Obsessive-Compulsive Foundation

Research Digest

Long-Term Treatment Of Obsessive-Compulsive Disorder After An Acute Response: A Comparison Of Fluoxetine Versus Placebo
Journal of Clinical Psychopharmacology, 21: 46 -52, 2001, S. Romano, W. Goodman, R. Tamura, J. Gonzales and the Collaborative Research Group
Few controlled studies have evaluated the long-term continuation of drug therapy for relapse prevention in patients with OCD. This study assessed effectiveness and safety of fluoxetine (Prozac) versus placebo in preventing relapse of OCD during a 52-week period in responders to short-term, 20 weeks, fluoxetine therapy. Patients who continued treatment with fluoxetine at 60 mg/day had significantly lower rates of relapse than those who we reswitched to placebo. Patients who responded to fluoxetine doses of 40 or 20 mg/day and continued those doses also had low overall rates of relapse, but the difference in relapse rates between fluoxetine-treated and placebo-treated patients was not statistically significant. Analyses of adverse effects, vital signs and clinical laboratory data indicated that fluoxetine was safe and well-tolerated over the 52-week period. The current study represents the largest drug therapy relapse prevention trial to date. The fact that continued treatment with fluoxetine did not reveal increased response beyond the point reached during the first 20 weeks of treatment, suggests the benefit of a multimodal therapeutic approach. Based on the findings of this study, consideration should be given to administering fluoxetine for up to 1 year to those patients who responded to initial treatment with addition of cognitive behavioral treatment to increase response, if skilled cognitive behavioral therapists can be found.
Relapses After Discontinuation Of Drug Associated With Increased Resistance To Treatment In Obsessive-Compulsive Disorder
International Clinical Psychopharmacology, 16: 33-38, 2001, G. Maina, U. Albert and F. Bogetto
The majority of follow-up studies of OCD patients indicate that drug discontinuation leads to the recurrence of OCD in most patients (23-89%). The aim of this study was to determine whether OCD patients initially responding to drug therapy and who relapsed upon drug discontinuation would respond again when given the same drug at the same daily dose. Of 183 patients responding to treatment with Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox) or paroxetine (Paxil), 44.8% relapsed within 6 months of drug discontinuation. In the majority of these patients, OCD symptoms returned within the second month of discontinuation with the exception that most patients who we re on fluoxetine relapsed after the third month of discontinuation. Results indicate that patients whose symptoms recur after drug discontinuation respond again when the same drug used previously (at the same dosage) is used, but the degree of response was less for some patients. This implies that some patients were more resistant the second time around and suggests that the increasing resistance may be a product of the passage of time in OCD or, alternatively, a product of additional episodes. Researchers suggest that their findings of possible lowered response after discontinuation and high relapse rates upon discontinuation support continuing medication treatment in OCD over the long term.
A Double-Blind Comparison Of Fluvoxamine Versus Placebo In The Treatment Of Compulsive Buying Disorder
Annals of Clinical Psychiatry, 12: 205-211, 2000, D. W. Black, J. Gabel, J. Hansen et al.
Case reports have suggested that patients with compulsive buying improved when treated with selective serotonin reuptake inhibitors (SSRIs). Open label trials of fluvoxamine (Luvox) and citalopram (Celexa) have also supported the use of SSRIs. In contrast to these promising case reports and open label trials, this double-blind placebo controlled study found equal responses to fluvoxamine and placebo. This is the second placebo controlled investigation of the effectiveness of fluvoxamine in the treatment of compulsive buying disorder. We presented results from the earlier study in the OC Foundation Summer 2000 newsletter (Journal of Clinical Psychopharmacology, 20: 362-366, 2000). It is of interest that both controlled studies found the medication was not more effective than the placebo. It could be that longer trials are necessary, response was only measured for 9 to 12 weeks in these studies. Most importantly, both studies had high placebo responses that could be attributed to the benefits of education and activities such as record keeping diaries to increase awareness of compulsive shopping behaviors. Further investigation of behavioral treatments of compulsive buying is warranted, including the use of simple measures such as maintaining shopping diaries.
Symptoms Of Eating Disorders In Obsessive-Compulsive Disorder
Acta Psychiatrica Scandinavica, 102: 449-453, 2000, H. J. Grabe, A. Thiel and H.J. Freyberger
Previous studies have found high rates of obsessive-compulsive symptoms or personality traits in patients with eating disorders. It has also been hypothesized that eating disorders are related to OCD as part of the obsessive compulsive spectrum. Eating disorder symptoms and OCD symptoms are compared between 61 patients with OCD and 288 healthy control subjects. The OCD patients were found to have significantly more eating disorder symptoms than controls. The results also identified a gender difference in that OCD symptoms were associated with core eating disorder symptoms in females, but not in males.
Hair Pulling In African Americans -- Only Your Hairdresser Knows For Sure: An Exploratory Study
Cultural Diversity And Ethnic Minority Psychology, 6:352-362, 2000, A. M. Neal-Barnett, B. J. Ward -- Brown, M. Mitchell et al.
The authors examined whether African American hair care professionals saw individuals with Trichotillomania, chronic hair pulling, that results in significant hair loss. Thirty eight African American hairdressers and 1 Caucasian hairdresser were interviewed about their customers' hair-pulling behavior. These hair care professionals saw 27 individuals who met general criteria for Trichotillomania. Interestingly these hair care professionals attributed the hair pulling behavior to bad nerves, stress, habit, and worry. Hair care professionals appeared skilled at treating the consequences of chronic hair pulling (camouflaging the bald areas). Two customers were offered assistance for the actual hair pulling; these customers were advised to wear mittens and stocking caps at home. Researchers believe the relationship between African American women and their hairdressers coupled with the emphasis placed on hair in the Black community would make African American women more likely to seek some remedy for the hair pulling. They also believe that African American hairdressers can play an important role in educating and informing their communities about Trichotillomania. To this end, they have developed a community education program. As part of this program they have produced a video and put together a free Continuing Education workshop for licensed haircare professionals about Trichotillomania. The goal is to familiarize hair care professionals with the disorder and the help that is available.
Gender-Related Clinical Differences In Obsessive-Compulsive Disorder
European Psychiatry, 14:434-441, 1999, F. Bogetto, S. Venturello, U. Albert et al.
This study investigated the gender-related (sex-related) differences in a sample of 160 patients with OCD. Researchers found three interesting gender-related features of OCD. The first concerns the onset of the disorder: males have an earlier age at onset and precipitant events appear less likely to trigger the disorder. Females more often reported at least one life event or one severe event prior to OCD onset. Childbirth was the most frequently reported event. In 25% of the women versus 2.6% of men, childbirth preceded OCD onset. The second interesting finding is that OCD occurs in a high propor-tion of males who already have phobias and/or tic disorders. The third finding is that an episodic course (marked by symptom free intervals) of OCD is more frequent in females (35.7%) than in males (13.2%).
A Differential Neural Response In Obsessive-Compulsive Disorder Patients With Washing -- Compared With Checking -- Symptoms To Disgust
Psychological Medicine, 30:1037-1050, 2000, M.L. Phillips, I.M. Marks, C. Senior et al.
Patients with OCD have symptoms that predominantly concern washing or checking, or both. This study compared OCD patients who were mainly washers or mainly checkers with normal controls while they viewed pictures of either generally disgusting scenes (rated as disgusting by all subjects) or scenes that particularly disgusted washers. Functional magnetic resonance imaging (brain scans) was used to identify the neural responses. The experience of disgust, in addition to fear and anxiety, when viewing pictures evoking general disgust is associated with activation in visual cortical regions and the insula. Only in washers were similar regions activated by washer relevant pictures. This study provides evidence for a distinction between the two main types of obsessive-compulsive symptoms on the basis of the neural response to visual stimuli.
Hypochondriasis And Its Relationship To Obsessive-Compulsive Disorder
Psychiatric Clinics of North America, 23:605-616, 2000, B.A. Fallon, A.I. Qureshi, G. Laje et al.
Hypochondriasis is a disorder characterized by the fear or belief that one has a severe illness based on physical signs or symptoms. Determination by a physician after a thorough evaluation that one is not medically ill fails to result in sustained reassurance ... the obsessions with disease return. This article compares hypochondriasis and OCD, and discusses the possibility that hypochondriasis is a subtype of OCD. Response to similar medications supports the concept of hypochondriasis as an OC spectrum disorder, but differing comorbidity patterns (other disorders occurring at the same time) supports the concept of hypochondriasis as a distinct disorder from OCD.
Neuroanatomically Based Approaches To Obsessive-Compulsive Disorder: Neuro-Surgery And Transcranial Magnetic Stimulation
Psychiatric Clinics of North America, 23:671-686, 2000, B.D. Greenberg, D.L. Murphy and S.A. Rasmussen
Authors review the neurosurgical techniques used in the United States for treatment-resistant OCD. Results of these surgeries show that 40% to 60% of patients with treatment-refractory OCD are considerably improved after neurosurgery. However, the conclusion that neurosurgery benefits patients with intractable OCD must remain tentative, as no controlled trials have been conducted. In contrast to neurosurgery, transcranial magnetic stimulation (TMS) was developed not as a therapy but as a research tool to study brain activity. In TMS, a pulsing magnetic field created by an electromagnet on the scalp changes the electrical activity in the underlying brain. Repetitive TMS (TMS) has been shown to modify activity in particular brain regions and there is some preliminary indication that TMS may have therapeutic effects in patients with OCD.
An Open Trial Of Plasma Exchange In Childhood-Onset Obsessive-Compulsive Disorder Without Poststreptococcal Exacerbations
Journal of the American Academy of Child and Adolescent Psychiatry, 39:1313- 1325, 2000, R. Nicolson, S.E. Swedo, M. Lenane et al.
Children with OCD with symptom onset or exacerbations following streptococcal infections have benefited from treatment with plasma exchange, an immunomodulatory therapy. In this study, 5 patients with treatment-refractory OCD without a history of streptococcus-related OCD symptoms underwent an open 2-week course of therapeutic plasma exchange. All 5 patients completed the trial with few side effects, but none showed significant improvement. Researchers state that plasma exchange should be reserved for research studies involving those patients with a clear history of streptococcus-related symptoms.
