Yale-Brown Obsessive-Compulsive Scale Checklist Research Articles

Effectiveness of clozapine on quality of life and functioning in patients with treatment-resistant schizophrenia

Background Although it is well known that treatment with clozapine is associated with improvement in core symptoms of schizophrenia, little information is available about its impact on other outcome variables. Accordingly, this study aimed to evaluate the short term (3 months) effectiveness of clozapine in patients with treatment-resistant schizophrenia (TRS) in terms of quality of life, disability, and level of functioning. Methods This naturalistic follow-up study evaluated 52 participants at the baseline and three months (±1 week) after initiation of clozapine (prospective assessment) on Positive and Negative Syndrome Scale for schizophrenia, Calgary Depression Scale for Schizophrenia, Yale-Brown Obsessive-Compulsive Scale Checklist and Scale, Clinical Global Impression (CGI) scale, Beck Cognitive Insight Scale (BCIS), Scale to Assess Unawareness of Mental Disorders (SUMD), Social Occupational Functioning Scale – SOFS, Functioning Assessment Short Test (FAST), Indian Disability Evaluation and Assessment Scale (IDEAS), World Health Organisation Quality Of Life–BREF (WHOQOL-BREF) and Self-report Quality of Life Measure for people with schizophrenia. Results Treatment with clozapine led to significant improvement in the quality of life, functioning, and disability; reduction in psychopathology (positive, negative, general psychology, depression), the severity of illness, compulsive behavior, and improvement in insight including cognitive insight. Conclusions Treatment with clozapine leads to improvement in core symptoms of schizophrenia and is also associated with significant improvement in the quality of life, functioning, and disability.

Psychometric evaluation of the Vancouver Obsessional-Compulsive Inventory (VOCI) and its adaptation based on the DSM-5 in Iranian patients with obsessive-compulsive disorder

abstract The Vancouver Obsessional-Compulsive Inventory (VOCI) was validated in Iranian non-clinical individuals, but not in patients with obsessive-compulsive disorder (OCD). Accordingly, this study aims to further evaluate the six-factor first-order and one-factor second-order structures, validity, and reliability of the scale and also to adapt this scale to the DSM-5 recommendations regarding hoarding behavior in Iranian OCD patients. Three hundred and sixty patients completed the VOCI, the Dimensional Obsessive-Compulsive Scale (DOCS), the Yale-Brown Obsessive Compulsive Scale checklist (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R); the Penn State Worry Questionnaire (PSWQ-SF), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Results showed that the six-factor first-order model of the VOCI had acceptable fit, while the five-factor first-order model had more appropriate fit by deleting the hoarding subscale's items. Also, one-factor second-order structure of the scale has been found to have an adequate fit. In addition, reliability and convergent and discriminant validity of the VOCI have been found to be good. The findings indicate that although the VOCI with the six-factor first-order and one-factor second-order structures is a valid scale in Iranian OCD patients, the VOCI adapted to the DSM-5 is more reliable to be used in Iranian community.

Neurological soft signs and insight in obsessive–compulsive disorder

Background Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by the presence of obsessions and compulsions that interfere with the patient’s life. It has been shown that patients with OCD have increased rates of neurological soft signs (NSS) when compared with healthy controls. NSS are minor abnormalities like poor motor coordination, sensory and perceptual difficulties, and difficulties in sequencing of complex motor tasks. It has been suggested that OCD patients with poor insight are at the most severe end of this spectrum. Aim of the work The aim of this study was to determine the frequency pattern of symptoms (obsessions and compulsions) in OCD patients, to examine NSS in patients compared with healthy individuals, and find any correlation between NSS scores and the severity of OCDs [total Yale Brown Obsessive Compulsive Scale (YBOCS) score] and the degree of insight. Participants and methods The study included two groups: 30 OCD patients and 30 healthy individuals as controls. Both groups were subjected to psychiatric and neurological examination using the Cambridge Neurological Inventory (Part 2), the YBOCS checklist to detect types of obsessions and compulsions, and the Overvalued Ideas Scale to assess the degree of insight in OCD patients. Results The most common types of obsessions and compulsions among the patients were religious (70%), contamination (77%), and cleaning compulsions (77%). OCD patients recorded significantly higher total scores of NSS and domain scores (motor coordination, sensory integration, and primitive reflexes) compared with the control group (P Conclusion We conclude that OCD patients have higher scores for NSS compared with controls, particularly for motor coordination signs. NSS positively correlated with the severity of disease. There was a positive correlation between NSS scores and OVIS scores, which measures the degree of insight.

