强迫症患者、强迫型人格障碍患者和健康对照者之间的认知灵活性和计划能力比较

背景：强迫症患者(Obsessive Compulsive Disorder, OCD)与强迫型人格障碍患者(Obsessive Compulsive Personality Disorder, OCPD)的认知功能还没有得到充分的研究。
　　目标：验证OCD和OCPD患者的认知灵活性和计划能力。
　　方法：本研究在德黑兰心理咨询门诊选定了25例OCD患者和20例OCPD患者,他们在既往两周都没有服药,并且从大学工作人员和当地社区居民中选定了25名健康对照者。对所有参与者均进行28项一般健康问卷(28-item version of the General Health Quesitonnaire, GHQ-28)、威斯康星卡片分类测验(Wisconsin Card Soritng Test, WCST)、和伦敦塔试验(Tower of London test, TOL)）。本研究运用WCTS的两个测量指标（持续错误数和完成分类数）评估认知灵活性以及TOL的三个测量指标（12个试验总共的移动次数、总应答时和计划时间）评估计划能力。
　　结果：2组患者的当前心理困扰程度显著高于对照组。在控制人口学因素和心理困扰水平后,OCD患者和OCPD患者在WCST测试中比对照组更容易出现持续性错误,而OCD患者（不包括OCPD患者）的完成分类数比对照组显著减少。OCD患者和OCDP患者都比对照组需要更多的移动次数来完成12项TOL任务,并且OCD患者比OCPD患者和对照组需要花更长的时间来完成任务。
　　结论：与健康对照组相比,OCD和OCPD患者的认知灵活性和计划能力都有所受损,并且OCD和OCPD患者之间的认知功能测试也存在一些差异。我们需要对OCD和OCPD患者进行长期随访研究评估在强迫症状严重性加重与减轻时认知功能的改变,从而决定此类认知评估指标对于强迫症是否有诊断或临床关联性。     

递质受体相关候选基因与强迫谱系障碍

目的:了解多巴胺D2受体(DRD2)基因、D3受体(DRD3)基因、D4受体(DRD4)基因、多巴胺转运体(DAT1)基因、儿茶酚胺氧位甲基转移酶(COMT)基因、5-羟色胺2A受体(5-HTR2A)基因、5-羟色胺转运体(5-HTT)基因等与强迫谱系障碍(OCSDs)的连锁关系。方法:选取一个连续3代发病的强迫谱系障碍家系,共20名,量表采用遗传研究诊断问卷(DIGS)及遗传研究家族问卷(FIGS)。采集该家系中12个正常个体,8个受累个体的血样,选取DRD2、DRD3、DRD4、DAT1、COMT、5-HTR2A、5-HTT基因附近27对微卫星标记引物,采用两点和多点非参数分析的方法对该家系进行连锁分析。结果:27对微卫星标记位点的两点和多点非参数分析LOD值(NPL值)均未达到验证性连锁的阈值(NPL=1.2)。结论:未能验证DRD2、DRD3、DRD4、DAT1、COMT、5-HTR2A、5-HTT基因与OCSDs的连锁关系,但亦不能排除这些基因与OCSDs的相关性。     

Impulse control disorders in adults with obsessive compulsive disorder

Little is known about impulse control disorders (ICDs) in individuals with obsessive compulsive disorder (OCD). Although studies have examined ICD comorbidity in OCD, no previous studies have examined clinical correlates of ICD comorbidity in a large sample of individuals with a primary diagnosis of OCD. We examined rates and clinical correlates of comorbid ICDs in 293 consecutive subjects with lifetime DSM-IV OCD (56.8% females; mean age=40.6+/-12.9 years). Comorbidity data were obtained with the Structured Clinical Interview for DSM-IV. ICDs were diagnosed with structured clinical interviews using DSM-IV criteria. OCD severity was assessed with the Yale-Brown Obsessive-Compulsive Scale. Quality of life and social/occupational functioning were examined using the Quality of Life Enjoyment and Satisfaction Questionnaire and the Social and Occupational Functioning Assessment Scale. All variables were compared in OCD subjects with and without lifetime and current ICDs. Forty-eight (16.4%) OCD subjects had a lifetime ICD, and 34 (11.6%) had a current ICD. Skin picking was the most common lifetime (10.4%) and current (7.8%) ICD, followed by nail biting with lifetime and current rates of 4.8% and 2.4%, respectively. OCD subjects with current ICDs had significantly worse OCD symptoms and poorer functioning and quality of life. These preliminary results suggest that there is a low prevalence of ICDs among individuals with OCD, although certain ICDs (skin picking) appear to be more common.     