Personality Disorders And Traits In Patients With Body Dysmorphic Disorder
Comprehensive Psychiatry, 41:229-236, 2000, K.A. Phillips and S.L. McElroy
A majority of individuals with body dysmorphic disorder (BDD), a preoccupation with a nonexistent or slight defect in appearance, are also diagnosed with personality disorders. Personality disorders were assessed in patients with BDD participating in a fluvoxamine (Luvox) treat-ment study. Fifty seven percent of these patients with BDD had one or more personality disorders. An interesting finding is that nearly two thirds of personality disorders were no longer present in patients responding to treatment with fluvoxamine (Luvox). This finding is consis-tent with similar reports of the disappearance of personality disorders in patients with OCD when the OCD responded to treatment. Ricciardi and others found that 83% of patients with OCD who also met criteria for personality disorders before treatment, no longer met criteria for these disorders after they were effectively treated (Ricciardi J.N., Baer L, Jenike MA et al., Changes in DSM-III-R axis II diagnoses following treatment of obsessive-compulsive disorder. Am J Psychiatry, 149:829-831, 1992).
Treatment Histories Of Patients With Three Anxiety Disorders
Depression and Anxiety, 12:92-98, 2000, K. Rowa, M.M. Anthony, S. Brar et al.
This study examined the extent to which research-supported treatments were used by individuals with panic disorder (n=41), social phobia (n=34) or OCD (n=21). Results indicated that the drug treatments received were more often consistent with research findings than were the psychological treatments received. In the past year efficacious medications were prescribed, either an SSRI (selective serotonin reuptake inhibitor) in 52% of those with OCD or SRI serotonin reuptake inhibitor [Clomipramine (Anafranil)] in 33% of those with OCD. In contrast, research evidence supports exposure and ritual prevention for OCD, but only 38% of those with OCD had tried behavior therapy. Results of this study suggest that more work is needed to improve the extent to which patients with anxiety disorders are able to receive evidence-based treatments, particularly cognitive-behavior therapy. Additionally, further research is needed to investigate why there is a discrepancy between the treatments that have been identified as effective and those that are received by patients in clinical practice.
The Challenge Of Obsessive-Compulsive Disorder Hoarding
Primary Psychiatry, 8:79-86, 2001, D.D. Christensen and J.H. Greist
Information is presented on individuals with OCD with prominent hoarding who were inquiring about or were included in a 12-week self-help behavior therapy study. There was a poor response to the behavior therapy, which is consistent with anecdotal clinical experience. Patients with hoarding do not seem to habituate easily to exposure therapy. Prominent hoarding is rarely included on published lists of factors contributing to poor response in OCD, and the authors suggest its inclusion. Also discussed are characteristics of OCD hoarders in this study. Common characteristics included: (1) a €significant other€ insisted that the patient obtain help; (2) there was significant denial, rationalization and low personal motivation for change; (3) treatment was passively resisted, with procrastination in doing homework behavior therapy exercises; (4) expressions of intention to try harder and do better were common; (5) marked indecision was seen; (6) there was a seeming desire to please the researchers with obvious overestimation of improvement on self-assessment scales; and (7) treatment outcome was poor.
A Compulsive Collecting Behavior Following An A-Com Aneurysmal Rupture
Neurology, 56:398-400, 2001, D.S. Hahm, Y. Kang, S.S. Cheong et al.
Hoarding refers to pathologic collecting behavior, and most often objects of little practical value to the individual are collected. This case report is of interest because the hoarding resulted from an injury to the frontal lobe and the caudate nucleus, brain areas involved in OCD. The authors report a 46-year-old man who hoarded a specific item (toy bullets). The hoarding began several months after the rupture of a brain aneurysm (swelling of an artery formed by the thinning of the artery wall). This case of hoarding is likely not OCD as he compulsively collected only toy bullets without any associated obsessive thoughts. In addition, the hoarding did not respond to sertraline (Zoloft) or fluoxetine (Prozac) treatment.
Group And Individual Treatment Of Compulsive Hoarding: A Pilot Study
Behavioural and Cognitive Psychotherapy, 28:259-268, 2000, G. Steketee, R.O. Frost, J. Wincze et al.
Findings are presented from a small pilot study of cognitive-behavioral treatment of hoarding. Group treatment focused on education about hoarding, training in decision-making and organizing, behavioral exposure, and cognitive therapy. After 20 weeks of treatment five of the seven patients had noticeable improvement in the reduction in excessive acquisition of possessions, although problems with clutter persisted. After nearly a year, most continuing clients had made very good progress so that much more living space was available, but additional work was still needed to clear remaining clutter. Researchers discuss the benefits of group therapy in treating hoarding. The presence of others appears to apply social pressure supporting discarding items. Also of interest is that the clients in this study sought treatment primarily because of pressure from family members. Because motivation is one of the most difficult problems to overcome in hoarders, these researchers recommend continuing group therapy for at least a year. They also recommend including family members to help them understand the slow response and support the therapy.
Mood, Personality Disorder Symptoms And Disability In Obsessive Compulsive Hoarders: A Comparison With Clinical And Nonclinical Controls
Behaviour Research and Therapy, 38:1071-1081, 2000, R.O. Frost, G. Steketee, L.F. Williams et al.
Compulsive hoarding occurs in up to 31% of OCD patients. This study examined the severity of anxiety and depression associated with hoarding. It also examined the severity of disability in family, work and social relationships associated with hoarding. The authors postulated that hoarding results in living spaces sufficiently cluttered making daily activities difficult and creating significant distress or impairment in functioning. Compared to nonhoarding OCD and other anxiety disorder patients, OCD hoarding patients had more anxiety, depression, and social disability. OCD hoarding individuals had more symptoms of dependent personality disorder, consistent with earlier research indicating that hoarders have trouble making decisions. This may be a factor in treatment strategies since hoarders may seek to engage the therapist in efforts to make decisions for them. Hoarding subjects also had more schizotypal personality disorder symptoms which may help explain why OCD hoarding has come to be seen as treatment resistant.
Hoarding And Treatment Response In 38 Nondepressed Subjects With Obsessive-Compulsive Disorder
Journal of Clinical Psychiatry, 59:420-425, 1998, D.W. Black, P. Monahan, J. Gable et al.
This placebo controlled study compared the effectiveness of paroxetine (Paxil) therapy versus cognitive-behavioral therapy (CBT) of OCD. Treatment response (much or very much improved and greater than or equal to 40% reduction in the Yale-Brown Obsessive Compulsive Scale) was similar for paroxetine (50%) and CBT (60%), compared with 12.5% for placebo. In addition, researchers looked for differences between treatment responders and nonresponders. Hoarding was identified as a symptom predicting poor treatment response.
Hoarding In Obsessive-Compulsive Disorder: A Report Of 20 Cases
Journal of Clinical Psychiatry, 60:591-597, 1999, M.E. Winsberg, K.S. Cassic and L.M. Koran
Characteristics, family history and treatment responses of 20 adults with OCD and hoarding behavior are presented. Commonly hoarded items included newspapers, magazines, junk mail, old clothes, notes and old receipts. A family history of hoarding was reported in 84% of these individuals and 80% grew up in a home where someone else hoarded. Researchers found that the hoarding did not respond as well to medication treatment (SSRIs) as is expected for OCD in general. Typically 40% to 60% of individuals with OCD respond to treatment with SSRIs. In this study only one individual (5%) reported improvement of hoarding with the medication.
Acquired Obsessive-Compulsive Disorder Associated With Basal Ganglia Lesions
Journal of Neuropsychiatry and Clinical Neurosciences, 12:269-272, 2000, R.C. Chacko, M.A. Corbin and R.G. Harper
Onset of OCD later in life, after age 40, is unusual. The authors report 5 cases of late-onset OCD, patients 61 to 77 years of age, associated with depressive symptoms and brain lesions. These cases support the view that if depressive symptoms are correlated with dysfunction of brain processing, basal ganglia lesions may further predispose depressed patients to the development of OCD. These cases also illustrate the need for careful workup of older patients with recently acquired OCD because their symptoms may be mistaken for delusional disorders, placing them at risk for misdiagnosis and antipsychotic side effects. In these cases improvement of the patients' fixed obsessions and their depression occurred with the use of selective serotonin reuptake inhibitors (SSRIs).
Effectiveness Of Exposure And Ritual Prevention For Obsessive-Compulsive Disorder: Randomized Compared With Nonrandomized Samples
Journal of Counseling and Clinical Psychology, 68:594-602, 2000, M.E. Franklin, J.S. Abramowitz, M.J. Kozak et al.
The efficacy of behavior therapy (exposure and ritual prevention) for reducing symptoms of OCD has been demonstrated in several randomized controlled studies. Critics have argued that experimental control procedures used in these studies influence the treatment outcome and the results cannot be generalized to results that would be found in typical clinical practice. In this study the treatment outcome from 110 patients receiving behavior therapy on an outpatient fee-for-service basis were compared with the findings from four randomized controlled studies. Patients were not excluded because of treatment history, medications being taken, comorbid disorders, age or OCD severity. The OCD patients receiving outpatient behavior therapy achieved OCD and depressive symptom reductions comparable with those found in controlled trials. It appears that the encouraging findings for exposure and response prevention from controlled studies can also be achieved with "real" patients being seen outside research trials.
Muscle Dysmorphia In Male Weightlifters: A Case-Control Study
American Journal of Psychiatry, 157:1291-1296, 2000, R. Olivardia, H.G. Pope, Jr. and J.I. Hudson
Muscle dysmorphia is a form of body dysmorphic disorder in which individuals develop a preoccupation (obsessions) with their muscularity. The authors interviewed 24 men with muscle dysmorphia and 30 normal comparison weightlifters. The men with muscle dysmorphia differed significantly from the normal comparison weightlifters on numerous measures, including body dissatisfaction, eating attitudes, prevalence of steroid drug abuse and lifetime prevalence of mood, anxiety, and eating disorders. The men with muscle dysmorphia frequently described shame, embarrassment, and impairment of social and occupational functioning. Evidence also suggested that, like eating disorders, muscle dysmorphia may be stimulated by sociocultural influences. For example, the ideal male body image, as portrayed by the media, appears to have grown more muscular over the years.
