report. Families also completed several additional measurements assessing child- and parent-level variables of interest. Regression analyses were used to examine potential predictors of accommodation. Results support prior research suggesting that accommodation is ubiquitous among the families of children with OCD. Analyses revealed that several child-level (i.e., compulsion severity, oppositional behavior, and frequency of washing symptoms) and one parent-level (i.e., symptoms of anxiety) predictors work jointly to provide significant predictive models of parental accommodation. Clinicians and researchers should be aware of the impact of specific child- and parent-level variables on family accommodation in pediatric OCD and in turn their implications for treatment compliance, adherence, and, by extension, outcome. Study limitations warrant replication and extension of these findings; in particular, researchers may seek to obtain a better understanding of how the various facets of parental accommodation may differentially affect treatment.

Phenomenology of Comorbid Autism Spectrum and Obsessive-Compulsive Disorders Among Children

The occurrence of obsessive-compulsive disorder (OCD) in youth with autism spectrum disorders (ASD) is common (37% prevalence or higher) and results in additional distress and impairment. The phenomenology of OCD in youth with ASD is under-researched to date. This study compared the clinical characteristics of youth with comorbid ASD and OCD (ASD + OCD) with age and gender matched controls with OCD in 70 youth (7–13 years old). Youth with both syndromes did not present with more severe OCD symptoms. Obsessive-compulsive symptom severity and total number of obsessions and compulsions between the ASD + OCD group and the OCD group did not differ statistically. However, group differences in reports of specific OCD symptoms as well as patterns of comorbidity were identified. Attention deficit/hyperactivity symptoms, social phobia, and separation anxiety disorder were more common among youth with ASD + OCD. Better understanding of OCD/ASD co-morbidity may facilitate treatment development.

Basal ganglia dysfunction in OCD: subthalamic neuronal activity correlates with symptoms severity and predicts high-frequency stimulation efficacy

Functional and connectivity changes in corticostriatal systems have been reported in the brains of patients with obsessive–compulsive disorder (OCD); however, the relationship between basal ganglia activity and OCD severity has never been adequately established. We recently showed that deep brain stimulation of the subthalamic nucleus (STN), a central basal ganglia nucleus, improves OCD. Here, single-unit subthalamic neuronal activity was analysed in 12 OCD patients, in relation to the severity of obsessions and compulsions and response to STN stimulation, and compared with that obtained in 12 patients with Parkinson's disease (PD). STN neurons in OCD patients had lower discharge frequency than those in PD patients, with a similar proportion of burst-type activity (69 vs 67%). Oscillatory activity was present in 46 and 68% of neurons in OCD and PD patients, respectively, predominantly in the low-frequency band (1–8 Hz). In OCD patients, the bursty and oscillatory subthalamic neuronal activity was mainly located in the associative–limbic part. Both OCD severity and clinical improvement following STN stimulation were related to the STN neuronal activity. In patients with the most severe OCD, STN neurons exhibited bursts with shorter duration and interburst interval, but higher intraburst frequency, and more oscillations in the low-frequency bands. In patients with best clinical outcome with STN stimulation, STN neurons displayed higher mean discharge, burst and intraburst frequencies, and lower interburst interval. These findings are consistent with the hypothesis of a dysfunction in the associative–limbic subdivision of the basal ganglia circuitry in OCD's pathophysiology.

Objective sleep patterns and severity of symptoms in pediatric obsessive compulsive disorder: A pilot investigation

Sleep disturbances are common among youth with anxiety disorders, yet objective assessments of sleep in children with obsessive compulsive disorder (OCD) have been the focus of scant research. We therefore compared a small group of non-medicated, non-depressed children with primary OCD (ages 7–11 years) to matched healthy controls using home-based actigraphy during a 7-day prospective assessment. Validated parent and child sleep measures also were collected, and associations among objective sleep variables and severity of obsessions and compulsions were examined. We found significantly fragmented sleep patterns in the OCD group compared to controls including reduced total sleep time (TST) and longer wake periods after sleep onset. Severity of compulsions showed a significant negative correlation with TST. These preliminary findings indicate the presence of sleep abnormalities in pre-pubescent OCD patients with potential implications for future examinations of early developmental processes and features of the disorder.