Cortical thinning in obsessive compulsive disorder

Although studies of obsessive-compulsive disorder (OCD) over the last 20 years have suggested abnormalities in frontal-subcortical circuitry, evidences of structural abnormalities in those areas are still imperfect and contradictory. With recent advances in neuroimaging technology, it is now possible to study cortical thickness based on cortical surfaces, which offers a direct quantitative index of cortical mass. Using the constrained Laplacian-based automated segmentation with proximities (CLASP) algorithm, we measured cortical thickness of 55 patients with OCD (33 men and 22 women) and 52 age- and sex-matched healthy volunteers (32 men and 20 women). We found multiple regions of cortical thinning in OCD patients compared to the normal control group. Patients with OCD had thinner left inferior frontal, left middle frontal, left precentral, left superior temporal, left parahippocampal, left orbitofrontal, and left lingual cortices. Most thinned regions were located in the left ventral cortex system, providing a new perspective that this ventral cortical system may be involved in the pathophysiology of OCD.     

Treatment duration of obsessive compulsive disorder

The first breakthrough in the treatment of obsessive-compulsive disorder (OCD) came in 1967, when Fernandez and Lopez-Ibor reported on the efficacy of clomipramine (CMI) in the treatment of 16 patients with OCD (Fernandez and Lopez-Ibor, 1967). However, controlled studies with CMI were not published until 1980 (Montgomery, 1980; Thoren et al, 1980), and only in the last 5 years have large well-controlled studies been published (Clomipramine Collaborative Study, 1991). Several studies demonstrated that among the tricyclics (TCA), only CMI is effective in OCD, while effective antidepressants with a noradrenergic profile, such as desipramine (DMI), appear to be totally ineffective (Zohar and Insel, 1987; Goodman et al, 1990; Leonard et al, 1989). This selective response to TCA with a serotonergic profile led to the formulation of the serotonergic hypothesis of OCD and to the development and use of other serotonergic agents in the treatment of this disorder. Several drugs, possessing a serotonergic profile are currently being studied worldwide, among them CMI, fluoxetine, fluvoxamine, sertraline, paroxetine and citalopram. Currently, as the knowledge regarding the pharmacological approach to OCD is only beginning to accumulate, very little is known regarding treatment duration in OCD. In this review we shall attempt to examine the existing data regarding treatment duration in OCD.     

Amygdala subnuclei volumes and anxiety behaviors in children and adolescents with autism spectrum disorder,attention deficit hyperactivity disorder,and obsessive–compulsive disorder

Alterations in the structural maturation of the amygdala subnuclei volumes are associated with anxiety behaviors in adults and children with neurodevelopmental and associated disorders. This study investigated the relationship between amygdala subnuclei volumes and anxiety in 233 children and adolescents (mean age = 11.02 years; standard deviation = 3.17) with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and children with obsessive compulsive disorder (OCD), as well as typically developing (TD) children. Parents completed the Child Behavior Checklist (CBCL), and the children underwent structural MRI at 3 T. FreeSurfer software was used to automatically segment the amygdala subnuclei. A general linear model revealed that children and adolescents with ASD, ADHD, and OCD had higher anxiety scores compared to TD children (p < .001). A subsequent interaction analysis revealed that children with ASD (B = 0.09, p < .0001) and children with OCD (B = 0.1, p < .0001) who had high anxiety had larger right central nuclei volumes compared with TD children. Similar results were obtained for the right anterior amygdaloid area. Amygdala subnuclei volumes may be key to identifying children with neurodevelopmental disorders or those with OCD who are at high risk for anxiety. Findings may inform the development of targeted behavioral interventions to address anxiety behaviors and to assess the downstream effects of such interventions.     

