Neither bipolar nor obsessive-compulsive disorder: compulsive buyers are impulsive acquirers

IntroductionCompulsive buying (CB) is currently classified as an impulse control disorder (ICD) not otherwise classified. Compulsive buying prevalence is estimated at around 5% of the general population. There is controversy about whether CB should be classified as an ICD, a subsyndromal bipolar disorder (BD), or an obsessive-compulsive disorder (OCD) akin to a hoarding syndrome. To further investigate the appropriate classification of CB, we compared patients with CB, BD, and OCD for impulsivity, affective instability, hoarding, and other OCD symptoms.MethodEighty outpatients (24 CB, 21 BD, and 35 OCD) who were neither manic nor hypomanic were asked to fill out self-report questionnaires.ResultsCompulsive buying patients scored significantly higher on all impulsivity measures and on acquisition but not on the hoarding subdimensions of clutter and “difficulty discarding.” Patients with BD scored higher on the mania dimension from the Structured Clinical Interview for Mood Spectrum scale. Patients with OCD scored higher on obsessive-compulsive symptoms and, particularly, higher on the contamination/washing and checking dimensions from the Padua Inventory; however, they did not score higher on any hoarding dimension. A discriminant model built with these variables correctly classified patients with CB (79%), BD (71%), and OCD (77%).ConclusionPatients with CB came out as impulsive acquirers, resembling ICD- rather than BD- or OCD-related disorders. Manic symptoms were distinctive of patients with BD. Hoarding symptoms other than acquisition were not particularly associated with any diagnostic group.     

Prevalence of compulsive buying among customers of a Parisian general store

Compulsive buying is defined by the presence of repetitive impulsive and excessive buying, leading to personal and family distress. The objective of this study is to assess the prevalence of compulsive buying among "normal consumers" and to describe the specificities in the buying style of compulsive buyers. We tried to answer several questions. (1) Does compulsive buying occur more often during sales or periods of sales campaigns? (2) Is compulsive buying more impulsive and unplanned than normal buying? (3) Are compulsive buyers more "affectively" involved in their purchases (preference for specific brands they have a narcissistic relationship with, tendency to consider purchases as exceptional special occasions)? (4)Do women who buy compulsively use shopping Web sites and the Internet in general more than controls? We interviewed 200 women successively entering Les Galeries Lafayette, a famous Parisian department store. We diagnosed compulsive buying with standardized criteria and a specific rating scale. All subjects answered an additional questionnaire assessing their buying behavior. We also rated their duration of connection to the Web, the number of e-mails sent and received, and the time spent speaking on a cellular phone. Prevalence of compulsive buying was 32.5%. The proportion of married women was lower among compulsive buyers (66%) than in controls (85%). Compulsive buyers do not seek sales more than controls. Their decision to buy is more often made during their stay in the shop (48% vs 24%, chi(2) = 117, P < .001). Women buying compulsively consider more often their purchases as opportunities not to be passed by (33.7% vs 23.1%, P = .006). They have a higher tendency to use items less than expected (23.4% vs 14.4% in the control group, P < .001). They more often make purchases to impress others (6.5% vs 2.5%, P = .04) and consider more often their purchases as personally gratifying (44% vs 23%, P < .001). Their connections to online shopping sites are longer and more frequent. They spend significantly more time than controls speaking on their cellular phones.     

Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview.

Increasing attention has been paid to the possibility that a range of disorders, the putative obsessive-compulsive spectrum disorders (OCSDs), may share overlapping phenomenological and neurobiological features with obsessive-compulsive disorder (OCD). The development of a structured clinician-administered interview for the putative OCSDs (SCID-OCSD) is described. This instrument was used to investigate differences between OCD patients with a comorbid putative OCSD and OCD patients without a comorbid putative OCSD. A sample of 85 adult patients (38 men and 47 women) presenting for treatment of OCD was interviewed with the SCID-OCSD. OCD patients without comorbid putative OCSDs (n = 36) were compared to patients with comorbid OCSDs (n = 49) in terms of demographic features, clinical characteristics, and associated comorbidity with other non-OCSD DSM-IV axis I disorders. Of the OCD patients, 57.6% currently met criteria for at least one putative OCSD and 67.1% had a lifetime history of at least one comorbid OCSD. The OCSDs with the highest prevalence rates were compulsive self-injury (22.4%), compulsive buying (10.6%), and intermittent explosive disorder (10.6%). There was a significantly larger proportion of women in the group with comorbid OCSDs. Although the two groups did not differ in terms of severity of OCD symptoms, the group with comorbid OCSDs had significantly more obsessions and compulsions. The two groups did not differ significantly in terms of associated psychopathology other than OCSDs. We conclude that the SCID-OCSD provides clinicians and researchers with an instrument for the diagnosis of putative OCSDs. Our findings suggest that putative OCSDs have a relatively high prevalence rate in OCD patients. In addition, OCD patients with comorbid OCSDs differ with regard to certain demographic and clinical features. Further research, particularly genetic and neuroimmunological work, may ultimately be useful in validating the obsessive-compulsive spectrum.     