Obsessive-Compulsive Disorder With Delusions
Psychopathology, 33:55-61, 2000, C. Fear, H. Sharp and D. Healy
This study examines cognitive (mental functioning) processes in patients with OCD, patients with delusional disorders and patients with both OCD and delusions. Delusions were more often found in subjects obsessional about one rather than multiple themes. There was also some support for proposals that depression and schizotypy may bring out delusions in OCD, in that patients with OCD and delusional disorder had more depressive symptoms, dysfunctional attitudes and magical ideation than either OCD or delusional disorder patients. In the present study, 80% of the pure OCD patients had multiple obsessions and 20% had single obsessions. Researchers support a classification of OCD on the basis of single or multiple themes, versus classifying OCD into specific symptoms such as "washers" and "checkers."
An Open-Label Trial Of St. John's Wort (Hypericum Perforatum) In Obsessive-Compulsive Disorder
Journal of Clinical Psychiatry, 61:575-578, 2000, L.vH. Taylor and K.A. Kobak
Recent interest in and evidence for the efficacy of St. John's Wort (Hypericum Perforatum) for the treatment of mild-to-moderate depression has led to questions about its use to treat OCD. Twelve individuals with a primary diagnosis of OCD received a dose of 450 mg of 0.3% hypericin (psychoactive compound in St. John's Wort) twice daily for 12 weeks. Results of this study found a significant improvement with St. John's Wort, with a drop in Yale-Brown Obsessive Compulsive Scale scores similar to that found in clinical trials of selective serotonin reuptake inhibitors (SSRIs). The most common side effects reported were diarrhea and restless sleep. The fact that a significant change was found in as early as one week of treatment suggests a possible initial placebo response, although improvement grew larger over time. The positive results of this study warrant further investigation of St. John's Wort in OCD. Issues such as how to standardize herbal medications, contraindications, and drug interactions need to be examined as well.
The Relationship Of Obsessive-Compulsive Disorder To Possible Spectrum Disorders: Results From A Family Study
Biological Psychiatry, 48:287-293, 2000, O.J. Bienvenu, J.F. Samuels, M.A. Riddle et al.
The concept of an "obsessive-compulsive spectrum" of disorders is currently popular. These disorders are characterized as similar to OCD in terms of symptoms, presumed causes and response to treatments. This study investigated the occurrence of OC spectrum disorders in OCD patients, in control individuals without OCD and in first-degree relatives of the OCD patients and controls. Body dysmorphic disorder, hypochondriasis, eating disorders, nail biting, skin picking and Trichotillomania occurred more frequently in individuals with OCD. With the exception of eating disorders, these disorders also occurred more frequently in relatives of individuals with OCD than in relatives of the controls. These findings indicate that somatoform (body dysmorphic disorder and hypochondriasis) and pathologic grooming conditions (Trichotillomania, nail biting and skin picking) are part of the familial (inherited) OCD spectrum.
Serum Cholesterol In Patients With Obsessive Compulsive Disorder During Treatment With Behavior Therapy And SSRI Or Placebo
International Journal of Psychiatry in Medicine, 30:27-39, 2000, H. Peter, S. Tabrizian and I. Hand
There is evidence that serum cholesterol levels are elevated in panic disorder and generalized anxiety disorder. There are few data on cholesterol levels in patients with OCD. Thirty-three patients with OCD participated in this study. Serum cholesterol was measured at pretreatment and at the end of ten weeks. All patients received behavior therapy and either fluvoxamine (Luvox) or placebo. Cholesterol levels of OCD patients were higher than in the normal control subjects and comparable with cholesterol levels of patients with panic disorder. Secondly, the cholesterol levels decreased significantly with treatment of the OCD. Findings suggest that effective treatment, behavior therapy and/or a selective serotonin reuptake inhibitor (SSRI), may decrease cholesterol levels, especially in patients with high initial cholesterol levels. Researchers suggest caution in interpreting their results, as this is the first study investigating the influence of OCD treatments on cholesterol levels in OCD and the study design had several shortcomings.
A 6 Month Double-Blind Parallel Study Of Sertraline And Fluoxetine Treatment Of OCD
International Journal of Neuropsychopharmacology, 3 (Suppl 1):S240-241, 2000, A.V. Ravindran, R. Bergeron, V. Hadrava et al.
One hundred fifty adult OCD patients from 11 Canadian centers were randomized double-blind to either sertraline (Zoloft) or fluoxetine (Prozac) for 24 weeks. The study demonstrated that both sertraline and fluoxetine are effective and well tolerated in the long term treatment of OCD. There is some evidence suggesting that sertraline produced improvement at an earlier time point.
Compulsivity And Obsessionality In Opioid Addiction
Journal of Nervous And Mental Disease, 188:155-162, 2000, I. Friedman, R. Dar and E. Shilony
Seventy-one individuals with opioid dependence participated in a personal interview assessing the importance of their opioid-use rituals. Findings suggest that many opioid-dependent individuals take their drugs in a ritualistic manner and that the need for a fixed ritual is a major component in opioid dependence. The level of compulsivity and obsessionality in opioid dependence was comparable to that found in OCD and alcohol addiction. In addition, 11.4% of those with opioid addiction also met the criteria for an OCD diagnosis, a rate which is over 4 times higher than the rate of OCD in the general population.
A Family Study Of Obsessive-Compulsive Disorder
Archives of General Psychiatry, 57:358-363, 2000, G. Nestadt, J. Samuels, M. Riddle et al.
The role of heredity in OCD has long been suspected. This study reports three main findings. First, OCD is familial, meaning OCD occurs in more members of a family than would be expected by chance. The first-degree relatives (e.g., parents, siblings) of patients diagnosed with OCD had a nearly 5-fold higher lifetime prevalence of OCD. Second, obsessions are more specific to the familial aspect of the disorder than are compulsions. Relatives of patients are at greater risk for both obsessions and compulsions than the relatives of individuals without OCD; however, the magnitude of the association is substantially stronger for obsessions than compulsions. Third, earlier age at onset of the symptoms of OCD indicates a more familial subgroup.
Feared Consequences, Fixity Of Belief, And Treatment Outcome In Patients With Obsessive-Compulsive Disorder
Behavior Therapy, 30:717-724, 1999, E.B. Foa, J.S. Abramowitz, M.E. Franklin et al.
This study examined the degree to which the presence of feared consequences and poor insight into obsessive-compulsive symptoms influenced the benefit of behavior therapy for OCD. Twenty OCD patients received behavior therapy, exposure and ritual prevention, and the patients' degree of insight into the senselessness of their obsessional beliefs was measured. Patients who were extremely certain that their feared consequences would occur had poorer outcome than patients with mild or moderate certainty. Extremely poor insight may indicate the need for additional treatment options such as treatment with medication in addition to behavior therapy.
Multicentre, Double-Blind Comparison Of Fluvoxamine And Clomipramine In The Treatment Of Obsessive-Compulsive Disorder
International Clinical Psychopharmacology, 15:69-76, 2000, E. Mundo, G. Maina and C. Uslenghi
Study results show that fluvoxamine (Luvox) and clomipramine (Anafranil) have similar effectiveness in the treatment of OCD; 60% response in the fluvoxamine group and 67% response in the clomipramine group. There were more patient dropouts due to side effects in the clomipramine group and there were significantly more reports of constipation and dry mouth with clomipramine. With fewer side effects, fluvoxamine was better tolerated, providing an advantage in long term treatment which is usually needed in OCD.
Naturalistic Course Of Obsessive-Compulsive Disorder And Comorbid Depression
Psychopathology, 33:75-80, 2000, W. Zitterl, U. Demal, M. Aigner et al.
Seventy-four patients with obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate the course and prognosis of OCD with or without comorbid depression. The study found that if OCD symptoms decreased, depressive symptoms also decreased. In most cases OCD is dominant over depression, and this suggests a priority for the treatment of OCD over the treatment of depression. Fortunately, the potent serotonin reuptake inhibitors (clomi-pramine and the SSRIs) necessary for treatment of OCD are also effective antidepressants.
People Who Hoard Animals
Psychiatric Times, 17(4):25-29, 2000, The Hoarding of Animals Research Consortium and R. Frost
Research on animal hoarding is in its infancy, despite its seriousness and the frequency with which it is described in the news media. This article reviews existing literature on the hoarding of animals. Nearly two-thirds of animal hoarders are women, 70% are unmarried, and social isolation is common but appears to result from the hoarding behavior rather than causing it. As people who hoard possessions, animal hoarders often lack insight into the problematic nature of their behavior. A common and peculiar characteristic of animal hoarding is a persistent and powerful belief that they are providing proper care for their animals, despite clear evidence to the contrary. Careful assessment is needed to determine if these beliefs reflect a delusional disorder or overvalued ideation in the context of OCD.
Rate Of Body Dysmorphic Disorder In Dermatology Patients
Journal of the American Academy of Dermatology, 42:436-444, 2000, K.A. Phillips, R.G. Dufresne Jr., C.S. Wilkel et al.
Dermatologists appear to be the physicians most often seen by patients with the psychiatric condition, body dysmorphic disorder (BDD), a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. Using a self-report questionnaire, this study found that 11.9% of 268 patients seeking dermatologic treatment screened positive for BDD. In addition, a sizable percentage of these individuals with BDD reported experiencing severe or extreme distress or functional impairment, which in some cases consisted of missing work, staying in the house, and avoiding family and friends.
Sensory Phenomena In Obsessive-Compulsive Disorder And Tourette's Disorder
Journal of Clinical Psychiatry, 61:150-156, 2000, E.C. Miguel, M.C. Rosario-Campos, H. Silva Prado et al.
Sensory phenomena in patients with OCD and/or Tourette's disorder were investigated to determine if these phenomena are valid clinical features for differentiating tic-related OCD from non-tic-related OCD. Bodily sensations include localized or generalized body sensations occurring either before or during performance of the repetitive behaviors. These sensations are more frequently found in patients with OCD plus Tourette's disorder than in patients with OCD alone. Mental sensations include urge only, tension, incompleteness, and just-right perceptions. These are also more frequently found in patients with OCD plus Tourette's disorder than in patients with OCD alone. The researchers conclude that sensory phenomena may be an important feature for grouping patients along the OCD-Tourette's disorder spectrum.
