Management of Obsessive Compulsive Symptoms in a Patient Diagnosed With Bipolar 1 Disorder and a History of Migraines

Bipolar disorder and obsessive compulsive disorders (OCDs) may exist together. If the patient also experiences migraines, medication management may be complicated. Lithium and aripiprazole are prescribed as combination therapy to manage both bipolar disorder and OCD. Lamotrigine can be added for depressive symptoms and migraine prophylaxis; however, lamotrigine may exacerbate OCD symptoms. For proper medication management, advanced practice nurses will be asked to be a collaborating partner in the care of patients with both medical and psychiatric disorders.     

小剂量阿立哌唑作为增效剂治疗强迫症的疗效

目的：探讨小剂量阿立哌唑作为增效剂治疗强迫症的疗效与不良反应。方法将99例强迫症患者按随机数字表法分为3组：A组33例口服盐酸帕罗西汀40 mg·d-1,B组32例口服盐酸帕罗西汀40 mg·d-1＋阿立哌唑2.5 mg·d-1, C组34例口服盐酸帕罗西汀40 mg·d-1＋阿立哌唑5 mg·d-1。采用耶鲁布朗强迫量表（Y-BOCS）评定3组临床疗效,并采用副反应评定量表（TESS）对3组治疗期间的不良反应情况进行评价。结果治愈率A、B、C 组分别为15.1%、28.1%、29.4%,总有效率A、B、C组分别为65.4%、68.7%、64.7%,B、C组治愈率、总有效率均显著高于A组（P〈0.05）;治疗期间3组不良反应发生率比较差异均无统计学意义（P＞0．05）。结论小剂量阿立哌唑作为增效剂治疗强迫症具有明显的增效作用,且无严重不良反应发生。     

舍曲林联合氨磺必利治疗难治性强迫症的临床研究

目的:探讨舍曲林联合氨磺必利治疗难治性强迫症的临床疗效及安全性。方法:难治性强迫症患者45例,随机分为对照组23例和实验组22例。对照组单用舍曲林,实验组给予舍曲林合并氨磺必利治疗,均治疗8周。治疗前后采用耶鲁-布朗强迫量表(Y-BOCS)评定强迫症严重程度,不良反应量表(TESS)评定不良反应。结果:治疗8周后,对照组和实验组的总有效率分别为66.7%、90.1%,实验组优于对照组,差异有统计学意义(P0.05)。治疗2周和4周后,实验组Y-BOCS评分较对照组降低(P0.05),治疗8周末实验组的Y-BOCS评分较对照组显著降低(P0.01)。2组组内比较,除对照组在治疗2周末与治疗前比较Y-BOCS评分差异不明显,其余各周评分与治疗前比较均有显著性差异(P0.01)。2组的不良反应中,唾液增多差异有统计学意义(P0.05)。结论:舍曲林联合氨磺必利治疗难治性强迫症与舍曲林单药治疗比较,起效更早、疗效更好,安全性较好。     

Risk Aversion Among Depressed Older Adults with Obsessive Compulsive Personality Disorder

Despite considerable research on depression in older adults, few studies have included individuals with personality disorders or have used laboratory tasks to examine behavioral correlates of depression among older adults. This study used the Bechara Gambling Task to examine the hypothesis that depressed older adults with co-morbid personality disorders (n = 59) would demonstrate greater aversion to risk, when compared with older adult controls without depression or personality disorders (n = 34). Results indicated weak support for the notion that depressed individuals are more risk averse than non-depressed controls, and stronger support for the role of obsessive-compulsive personality disorder (OCPD) in risk aversion. Individuals with OCPD became considerably more risk averse as the task progressed, compared with controls. In addition, the severity of OCPD features, rather than depression, accounted for increased risk aversion in depressed older adults with OCPD.     

Do Patients with Obsessive–Compulsive Disorder Have Deficits in Decision-Making?

In this study we examined three variables related to decision-making in obsessive–compulsive disorder (OCD): (1) the amount of information requested before making a decision, (2) the amount of time spent deliberating before making a decision, and (3) the level of risk the decision carries. Eighteen individuals with OCD (OCs) and 18 nonanxious controls (NACs) were presented with 12 scenarios in which they had to choose between two alternatives. Scenarios carried varying degrees of risk. Both groups distinguished between the levels of risk. However, compared to NACs, OCs requested more information about, and spent more time deliberating for low-risk and OCD-relevant decisions; no group differences were found for high-risk situations. Moreover, increased time spent on decisions about OCD-relevant situations appears dependent on perceived risk in the situation and not simply on the tendency to obsess.     

Insight as a Predictor of Treatment Outcome in Behavioral Group Treatment for Obsessive–Compulsive Disorder

The presence of poor insight into the senselessness of symptoms of obsessive–compulsive disorder (OCD) has been theoretically linked to poor treatment response, yet few studies have examined this question. This study examined the role of poor insight in 69 OCD patients, who completed 7 weeks of cognitive behavioral group therapy. Participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other measures of psychopathology. Insight was measured using interviewer ratings on an item of the Y-BOCS and participants were grouped as having “poor” or “adequate” insight. The analyses revealed that, after pre-treatment levels of OCD severity, depression, and medication status, were controlled, patients with adequate insight experienced better post-treatment outcomes than those with poor insight. These results suggest that patients with poorer insight can still benefit from treatment, but may experience a less favorable outcome than patients with better insight. Implications for the treatment of OCD are discussed.     