Latent class analysis of obsessive–compulsive symptoms in a clinical sample

ObjectiveObsessive–compulsive disorder (OCD) is probably a heterogeneous condition. To date, research investigating the symptom structure of OCD has generally focused on variable-classification approaches, primarily factor analysis. Our aim was to use the latent class analysis, an advanced individual-classification method, in order to define homogeneous sub-groups based on the Yale–Brown Obsessive–Compulsive Scale Check List (Y-BOCS CL) assessments within 193 outpatients with OCD. MethodLatent class analysis of 13 obsessive–compulsive symptom-clusters measured by the Yale–Brown Obsessive–Compulsive Scale Check List was performed. Associations of demographic and clinical features with latent class membership were tested by using logistic regression models. Differences in severity of obsessive–compulsive symptoms, obsessive beliefs, and depressive symptomotology between latent classes were evaluated with the chi-square likelihood test. ResultsLatent class analysis models of best fit yielded 3 latent classes: “autogenous obsessions”, “reactive obsessive–compulsive”, and “reactive obsessions”. Outpatients in reactive obsessive–compulsive group reported significantly higher scores on the Y-BOCS global, obsessions, and compulsions scales than outpatients in other two sub-groups. Participants in reactive obsessive–compulsive group were predominantly female, single, and had a history of family psychopathology; whereas autogenous and reactive obsessions groups were predominantly male. There were no differences in severity of depression and obsessive belief domains. ConclusionsThe results provide support for the validity of autogenous/reactive distinction for OCD. These three classes may have important implications for research and clinical purposes.

Study of symptom dimensions and clinical characteristics in Chinese patients with OCD

BackgroundThe current study explored the main symptom dimensions and clinical characteristics of obsessive-compulsive disorder (OCD) in Chinese patients. MethodsObsessive-compulsive (OC) symptoms of participants (N=512) were assessed through the Yale–Brown Obsessive Compulsive Scale Checklist (YBOCS-CL). Exploratory category-level and item-level factor analyses were performed. Regression analysis was carried out to study the relationships between clinical characteristics in our sample and the symptom dimensions obtained. Relationships among the clinical characteristics were explored using the chi-square test. ResultsWe found five symptom dimensions in the category-level analysis and six similar symptom dimensions in the item-level analysis. Moreover, the factors identified in our study overlapped with the results of prior studies. Association between gender and the symptom dimension of ‘contamination/cleaning’ was observed, with females showing more significant association with this dimension than males. Age of onset was associated with the symptom dimension of ‘symmetry/arranging/repeating/counting’, with the early-onset group more actively associated with this dimension than the late-onset group. Early-onset patients with OCD were more likely to be male and show tic comorbidity. LimitationsData from only one site do not represent the full range of Chinese OCD patients. Furthermore, past symptoms may show memory bias. Inherent problems in the YBOCS-CL have also been identified. ConclusionSymptoms in Chinese OCD patients are multidimensional. The main components of symptom dimensions of OCD patients show similarity or consistency among different regions and sociocultural backgrounds. The pathogenic mechanism of OCD may show potential distinctions.

Quetiapine augmentation of serotonin reuptake inhibitors in treatment-refractory obsessive–compulsive disorder

Several studies have examined the predictors of treatment response in obsessive-compulsive disorder (OCD). Only limited information is available on the predictors of response to antipsychotic augmentation of serotonin reuptake inhibitors (SRIs). Data from placebo-controlled studies of augmentation with quetiapine were combined in a best subsets logistic regression to derive a predictive model for Yale-Brown obsessive-compulsive scale (YBOCS) change and the YBOCS endpoint. Data from the YBOCS checklist and a variety of clinical and demographic variables previously shown to predict treatment outcome in OCD were analysed. In univariate analyses, the failure of fewer previous SRI trials was associated with the YBOCS response. In the multivariate model, for YBOCS change, 45% of the variance was attributed to the fact that patients had failed fewer previous SRI treatments, had higher baseline obsession scores, and ordering and arranging compulsions. For the YBOCS endpoint scores, 50% of the variance was attributed to the fact that patients had fewer failed SRI trials, higher baseline compulsion scores, and counting/ordering and arranging compulsions. These data indicate a number of predictors of response to augmentation of SRIs in treatment-refractory OCD. These include fewer previously failed SRI trials and generally higher overall baseline scores for obsessions and compulsions as well as counting/ordering and arranging compulsions. Other factors are, however, also likely to play an important role in predicting outcome.