A Double-Blind, Placebo-Controlled Study Of Risperidone Addition In Serotonin Reuptake Inhibitor-Refractory Obsessive-Compulsive Disorder
Archives of General Psychiatry, 57:794-801, 2000, C.J. McDougle, C.N. Epperson, G.H. Pelton et al.
This is the first controlled study of risperidone (Risperdal) addition in patients with OCD refractory to treatment with serotonin reuptake inhibitors (SRIs). Thirty-six patients who did not respond to 12 weeks of SRI treatment participated in a double-blind study to take placebo or risperidone (1 mg/day for 7 days, with the dosage then increased by 1 mg every week, to a maximum of 6 mg/day). Fifty percent of the patients taking risperidone (average dose 2.2 mg/day) in addition to the SRI became responders. The response was not dependent upon a particular SRI, as patients were taking clomipramine, fluoxetine, fluvoxamine, paroxetine or sertraline, nor on the presence of motor tics which had been necessary for a response to augmentation with haloperidol (Haldol) in a previous study. Other than mild, transient sedation, risperidone addition was well tolerated. These results suggest that OCD patients may benefit from the addition of low-dose risperidone to ongoing SRI therapy.
Family Distress And Involvement In Relatives Of Obsessive-Compulsive Disorder Patients
Journal of Anxiety Disorders, 14:209-217, 2000, N. Amir, M. Freshman and E.B. Foa
OCD affects the lives of relatives as well as patients. This study examined the relationship between family members' reactions to the patient's illness (e.g., assistance with rituals, modification of family routine, rejection of the patient) and patient's severity of OCD and response to treatment. The patient's severity of OCD was not related to the family's reactions to the illness, but the patient's response to behavioral treatment was affected by family accommodation and modification of routine. Researchers conclude that while family members should be told that their coping behaviors (e.g., helping the patient carry out rituals, etc.) are not likely to have worsened the patient's OCD, they should also be told that to continue such misguided help during treatment may hinder the patient's improvement.
Neurological And Neuropsychological Signs In Obsessive Compulsive Disorder: Interaction With Behavioural Treatment
Behaviour Research and Therapy, 38:695-708, 2000, D. Bolton, P. Raven, R. Madronal-Luque and I.M. Marks
It has been suggested that a poor response to behavior therapy may be caused by neurological deficits (structural brain abnormalities). This study correlated neurological deficits, indicated by lowered neuropsychological test performance and the presence of neurological soft signs, to response to behavior therapy. Neither neuropsychological test performance nor the presence of neurological soft signs predicted a poor response to behavior therapy. In addition, there was no relationship between the level of performance on neuropsychological tests and the severity of obsessive-compulsive symptoms.
Obsessive-Compulsive Disorder In Popular Magazines
Community Mental Health Journal, 36:307-312, 2000, O.F. Wahl
Research suggests that what people learn from media sources about mental illness is not always accurate or up-to-date. This study examines what is being presented about OCD in popular magazines. Between 1983 and 1997, 107 articles with the index heading Obsessive-Compulsive Disorder were identified. Only 31 (29%) of these articles actually dealt with OCD, while incidents of "stalking" of famous people by "obsessed" fans was the main focus of the other articles. There is potential for the lay public to develop misconceptions about OCD, given that many articles labeled criminal and violent behavior obsessive and/or compulsive. On the positive side, accurate information was found in the 31 articles that dealt with OCD.
Placebo-Controlled Study Of Fluvoxamine In The Treatment Of Patients With Compulsive Buying
Journal of Clinical Psychopharmacology, 20:362-366, 2000, P.T. Ninan, S.L. McElroy, C.P. Kane et al.
Compulsive buying is reported by 1.1% to 5.9% of the general population, and is often associated with other psychiatric disorders, (i.e., 4% suffer from OCD and 19% suffer from depression). Serotonin reuptake inhibitors (SRIs) have been effective in case reports and open drug trials. In this study fluvoxamine (Luvox) significantly re-duced compulsive buying during 12 weeks of treatment, but there was also a comparable response to placebo. The researchers state that the benefits of maintaining a daily diary to monitor symptoms might itself have had significant benefit. The daily diary, therefore, might have been a cognitive behavioral therapy, contributing significantly to the placebo response. This study illustrates the importance of placebo controls, the difficulty of selecting true placebos and the possible potency of even simple behavior therapy measures such as keeping a daily diary of compulsive urges and success in resisting them.
Subjective Imagery In Obsessive-Compulsive Disorder Before And After Exposure Therapy: Pilot Randomized Controlled Trial
British Journal of Psychiatry, 176:387-391, 2000, I.M. Marks, A.M. O'Dwyer, O. Meehan, J. Greist, L. Baer and P. McGuire
Distressing mental imagery is hard to study experimentally in OCD. Researchers developed a means by which ritual-evoking mental imagery in OCD can be studied systematically. Before and after exposure treatment by a behavior therapist or the BT STEPS computer program for self-help behavior therapy, patients imagined previously-rehearsed scenarios that evoked an urge to ritualize and then rated their discomfort during this imagery. The patients who received exposure therapy guided by a therapist or the computer program improved while patients receiving relaxation (without exposure) guided by an audio-tape and manual did not improve.
Thalamic Volume In Pediatric Obsessive Compulsive Disorder
Biological Psychiatry, 47(8):148S-149S, 2000, D.R. Rosenberg, N.B. Benazon, A.R. Gilbert et al.
Previously researchers reported increased size in the thalamus (a specific brain region) of children with OCD. These volumes decreased significantly after children received paroxetine (Paxil) treatment. In this study the thalamic volume was studied in children with OCD, before and after cognitive-behavioral therapy. As in previous studies the thalamic volume of children with OCD was larger than that of children without OCD, but the thalamic volume did not change with the cognitive-behavioral therapy. These findings suggest that the decrease in thalamic volume observed after paroxetine treatment may be specific to paroxetine and different from changes associated with effective cognitive-behavioral therapy.
Cognitive-Behavioral Therapy As An Adjunct To Serotonin Reuptake Inhibitors In Obsessive-Compulsive Disorder: An Open Trial.
Journal of Clinical Psychiatry, 60:584-590, 1999, H.B. Simpson, K.S. Gorfinkle and M.R. Liebowitz .
This small open trial of 6 patients suggest that cognitive-behavioral therapy (CBT), using exposure and ritual prevention, can lead to a significant reduction in OCD symp-toms in patients who remain symptomatic despite an adequate trial of a selective serotonin reuptake inhibitor (SSRI). While taking a stable dose of an SSRI and having been on the medication for 12 weeks or longer, patients received 17 session of exposure and ritual prevention. All patients improved significantly with a mean Yale-Brown Obsessive Compulsive Scale decrease of 11.6 points. Study results were based on a small sample of patients who were motivated to try this therapy. Whether all OCD patients who respond only partially to SSRI medication can gain additional benefit from CBT is unclear.
Is Episodic Obsessive Compulsive Disorder Bipolar? A Report Of Four Cases.
Journal of Affective Disorders, 56:61-66, 1999, C.M. Swartz and W.W. Shen.
Lithium and electroconvulsive therapy (ECT) were effective treatments in four unusual cases of OCD which had not responded to tricyclic or SSRI antidepressants. Lithium and ECT are rarely effective for patients with typical OCD, but in these case reports, episodic OCD appeared to be manic symptoms of bipolar disorder. The onset of the OCD was acute and appeared at an older than ex-pected age (range 32-55 years). These four cases suggest s syndrome of OCD symptoms, which appears suddenly at an older age, and may be an expression of bipolar disorder and may respond to lithium, ECT, or other effective treatment of bipolar disorder.
Multicenter Double-Blind Comparison Of Sertraline And Desipramine For Concurrent Obsessive-Compulsive And Major Depressive Disorders.
Archives of General Psychiatry, 57:76-82, 2000, R. Hoehn-Saric, P. Ninan, D.W. Black, et al.
This multicenter trial, with one hundred and sixty-six patients, is the first comparison of an SSRI (selective serotonin reuptake inhibitor) and a non-SS RI antidepressant in the treatment of OCD with concurrent major depressive disorder (MDD). Sertraline (Zoloft) was more effective than desipramine (Norpramin) for both OCD and depressive symptoms. Studies show a high co-occurrence of MDD, ranging from 30% to 60%, for individuals with OCD. It has been suggested that patients with both OCD and a depressive disorder may be less responsive to treatment. This study is of interest because there was a favorable OCD response to sertraline (Zoloft), similar to the response shown for OCD patients without major depression.
Obsessive-Compulsive Disorder And Anorexia Nervosa In A High School Athlete: A Case Report.
Journal of Athletic Training, 34:375-378, 1999, R.L. Gee and N. Telew.
This is a case report of an adolescent athlete who exercised compulsively outside of her athletic program and dieted to the point of starvation. Her OCD was not recognized while she was under lengthy treatment for anorexia nervosa, and there was a dramatic recovery of both her OCD and anorexia nervosa following the recognition and subsequent treatment of her OCD. A combination of cognitive-behavior therapy and fluoxetine (Prozac) was used. OCD occurs frequently in patients with anorexia, and successful management requires that both conditions be identified and treated.
A Placebo-Controlled Trial Of Cognitive-Behavioral Therapy And Clomipramine In Trichotillomania.
Journal of Clinical Psychiatry, 61:47-50, 2000, P.T. Nina, B.O. Rothbaum, F.A. Marsteller, et al.
Cognitive-behavior therapy (CBT) with habit reversal and serotonin reuptake in-hibitors such as clomipramine (Anafranil) are reported to be effective treatments for Trichotillomania. This study compared CBT and clomipramine in a 9-week, placebo-controlled, trial. CBT has a dramatic effect in reducing symptoms of Trichotillomania and was significantly more effective than clomi-pramine. Clomipramine resulted in symptom reduction greater than placebo, but the difference fell short of statistical significance.
Recent Life Events And Obsessive-Compulsive Disorder (OCD): The Role Of Pregnancy/Delivery.