Obsessive–Compulsive Symptoms and the Expression of Anger

The present study investigates the association between Obsessive–Compulsive (OC) symptoms and the expression of anger in a sample of 131 undergraduates. Participants were divided into two groups based on their self-reported OC symptoms and compared on their tendency to suppress anger inwardly, express anger outwardly, and control their anger. In addition, the associations between anger and specific OC symptoms were investigated. Results indicated that individuals high in OC symptoms tended to experience more anger, be more likely to suppress it inwardly, and report more difficulty controlling their anger than individuals low in OC symptoms. However, these differences appear to be attributable to the presence of depressive symptoms in the participants with high levels of OC symptoms. In addition, OC checking was found to be weakly associated with anger independent of depressive symptoms. These results were discussed within the framework of the cognitive theory of obsessive compulsive disorder.     

认知行为疗法对强迫症患者的治疗效果

目的了解认知行为疗法对强迫症患者的治疗效果。方法便利抽样法选择2011年2月至2012年2月在梅州市第三人民医院精神科治疗的强迫症患者70例为研究对象,按住院顺序先后将其分成观察组和对照组,每组35例。对照组患者给予药物治疗并辅以常规护理,观察组患者在对照组的基础上给予认知行为治疗,治疗前及治疗8周后采用耶鲁布朗强迫症量表(Yale-Brown obsessive-compulsive scale,YBCOS)对两组患者进行测评,并比较分析。结果治疗8周后,两组患者YBCOS量表评分与治疗前比较,差异均有统计学意义(均P0.05)。干预后2、4、6、8周,两组患者YBCOS量表评分、强迫性思维因子评分、强迫性行为因子评分的差异均有统计学意义(均P0.05)。经过8周治疗后,观察组痊愈16例、显效10例、有效5例、无效4例,对照组分别为8、7、9、11例;两组的显效率分别为74.29%和42.86%,有效率分别为88.57%和68.57%,两者的差异均有统计学意义(均P0.05)。结论认知行为疗法在强迫症患者的临床治疗中有显著的疗效,有利于患者的康复,值得在临床工作中推广。     

Predicting Changes in Obsessive Compulsive Symptoms Over a Six-Month Follow-Up: A Prospective Test of Cognitive Models of Obsessive Compulsive Disorder

Cognitive models of obsessive compulsive disorder (OCD) propose that OCD-related beliefs (e.g., inflated responsibility) and negative life events should predict changes in OC symptoms over time (Rachman, 1997, Behaviour Research and Therapy, 35, 793–802; Rachman, 1998, Behaviour Research and Therapy, 36, 385–401; Rachman, 2002, Behaviour Research and Therapy, 40, 625–639; Salkovskis, 1985, Behaviour Research and Therapy, 23, 571–583; Salkovskis & Kirk, 1997, In The science and practice of cognitive behavior therapy. Oxford: Oxford University Press). However, very little research has tested these longitudinal predictions. The current study sought to replicate and extend findings by Coles and Horng (2006, Cognitive Therapy and Research, 30, 723–746) showing that OCD-related beliefs and negative life events significantly predicted changes in the frequency of OC symptoms over 6 weeks. Results of the current study, using a 6-month prospective longitudinal design, provided modest support for cognitive models of OCD. Negative life events significantly predicted residual change in both the frequency of, and distress associated with, OC symptoms. Initial OCD-related beliefs significantly predicted residual change in the distress associated with OC symptoms, but there was much additional variance to be accounted for. Additional data are presented that both examine the specificity of these predictors to changes in OC symptoms versus social anxiety and depressive symptoms, and explore particular types of life events in predicting symptom changes over time.

认知行为疗法在强迫症患者中的应用效果观察

目的探讨认知行为疗法在强迫症患者中的应用效果。方法选择强迫症患者52例,随机均分为A组和B组,每组各26例,两组患者给予常规护理,在此基础上B组患者实施认知行为疗法。在就诊时及治疗后(治疗第4周和第8周),采用耶鲁布朗强迫症状量表(Y-BOCS)对两组患者进行测评。结果治疗第4周和第8周,两组患者Y-BOCS总评分比较,均P<0.05,差异具有统计学意义。结论在强迫症患者的治疗过程中,实施认知行为疗法,可提高临床疗效,促进疾病的康复。     

Pharmacologic Treatment of Children and Adolescents with Obsessive-Compulsive Disorder

The SRIs represent a major breakthrough in the treatment of OCD. Recent studies suggest that these medications are safe and effective for children and adolescents with OCD, but the SRIs are not free of side effects. Frequent side effects include heartburn, diarrhea, and behavioral activation. The long half-life of the SRIs mandates slow upward adjustment to avoid overshooting the optimal dose. Drugs that are metabolized in the liver, such as neuroleptics, can retard the processing of the SRIs, resulting in an increased dose of both drugs. Although the SRIs often are effective in the treatment of OCD in children and adolescents, they are not effective in all cases, and other treatments such as behavioral treatment may be needed as an adjunct to pharmacotherapy.     

