Sleep in obsessive compulsive disorder

Several lines of evidence suggest that brain serotonergic systems may be disturbed in obsessive compulsive disorder (OCD). The serotonergic system strongly affects sleep and characteristic abnormalities of sleep are documented in depression. This study, therefore, aimed to investigate sleep structure of OCD patients in order to evaluate whether similar changes as in depression are present. Up to now, this issue has been addressed only in few studies with small numbers of patients. Sleep patterns of 62 unmedicated patients with primary OCD and 62 age- and sex-matched healthy controls were investigated by polysomnography. Additionally, the impact of tryptophan depletion on sleep was studied in a subgroup of 12 OCD patients and 12 controls. The OCD patients exhibited moderate, but significant disturbances of sleep continuity measures but no abnormalities of slow wave sleep or REM sleep, except a significant elevation of 1st REM density. Tryptophan depletion induced a worsening of sleep continuity, but no changes of REM sleep or slow wave sleep. Assuming that changes of sleep architecture indicate underlying neurobiological abnormalities, this study indicates that neurobiological disturbances are different in primary OCD as compared with primary depression.     

Hypochondriasis and obsessive compulsive disorder.

Hypochondriasis and OCD differ conceptually in the degree to which the patient's disease concerns are experienced as an intrusive mental event or a reasonable psychological response to a realistic health threat, in the degree to which the ideation is resisted, and in the presence of somatic sensations and medical help-seeking. There are, however, some similarities between the conditions, including the development of excessive, stereotyped, repetitive behaviors in an attempt to allay their anxiety. Empirical data on the degree of overlap between the conditions are too limited to permit definitive conclusions. The little that we do know, however, suggests that (1) the prevalence of OCD in hypochondriasis is probably elevated, but not extraordinarily so; (2) the prevalence of hypochondriasis in OCD is unknown; (3) fears about disease, illness, and injury are one of the more common forms of obsessions seen in OCD; and (4) there are several ill-defined and largely unexplored conditions, such as disease phobias, which appear to be very similar to both OCD and hypochondriasis. Clinical experience suggests that there may be a subgroup of hypochondriacal patients who are closer to the anxiety disorders in general and to OCD in particular. This subgroup might respond to the newer, antiobsessional, serotonin reuptake blocking agents.     

Obsessive compulsive disorder and obsessive compulsive personality disorder and the criminal law

Obsessive compulsive disorder (OCD) is a mental illness that has penetrated public consciousness. However, the extent to which OCD and obsessive compulsive personality disorder (OCPD) can constitute debilitating conditions that adversely affect most aspects of a person’s functioning and quality of life are not so well known, including as to how they can impair the capacity to give reasoned consideration to conduct options and the consequences of choices. Little scholarship exists about the legal repercussions of OCD and OCPD and, in particular, their potential relevance for both assessments of criminal responsibility and criminal culpability. This article commences to redress that deficit, outlining contemporary clinical knowledge about the disorders that is relevant to the legal context and identifying important judgments by courts in the United Kingdom, Ireland, Canada, Australia, New Zealand and India which have dealt with the potential impact of OCD and OCPD, in particular for decisions at the sentencing phase of criminal proceedings. It calls for better awareness of OCD and OCPD on the part of forensic mental health practitioners, criminal law practitioners and members of the judiciary.Key words: autism spectrum disorder, criminal culpability, obsessive compulsive disorder, obsessive compulsive personality disorder, sentencing

Countless times, I have endured severe depression, suicidal thoughts, debilitating anxiety, recurring feelings of lacking self-worth or self-esteem, a proclivity for physical violence, a disdain for authority, the loss of employment and a general malaise regarding my purpose in life. While also experiencing exhilarating highs and personal successes, I have felt possessed by the devil. Wherever you have visited in your own mind, I have been there or close by. For decades I constantly searched for different medications and more effective therapies to control my OCD, all in vain. … No psychiatrist, no psychologist, no parent or family member, no human being who doesn’t suffer from OCD, can realistically understand the insidiousness, the intensity or level of debilitation the disorder brings.James S Julian, A Secret Life (2019), p 9, 163

     

Neurobiology of obsessive compulsive disorder.

In this brief review of two of the neurobiologic aspects of OCD, two simplistic models have been suggested. Although these models reflect different perspectives, they may not be independent. For instance, the striatum, which is a focus for the neuroanatomic model, receives a dense serotonergic projection from the dorsal raphé. Similarly, as mentioned previously, combining PET studies and drug treatment demonstrates that the increased metabolic activity seen in the orbital cortex appears to normalize with serotonin uptake inhibitor treatment. Insights into the neurobiology of this syndrome will require combining perspectives as well as developing additional approaches. In addition, the search for neurobiologic abnormalities must be guided by a continuing regard for phenomenology. There is no reason, a priori, to assume that this syndrome subsumes only one disorder. The careful dissection of subgroups--whether based on symptom type, character style, or comorbid diagnoses--will be increasingly vital for understanding the results of neuropharmacologic and functional imaging studies.     

Tricyclic response in obsessive compulsive disorder

Therapeutic responses to the tricyclic antidepressant clomipramine have been demonstrated in five double blind studies of patients with obsessive compulsive disorder. Biological alterations in patients with obsessive compulsive disorder resemble those of depressed patients for the dexamethasone suppression test, for some measures of sleep physiology, and in similar neuroendocrine responses to clonidine. Clomipramine's antiobsessional effect does not require high baseline depression ratings or biological abnormalities similar to those seen in depressives. Preliminary results suggest that in contrast to depressives, patients with obsessive compulsive disorder may respond to clomipramine but not to the tricyclic antidepressant desipramine.     