Psychiatry Research, 89:49-58, 1999, G. Maina, U. Alpert, F. Bogetto, et al.
Conflicting results have been reported on the possible role of stressful life events or trauma in triggering OCD onset. This study investigated life events that occur prior to the onset of OCD, with particular attention to pregnancy and postpartum effects. Results of this study did not show a significant increase in the number of life events in patients who develop OCD in the 12 months or the 6 months before onset of OCD. Also the study did not find an association between pregnancy and the onset of OCD, but did confirm the high rate of postpartum OCD. Findings suggest that postpartum OCD may be associated with caesarean section without labor and to pre- and post-term childbirth, but these date need to be confirmed by further study.
Strategic Processing And Episodic Memory Impairment In Obsessive Compulsive Disorder.
Neuropsychology, 14:141-151, 2000, C.R. Savage, T. Deckersbach, S. Wilhelm, et al.
This study examined verbal and nonverbal memory performance in 33 OCD patients and 30 normal controls. OCD patients showed impaired recall on both verbal and nonverbal memory tests. Specifically, they used less systematic organizational strategies in the memory tests. Information processing skills may cause these memory problems in OCD. It is possible that disruptions in memory contribute to some clinical symptoms of OCD, such as chronic doubt and repetitive behaviors. On the basis of these findings, the researchers are currently investigating the effectiveness of cognitive retraining approaches for OCD, in which patients are taught to use more eff-ective memory encoding and retrieval strategies.
The Stress Of Caring For People With Obsessive Compulsive Disorder.
Community Mental Health Journal, 35:443-450, 1999, T.M. Laidlaw, I.R.H. Falloon, D. Barnfather, et al.
Findings from this survey of key caregivers of patients with OCD show that 28% of caregivers were severely burdened by their career role and 25% were extremely distressed at the prospect of ongoing care provision. Caregivers particularly felt the OCD affected their marital relationships and home management. These results indicate that caregivers, and probably others in the family, need substantial support. Appropriate stress reduction interventions for careers including education and cognitive-behavioral strategies could be combined with the patient's treatment program, although such strategies have yet to be evaluated for their helpfulness.
Alteration Of The Platelet Serotonin Transporter In Romantic Love.
Psychological Medicine, 29:741-745, 1999, D. Marazziti, H.S. Akiskal, A. Rossi et al.
In subjects who had recently fallen in love and were still at the early, romantic phase of the relationship, the density of the platelet serotonin transporter was similar to that found in patients with OCD, levels which were significantly decreased from the normal control levels. This study suggests common neurochemical changes involving the serotonin system are shared by individuals newly in love and patients with OCD. This shared physiologic effect may result from a similarity between an overvalued idea, that early obsessive pre-occupation about the new partner and an OCD obsession.
Clomipramine vs. Desipramine Crossover Trial In Body Dysmorphic disorder: Selective Efficacy Of A Serotonin Reuptake Inhibitor In Imagined Ugliness.
Archives of General Psychiatry, 56: 1033-1039, 1999, E. Hollander, A. Allen, J. Kwon et al.
Body dysmorphic disorder (preoccupation with an imagined or slight defect in appearance) is a common and disabling disorder associated with high rates of delusional symptoms and suicide attempts. Although preliminary studies suggest that serotonin reuptake inhibitors (SRIs) may be effective for body dysmorphic disorder, this is the first controlled treatment trial. Results show that clomipramine (Anafranil), an SRI, is more effective than the control medication, desipramine, a norepinephrine reuptake inhibitor, in the treatment of body dysmorphic disorder and is effective even with delusional patients.
Cognitive-Behavioral Therapy As An Adjunct To Serotonin Reuptake inhibitors In Obsessive-compulsive Disorder: An Open Trial.
Journal of Clinical Psychiatry, 60: 584-590, 1999, H.B. Simpson, K.S. Gorfinkle and M.R. Liebowitz.
Many studies have reported that behavior therapy can help significantly OCD patients. The advantage of the present study is that it was designed to separate the medication and behavior therapy effects. Results from this trial show that cognitive-behavior therapy using exposure and ritual prevention can lead to a significant reduction in OCD symptoms in patients who remain symptomatic despite an adequate trial of an OCD medication. A previous study suggested that Inositol, one of the B vitamins, may be effective in the treatment of OCD. The following two studies evaluated Inositol as an augmenting agent of serotonin reuptake inhibitors (SRIs). The addition of Inositol to the ongoing SRI treatment was not beneficial in either study.
Inositol Augmentation Of Serotonin Reuptake Inhibitors In Treatment-Refractory Obsessive-compulsive Disorder: An Open Trial.
International Clinical Psychopharmacology, 14: 353-356, 1999, S. Seedat and D.J. Stein.
Ten OCD patients who had failed to respond to current and previous trials of SRIs participated in a trial of Inositol (18 mg/day) augmentation for 6 weeks. Inositol augmentation of a SRI did not lead to significant improvement in the majority of these patients.
Inositol Versus Placebo Augmentation Of Serotonin Reuptake Inhibitors In the Treatment Of Obsessive-compulsive Disorder: A Double Blind Cross-Over Study.
International Journal of Neuropsychopharmacology, 2: 193-195, 1999. M. Fux, J. Benjamin and R. H. Belmaker.
This double-blind study compared the addition of Inositol versus placebo to ongoing SRI treatment in ten OCD patients. No significant difference was found between Inositol and placebo treatment augmentations.
Family Accommodation Of Obsessive-compulsive Symptoms: Instrument development And Assessment Of Family Behavior.
Journal of Nervous and Mental Disease, 187:636-642, 1999, L. Calvocoressi, C.M. Mazure, S. V. Kasl et al.
Relatives frequently accommodate patients' obsessive-compulsive symptoms, and clinicians hypothesize that such accommodations adversely affect treatment outcome. Researchers found family accommodation was significantly associated with patient symptom severity and dysfunction, and with relatives' own obsessive-compulsive symptoms. Also of interest is that nearly 70% of relatives in this study experienced some degree of distress when accommodating patients. This new scale will provide clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing family coping strategies.
Randomized Trial Of Plasma Exchange vs. Immune Globulin In childhood-onset Obsessive Compulsive Disorder (OCD).
Transfusion,39 (10): S 112-1999, S.F. Leitman, R.A. Werden, M.A. Garvey et al.
In children, worsening of OCD symptoms may occur after infection with streptococcal bacteria. If post-streptococcal autoimmunity is the cause of the worsening symptoms, then children might respond to treatments such as plasma exchange or intravenous immunoglobulin (IVIG). Results from this sham procedure controlled study found that plasma exchange and IVIG were both effective in lessening of symptom severity for children with strep-triggered OCD and tic disorders. More than 80% of the patients who received IVIG or plasma exchange remained "much" or "very much" improved one year after the treatments.
High-Density Exposure Therapy For Obsessive-Compulsive Inpatients: A 1-Year Follow-Up.
Psychotherapy And Psychosomatics, 68:186-192, 1999. C. Wetzel, H. Bents and I. Florin
This study evaluated the effects of individual high-density behavior therapy (2-3 weeks of all day behavior therapy) of 85 hospitalized patients with OCD. At 1-year follow-up, 75% of patients were very much improved. The long-term benefits for high-density treatment of unselected OCD patients were as good as behavior therapy performed with selected patients in research settings.
Treatment Of Obsessive-Compulsive Disorder Using Clomipramine In A Very Old Patient.
Annals of Pharmacotherapy, 33:686-690, 1999, B. Trappler.
With the onset of Alzheimer's disease, a 93-year-old woman's OCD worsened. Her obsession consisted of remembering names of famous people and her compulsion consisted of excessive list making. With the onset of memory loss secondary to Alzheimer's disease, she became increasingly anxious and compulsive as a result of a failure to remember. She became jittery and more confused on fluoxetine (Prozac) and her medication was changed to clomipramine (Anafranil) which was effective in reducing obsessions and compulsions and better tolerated.
Low Prevalence Of Smoking Among Patients With Obsessive-Compulsive Disorder.
Comprehensive Psychiatry, 40:268-272, 1999, S. Bejerot and M. Humble.
Prevalence of smoking amount OCD patients is very low - half that found in the general population. Based on the observation that a few patients have reported that their OCD symptoms worsened when smoking a cigarette, it was hypothesized that nicotine increases attention span and awareness of obsessions.
A Pilot Study Of Penicillin Prophylaxis For Neuropsychiatric Exacerbations Triggered By Streptococcal Infections.
Biological Psychiatry, 45:1564-1571, 1999, M. A. Garvey, S. J. Perlmutter, A. J. Allen et al.
Some children with obsessive-compulsive disorder and tic disorders appear to have their symptoms worsened by streptococcal infections. The researchers postulated that penicillin prophylaxis might prevent streptococcal-triggered symptom exacerbations in these children with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). This double-blind study compared penicillin, twice daily oral 250 mg, to placebo in 37 children with PANDAS. There was no significant change seen in either the obsessive-compulsive or tic symptoms with penicillin. The lack of effect on the primary symptoms of OCD and tics means that it is premature to recommend penicillin prophylaxis for children with OCD or tic disorders, even if it appears that their symptoms are triggered by streptococcal infections.
Olanzapine Addition In Obsessive-Compulsive Disorder Refractory To Selective Serotonin Reuptake Inhibitors: An Open-Label Case Series.
Journal of Clinical Psychiatry, 60:524-527, 1999, E.L. Weiss, M.N. Potenza, C.J. McDougle et al.
The results of this preliminary, open-label trial with 10 patients, suggest that olanzapine (zyprexa) may be effective in augmenting ongoing selective serotonin reuptake inhibitor (SSRI) treatment of patients with OCD not responding to SSRI treatment. Seven of the 10 patients showed at least moderate improvement. Sedation was the main adverse effective reported and the reason for discontinuation for two patients.
Hoarding: A Review.
Israel Journal of Psychiatry and Related Sciences, 36:35-46, 1999, D.J. Stein, S. Deedat and F. Potocnik
Hoarding is currently categorized as a symptom of both obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). However, hoarding has also been documented in association with other psychiatric disorders. The authors review hoarding and the need to determine if the hoarding is a symptom of an underlying disorder such as OCD, OCPD, schizophrenia or dementia. Once a diagnosis is made, this would then suggest the medications and psychotherapeutic interventions to be used.