Impulse control disorders and depression

This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).     

Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: a practical clinical trial

Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores ≥ 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n=70) or fluoxetine (n=88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p=0.875). Patients presented a mean of 2.7 psychiatric comorbidities, and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p=0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p=0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.     

A diffusion tensor imaging study of white matter in obsessive-compulsive disorder

Our objective was to test for differences between subjects with obsessive-compulsive disorder (OCD) and healthy controls with respect to white matter architecture within the cingulum bundle (CB) and anterior limb of the internal capsule (ALIC). We studied eight subjects with active OCD and 10 matched healthy controls using diffusion tensor magnetic resonance imaging (DT-MRI) at 1.5 T (Tesla). Fractional anisotropy (FA) was evaluated in both CB and ALIC. Both voxelwise and region-of-interest methods of analysis were employed. Within both the left CB and the left ALIC, subjects with OCD exhibited significantly greater FA than healthy controls. In the right CB, subjects with OCD exhibited significantly decreased FA versus healthy control subjects. Additionally, the OCD group exhibited abnormal asymmetry (left > right) of FA in the CB. These results provide preliminary evidence for abnormal architecture within the CB and ALIC in OCD. FA differences in these areas are consistent with the presence of abnormal connections between the nodes linked by these tracts. This could explain why surgically severing these tracts is therapeutic. Additional studies are needed to replicate these findings and to clarify their pathological and clinical significance.     

强迫症患者儿茶酚氧位甲基转移酶基因表达的研究

目的 探讨汉族人群中外周血儿茶酚氧位甲基转移酶(COMT)基因表达与强迫症的关系.方法 采用实时定量逆转录-聚合酶链反应技术检测35例强迫症首次发病患者(强迫症组)与31名健康对照(对照组)外周血COMT基因表达水平;使用美国精神障碍诊断与统计手册第4版轴Ⅱ诊断结构式临床访谈问卷(SCID-Ⅱ)评估强迫症与强迫性人格障碍的共病情况.结果 强迫症组COMT基因表达水平明显低于对照组(t=2.56,P＜0.05),下调约32%;无强迫人格患者(15例)与对照组间COMT基因表达水平的差异有统计学意义(t=2.41,P＜0.05),而伴强迫人格患者(20例)与对照组的差异无统计学意义(t=1.50,P＞0.05);伴强迫人格与无强迫人格的强迫症患者COMT基因表达水平分别下调14%和56%;COMT表达水平与症状严重度无显著相关(r＝0.09,P＜0.05).结论 COMT基因表达下调可能与强迫症发病有关;伴或无强迫人格患者的遗传机制可能存在差异.     

Severe obsessive-compulsive disorder with and without comorbid hair pulling: comparisons and clinical implications