强迫症患者的事件相关脑电位实验研究

背景 强迫症在辅助诊断上目前还缺乏客观的实验室依据。近年来国内外对强迫症的事件相关脑电位进行了研究,结果并不一致。分析其主要原因与所使用仪器、技术性能有关。为此本研究使用国际标准化的美国Nicolet脑电生理仪,并以较成熟的关联性负变、P300及失匹性负波3种事件相关脑电位为手段,并设临床上较多见的抑郁症和广泛性焦虑症为疾病对照,进一步探讨强迫症的脑电生理机制,为临床诊断及治疗提供参考依据。 方法 应用美国Nicolet Spirit 脑诱发电位仪,采用光和声成对刺激以及“听觉靶-非靶刺激序列”技术,对38例强迫症、20例抑郁症和18例广泛性焦虑症及28名正常人的关联性负变(CNV)、P300及失匹性负波(MMN)作了检测。3组疾病组病例均选自2002年5月至2005年12月上海市精神卫生中心,经2名以上的高年资医师确诊并符合中国精神障碍分类方案第三版（CCMD-3）中的强迫症和抑郁症及广泛性焦虑症诊断标准;听力均正常,并无躯体疾病或其他精神疾病,均为右利手。3组对象均未使用过精神科药物。结果 ①CNV：M1波幅抑郁症组[(5±4)μV]和广泛性焦虑症组[(7±4)μV]低于正常组[(14±6)μV]和强迫症组(16±6)μV,指令信号后负变化的出现率抑郁症组(60%)、强迫症组(45%)和广泛性焦虑症组(35%)均高于正常组(4%),上述组间差异均有统计学意义（P<0.05或P<0.01）。②P300：在靶刺激中,N2潜伏期在4组间的差异有统计学差异(P<0.01),其中强迫症组[(276±22)ms]和抑郁症组[(277±22)ms]的潜伏期均长于正常组[(259±14)ms],广泛性焦虑症组短于抑郁症组和强迫症组(P<0.01);P3波幅在4组间的差异亦有统计学差异(P<0.01),其中强迫症组[(3.4士1.6)μV]、抑郁症组[(2.9±1.3)μV]和广泛性焦虑症组[(3.3士1.3)μV]均低于正常组[(5.9土2.1)μV]。在非靶刺激中,广泛性焦虑症组P2波幅低于强迫症组和正常组(P<0.05)。③MMN：强迫症组、抑郁症组及正常组之间潜伏期和波幅的差异有统计学差异(P<0.05或P<0.01)。其中强迫症组和抑郁症组的潜伏期长于正常组(P<0.05);强迫症组的波幅高于正常组(P<0.05),抑郁症组的波幅低于正常组(P<0.05)和强迫症组(P<0.01)。结论 ERPs波幅一高一低变异特点可能对鉴别强迫症和抑郁症有参考意义。     

Vitamin D levels in children and adolescents with obsessive compulsive disorder

Background: Recent studies showed that vitamin D deficiency may lead to dysfunctional changes in the brain and may be associated with neuropsychiatric diseases.

Aims: The present study aims to investigate vitamin D, calcium, phosphorus and alkaline phosphatase levels in children and adolescents diagnosed with obsessive-compulsive disorder (OCD) and compared them to healthy controls. Additionally, the correlation of OCD symptom severity with serum vitamin D level will be analyzed.

Methods: A semi-structured interview form (K-SADS-PL) was used to diagnose OCD and other comorbidities in accordance with DSM-IV criteria. In addition, all participants were assessed with clinical interviews based on DSM-5 OCD diagnostic criteria. Children's Yale Brown Obsession Compulsion Scale (CY-BOCS) and Children’s Depression Inventory were used in the clinical evaluation.

Results: Vitamin D levels were lower in patients diagnosed with OCD (15.88?±?6.96?ng/mL) when compared to healthy controls (18.21?±?13.24?ng/mL), but the difference was not statistically significant (p?=?.234). Serum calcium, serum phosphate and serum alkaline phosphatase levels were not different between the groups. A negative correlation was found between serum 25OH-D3 levels and obsession scale scores in CY-BOCS.

Conclusions: To our knowledge this is the first study that evaluated vitamin D levels in OCD patients without comorbidity. The vitamin D levels of newly diagnosed OCD cases were lower but not statistically different than healthy controls. Furthermore, the study does also not support the presence of a significant association between serum vitamin D levels and OCD.     

Sensitivity of self-beliefs in obsessive compulsive disorder

Aspects of self-concept have been implicated in recent cognitive theories of obsessive compulsive disorder (OCD). It has been proposed that OCD is associated with perceptions of incompetence in self-domains considered important by the individual. A previous study in nonclinical individuals found that such "sensitivity of self" in the areas of job competence, morality and social acceptability was associated with elevated OCD symptoms and related beliefs. This study examined whether self-sensitivity is related to higher OCD symptoms and cognitions in individuals with OCD, and whether such self-sensitivity is specific to OCD versus other anxiety disorders. Clinical samples with OCD (N=30), other anxiety disorders (N=20) and a community control sample (N=32) participated in the study. It was found that in the OCD group, sensitivity in moral domains, but not job competence or social acceptability, was associated with higher levels of OCD symptoms and OCD-related beliefs. Sensitivity in the domains of morality and job competence was found in the OCD cohort, whereas individuals with other anxiety disorders did not show such sensitivity, suggesting some specificity of relationships to OCD. Implications for theory and therapy are discussed.     