Factor Analysis of Repetitive Behaviors in Autism as Measured by the Y-BOCS

The authors carried out a factor analysis of the Yale-Brown Obsessive-Compulsive Scale checklist at the category level in order to reduce the number of variables in this domain and ultimately identify possible endophenotypes; 181 children with autism were enrolled. The authors estimated a tetrachoric correlation matrix among the dichotomous symptom categories and then used exploratory and confirmatory factor analyses to identify a clinically meaningful factor structure for this correlation matrix. Their analysis supported a four-factor solution: obsessions, higher-order repetitive behaviors, lower-order repetitive behaviors, and hoarding. These findings are another step in the effort to identify genetically and biologically distinct groups within this population.

Symptom Dimensions in OCD: Item-Level Factor Analysis and Heritability Estimates

To reduce the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) for genetic, clinical and translational studies, numerous factor analyses of the Yale-Brown Obsessive Compulsive Scale checklist (YBOCS-CL) have been conducted. Results of these analyses have been inconsistent, likely as a consequence of small sample sizes and variable methodologies. Furthermore, data concerning the heritability of the factors are limited. Item and category-level factor analyses of YBOCS-CL items from 1224 OCD subjects were followed by heritability analyses in 52 OCD-affected multigenerational families. Item-level analyses indicated that a five factor model: (1) taboo, (2) contamination/cleaning, (3) doubts, (4) superstitions/rituals, and (5) symmetry/hoarding provided the best fit, followed by a one-factor solution. All 5 factors as well as the one-factor solution were found to be heritable. Bivariate analyses indicated that the taboo and doubts factor, and the contamination and symmetry/hoarding factor share genetic influences. Contamination and symmetry/hoarding show shared genetic variance with symptom severity. Nearly all factors showed shared environmental variance with each other and with symptom severity. These results support the utility of both OCD diagnosis and symptom dimensions in genetic research and clinical contexts. Both shared and unique genetic influences underlie susceptibility to OCD and its symptom dimensions.

Symptom clusters in obsessive–compulsive disorder (OCD): influence of age and age of onset

Obsessive-compulsive disorder (OCD) is an ailment of heterogeneous nature. It is believed that the age of onset determines the subtype of juvenile OCD. The objective of our study was to evaluate the rates of symptoms' contents and the age of manifestation of the various OCD symptoms in adolescents and adults with early and late onset of disorder. Both authors independently reviewed the medical charts of patients treated for OCD between 1999 and 2007 in a psychiatric university hospital. Patients were evaluated using the Yale-Brown obsessive-compulsive scale check list (Y-BOCS). The patients were grouped as adolescents (group 1), adults with late onset (group 2) and adults with early onset (group 3). Chi2 was used for nominal variables and the non-parametric Kruskal-Wallis ANOVA for continuous comparisons due to deviations from normality of distribution. A total of 132 patients were enrolled in the study (44 group 1, 43 group 2 and 45 group 3). There were no differences in gender distribution. Religious, sexual and miscellaneous obsessions were more frequent and somatic less frequent in group 1 than in group 2. Contamination compulsions were most seldom found in group 1. Cleaning obsessions were more frequent in group 3 than in group 1. Checking were the rarest and miscellaneous, the most often compulsion among adolescents in comparison to other groups. The symptoms' content in adolescents differed from those observed in adult, both with early and later onset of the disease. The age at onset influences the rates of adult patients' compulsions.