Use Of Factor-Analyzed Symptom Dimensions To Predict Outcome With Serotonin Reuptake Inhibitors And Placebo In The Treatment Of Obsessive-Compulsive Disorder.
American Journal of Psychiatry, 156:1409-1416, 1999, D. Mataix-Cols, S. L. Rauch, P.A. Manzo et al.
Patients with OCD vary in their response to treatment with serotonin reuptake inhibitors. This study correlated symptoms of OCD with response to medication in 354 patients with OCD. The presence of hoarding obsessions and compulsions was associated with poorer response to serotonin reuptake inhibitors. Other symptoms of OCD, such as symmetry/ordering, contamination/cleaning, aggressive/checking and sexual/religious obsessions were not useful in predicting response to medication.
Self-Injurious Skin Picking: Clinical Characteristics And Comorbidity.
Journal of Clinical Psychiatry, 60:454-459, 1999, S. Wilhelm, N.J. Keuthen, T. Deckersbach et al.
Repetitive skin picking is a self-injurious behavior that may cause severe tissue damage. Symptoms and demographics in 31 patients with compulsive skin picking are examined. Skin picking appears more prevalent in women than men and the mean age at onset of the skin picking was 15. Most individuals had engaged in skin picking for many years and about half of them had never been treated. The main reason reported for not seeking treatment was social embarrassment. All subjects picked at more than one body area, and the most frequent sites of skin picking were acne and scabs. Recently, it has been suggested that skin picking may be a variant of OCD or a symptom of body dysmorphic disorder. This study supports these associations as OCD was diagnosed in 52% of the individuals with skin picking and body dysmorphic disorder in 32%.
Attitudes Toward Neurosurgical Procedures For Parkinson's Disease And Obsessive-Compulsive Disorder.
Journal of Neuropsychiatry and Clinical Neurosciences, 11:259-267, 1999, S.J. Mathew, S.C. Yudofsky, L.B. McCulough et al.
Similar neurosurgical procedures exist for severe Parkinson's disease (PD) and incapacitating obsessive-compulsive disorder (OCD). Because PD is seen as a brain disease and OCD as a disease of the mind, neurologists and psychiatrists may be more aware of and more optimistic toward neurosurgery for PD than for OCD. Physician awareness of and attitudes towards neurosurgery were surveyed. Questionnaires were sent to a random sampling of psychiatrists and neurologists. Specialty affected willingness to refer to OCD neurosurgery; 74.1% of psychiatrists versus 25.6% of neurologists would refer OCD patients for neurosurgery. Specialty and degree of contact with neurosurgeons affected willingness to refer for PN neurosurgery; 67.4% of psychiatrists would refer and 94.3% of neurologists would refer. There is poor physician awareness of neurosurgical options for OCD compared with PD, as well as a risk-benefit bias against OCD surgery by the neurologists surveyed.
Risperidone Addition In Serotonin Reuptake Inhibitor-Resistant Trichotillomania: Three Cases.
Journal of Child and Adolescent Psychopharmacology, 9:43-49, C.N. Epperson, D. Fasula, S. Wasylink et al.
Three adult patients with Trichotillomania unresponsive to serotonin reuptake inhibitors (SRIs) responded to the addition of risperidone (Risperdal) 0.5 to 3 mg/day to their SRI treatment. Sedation, the main side effect reported by these patients, was not excessive.
Combination Treatment With Clomipramine And Fluvoxamine: Drug Monitoring, Safety, And Tolerability Date.
Journal of Clinical Psychiatry, 57:257-264, 1996, A. Szegedi, H. Wetzel, M. Leal et al.
The tolerability and safety of combined treatment with fluvoxamine and clomipramine is studied in 22 patients with OCD or depression. Results suggest that comedication of fluvoxamine and clomipramine will result in elevated blood clomipramine levels produced by inhibiting metabolism to demethyclomipramine. This effect is similar to that obtained when patients receive clomipramine by intravenous administration: some patients do better with intravenous than with oral clomipramine. Combination treatment should be carefully monitored by determination of clomipramine blood levels. The higher blood levels may be associated with an increased risk of EEG changes and changes in heart conduction. EEG and ECG should be used regularly to monitor commedicated patients.
Citalopram For Treatment-Resistant Obsessive-Compulsive Disorder.
European Psychiatry, 14:101-106, 1999, S. Pallanti, L. Querciolo, R.S. Paiva and L.M. Koran
The effectiveness of citalopram (Celexa) alone versus citalopram with clomipramine (Anafranil) is studied in sixteen patients with OCD unresponsive to clomipramine or fluoxetine (Prozac). The citalopram-plus-clomipramine group experienced a significantly larger decrease in symptoms than the citalopram alone group. Since citalopram does not significantly affect clomipramine metabolism, the improvement in the combined drug group is unlikely to have resulted from increased blood clomipramien levels.
Pathological Gambling And Obsessive-Compulsive Spectrum Disorders.
Psychological Reports, 84:107-113, 1999, A. Blaszcaynski.
This study provides support for the classification of compulsive gambling as an obsessive-compulsive spectrum disorder. The Padua Inventory was administered to 40 diagnosed pathological gamblers and a control group of 40 normal subjects. Analysis showed that the pathological gamblers obtained a significantly higher mean total score on obsessionality and impulsivity than controls. Pathological gambling has many similarities to obsessive-compulsive disorder.
Patterns Of Remission And Relapse In Obsessive-Compulsive Disorder: A 2-Year Prospective Study.
Journal of Clinical Psychiatry, 60:346-351, 1999, J.L. Eisen, W. K. Goodman, M. B. Keller et al.
This study examined the course of illness in 66 patients with OCD over a 2-year period. Over two-thirds of the patients in this study received at least 12 weeks of medium-to-high doses of a serotonin reuptake inhibitor (SRI). Full remission was found in 12% of patients and partial remission in 47% of patients. After achieving remission from OCD, the relapse rate was 48%. Despite treatment with and SRI, the likelihood of full remission of OCD in this study was low. Results of this study also suggest that behavior therapy may be underutilized.
Neuropsychological Study Of Frontal Lobe Function In Psychotropic-Naive Children With Obsessive-Compulsive Disorder.
American Journal of Psychiatry, 156:777-779, 1999, S. R. Beers, D. R. Rosenberg, E. L. Dick et al.
This study evaluates cognition (mental functioning such as memory and ability to learn and comprehend) in children with OCD. Neuropsychological tests were administered to 21 children with OCD and 21 children without OCD. The children with OCD were not depressed, and none had ever received psychotropic medication. Children with OCD performed as well as the healthy children on the neuropsychological tests. Psychiatric symptoms and cognitive performance were not related. The authors conclude that OCD symptoms may not interfere with cognitive abilities early in the illness.
Obsessions And Compulsions In Women With Postpartum Depression.
Journal of Clinical Psychiatry, 60:176-180, 1999, K.L. Wisner, K.S. Peindl, T. Gigliott et al.
The quantity, content, and intensity of the obsessions and compulsions of women with postpartum onset major depressive disorder were compared with those of women with major depressive disorder with non-postpartum onset. The most frequent content of the aggressive thoughts for women with postpartum onset major depression was causing harm to their infants. This study concludes that women with postpartum onset major depression experience disturbing aggressive obsessional thoughts more frequently than women whose depression occurs independent of childbearing.
Fluvoxamine Treatment Of Obsessive-Compulsive Symptoms In Schizophrenic Patients: An Add-on Open Study.
International Clinical Psychopharmacology, 14:95-100, 1999, M. Poyurovsky, V. Isakov, S. Hromnikov et al.
Obsessive-compulsive symptoms are observed in a substantial proportion of individuals with schizophrenia. This study examines the effect of adding fluvoxamine (Luvox) to the ongoing antipsychotic medication treatment of schizo-obsessive patients. The results indicate that adjunctive fluvoxamine treatment improves obsessive symptoms in patients with schizo-obsessive disorder. Positive and negative symptoms of schizophrenia also improved.
Managing Aggressive Behavior In Patients With Obsessive-Compulsive Disorder And Borderline Personality Disorder.
Journal of Clinical Psychiatry Monograph, 17(2):28-31, 1999, E. Hollander.
Aggression and anger can be present in obsessive-compulsive disorder, in its comorbid conditions, and in borderline personality disorder. There is evidence for the efficacy of medications, including divalproex (Depakote) and the selective serotonin reuptake inhibitors (SSRIs), in treating aggression and affective instability in patients with comorbid OCD and borderline personality disorder.
Near-Fatal Skin Picking From Delusional Body Dysmorphic Disorder Responsive To Fluvoxamine.
Psychosomatics, 40:79-81, 1999, R.L. O'Sullivan, K.A. Phillips, N.J. Keuthen et al.
This case report demonstrates that skin picking secondary to body dysmorphic disorder (BDD) can be very severe, even life-threatening. As a result of using tweezers in an attempt to remove a perceived defect from her skin, the patient nearly lacerated her carotid artery. This case is also consistent with uncontrolled studies suggesting that BDD and compulsive skin picking may improve with selective serotonin reuptake inhibitors, in this case fluvoxamine (Luvox).
Placebo-Controlled, Multicenter Study Of Sertraline Treatment For Obsessive-Compulsive Disorder.
Journal of Clinical Psychopharmacology, 19:172-176, 1999, M.H. Kronig, J. Apter, G. Asnis et al.
The safety and efficacy of sertraline (Zoloft) versus placebo were examined in a group of nondepressed outpatients with obsessive-compulsive disorder (OCD). Significantly greater improvement in the sertraline group first became apparent by the end of week 3. Sertraline was well tolerated, without serious adverse effects. In conclusion, sertraline was safe and effective in the treatment of patients with OCD.
Responsibility And Perfectionism In OCD: An Experimental Study.
Behaviour Research and Therapy, 37: 239-248, 1999, C. Bouchard, J. Rheaume and R. Ladouceur.