OBJECTIVE: Chronic hair pulling and trichotillomania are putative obsessive-compulsive spectrum disorders. This study determined the prevalence of hair pulling in an inpatient obsessive-compulsive disorder (OCD) population and compared clinical characteristics and treatment response between subgroups with and without comorbid hair pulling. METHOD: Patients with severe DSM-IV-diagnosed OCD (N = 154) who were consecutively admitted to an OCD residential treatment facility between August 2000 and July 2003 were included. Clinician-rated (Yale-Brown Obsessive Compulsive Scale) and patient-rated (Massachusetts General Hospital Hairpulling Scale, Beck Depression Inventory, and Posttraumatic Diagnostic Scale) measures were administered at index evaluation. OCD patients with and without moderate to severe hair pulling were statistically compared on clinical and treatment characteristics and treatment response. RESULTS: Of the OCD subjects, 18.8% (N = 29) endorsed any hair pulling, 15.6% (N = 24) had moderate to severe hair pulling, and 7.8% (N = 12) had severe hair pulling comparable to that of a specialty trichotillomania clinic population. OCD patients with moderate to severe hair pulling were more likely to be women (p < .001), endorse > 1 comorbid tic (p < .05), and have earlier-onset OCD (p = .001). This cohort also had fewer contamination obsessions (p = .04) and checking compulsions (p = .04) and was more likely to be receiving stimulant (p = .006) or venlafaxine (p = .02) medication than those patients without hair pulling. Posttraumatic Diagnostic Scale scores were nearly significantly higher in the OCD + hair pulling group (p = .08). OCD treatment response was unaffected by the presence of comorbid hair pulling. CONCLUSION: Hair pulling is a highly common comorbidity in severe OCD. Women and early-onset OCD patients appear to be more vulnerable to comorbid hair pulling. OCD sufferers with comorbid hair pulling also exhibit an increased risk for tics and may present with different OCD symptomatology.     

Anterior limb lesions in bilateral internal capsules and memory function in patients with refractory obsessive-compulsive disorder

BACKGROUND: Previous studies have shown that lesions in the anterior limb of the internal capsule contribute to obsessive-compulsive symptoms in patients with refractory obsessive-compulsive disorder (OCD). However, few reports have addressed the effects of lesions in the anterior limb of the internal capsule on cognition, learning, and memory functions in patients with refractory OCD.OBJECTIVE: To investigate the degree of damage to memory tasks in refractory OCD patients following lesions to the anterior limb of the internal capsule. DESIGN, TIME AND SETTING: A case-controlled, observational study was performed at the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008. PARTICIPANTS: A total of 10 refractory OCD patients were admitted to the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008 and were recruited for this study. The OCD patients were of equal gender, with an average age of (25.1 ± 9.6) years. An additional 10 healthy volunteers were enrolled from a community of Shanghai City as controls; they were of equal gender and aged (25.1 ± 8.6) years. METHODS: A total of 10 refractory OCD patients were subjected to lesions in the anterior limbs of the bilateral internal capsules. Wechsler Memory Scale-Chinese Revision (WMS-CR, as a task of explicit memory) and the Nissen Version (serial reaction time task) software (SRTT, as a task of implicit memory) were applied to determine memory functions and learning performance in pre- and post-operative OCD patients and controls. MAIN OUTCOME MEASURES: WMS scores, reaction time in SRTT, and Yale-Brown obsessive compulsive scale scores were measured in pre- and post-operative OCD patients and controls. RESULTS: Compared to controls, the pre-operative OCD patients exhibited reduced memory task scores (P = 0.005), whereas scores for reciting numbers of backwards digits were greater (P = 0.000). Figure recall and associative memory were less in OCD patients at 1 week following surgery than in the pre-operative OCD patients (P = 0.042, P = 0.002, respectively). Reaction time in implicit SRTT was significantly longer in pre-operative OCD patients compared with controls and post-operative OCD patients (P = 0.01, P = 0.03, respectively). These results suggested ameliorated SRTT following neurosurgery. Yale-Brown Obsessive Compulsive Scale results revealed significantly improved OCD following lesions in the internal capsule (P = 0.04). Some post-operative OCD patients suffered from deficits in short-term memory and implicit memory. CONCLUSION: Lesions in anterior limbs of bilateral internal capsules improve obsessive- compulsive symptoms and implicit memory in OCD patients, but result in aggravated short-term memory deficits.     

Obstructive sleep apnoea: a case-control study

INTRODUCTION: Obstructive sleep apnoea (OSA), is characterized by loud snoring and excessive daytime sleepiness. Though the gold standard for diagnosis is overnight polysomnography (PSG), sleep questionnaires have also been used to diagnose this with good predictive value. MATERIAL AND METHODS: A pre-designed proforma with clinical details, symptom-specific questions for diagnosis of OSA, and Epworth Sleepiness Scale (ESS) was administered to 20 patients presenting to the Sleep Disorder Clinic of our hospital and to 40 age and sex-matched relatives (control group). The students 't-test' and chi-square were used as the statistical tests. RESULTS: There were 20 patients with a mean age of 41+/- 8 years, and 40 controls with a mean age of 41 +/- 6 years (P=>0.05). Seven had family history of snoring in the study group and 3 in the control group (P=0.02). Four had met with road traffic accidents in the study group and none in the control group (P=0.001). The body mass index (BMI) was 29.9 (SD 4.4) in the study group and 24.5 (SD3.5) in the controls (P=0.001). The mean ESS was 13.3 +/- 6 in the patients and 4.2+ 4 in the controls (P=0.001). A larger number of patients with OSA had hypertension: 5/20 vs. 3/40 (P=0.01). CONCLUSION: Patients with OSA had significantly higher BMI and ESS score, and were more likely to have hypertension and road traffic accidents. Increased awareness of this entity is essential.     