Adolescent obsessive compulsive disorder heralding chorea‐acanthocytosis

We describe one male and one female patient who each developed childhood/adolescent obsessive‐compulsive disorder as a prelude to the development of a typical picture of chorea‐acanthocytosis (ChAc). In each patient, the caudate nucleus showed dramatic atrophy. The role of the caudate in compulsive phenomena, and the predilection for neurological disorders with onset in adolescence to present as major mental illness, is discussed. On the basis of the current evidence and previous findings, we suggest that ChAc can be understood as a disorder whose clinical presentation reflects an interaction between the disease process and the individual's neurodevelopmental stage with both initial interrupted neurodevelopment, and supervening neurodegeneration. © 2007 Movement Disorder Society     

Prediction of remission in obsessive compulsive disorder using a novel machine learning strategy

The study objective was to apply machine learning methodologies to identify predictors of remission in a longitudinal sample of 296 adults with a primary diagnosis of obsessive compulsive disorder (OCD). Random Forests is an ensemble machine learning algorithm that has been successfully applied to large‐scale data analysis across vast biomedical disciplines, though rarely in psychiatric research or for application to longitudinal data. When provided with 795 raw and composite scores primarily from baseline measures, Random Forest regression prediction explained 50.8% (5000‐run average, 95% bootstrap confidence interval [CI]: 50.3–51.3%) of the variance in proportion of time spent remitted. Machine performance improved when only the most predictive 24 items were used in a reduced analysis. Consistently high‐ranked predictors of longitudinal remission included Yale–Brown Obsessive Compulsive Scale (Y‐BOCS) items, NEO items and subscale scores, Y‐BOCS symptom checklist cleaning/washing compulsion score, and several self‐report items from social adjustment scales. Random Forest classification was able to distinguish participants according to binary remission outcomes with an error rate of 24.6% (95% bootstrap CI: 22.9–26.2%). Our results suggest that clinically‐useful prediction of remission may not require an extensive battery of measures. Rather, a small set of assessment items may efficiently distinguish high‐ and lower‐risk patients and inform clinical decision‐making. Copyright © 2015 John Wiley & Sons, Ltd.     

Vitamin B12 and folic acid serum levels in obsessive compulsive disorder

Vitamin B12 and folate serum levels were studied in 30 patients with obsessive compulsive disorder (OCD), and in two control groups comprised of 30 chronic schizophrenics and 30 normal healthy subjects. Six patients (20%) of the OCD group had abnormal low levels of vitamin B12. This prevalence was significantly higher than that of the control groups. No clinical neurological or haematological abnormalities accompanied the reduced vitamin B12 levels. Possible implication of this finding for the pathophysiology of OCD in a subgroup of patients and the possibility that the B12 deficiency could be the consequence rather than the cause of OCD are suggested.     

Acute obsessive compulsive disorder (OCD) in veterans with posttraumatic stress disorder (PTSD)

Abstract

Objectives. Posttraumatic obsessions have been reported in a few studies and case series. However, as the patients described were chronic, and the onset of their posttraumatic stress disorder (PTSD) and obsessive–compulsive disorder (OCD) symptoms was dated some time previously, this hampers interpretation of the temporal, biological and psychological relationship of OCD following traumatic events. In the current paper we describe the emergence of posttraumatic obsessions a short time following the exposure to a traumatic event. Methods. The emergence of posttraumatic obsessions, a few months after exposure to trauma, is described for five veterans. All the veterans participated in combat during the summer of 2006 (in the Second Lebanon War). Results. For all cases, OCD symptoms were initially related to the trauma but later became generalized and independent. Conclusions. The course of the symptoms suggests a potential environmental role in the development of OCD following an exposure to a traumatic event. These observations suggest a biological linkage between exposure to trauma and OCD.     

广泛性焦虑与强迫症患者条件负变化对照研究

目的:用新的分析软件验证彩照诱发条件负变化(CNV)在广泛性焦虑(GAD)和强迫症(OCD)中的临床价值。方法:应用美国NicoletBravo脑诱发电位仪,采用彩照诱发以及反应时间技术,记录了41例GAD和69例OCD患者的CNV,并与58名正常对照者(NC)CNV进行比较。结果:①OCD组波形不规则,CNV-Ⅱ型尤甚;②OCD组、GAD组及NC组在命令信号后负变化(PINV),波幅M1上差异有显著性(P<0.01);与NC组相比,GAD组波幅M1降低,OCD组波幅M1增高;③与NC组相比,OCD和GAD组PINV出现率明显增多,OCD组最高,GAD组其次。结论:新软件为CNV临床应用提供强有力的技术支持。CNV可能是评定GAD和OCD大脑综合功能的有效工具之一,OCD患者CNV变化诸特点值得跟踪随访。     

Corpus callosal morphology in treatment-naive pediatric obsessive compulsive disorder

1. 1. Abnormalities in association circuits have been described in Obsessive Compulsive Disorder (OCD) and may reflect neurodevelopmental abnormalities. Primary and association cortices are topographically mapped in the corpus callosum (CC). The authors hypothesized alterations in CC subdivisions that connect association, but not primary cortices in pediatric OCD. The authors predicted that normal age-related increases in CC area would be absent in OCD.