Cognitive models of OCD suggest a number of different variables that may play a role in the development and maintenance of obsessive compulsive symptoms. This study's aim was to verify the effect of perfectionism and excessive responsibility on checking behaviors and related variables. Twenty-four perfectionistic subjects were submitted to a manipulation of responsibility. The results suggest that perfectionism, when it reaches a dysfunctional level, could predispose the individual to overestimate his or her own responsibility for negative events, which in turn could potentially contribute to an increase in checking behavior.
The Treatment Of Kleptomania With Serotonin Reuptake Inhibitors.
Clinical Neuropharmacology, 22: 40-43, 1999, E. Lepkifker, P.N. Dannon, R. Ziv et al.
Kleptomania is characterized by an irresistible impulse to steal objects not needed for personal use or for their monetary value. Several recent case reports have shown that selective serotonin reuptake inhibitors (SSRIs) could be effective in the treatment of kleptomania, just as SSRIs have been effective treatment in other obsessive-compulsive spectrum disorders. Five cases of kleptomania patients, successfully treated with fluoxetine (Prozac) or paroxetine (Paxil), are discussed.
A 40-Year Follow-Up Of Patients With Obsessive-Compulsive Disorder.
Archives of General Psychiatry, 56:121-127, 1999, G. Skoog and I. Skoog.
The course of obsessive-compulsive disorder in 144 Swedish patients, followed for over 40 years, is presented. Improvement was observed in 83% of the patients, including complete recovery in 20% and partial recovery in 28%. Early age of onset, having both obsessive and compulsive symptoms, low social functioning, and a chronic course at the initial assessment in the 1950s were correlated with a worse outcome as were magical obsessions and compulsive rituals. Although most individuals with OCD improved, most patients also continue to have clinical or subclinical symptoms. During most of this study period (1950s-1990s), there were no effective and lasting therapies for OCD. Now that effective treatments have been introduced, the study would be difficult to replicate. An added distinction of the study is that the patients were examined by the same psychiatrist in both examinations using the same semi-structured interview.
Biologic Approaches To Treatmemt-Refractory Obsessive-Compulsive Disorder.
Psychiatric Annals, 28 (11): 641-649, 1998, W.K. Goodman, H.E. Ward and T.K. Murphy.
This article focuses on medical approaches to the patient with OCD who is either a nonresponder or a partial responder to treatment with selective serotonin reuptake inhibitors. The current state of knowledge regarding the efficacy of these approaches is summarized and recommendations are made based on empirical evidence and the clinical experience of the authors.
Citalopram Treatment Of Obsessive Compulsive Disorder: Results From A Double-Blind, Placebo-Controlled Trial.
Scientific Abstract presented at the 37th Annual Meeting of the American College of Neuropsychopharmacology, Las Croabas, Puerto Rico, December 14-18, 1998, S. Montgomery.
Initial results from a 12 week, double-blind, study of citalopram (Celexa) treatment of approximately 400 patients with obsessive compulsive disorder are presented. Significantly greater improvement was found in citalopram-treated patients compared to placebo-treated patients. The results from this study support the effectiveness of citalopram in the treatment of OCD.
Episodic Course In Obsessive-compulsive Disorder.
European Archives of Psychiatry and Clinical Neuroscience, 248:240-244, 1998, G. Perugi, H.S. Akiskal, A. Gemignani et al.
The course of OCD is variable, ranging from episodic to chronic. The authors hypothesized that the episodic course is more likely to be related to bipolar mood disorders. A comparison of clinical characteristics, family history and comorbid disorders is made between 37 patients with an episodic course and 90 patients with a continuous course. The analyses showed that episodic OCD had a significantly lower rate of checking rituals, a significantly higher rate of a positive family history to mood disorder, higher lifetime comorbidity for panic and bipolar-II disorders (hypomania and major depression), later age of onset and a negative correlation with generalized anxiety disorder.
FDG-PET Predictors Of Response To Behavioral Therapy And Pharmacotherapy In Obsessive Compulsive Disorder.
Psychiatry Research: Neuroimaging Section, 84:1-6, 1998, A.L. Brody, S. Saxena, J.M. Schwartz et al.
This is an investigation of treatment response prediction for obsessive-compulsive disorder, utilizing positron emission tomography scans of the brain. A higher pre-treatment brain metabolic acticity in the left orbitalofrontal cortex (OFC) as associated with a better response to behavior therapy. In contrast, a lower left OFC metabolic activity was associated with a better response to treatment with fluoxetine (Prozac). These results suggest that patients with differing patterns of brain metabolism respond preferentially to behavior therapy and medication.
Lesion Topography And Outcome After Thermocapsulotomy Or Gamma Knife Capsulotomy For Obsessive-Compulsive Disorder: Relevance Of The Right Hemisphere.
Neurosurgery, 44:452-460, 1999, B.E. Lippitz, P. Mindus, B.A. Meyerson et al.
This was a follow-up study of 25 patients with OCD who received neurosurgery between 1976 and 1989. All patients had been extremely disabled with a nonresponding, chronic, deteriorating course of OCD. Researchers compared the patients responding to neurosurgery (over 50% reduction in symptoms) to the patients not responding significantly to the treatment (less than 50% reduction in symptoms). Their results indicate that the size and site of the surgically induced lesions correlated with treatment outcome. A further investigation is currently being conducted to test the hypothesis of a specific relevance of the right cerebral hemisphere in neurosurgical treatment of OCD.
Obsessional Indecision: Its Psychological Conceptualization, Assessment, And Treatment, Behaviour Change.
Pergamon Press: Australia, 15(3):165-177, 1998, P. Dunne and M. Llamas.
This paper examines obsessional indecision, that is, difficulty making decisions. Four case reports of individuals having problems with making the "best" or "right" decisions are presented and the authors classify these as cases of "pure" obsessional disorder. Intervention techniques are proposed which consist of (a) identifying and challenging overvalued ideas, (b) problem-solving strategies, (c) incorporating a "worry time" within the problem-solving strategy when necessary, and (d) prolonged exposure to those obsessional thoughts that continue subsequent to having made a decision.
Sertraline In Children And Adolescents With Obsessive-compulsive Disorder: A Multicenter Randomized Controlled Trial.
JAMA, 280(2):1752-1756, 1998, J.S. March, J. Biederman, R. Wolkow et al.
Sertraline (Zoloft) was found to be a safe and effective short-term treatment for children and adolescents with OCD. One hundred and eighty-seven children and adolescents participated in a double-blind, placebo controlled, study of sertraline treatment of OCD. A maximum dosage of 200 mg/day of sertraline was used and 57% of children and 82% of adolescents were treated with this maximum dosage. Based on the Clinical Global Improvement Scale, 42% of patients were considered very much or much improved. Adverse events of insomnia, nausea, asgitation, and tremor were more common in those receiving sertraline than in placebo-treated patients. No clinically meaningful abnormalities were apparent in vital sign determinations, laboratory findings, or electrocardiographic measurements.
Behavior therapy versus clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents.
Journal of the American Academy of Child and Adolescent Psychiatry, 37(10):1022-1029, 1998, E. De Haan, K.A.L. Hoogduin, J.K. Buitelaar and G.P.J. Keijsers
This study compares the two main effective treatments for OCD, behavior therapy versus a potent serotonin reuptake inhibitor, in twenty-two children between 8 and 18 years of age. Treatment response was measured by the Child Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Leyton Obsessional Inventory-Child Version (LOI-CV). Significant improvement was obtained with both treatments at 12 weeks. Behavior therapy produced greater therapeutic changes than clomipramine (Anafranil) on the CY-BOCS, whereas no significant differences between treatments was found on the LOI-CV. This study indicates that behavior therapy in children and adolescents with OCD is at least as effective as medication treatment over the short term.
Body dysmorphic disorder: clinical aspects and treatment strategies.
Bulletin of the Menninger Clinic, 62(4) Suppl A: 33-48, 1998, K.A. Phillips
Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, is reviewed. BDD is considered an OC-Spectrum Disorder that is relatively common. Any body part can be the focus of concern (most often, skin, hair, and nose), and most patients engage in compulsive behaviors, such as mirror checking, camouflaging, excessive grooming, and skin picking. Nearly all patients suffer some impairment in functioning as a result of their symptoms, some people to a debilitating degree. While treatment data are preliminary, selective serotonin reuptake inhibitors (SSRIs) often appear to be effective for BDD. Cognitive-behavioral therapy is another promising approach.
Effect of adjuvant pindolol on the antiobsessional response to fluvoxamine: a double-blind, placebo-controlled study.
International Clinical Psychopharmacology, 13:219-224,1998, E. Mundo, E. Guglielmo and L. Bellodi
Pindolol (Visken), a beta-blocker, may be effective in augmenting antidepressant response to several selective serotonin reuptake inhibitors (SSRIs), especially by shortening response time. This study evaluated the effect of pindolol on the length of time for an antiobsessional response to fluvoxamine (Luvox). Pindolol did not shorten the response time to fluvoxamine and there was no increase in amount of fluvoxamine improvement with pindolol augmentation.
Olanzapine augmentation of fluoxetine in the treatment of refractory obsessive-compulsive disorder.
Journal of Clinical Psychopharmacology, 18(5):423-424, 1998, M.N. Potenza, S. Wasylink, J.G. Longhurst, C.N. Epperson and C.J. McDougle
Olanzapine (Zyprexa) is a new antipsychotic medication which may be beneficial for treatment resistant OCD. Augmentation of OCD medications with antipsychotics, such as haloperidol and risperidone, have shown therapeutic value. The authors present a case report of treatment resistant OCD responding to olanzapine augmentation of fluoxetine (Prozac). This report is particularly interesting because the patient had not responded to risperidone augmentation of fluoxetine.
Practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder.
Journal of the American Academy of Child and Adolescence Psychiatry, 37(Suppl 10):27S-45S, 1998
Practice guidelines for patient management, have been developed by the American Academy of Child and Adolescence Psychiatry. These guidelines, based on evaluation of the scientific literature and clinical consensus, describe the accepted approaches to assess and treat obsessive-compulsive disorder in children and adolescents.
The SSRI discontinuation syndrome.