Markers of vulnerability to obsessive-compulsive disorder in an ultra-high risk sample of patients who developed psychosis

Aims: The study aims to identify markers of vulnerability to obsessive–compulsive disorder (OCD) in an ultra‐high risk sample of patients who developed psychosis. Methods: Three hundred and eleven patients at ultra‐high risk for psychosis were examined at baseline and after a mean of 7.4 years follow‐up. Patients who developed psychosis with OCD (PSY + OCD; n = 13) and psychosis without OCD (PSY − OCD; n = 45) were compared in terms of socio‐demographic and clinical features. Results: PSY + OCD patients displayed greater severity of depression before and after conversion to PSY + OCD, and increased rates of depressive disorders before exhibiting PSY + OCD. However, they only displayed greater severity of anxiety and increased rates of non‐OCD anxiety disorders after psychosis. Further, PSY + OCD patients were more likely to report a positive family history for anxiety disorders than PSY − OCD. Conclusion: Although depression and a family history of anxiety disorder may act as vulnerability markers for OCD in psychosis, the resulting anxiety may be a correlate or a consequence of PSY + OCD.     

Association of the serotonin transporter promoter regulatory region polymorphism and obsessive-compulsive disorder.

Although modulation of symptoms of obsessive-compulsive disorder (OCD) by serotonergic agents is well established, it is unclear whether an abnormality in the central serotonergic system is involved in its etiology. The serotonin (5-HT) transporter (5-HTT), which is the key modulator of serotonergic neurotransmission, is the target for serotonin reuptake inhibiting drugs (SRIs) that are uniquely effective in the treatment of OCD. In this preliminary study we report an association of a functional polymorphism in the 5-HTT 5' regulatory-region and OCD. Seventy-five OCD Caucasian patients and 397 ethnically-matched individuals from a non-patient control group were genotyped for the 5-HTTLPR. Population-based association analysis revealed that patients with OCD were more likely to carry two copies of the long allele (l) as compared to controls (46.7% vs 32.3%: chi2 = 5.19, P = 0.023). This finding replicates a recent family-based study of this polymorphism in OCD, and thus indicates that the 5-HTTLPR may be associated with susceptibility to OCD.     

Corpus callosal signal intensity in treatment-naive pediatric obsessive compulsive disorders.

1. Obsessive compulsive disorder (OCD) is increasingly recognized as a severe, highly prevalent and chronically disabling disorder, emerging during childhood in as many as 80% of cases. The authors previously found significant abnormalities in the region of the corpus callosum (CC) connecting ventral prefrontal cortex and striatum in pediatric OCD patients compared to controls that correlated significantly with OCD symptom severity. We speculated that this abnormality might reflect aberrant myelinization in OCD patients. 2. In order to better characterize the abnormality, the authors examined CC signal intensity (SI), believed to be a reliable index of myelinization of the CC. Lower numbers would indicate a greater concentration of white matter, while higher numbers indicate higher concentrations of gray matter. We compared the SI from midsagittal magnetic resonance images of 21 treatment-naive OCD patients, 7.2-17.7 years, and 21 case-matched healthy controls to examine regional CC signal intensity of the anterior, middle and posterior genu, body, isthmus, and the anterior, middle and the posterior splenii. 3. Mean total genu SI for the patient group (.993 + .006) was significantly less than the total genu SI of controls (.994 + .006) at F(1,37) = 4.73; p = .036. This abnormality in SI was localized to the CC region connecting ventral PFC and striatum, the anterior genu for the OCD group (.991 + .007) which was also less than control (.995 + .007) at F(1,37) = 5.47; p = .025., with no abnormality observed in middle or posterior genu regions. Genu SI was also inversely correlated with OCD symptom severity (r = -.55, p = .013) but not illness duration. Genu SI also correlated positively with genu area (r = .52, p = .020) in OCD patients but not controls. 4. Developmental abnormalities in genu size may arise from abnormalities in myelination in early onset OCD patients. The increased genu myelination observed in OCD patients may alter signal transduction and function of VPFC-striatal association circuits.     