2. 2. The authors compared the midsagittal magnetic resonance images of 21 psychotropic-naive, nondepressed OCD patients, 7.2–17.7 years, and 21 case-matched healthy controls. Total CC area as well as that of the anterior, middle and posterior genu, anterior and posterior bodies, isthmus, and the anterior, middle and the posterior splenii were measured.

3. 3. All of the CC regions except the isthmus were significantly larger in OCD patients than in controls. CC area correlated significantly with OCD symptom severity but not illness duration. The age-related increase in CC size seen in normal subjects was absent in OCD patients.

4. 4. These findings support theories of abnormal association cortex development in OCD but also suggest possible abnormalities of other primary cortical regions as well.

     

Comorbid psychiatric disorders in Arab children with Autism spectrum disorders

The objective of our study is to estimate the prevalence of comorbid psychiatric disorders in a sample of children with autism spectrum disorders (ASD) recruited from three Arab countries. We also examine the relationship between comorbidity and children's cognitive functioning and gender. Children who received a diagnosis of ASD (n = 60) from a child psychiatric outpatient clinic in Mansoura (Egypt), Al-Ahsa (Saudi Arabia) and Amman (Jordan) were included in this study. Comorbid diagnoses were established with a clinical interview and a semi-structured clinical interview for children and adolescents (SCICA). In addition, for all patients the cognitive evaluation was measured given the range in age and level of ability. Sixty-three percent of the children were diagnosed with at least one comorbid disorder. The most commonly reported comorbid disorders were anxiety disorders (58.3%), ADHD (31.6%), conduct disorders (23.3%), and major depressive disorder (13.3%). Out of the total sample, Obsessive compulsive disorder was the most prevalent anxiety disorder (55%). Elimination disorders were also diagnosed in 40% of patients. These findings emphasize a wide variety of psychiatric comorbidity afflicting youth with ASD and may be important targets for intervention.     

Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD)

OBJECTIVE: Assess the prevalence of autistic traits (AST) in pediatric obsessive-compulsive disorder (OCD) and relate them to OCD co-morbidity and compare them with published normative data. METHODS: Pediatric patients with obsessive-compulsive disorder (n=109) according to the DSM-IV were studied using parent ratings of the Autistic Symptom/Syndrome Questionnaire to assess AST symptoms as a continuous rather than categorical trait. The KSADS, a semi-structured psychiatric interview, was used for the psychiatric diagnostic evaluation. Also, the Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD severity and other clinical features. RESULTS: AST was common among our patients. Symptom scores were highest in cases with co-morbid Autistic Spectrum Disorders, but cases with other co-morbidities as tics/Tourette and attention/behavioral disorders also scored higher. All sub-groups, including OCD without these co-morbidities scored higher than the Swedish normative group. Using ANOVA, co-morbid ASD and tics/Tourette (plus a term for gender by tic interaction indicating that girls with tics scored high, otherwise low) and pathological doubt contributed (R2=.41) to the AST-traits, while OCD severity and co-morbid anxiety- and depressive disorders did not. CONCLUSION: AST traits are prevalent in OCD and seem to be intricately associated with the co-morbidities as well as the OCD syndrome itself. The findings might have implication for our nosological understanding of OCD which currently is discussed.     

Factor structure of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder

OBJECTIVE: To examine the factor structure of DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). METHOD: Two hundred and eleven consecutive out-patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. The eight criteria for the OCPD diagnosis were examined with reliability and correlational analyses. Exploratory factor analysis was performed to identify potential components. RESULTS: Cronbach's coefficient alpha for the OCPD criteria was 0.77. Principal components factor analysis with varimax rotation revealed a three-factor solution (rigidity, perfectionism, and miserliness), which accounted for 65% of variance. CONCLUSION: The DSM-IV criteria for OCPD showed good internal consistency. Exploratory factor analysis, however, revealed three components that may reflect distinct interpersonal, intrapersonal (cognitive), and behavioral features.     

Perceived parental characteristics of patients with obsessive compulsive disorder,depression, and panic disorder

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.