Journal of Psychopharmacology, 12(3):305-313, 1998, P. Haddad
Discontinuation of selective serotonin reuptake inhibitors (SSRIs) may produce withdrawal symptoms which are usually mild, commence within one week of stopping medication and disappear spontaneously within three weeks. The most common symptoms are dizziness, nausea, lethargy and headache. In cases of moderate severity, symptomatic treatment is appropriate, e.g., insomnia by a short course of a benzodiazepine. With severe symptoms, the SSRI should be reinstated and withdrawn more gradually. Clinicians can reduce the likelihood of discontinuation symptoms by ensuring that SSRIs, taken continuously for more than a few weeks, are not stopped abruptly but are gradually tapered.
Venlafaxine treatment of trichotillomania: an open series of ten cases.
CNS Spectrums, 3(9):56-60, 63, 1998, R.L. O'Sullivan, N.J. Keuthen, D. Rodriguez, P. Goodchild, G.A. Christenson, S.L. Rauch, M.A. Jenike and L. Baer
This retrospective treatment study indicates that short-term treatment with venlafaxine (Effexor) significantly improved thrichotillomania symptoms. Although limited by the small sample size of 10 patients and the open nature of treatment, these data concur with preliminary data from a clinical trial in which 6 out of 9 trichotillomania patients showed a favorable response after 12 weeks of venlafaxine treatment.
Gabapentin augmentation for fluoxetine-treated patients with obsessive-compulsive disorder.
Journal of Clinical Psychiatry, 59 (9):480-481, 1998, by G. Cora-Locatelli, B.D. Greenberg, J. Martin and D. L. Murphy.
All five OCD patients with partial response to fluoxetine (Prozac) benefited from the addition of Gabapentin (Neurontin). Mean dose of fluoxetine was 68 mg/d and did not change during the 6 week trial. Gabapentin was initiated at 900 mg/d and increased to a mean dose of 2520 mg/d (range 900 to 3600 mg/d). Improvements were noted in OC symptoms, anxiety, mood and sleep. On the basis of these preliminary results, the researchers are currently conducting a controlled trial to evaluate the possible efficacy of Gabapentin augmentation in OCD patients partially responsive to serotonin reuptake inhibitor monotherapy.
Obsessive-compulsive disorder: cognitive behavioral treatment of older versus younger adults.
Clinical Gerontologist, 19(2):77-81, 1998, by C.N. Carmin, C.A. Pollard and R.L. Ownby.
Elderly patients can benefit from cognitive behavioral treatment of their OCD and the level of improvement may be comparable to that of younger adults. The findings of this study are particularly noteworthy given that the older patients had experienced OCD symptoms for approximately twice as long as the younger adults.
Symptom exacerbation of vocal tics and other symptoms associated with streptococcal pharyngitis in a patient with obsessive-compulsive disorder and tics.
American Journal of Psychiatry, 155(10):1459-1460, 1998 by B.D. Greenberg, D.L. Murphy and S.E. Swedo.
Streptococcal infections have been reported to worsen obsessive compulsive disorder in children and adolescents. The authors present a case report of the illness worsening in an adult with a streptococcal infection. After antibiotic treatment of the strep infection, the OCD symptoms returned to the level of severity experienced before the infection.
Obsessive-compulsive disorder in children and adolescents.
British Journal of Psychiatry, 173 (supplement 35):91-96, 1998 by M. Riddle.
Current knowledge of child/adolescent obsessive compulsive disorder is reviewed. The article includes discussion of the prevalence of OCD, OCD subtypes, causes of OCD, assessment of OCD, and treatment of OCD.
Pharmacotherapy for obsessive-compulsive disorder.
British Journal of Psychiatry, 173 (supplement 35):64-70, 1998 by J. H. Greist and J.W. Jefferson.
Current medication treatment of obsessive compulsive disorder is reviewed. The selective serotonin reuptake inhibitors (SSRI's) are well tolerated by patients with OCD and are the medication of choice. Antipsychotic augmentation helps many OCD patients with comorbid tics. Other medication strategies are discussed. Guidelines for dosage and length of treatment trials are given.
Combination of behavior therapy with fluvoxamine in comparison with behavior therapy and placebo: results of a multicenter study.
British Journal of Psychiatry, 173 (supplement 35):71-78, 1998 by F. Hohagen, G. Winkelmann, H. Rasche-Rauchle et al.
An investigation of whether the combination of behavior therapy with fluvoxamine (Luvox) is superior to behavior therapy alone in the treatment of severely ill in-patients with obsessive compulsive disorder is reported. The behavior therapy plus fluvoxamine group showed a significantly higher response rate 87.5%) versus the behavior therapy plus placebo group (60%). The results of this study suggest that behavior therapy should be combined with medication when obsessions dominate the clinical picture and when a secondary depression is present.
Behavioral treatment of obsessive-compulsive disorder in African-Americans Clinical issues.
Journal of Behavior Therapy and Experimental Psychiatry, 29:163-170, 1998 by K. E. Williams, D. L. Chambless and G. Steketee.
African Americans with obsessive compulsive disorder are underrepresented in behavioral treatment studies. This paper discusses issues arising during behavior therapy of two African-American women with OCD. One issue that set these two women apart from white patients with OCD was a greater level of shame at having the disorder. Both women made significant improvement with behavior therapy.
Clinical features distinguishing patients with Tourettes Syndrome and obsessive-compulsive disorder from patients with obsessive-compulsive disorder without tics.
Journal of Clinical Psychiatry, 59(9):456-459, 1998 by T Petter, M.A. Richter and P. Sandor.
Subtle but definite differences in symptomatology of patients with pure OCD compared to those with OCD and Tourettes Syndrome (TS) were found. Subjects with OCD alone had very few obsessions and compulsions that were not also experienced by subjects with both TS and OCD. In contrast, subjects with TS and OCD were significantly more likely to report obsessions involving nonviolent images, excessive concern with appearance, and need for symmetry. Touching, blinking or staring, and counting compulsions were also significantly more common in the group with tics.
Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytical evaluation of clinical significance.
Behavior Therapy, 29(2):339-355, 1998, by J.S. Abramowitz.
Dr. Abramowitz provides an analysis and review of 16 behavioral therapy studies. As expected, substantial improvements during the course of OCD treatment were observed. The results of this meta-analysis are supportive of the use of exposure and response prevention for reducing obsessive-compulsive symptoms, particularly washing and checking rituals. While cure is the exception, substantial improvement should be the expectation with competent cognitive-behavior therapy.
Sertraline treatment of children and adolescents with obsessivecompulsive disorder or depression: pharmacokinetics, tolerability, and efficacy.
Journal of the American Academy of Child and Adolescent Psychiatry, 37(4):386-394, 1998, J. Alderman, R. Wolkow, M. Chung, and H.F. Johnston
This study evaluated the effectiveness and safety of sertraline treatment of OCD in 61 children and adolescents. Sertraline was well tolerated in both children and adolescents, with adverse effects similar to those previously reported by adult patients. The most frequently reported adverse effects, of mild to moderate severity, were headache, nausea, insomnia, somnolence (sleepiness), dyspepsia (stomach upset), and anorexia. Improvement in both OCD and depression were seen. The study concluded that sertraline can be safely administered to children and adolescents using the recommended adult dosage schedule.
Psychotropic drug use during pregnancy: weighing the risks.
Journal of Clinical Psychiatry, 59(Suppl 2):18-28, 1998, L.S. Cohen and J.F. Rosenbaum.
The risks and benefits of anti-OCD medications in pregnant women are assessed. Behavior therapy for OCD is an alternative to medication for some patients. Clomipramine and fluoxetine represent a reasonable treatment approach during, or particularly after, the first trimester. The authors conclude that psychotropic medications may be used during pregnancy when the potential risk to the fetus from drug exposure is outweighed by the risk of untreated maternal psychiatric disorder.
Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: an open clinical trial.
Journal of the American Academy of Child and Adolescent Psychiatry, 37 (4):412-419, 1998, M.E. Franklin, M.J. Kozak, L.A. Cashman, M.E. Coles, A.A. Rheingold, and E.B. Foa.
This clinical trial examined the effectiveness of cognitive-behavioral treatment involving exposure and ritual prevention for 14 children and adolescents with OCD. Twelve of the 14 patients improved at least 50% and the vast majority remained improved at follow-up.
Transcranial magnetic stimulation as a probe and potential treatment in Obsessive-Compulsive Disorder.
CNS Spectrums, 3(5-Suppl 1):30-32, 1998, B.D. Greenberg, G. Cora-Locatelli, E.M. Wassermann, U. Ziemann, and D.L. Murphy.
Transcranial magnetic stimulation (TMS) as a means of studying the brain's functioning in OCD and as a possible therapy to treat OCD is discussed. In TMS, a pulsed magnetic field affects the brain activity in regions underlying an electromagnetic coil placed on the scalp. Whether repeated TMS sessions might have a beneficial effect on OCD is the focus of an ongoing investigation by the authors.
Self-treatment for obsessive compulsive disorder using a manual and a computerized telephone interview: a U.S.-U.K. study.
M.D. Computing , 15(3):149-157, 1998, J.H. Greist, I.M. Marks, L. Baer, J.R. Parkin, P.A. Manzo, J.M. Mantle, K.W. Wenzel, C.J. Spierings, K.A. Kobak, S.L. Dottl, T.M. Bailey, and L. Forman.
BT STEP ™ is a patient-centered behavioral therapy program that uses a manual and a computer-driven interactive voice response system to assess and treat OCD. The patient reads about this nine-step exposure and ritual prevention program in a manual and then uses a touch-tone telephone to contact the program, in which a recorded voice conducts the interview. The system produced significant improvements on measures of OCD.
Retrospective review of treatment outcome for 63 patients with Trichotillomania.
American Journal of Psychiatry, 155(4):560-561, 1998, N.J. Keuthen, R.L. O'Sullivan, P. Goodchild, D. Rodriguez, M.A. Jenike, and L. Baer.
The authors studied the treatment outcome for patients with Trichotillomania. Significant improvement was found on measures of hairpulling, depression, anxiety, self-esteem, and psychosocial functioning. State-of-the-art behavioral and pharmacological treatments offered substantial benefit to patients with Trichotillomania.

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