Interaction of Cognitive Distortions and Cognitive Deficits in the Formulation and Treatment of Obsessive–Compulsive Behaviours in a Woman with an Intellectual Disability

Aims This case study describes the formulation and cognitive–behavioural treatment (CBT) of obsessive–compulsive thoughts and behaviours in a woman with an intellectual disability. The report aimed to distinguish the cognitive deficits that reflect her disability from the cognitive distortions integral to her obsessive–compulsive disorder. Case study Hence, we present one account of the cognitive–behavioural interventions aimed at correcting the cognitive distortions, and a separate account of the modifications necessary to compensate for specific cognitive deficits, which include impairments not only of ‘cognitive therapy skills’, but also of aspects of memory and executive functioning skills. Discussion We suggest that this analysis may provide a rational approach to the problem of simplifying CBT to meet the needs of people with intellectually disabilities, by identifying more clearly the specific adaptations that are needed by a particular individual. We also discuss the assessment of cognitive deficits that might impact on CBT, and some implications of this approach for research and training.     

Parameter signature of a reel problem

Clinics involved in follow-up of cardiac implantable electronic devices, especially implantable cardiac defibrillators (ICDs), increasing rely upon remote monitoring. This case describes the parameter signature characteristic of an uncommon but well-described syndrome. Analysis of the nature and timing of the sequence of abnormalities contained in the archived device data, all of which is available for review via remote monitoring, reveals the cause for failure of this primary prevention ICD system.     

Cognitive Bias in Adolescents with Social Anxiety Disorder

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. Previous research has shown that adults with social anxiety disorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the case in adolescents with social anxiety disorder. Elucidation of the cognitive processes of social anxiety disorder in the adolescent population may aid in a better understanding of the etiology and maintenance of the disorder, and may suggest directions for treatment and prevention efforts. This study investigated probability and cost estimations of negative social and nonsocial events among adolescents with social anxiety disorder relative to nonanxious controls. Results indicated that socially anxious adolescents overestimated the cost and probability of negative social events compared to nonanxious adolescents, even after controlling for depressive symptoms. Implications and limitations of these findings are discussed.     

Emotion Dysregulation in Generalized Anxiety Disorder: A Comparison with Social Anxiety Disorder

From an emotion regulation framework, generalized anxiety disorder (GAD) can be conceptualized as a syndrome involving heightened intensity of subjective emotional experience, poor understanding of emotion, negative reactivity to emotional experience, and the use of maladaptive emotion management strategies (including over-reliance on cognitive control strategies such as worry). The current study sought to replicate previous findings of emotion dysregulation among individuals with GAD and delineate which aspects of emotion dysregulation are specific to GAD or common to GAD and another mental disorder (social anxiety disorder). Individuals with GAD reported greater emotion intensity and fear of the experience of depression than persons with social anxiety disorder and nonanxious control participants. Individuals with social anxiety disorder indicated being less expressive of positive emotions, paying less attention to their emotions, and having more difficulty describing their emotions than either persons with GAD or controls. Measures of emotion differentiated GAD, social anxiety disorder, and normal control groups with good accuracy in a discriminant function analysis. Findings are discussed in light of theoretical and treatment implications for both disorders.An earlier version of this paper was presented at the Association for Advancement of Behavior Therapy, Reno, NV, November, 2002     

A Case Report of Cavernous Sinus Syndrome in a Patient With Takayasu's Arteritis

Neurologists must entertain a broad differential diagnosis when considering a patient with cavernous sinus syndrome, including neoplasm, trauma, vascular causes, inflammatory processes, and infections. We report the case of a 37‐year‐old woman initially diagnosed with cavernous sinus syndrome, where subsequent investigations revealed findings of Takayasu's arteritis, a large vessel vasculitis. The patient also tested positive for perinuclear antineutrophil cytoplasmic antibodies, suggesting the possibility of a vasculitic spectrum disorder although no clinical features of Wegener's granulomatosis were present. Criteria for Takayasu's arteritis and its protean neurologic manifestations are reviewed. This case highlights the spectrum of vasculitic conditions that may be associated with cavernous sinus inflammation.     

Preliminary Psychometric Evaluation of a New Self-Efficacy Scale and Its Relationship to Treatment Outcome in Social Anxiety Disorder

The concept of self-efficacy as applied to individuals with social anxiety disorder (SAD) represents a person's confidence in being able to convey a favorable impression to others. The current study investigated the psychometric properties and clinical usefulness of a new measure called the Self-Efficacy for Social Situations (SESS) Scale. Results provide preliminary evidence for the reliability and validity of the SESS in a clinical sample of individuals with SAD. Pre- to posttreatment change in self-efficacy was a significant and independent predictor of change in social anxiety symptoms. Implications for treatment are discussed.