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.     

The epidemiology of obsessive compulsive disorder

The literature on the epidemiology and genetics of obsessive compulsive disorder (OCD) is reviewed. The application of recently developed diagnostic criteria, psychometric testing, and biologic markers to epidemiologic studies of OCD should provide important new data for increasing our understanding of the pathogenesis of the disorder. Identification of diagnostic subgroups will be important in reliably evaluating treatment response to current and new therapeutic agents. Directions for potential research in these areas are discussed.     

Social adjustment in obsessive compulsive disorder

The Social Adjustment Scale-Self Report was administered to 32 subjects with Obsessive Compulsive Disorder and age-sex matched controls. The patients had global impairment, especially during leisure, which correlated with severity of the disorder. The improvement of this impairment with therapy is highlighted. It is stressed that social adjustment in Obsessive Compulsive Disorder subjects should be considered during their therapy.     

Biological challenges in obsessive compulsive disorder

1. Obsessive compulsive disorder and affective disorder have been investigated by means of various biological challenges. 2. Total sleep deprivation and methylphenidate challenge were used to determine the effects on a group of subjects with obsessive compulsive disorder. 3. The findings of a lack of response to total sleep deprivation and methylphenidate in obsessive compulsive patients contrasts with the findings in affective disorder patients. 4. The findings are more consistent with those in studies of panic disorder. 5. The relationship of obsessive compulsive disorder to affective and anxiety disorder may be elucidated by further studies.     

Psychic euosmia and obsessive compulsive personality disorder

Patients with obsessive compulsive personality disorder (OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.     

Dysregulation in pediatric obsessive compulsive disorder

Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.     

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.     

强迫症的临床特征

目的：探讨强迫症（ＯＣＤ）的临床表现。方法：对４０例符合ＤＳＭ－ⅣＯＣＤ诊断标准病人进行以下量表和问卷评定：强迫症量表（Ｙ－ＢＯＣＳ）,Ｈａｍｉｌｔｏｎ抑郁量表（ＨＡＭＤ）,Ｈａｍｉｌｔｏｎ焦虑量表（ＨＡＭＡ）,Ｍａｒｋｓ恐怖强迫量表（ＭＳＣＰＯＲ）,临床疗效总评量表（ＣＧＩ）和艾森克个性问卷（ＥＰＱ）;并对６５名正常人进行ＥＰＱ测试。结果：１５岁以前发病患者的ＭＳＣＰＯＲ的工作适应能力下降（ＷＤ）分显著高于１５岁以后发病患者;合病组病人的ＨＡＭＤ和ＥＰＱ的神经质分显著高于非合病组;洗涤／回避组的ＨＡＭＡ评分显著较高,迟缓／仪式化组的发病年龄显著较低,两组的ＭＳＣＰＯＲ的ＷＤ评分均显著高于强迫检查行为组。结论：１５岁以前发病,合病组,主要表现迟缓／仪式化或洗涤／回避症状的病人是ＯＣＤ较为严重的亚型。     

Depressive and anxiety disorder comorbidity in obsessive compulsive disorder

BACKGROUND: Depressive and other anxiety disorders are commonly found to coexist with obsessive compulsive disorder (OCD). Although western studies have looked at this issue, there are no reports from India investigating anxiety and depressive comorbidity in adult OCD. METHODS: Between January and December 2001, charts of 218 OCD patients seen in the OCD clinic at the National Institute of Mental Health and Neurosciences, Bangalore, were evaluated using the OPCRIT criteria for ICD-10 for the presence of comorbid depressive and anxiety disorders. RESULTS: There were 146 males and 72 females; their mean age at OCD onset was 21.32 +/- 0.64 years. Thirty-six (16.5%) patients had depressive episodes, 12 (5.5%) dysthymia and 15 (6.9%) any anxiety disorder. No significant difference in terms of age, sex, marital status or age at onset was found between the OCD patients with and without comorbid anxiety disorder, major depression or dysthymia, except that female OCD patients were more likely than males to have comorbid major depressive disorder. CONCLUSIONS: The results of our study are in keeping with previous data from other parts of the world, though the actual rates of comorbidity in our sample appear to be much lower. It remains to be seen whether the differences in rates are a result of methodological issues or different characteristics of sample populations. Further long-term, prospective, methodologically sound studies investigating the comorbidity of depressive and other anxiety disorders in OCD patients are needed to clarify this issue.     

Insight in obsessive compulsive disorder and body dysmorphic disorder

Similarities between obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) have been described in terms of clinical presentation, comorbidity rates, treatment response profiles, and other features. This is the first study to compare insight in OCD and BDD measuring global insight and numerous components of insight. We compared insight in 64 adult outpatients with DSM-IV OCD and 85 adult outpatients with DSM-IV BDD using a reliable and valid measure (the Brown Assessment of Beliefs Scale [BABS]). BDD patients had significantly poorer global insight than OCD patients. BDD patients also had significantly poorer insight on the following components of insight: conviction that the belief is accurate, perception of other's views of the belief, explanation for differing views, willingness to consider that the belief is wrong, and recognition that the belief has a psychiatric/psychological cause. Poorer insight was significantly positively correlated with more severe symptoms of the disorder only in the BDD group.