Case Series of Behavioral Psychotherapy for Obsessive-Compulsive Symptoms in Youth with Prader-Willi Syndrome

Obsessive-compulsive symptoms among youth with Prader-Willi Syndrome (PWS) are frequently present and associated with considerable problems in the daily functioning of the child and his/her family. Although pharmacological and psychosocial treatments exist that target obsessive-compulsive symptoms among typically developing youth, these treatments have not been systematically adapted and/or evaluated for this population. Furthermore, although psychotropic medications have shown promising support in addressing obsessive-compulsive symptoms in several case reports involving youth with PWS, associated efficacy is modest and potential for side effects is a realistic concern. Given efficacy and tolerability of cognitive-behavioral treatment for obsessive-compulsive symptoms in typically developing youth, an adapted version of this approach may hold promise in treating clinically problematic obsessive-compulsive symptoms in youth with PWS. Thus, we report on a case series of behavioral treatment for obsessive-compulsive symptoms in three youth with PWS. Diagnostic and symptom severity assessments were conducted at screening, pre-treatment, and post-treatment by a trained independent evaluator. All youth were considered treatment responders and exhibited meaningful reductions in compulsion severity, overall obsessive-compulsive severity, and obsessive-compulsive related impairment. These data provide preliminary evidence for the utility of behavioral therapy in treating obsessive-compulsive symptoms in youth with PWS.

Childhood trauma in obsessive compulsive disorder: The roles of alexithymia and attachment

The aim of this study was to investigate the interrelationships between childhood trauma, attachment, alexithymia, and the severity of obsessive compulsive disorder (OCD) in a cohort of participants with OCD. There is a growing body of research linking traumatic experiences in childhood with the development of OCD. The mechanisms involved in this association are not yet clear. The sample was comprised of 82 people with OCD and 92 comparison participants. A cross-sectional design was used, utilizing internet-mediated administration of the Childhood Trauma Questionnaire - revised (CTQ-R); the Yale-Brown Obsessive Compulsive Scale - Self-Report (Y-BOCS-SR); the Experiences in Close Relationships Scale (ECR); and Toronto Alexithymia Scale (TAS-20). Partial least squares (PLS) analysis was used to determine significant paths between the constructs. Results of PLS analysis supported all of the hypotheses made: there was a significant positive correlation between childhood trauma and attachment avoidance, which in turn was significantly positively associated with alexithymia. Alexithymia was significantly associated with the severity of OCD symptoms and the number of OCD symptoms. Mediational analysis showed that alexithymia significantly carried an influence from attachment avoidance to the severity of obsessions and the number of obsession symptoms. There is a relationship between childhood trauma and OCD, however this relationship is not direct in nature but is influenced by peoples' past experiences with significant others and associated difficulties in emotional processing.

Mechanisms of symptom reduction in treatment for obsessions.

We explored the dynamic relationship between cognition and obsession severity during 2 different treatments for primary obsessions, examining evidence for the hypothesis that symptom reduction would be mediated by appraisals about the meaning of unwanted intrusive thoughts. Data from a recent randomized controlled trial were analyzed with traditional mediation analyses and latent difference scores. The trial had compared cognitive behavioral therapy and stress management training among 73 patients with primary obsessions. Mediation analyses were conducted with pre-, post-, and follow-up scores on the Obsessions subscale of the Yale-Brown Obsessive Compulsive Scale and 2 self-report measures of cognitions related to obsessive-compulsive disorder. Bivariate dual change score (BDCS) analyses were conducted with weekly assessments of obsession severity and appraisals of personal significance. Change in most cognitions related to obsessive-compulsive disorder accounted for reduction in obsession severity during the course of treatment and follow-up. BDCS analyses of the longitudinal data, however, indicated prior obsession severity is a leading indicator of subsequent change in appraisals, rather than the reverse. Analyses also suggested cognitive behavioral therapy is more effective than stress management training when symptoms are severe and that stress management training is more advantageous in the context of mild-to-moderate obsessions. The traditional mediation analysis indicated that appraisal change is a tenable mediator of obsession reduction, but the BDCS results raise doubts about the causal direction. The results highlight the importance of examining the dynamic relationship between putative mediators and outcome variables, and they suggest interesting hypotheses about mechanisms in treatment of obsessions.