Kinematic analysis of handwriting movements in patients with obsessive-compulsive disorder

OBJECTIVES: Basal ganglia dysfunction is supposed to play a part in the pathophysiology of obsessive-compulsive disorder (OCD). A new computer aided technique for the analysis of hand movements, allowing the detection of subtle motor performance abnormalities, was applied in this study of patients with OCD and healthy controls. METHODS: Using a digitising graphic tablet, hand motor performance was studied in 22 unmedicated patients with OCD and compared with 22 healthy controls. All subjects drew superimposed concentric circles with both the right and the left hand, in addition to writing a given sentence, their personal signature, and letter sequences in four different sizes. Kinematic parameters were calculated to quantify hand motion. RESULTS: Patients with OCD had significant impairments of handwriting performance, reflected by lower peak velocity (sentence t=3.6; p=0.001; signature t=2.8; p=0.01) and micrographia (sentence t=3.4; p=0.002; signature t=2.5; p=0.02), compared with controls and shortened acceleration phases per stroke (sentence t=2.4; p=0.02; signature t=4.1; p=0.000). By contrast, in repetitive drawing, patients with OCD had higher peak velocity than healthy controls (group x task interaction p<0.01). There were no significant differences in left and right hand performance between groups. Patients with early versus late age of onset differed in handwriting parameters, such as handwriting consistency. Greater severity of obsessions and compulsions correlated with increasingly poor handwriting performance in patients with OCD. CONCLUSIONS: A subtle motor dysfunction in OCD can be detected with a digitising tablet. The findings show handwriting impairments in patients with OCD, in line with the assumption that basal ganglia dysfunction is part of OCD pathophysiology. Repetitive motor pattern performance was not impaired, but rather tended to be even better in patients with OCD than in controls. The findings also support the concept that patients with OCD with early versus late age of onset differ in pathophysiological mechanisms and basal ganglia dysfunction.     

Preferential aggregation of obsessive-compulsive spectrum disorders in schizophrenia patients with obsessive-compulsive disorder.

OBJECTIVE: To validate a complex association between schizophrenia and obsessive-compulsive disorder (OCD). METHOD: We used the Structured Clinical Interview for DSM-IV Axis I disorders to compare the rate of OCD spectrum and additional Axis I disorders in 100 patients who met criteria for both schizophrenia and OCD, non-OCD schizophrenia (n = 100), and OCD (n = 35). RESULTS: There was a robust between-group difference in the number of patients with one or more OCD spectrum disorders (schizo-obsessive n = 30, compared with schizophrenia n = 8; P = 0.001), that is, higher rates of body dysmorphic (8% compared with 0%) and tic (16% compared with 4%) disorders. No difference was revealed in affective, anxiety, and substance use disorders. We found comparable rates of OCD spectrum disorders in the schizo-obsessive and OCD groups (30% and 42.8%, respectively; P = 0.32). CONCLUSION: Preferential aggregation of OCD spectrum disorders in the schizo-obsessive group supports this unique clinical association. Whether a schizo-obsessive interface represents comorbidity or a specific subtype of schizophrenia warrants further investigation.     

Characterization of event-related potentials in obsessive compulsive disorder patients Comparison with depression and generalized anxiety disorder patients