Temperament and character in subjects with obsessive-compulsive disorder

Background The aims of this study were to evaluate the differences between personality traits of patients with obsessive-compulsive disorder (OCD) and normal controls using the Temperament and Character Inventory (TCI) and to examine the relationship of personality traits and the severity of obsessive-compulsive (OC) symptoms. We also aimed to examine the influence a particular personality trait might have on the 5 factor-analyzed symptom dimension scores of OCD. Method We recruited 130 patients with OCD and 185 age- and sex-matched normal controls. All subjects completed the TCI. Patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale, and the factor-analyzed symptom dimension scores from the Y-BOCS checklist. Results Patients with OCD had higher harm avoidance scores and lower self-directedness (SD), reward dependence (RD), and cooperativeness (C) scores than the controls. Lower SD scores and lower C scores were associated with OC symptom severity measured by the Y-BOCS after adjusting for age and depression severity. Hoarding dimension of OC symptoms was associated with lower SD scores and higher persistence (P) scores after adjusting for age, OC symptom severity, and depression severity. Conclusions There were significant differences in TCI subscales between patients with OCD and controls. Particular personality traits may have an influence on the severity and the dimensions of OC symptoms.

Escitalopram in Obsessive-Compulsive Disorder:Response of Symptom Dimensions to Pharmacotherapy

There is a substantial body of evidence that obsessive-compulsive disorder (OCD) symptoms can be grouped into a series of discrete dimensions, and some evidence that not all OCD symptom dimensions respond equally well to pharmacologic or psychotherapeutic intervention. The response of OCD symptom dimensions to 12 weeks of treatment with escitalopram or placebo was investigated. Data from a randomized, double-blind, placebo-controlled study of escitalopram in 466 adults with OCD were analyzed. Exploratory factor analysis of individual items of the Yale-Brown Obsessive-Compulsive Scale checklist was performed and subscale scores based on the extracted factors were determined. Analyses of covariance were undertaken to determine whether inclusion of each subscale score in these models impacted on the efficacy of escitalopram versus placebo. Exploratory factor analysis of individual Yale-Brown Obsessive-Compulsive Scale items yielded 5 factors (contamination/cleaning, harm/checking, hoarding/symmetry, religious/sexual, and somatic/hypochondriacal). Analyses of covariance including all the subscales demonstrated that escitalopram was more effective than placebo. There was a significant interaction for the hoarding/symmetry factor, which was associated with a poor treatment response. Escitalopram shows good efficacy across the range of OCD symptom dimensions. Nevertheless, hoarding/symmetry was associated with a poorer treatment response. Hoarding/symmetry may be particularly characteristic of an early-onset group of OCD patients, with the involvement of neurotransmitters other than serotonin. Further work is needed to delineate fully the subtypes of OCD, and their correlates with underlying psychobiology and treatment responsivity.

Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo

There is increasing evidence that the symptoms of obsessive-compulsive disorder lie on discrete dimensions. Relatively little work has, however, explored the relationship between such factors and response to pharmacotherapy. Data from a multi-site randomized placebo-controlled study of citalopram in obsessive-compulsive disorder were analyzed. Factor analysis of individual items and symptom categories of the Yale-Brown Obsessive-Compulsive Scale Checklist were undertaken, and the impact of symptom dimensions on treatment outcomes was analysed. Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist individual items yielded 5 factors (contamination/cleaning, harm/checking, aggressive/sexual/religious, hoarding/symmetry, and somatic/hypochondriacal). Hoarding/symmetry was associated with male gender, longer duration of obsessive-compulsive disorder and early onset, whereas contamination/cleaning was associated with female gender. Citalopram was more effective than placebo, but high scores on the symmetry/hoarding and contamination/cleaning subscales predicted worse outcome at the end of study while high scores on the aggressive/religious/sexual subscale predicted better outcome. Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist symptom clusters yielded a 4 factor solution, but confirmed that symmetry/ordering was associated with male gender, early onset, and long duration of obsessive-compulsive disorder while high scores on the hoarding subscale predicted worse response to pharmacotherapy. Citalopram shows good efficacy across the range of obsessive-compulsive disorder symptom dimensions. The relatively worse response of symmetry/hoarding to a selective serotonin reuptake inhibitor is consistent with other evidence that this symptom dimension is mediated by the dopamine system. There may be associations between symmetry/hoarding, male gender, early onset, tics, and particular genetic variants; further work is, however, needed to delineate fully obsessive-compulsive disorder subtypes and their underlying neurobiology.