Effects of selective serotonin reuptake inhibitors on thought-action fusion, metacognitions, and thought suppression in obsessive-compulsive disorder

Objective We aimed to assess whether cognitive processes change over time in patients with obsessive-compulsive disorder (OCD) receiving selective serotonin reuptake inhibitors without cognitive behavioral therapy and to investigate the factors associated with probable cognitive changes. Methods During the 16 weeks of the study, 55 patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for OCD received open-label treatment with sertraline (100-200 mg/d) or fluoxetine (40-80 mg/d) and were assessed using the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), and White Bear Suppression Inventory (WBSI). Results The Yale-Brown Obsessive-Compulsive Scale ( P < .001), BDI ( P < .001), TAFS morality ( P < .005), MCQ-30 ( P < .01), and WBSI ( P < .005) scores at follow-up were significantly lower than baseline scores. When we excluded OCD patients with depressive disorder (n = 12), statistical significance in paired comparisons for MCQ and WBSI disappeared. Similarly, when OCD patients with religious obsessions (n = 16) were excluded, paired comparisons for MCQ and TAF morality were not statistically significant. Changes in BDI, TAFS morality, MCQ-30, and WBSI ( P < .005) were significantly correlated with changes in severity of obsessions, but not that of compulsions. After controlling for the change in depression severity, significant correlations between changes in obsessive and cognitive scales did not continue to have statistical significance. The BDI changes ( P < .05) significantly explained the changes in symptom severity in a linear regression model. Conclusions Our findings suggest that selective serotonin reuptake inhibitors can change appraisals of obsessive intrusions via their effects on negative emotions.

Obsessions and worry beliefs in an inpatient OCD population

Dysfunctional beliefs in obsessive–compulsive disorder (OCD) and worry are thought to contribute to vulnerability and maintenance of pathological anxiety. In this study, five belief domains concerning responsibility/threat estimation, perfectionism, intolerance of uncertainty, importance/control of thoughts and thought–action fusion were examined to see whether they differentially predicted worry and obsession severity in patients with severe OCD. Correlational analysis revealed that perfectionism and intolerance of uncertainty were associated with worry, whereas beliefs in the importance and control of thoughts and thought–action fusion were associated with obsession severity when obsession severity and worry, respectively, were controlled. In regression analyses, thought–action fusion and intolerance of uncertainty predicted OCD severity. The relation between dysfunctional beliefs and specific subtypes of OCD symptoms was also examined. Specific relationships were identified, including perfectionism with ordering, obsessions with control/importance of thoughts and checking and washing with threat estimation.

Bradykinesia in patients with obsessive-compulsive disorder

Objective To investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features. Methods We studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness. Results Of the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test. Conclusions Clinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores.

Problematic Internet use: is it more compulsory than rewarding or mood driven?

Internet represents the most important product of cultural industry in the mass society, and at the same time the ultimate threatening to the intimate space of subjectivity. Nonetheless, for most of us, it is just an unavoidable part of daily rituality. A few years ago, L. Wittgenstein stated that newspaper reading has replaced the morning prayer in the modern age. Today we could state that the laptop screen has replaced the tabernacle. Nowadays Internet dysfunctional use is a true concern. In a sample of Italian students 1, we found that 5.6% were addicted to Internet according to the Internet Addiction Scale, and more than 15%, when interviewed by the PROMIS Questionnaire, reported they were disturbed by compulsive submissive or dominant repetitive behavior (including Internet chatting and mobile phone messaging). All these compulsions were strongly related to substance addiction, such as alcohol or drug use. The distinction between physiological and pathological use of electronic media is, socially, a matter of quantity of time consumed and related social impairment. From the subjective viewpoint, the first signs are the psychological changes occurring in the virtual world (online disinhibition and increased risk-taking behaviors), along with the occurrence of dissociative experiences up to “loss of control”. In a recent study 2, we found that the severity measures of Internet addiction were positively correlated with perceived impairment of functioning in the family context (r = 0.814; p≤0.001) and Yale-Brown Obsessive Compulsive severity score (r = 0.771; p≤0.001). Scores on the Dissociative Experience Scale were higher than expected (23.2±1.8) and were related to higher obsessive compulsive scores (r = 0.618; p≤0.001), increased hours per week on the Internet (r = 0.749; p≤0.001), and a higher perceived impairment of functioning in the family context (r = 0.677; p≤0.001). From a phenomenological point of view, Internet addiction in our sample seemed to be more compulsory than rewarding or mood driven. The main attractiveness of Internet appeared to be emotional detachment. It remains unclear whether Internet problematic use should be included among impulse control or addictive disorders. It will be useful in this respect to investigate the brain mechanisms and candidate endophenotypes (especially the number of D2 receptors in the mesocorticolimbic system and their downregulation after stimulation of the system). This could help us to develop effective strategies to prevent and treat the disorder both pharmacologically and behaviourally.

Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive–Compulsive Scale

Background Preliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version. Methods Participants included 86 individuals with a principal diagnosis of obsessive–compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview. Results The two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings. Conclusions The study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods.

Evidence for specific cognitive deficits in visual information processing in patients with OCD compared to patients with unipolar depression

Objective Neuropsychological studies comparing cognitive performance in patients suffering from Obsessive-Compulsive Disorder (OCD) or Major Depressive Disorder (MDD) revealed deficits in the domains of verbal fluency and viso-motor speed/set shifting in both groups. Spatial working memory deficits, however, have been identified as specific markers of OCD. As yet, it has not been substantiated whether deficits in visual organization and complex visual memory are also specific to OCD and are not shared by MDD. Method Test performance in seven cognitive domains was assessed in 40 OCD patients, 20 MDD patients, and 40 healthy controls. Patient groups were matched according to severity of depressive symptoms. Results Deficits shared by both patient groups, as compared to controls, were found in delayed spatial recall and verbal fluency while verbal memory was normal in both patient groups. Only patients with OCD, but not MDD patients were impaired in the domains visual memory, viso-motor speed/set shifting, visual organization, and problem solving. In addition, OCD patients differed significantly from MDD subjects in visual organization and problem solving. Visual organization scores correlated significantly with severity of current compulsions in the OCD group ( r = −.324). Conclusions OCD patients demonstrate difficulties in visual organization and mental manipulation of complex visual material, which are not accounted for by depressive symptoms and which constitute a specific cognitive deficit of the disorder.

Neurocognitive Performance in Children with ADHD and OCD

Attention-deficit/hyperactivity Disorder (ADHD) and obsessive-compulsive disorder (OCD) have both been linked to dysfunction in the cortico-striato-thalamo-cortical circuitry (CSTCC). However, the exact nature of neurocognitive deficits remains to be investigated in both disorders. We applied two neuropsychological tasks that tap into different functions associated with the CSTCC, namely a serial reaction time (SRT) task, developed to assess implicit sequence learning, and a delay aversion (DA) task in order to assess abnormal motivational processes. The performance data of boys with ADHD (n=20), OCD (n=20) and healthy controls (n=25), all aged 10-18 years, were compared. Subjects with ADHD less frequently chose the larger, more delayed reward compared to those with OCD and controls, while subjects with OCD showed impaired implicit learning. In contrast, the ADHD group was unimpaired in their implicit learning behavior and the OCD group was not characterized by a DA style. Within the OCD-group, severity of obsessions was associated with implicit learning deficits and impulsive symptoms with DA in the ADHD-group. This double dissociation highlights the distinct cognitive dysfunctions associated with ADHD and OCD and might possibly point to different neural abnormalities in both disorders.

Development and psychometric evaluation of the Yale–Brown Obsessive-Compulsive Scale—Second Edition.

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989) is acknowledged as the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity. A number of areas where the Y-BOCS may benefit from revision have emerged in past psychometric studies of the Severity Scale and Symptom Checklist. Therefore, we created the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) by revising the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format. One hundred thirty treatment-seeking adults with OCD completed a battery of measures assessing OCD symptom severity and typology and depressive and anxious symptomology. Interrater and test-retest reliability were assessed on a subsample of participants. The Y-BOCS-II showed strong internal consistency for the Symptom Checklist (Kuder-Richardson-20 = .91) and Severity Scale (alpha = .89). Test-retest and interrater reliabilities were both high (intraclass correlations > .85). Confirmatory factor analyses did not show adequate fit with previous models of the Y-BOCS. Exploratory factor analysis revealed a two-factor solution generally consistent with the Obsession and Compulsion Severity subscales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of worry and depressive symptoms. Taken together, the Y-BOCS-II has excellent psychometric properties in assessing the presence and severity of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS-II may provide an alternative method of assessing symptom presence and severity.