BACKGROUND: Study results of event-related potential in obsessive compulsive disorder (OCD) remain controversial, potentially as a result of different instruments utilized and their differing technical characteristics.OBJECTIVE: To investigate the differences in several common event-related potentials, i.e. contingent negative variations, P300, and mismatch negativity (MMN), in OCD patients, depression patients, generalized anxiety disorder (GAD) patients, and healthy controls.DESIGN, TIME AND SETTING: A case-control study was performed in the Department of Electrophysiology, Shanghai Mental Health Center from May 2002 to December 2005.PARTICIPANTS: A total of 38 OCD patients, 20 depression patients, and 18 GAD patients, who were diagnosed according to the criteria of Chinese Classification of Mental Disorders (Version 3), formulated by the Chinese Psychiatry Association, were selected from the Outpatient Department of Shanghai Mental Health Center. Patients with two or more the above diseases were excluded. In addition, 28 healthy people, gender and age matched, were selected as controls.METHODS: Contingent negative variations, P300, and MMN were recorded by a Nicolet Spirit Instrument. All electrodes were attached at Cz according to the International 10-20 system, with the mastoid leads as reference and Fpz as ground. MAIN OUTCOME MEASURES: Amplitude and latency of contingent negative variations, P300, and MMN.RESULTS: The contingent negative variations, P300, and MMN were different (P < 0.01). OCD patients showed an increased M1 amplitude compared with controls, depression, and GAD patients (P < 0.01). Target P300 amplitudes were significantly lower in OCD, depression, and GAD patients compared with controls (P < 0.01). Moreover, N2 latency and latency of MMN were prolonged in OCD and depression groups compared with controls (P < 0.05).CONCLUSION: Event-related potentials were different in depression, GAD, and OCD patients and healthy controls. In particular, OCD patients exhibited unique characteristics.     

Serum leptin levels in obsessive-compulsive disorder

The aim of the present study was to evaluate serum leptin levels to demonstrate whether or not its eventual alterations might have an etiopathogenetic significance in patients with obsessive-compulsive disorder (OCD). Thus, it was planned to examine whether serum leptin levels were affected by pure OCD (OCD-D), pure depression (D) or the comorbidity of OCD and depression (OCD+D). Forty-four patients with OCD (27 with OCD-D and 17 with OCD+D), 38 depressed patients and 30 control subjects were enrolled and serum leptin and cortisol levels were measured. According to the mean leptin levels, no significant difference was found between the OCD-D and control groups and between the OCD+D and D groups, while statistically significantly lower levels were found in the OCD+D and D groups than in control group. Significant difference in the mean leptin levels was found among groups even after controlling for body mass index or sex. The present study confirms the strong relationship between serum leptin and cortisol values and suggests that reduced leptin levels, rather than having an etiopathogenetic significance in patients with OCD, seem to be associated with patients with OCD and depression but not with pure OCD patients, and that OCD may be a heterogeneous subtype containing some biological indications of anxiety and affective disorders.     

Study of impulse control disorders among women presenting nicotine dependence

Objective. Impulse control disorders (ICDs) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania and pathological gambling. Several studies have showed an association between ICDs and alcohol use disorders. The rate of co-occurrence ICDs and nicotine dependence has never been investigated. We thus assessed the frequency of all ICDs in a population of nicotine-dependent women compared to non-smoking women. We also checked criteria of two other impulsive behaviours, compulsive buying and bulimia. Methods. Five hundred consecutive patients were assessed by a general practitioner in Paris (France). One hundred and twenty-seven women presenting the DSM-IV-R criteria for nicotine dependence were included. They were compared to 127 women consulting the same practitioner but who did not smoke. Diagnosis of ICD (pyromania, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling) and of bulimia was based on DSM-IV criteria and a modified version of the Minnesota Impulsive Disorders Interview (MIDI). Diagnosis of compulsive buying was made with the McElroy et al. criteria and a specific questionnaire. Cigarette smoking was studied using the Fagerström questionnaire and the DSM-IV-R criteria for nicotine dependence. Alcohol use disorders were assessed with the DSM-IV-R criteria for dependence and the CAGE and the MAST questionnaires. Results. Thirteen patients presented trichotillomania, 22 explosive intermittent disorder and 12 pathological gambling. All these diagnoses were equally frequent in the nicotine-positive and nicotine-negative groups. We found no case of pyromania. Compulsive buying was the most frequent impulse control disorder. It was significantly more frequent in the nicotine-positive group than in the nicotine-negative group (58 vs. 39 cases, P=0.01). Scores of the compulsive buying scale were higher in the nicotine-positive group (4.07 vs. 2.9, P=0.01). None of the patients presented an association of two or more ICDs. Patients from the nicotine-positive group drunk higher quantities of alcohol each day, consumed alcohol more frequently each week and were more often intoxicated each week with alcohol. Their mean MAST scores of alcohol abuse disorders were higher. Conclusion. A total of 45.6% of the nicotine-dependent women presented compulsive buying and 23.6% bulimia. Compulsive buying was significantly more frequent among nicotine-dependent subjects than controls. Other impulse control disorders were as frequent among nicotine-dependent women as in controls. A total of 8.6% presented explosive intermittent disorder, 4.7% pathological gambling and 5% trichotillomania. Nicotine dependence in women was also associated with a higher level of alcohol consumption. These results indicate the possible need to systematically screen nicotine-dependent women, regardless of their motivation for consultation, for alcohol dependence, bulimia and compulsive buying.     