Neurological Soft Signs in Schizophrenia Patients With Obsessive-Compulsive Disorder

Neurological Soft Signs in Schizophrenia Patients With Obsessive-Compulsive Disorder

Obsessive–compulsive symptoms in sibling pairs concordant for obsessive–compulsive disorder

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder of unknown etiology. Phenotypic studies of affected sib-pairs (SPs) may help to characterize familial components of the phenotype. To determine whether SPs affected with OCD are similar in age at onset of obsessive-compulsive symptoms (OCS), symptom dimensions and presence of tic disorders (TDs). Forty OCD siblings ranging from 13 to 59 years old were evaluated by expert psychiatrists or psychologists. Families with two or more siblings affected with OCD were recruited from several OCD clinics in Brazil. The Yale Brown Obsessive-Compulsive Scale Checklist was used to assess OCS and the severity of OCD. The OCD diagnoses were made according to the DSM-IV. The chi-square test was used to assess concordance of TD presence within SPs based on the TD frequency reported in the literature (30%). There were significantly more siblings with early-onset OCS than with late-onset OCS (P = 0.002). Age at onset of OCS correlated positively and significantly between the two members of each SP (P = 0.005). Fourteen patients (35%) were diagnosed with TDs. There was no concordance of the TD presence within the SPs. When both were male, there was a significant sibling correlation in the contamination obsessions/cleaning compulsions dimension (ICC = 0.74; P = 0.002). Similarly, when both siblings were female, they were comparable in the hoarding obsessions/compulsions dimension (ICC = 0.76; P = 0.01). Familial factors seem to contribute to specific OCD phenotypic components such as age at onset of OCS and specific dimensions. The obvious influence of gender is as yet unexplained.

Patients with obsessive-compulsive disorder and hoarding symptoms: A distinctive clinical subtype?

We investigated whether patients with obsessive-compulsive disorder (OCD) and hoarding symptoms can be differentiated from their counterparts with other types of obsessions and compulsions in terms of sociodemographic and clinical features. Ninety-seven patients with OCD were assessed with a sociodemographic and clinical questionnaire, the Structured Clinical Interview for DSM-IV (SCID-I), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HDRS), and the Global Assessment of Functioning (GAF). Fifteen patients who reported hoarding symptoms in the Y-BOCS checklist (15.6% of the total sample) were compared and contrasted with 82 patients without those symptoms using the Mann-Whitney U test for continuous variables and the Pearson’s goodness-of-fit chi-square test for categorical ones; Fisher’s exact test was employed when indicated. Hoarders were characterized by (1) higher educational levels (χ 2 = 7.49; df = 2; P = .02); (2) earlier age at onset ( Z = −2.99; P = .003); (3) higher rates of symmetry obsessions (χ 2 = 7.03; df = 1; P = .01); (4) greater frequency of ordering (χ 2 = 10.08; df = 1; P = .004); (5) rituals repetition (χ 2 = 4.42; df = 1; P = .03); (6) counting compulsions (χ 2 = 5.92; df = 1; P = .02); and (7) significantly higher rates of comorbidity with bipolar II disorder (χ 2 = 10.62; df = 1; P = .02) and (8) with eating disorders (χ 2 = 7.42; df = 1; P = .02). In conclusion, patients with OCD exhibiting hoarding feature a distinctive sociodemographic and clinical profile. It remains to be investigated whether these phenotypical characteristics are underlined by specific neurobiological mechanisms.

Obsessive–compulsive behaviors in parents of multiplex autism families

Parents of autistic probands with high and low rates of repetitive behaviors were compared for rates of obsessive–compulsive traits and disorder. The rate of repetitive behaviors was assessed using the Autism Diagnostic Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex families. Obsessive–compulsive disorder (OCD) in parents was determined by direct interview using a parental history questionnaire, with screening for obsessive–compulsive traits using the Yale-Brown Obsessive–Compulsive Scale checklist. Children who had high total scores on the repetitive behavior domain of the ADI-R were significantly more likely to have one or both parents with obsessive–compulsive traits or disorder compared with children who had low total scores on this domain. Children with high scores on D1/D2 of the ADI-R (narrow restricted interests and rituals) were significantly more likely to have one or both parents with OCD, especially fathers, than those with low D1/D2. The occurrence of obsessive–compulsive traits or disorder in parents of autistic children in multiplex families is significantly more likely if autistic children have a high occurrence of repetitive behaviors. Dichotomizing autistic probands by severity and type of repetitive behaviors (circumscribed interests and compulsive rituals) may yield more homogenous groups, which could be helpful in genetic linkage studies.