Which clinical and demographic factors predict poor insight in individuals with obsessions and/or compulsions?

This study examined clinical and demographic predictors of poor insight in individuals with obsessions and/or compulsions. It was hypothesized that a combination of factors would explain variance on two measures of insight. Ninety-four individuals with obsessive–compulsive symptoms participated in a cross-sectional questionnaire-based design, completing measures relating to obsessions and compulsions, depression and anxiety levels, and demographic and clinical information. Results revealed that although demographic factors did not predict poor insight, clinical and comorbid variables as an overall model did. More comorbidities and ordering compulsions independently predicted poor insight, particularly when accompanied by high anxiety and high severity of compulsions. These findings highlight four clinical factors that could act as indicators of poor insight for clinicians when assessing individuals for therapy, since insight itself is difficult to assess accurately. Limitations and implications for future research are discussed.

Yale-Brown Obsessive Compulsive Scale: Psychometric Properties of the Self-Report Version in a Student Sample

The aim of the present study was to investigate the psychometric properties of an Icelandic translation of the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). The Y-BOCS-SR was administered to a sample of 427 Icelandic university students along with another measure of OCD symptoms (OCI-R) and measures of general anxiety and worry (GAD-Q-IV and PSWQ). The internal consistency of the Y-BOCS-SR total severity score and its obsession and compulsion subscales was very good. Confirmatory factor analysis supported the original two- factor structure of the severity dimensions but a three-factor model with obsession, compulsion and resistance/control factors fitted the data equally well. Five factors described best the latent structure of the symptom dimensions. Support was found for the convergent and divergent validity of the Y-BOCS-SR. The results indicate that the Y-BOCS-SR is a reliable and valid instrument for assessing the severity of obsessions and compulsions in a student population.

Internet addiction: a descriptive clinical study focusing on comorbidities and dissociative symptoms

Aims Internet addiction (IAD) is an emerging cause of morbidity and has been recently considered to merit inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Given the paucity of knowledge about IAD, we conducted a descriptive clinical analysis of patients focusing on clinical, demographic features, and comorbidities. The detachment has been suggested as a reason for the attractiveness of the Internet; thus, we assessed dissociative symptoms and their association with IAD disability. Design and Setting A cohort of 50 adult outpatients were screened using the Internet Addiction Scale . Exclusion criterion was using the Internet for only one purpose such as gaming or gambling. Participant Nine women and 6 men constituted the sample of Internet addicts; each of them had a score of 70 or higher on the Internet Addiction Scale. Measurement Comorbidities and subthreshold symptoms were screened carefully. Dissociative symptoms were analyzed with the Dissociative Experience Scale, and disability was assessed using the Sheehan Disability Scale. Findings Hours/week spent on the Internet were 42.21 ± 3.09. Clinical diagnoses included 14% attention deficit and hyperactivity disorder, 7% hypomania, 15% generalized anxiety disorder, 15% social anxiety disorder; 7% dysthymia, 7% obsessive compulsive personality disorder, 14% borderline personality disorder, and 7% avoidant personality disorder. One patient met criteria for binge eating disorder. Severity measures of IAD were associated with higher perception of family disability ( r = 0.814; P ≤ .001) and with higher Yale-Brown Obsessive Compulsive Severity score ( r = 0.771; P ≤ .001). Scores for the Dissociative Experience Scale were higher than expected (23.20 ± 1.83) and were related to higher obsessive compulsive scores ( r = 0.618; P ≤ .001), hours per week on the Internet ( r = 0.749; P ≤ .001), and perception of family disability ( r = 0.677; P ≤ .001). Conclusion From a phenomenological point of view, IAD in our sample population seems to be more compulsory than rewarding or mood driven. Dissociative symptoms are related to severity and impact of IAD.

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

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