A controlled study of sensory tics in Gilles de 1a Tourette syndrome and obsessive-compulsive disorder using a structured interview.

OBJECTIVE: To determine the prevalence and characteristics of sensory tics in the Gilles de la Tourette syndrome (GTS), and a matched population of patients with obsessive-compulsive disorder (OCD) using a structured assessment. METHODS: 50 subjects each of GTS, OCD, and healthy controls were studied to determine the prevalence and phenomenology of sensory tics, and diagnose tic disorders, OCD, and affective disorders according to DSM-III-R criteria. The severity of tics and obsessive-compulsive symptoms were quantified using the Tourette syndrome global scale (TSGS) and Yale-Brown obsessive-compulsive scale (Y-BOCS) respectively. RESULTS: The GTS group (28%) had significantly-greater life-time prevalence of sensory tics than the OCD (10%) and healthy (8%) groups (P < 0.05). The sensory tics in both the GTS and OCD groups were predominantly located in rostral anatomical sites. Multiple sensory tics occurred in some patients with GTS or OCD, but not in healthy subjects. Within the OCD group, those who had sensory tics had significantly higher TSGS scores (P < 0.0001), and a higher prevalence of GTS (P < 0.005). CONCLUSIONS: Sensory tics seem to be a common and distinctive feature of GTS and that subpopulation of patients with OCD predisposed to tic disorders. Neurophysiologically, a possible explanation for sensory tics is that they represent the subjectively experienced component of neural dysfunction below the threshold for motor and vocal tic production.     

强迫症首次发病未服药患者脑静息态低频振幅研究

目的 探讨强迫症首次发病未服药患者静息脑神经活动的特点.方法 采用磁共振成像低频振幅(ALFF)方法,对昆明医学院第一附属医院22例强迫症患者(患者组)和22名健康志愿者(对照组)静息态脑血氧水平依赖(BOLD)信号活动的改变进行分析;采用功能磁共振成像技术进行数据采集,计算出各受试者的ALFF值;采用两样本t检验,以P<0.001水平统计患者组与对照组的差异.结果 与对照组比较,患者组BOLD信号ALFF改变只存在增高的区域,主要分布在左前扣带回和左中扣带回;未发现患者组左前中扣带回的ALFF值与病程(r=0.004,P=0.985)、年龄(r=0.090,P=0.689)和受教育程度(r=0.048,P=0.831)、Yale-Brown强迫量表总分(r=0.007,P=0.977)、强迫思维分量表分(r=0.140,P=0.530)和强迫行为分量表分(r=0.100,P=0.660)的相关性.结论 静息状态下强迫症患者脑神经活动的ALFF存在异常,ALFF增高可能反映了患者大脑异常的情绪及行为监控.

Abstract：

Objective To study the changes of amplitude of low-frequency fluctuation (ALFF) of the resting-fMRI in the patients with obsessive-compulsive disorder (OCD). Methods The resting-fMRI data of 22 OCD patients and 22 healthy controls were performed ALFF analysis. The amplitude of the blood oxygenation level dependent activation of the resting-state brain was investigated. Results The increased ALFF was only found in first-episode, drug-native OCD group compared with controls. The regions with increased ALFF were the left anterior cingulate and left middle cingulate gyrus (P<0. 001, corrected,K≥33). No significant correlations between ALFF value in these regions and course of disease (r = 0. 004,P = 0. 985) , age (r = 0. 090, P = 0. 689) and level of education (r = 0. 048 , P =0. 831) , no significant correlations between ALFF value and Y-BOCS score (r= 0.007, P= 0.977) , obsessive score (r=0. 140,P =0.530) and compulsive score (r=0. 100, P = 0.660) were found. Conclusion Abnormal ALFF may exist in OCD in the resting-state. The increased ALFF might reflect the strengthening of the emotional management and action monitoring.