Disgust proneness and obsessive-compulsive symptoms in a clinical sample: structural differentiation from negative affect

Although a growing body of research has revealed robust associations between disgust and obsessive–compulsive disorder (OCD) symptoms, there remains a paucity of research examining the specificity of this association in clinical samples. The present study employed structural equation modeling to differentiate disgust from negative affect in the prediction of OCD symptoms in a clinical sample (n = 153). Results indicate that disgust and negative affect latent factors were independently related to OCD symptoms. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with OCD symptoms, whereas the association between latent negative affect and OCD symptoms became nonsignificant. Multiple statistical tests of mediation converged in support of disgust as a significant intervening variable between negative affect and OCD symptoms. The implications of these findings for further delineating the role of individual differences in disgust proneness in the development of OCD are discussed.     

Responsibility and impulsivity and their interaction in relation to obsessive-compulsive symptoms

In the present study, the role of responsibility and impulsivity and their interaction in obsessive-compulsive symptoms was investigated. The obsessive-compulsive inventory-revised (OCI-R), an attention deficit and hyperactivity/impulsivity self-report scale (AD/HD-SR), the responsibility attitudes scale (RAS), Eysenck's impulsiveness/venturesomeness/empathy questionnaire (IVE), the community epidemiological survey-depression (CES-D) and the Penn State worry questionnaire (PSWQ) were administered to a sample of 405 Icelandic university students. Responsibility attitudes (RAS) and impulsivity measures were significantly related to scores on the OCI-R total scale, even when depression had been taken into consideration. The interaction between responsibility and hyperactivity/impulsivity added to the prediction of OCI-R scores over and above simple effects.     

Lack of effects on core obsessive-compulsive symptoms of tryptophan depletion during symptom provocation in remitted obsessive-compulsive disorder patients.

BACKGROUND: Pharmacological evidence support that enhancement of serotonin (5-HT) neurotransmission is critical for treatment efficacy in obsessive-compulsive disorder (OCD). Surprisingly, acute tryptophan depletion (ATD), a procedure known to reduce 5-HT neurotransmission, carried out in remitted OCD patients on selective serotonin reuptake inhibitors (SSRIs) failed to worsen obsessive-compulsive (OC) symptoms. We hypothesized that the putative symptom exacerbation resulting from ATD would only be observed during symptom provocation but not at rest. METHODS: Double-blind placebo-controlled ATD study conducted in 16 OCD patients with stable improvement under either SSRI (n = 8) or specialized cognitive behavior therapy alone (n = 8), coupled with gradual symptom provocation, performed 5 hours after drink ingestion. RESULTS: Acute tryptophan depletion markedly reduced total and free plasma tryptophan levels but did not significantly increase obsessions or compulsions at rest or following symptom provocation. However, subjective distress in response to triggering situations was significantly higher during ATD; significant mood lowering was also present during ATD. CONCLUSIONS: These results are consistent with the view that relapses in OC core symptoms in remitted OCD patients may not depend solely on short-term changes in presynaptic 5-HT availability. In contrast to its apparent lack of effect on core OC symptoms, ATD affected the patient's mood and distress level resulting from provocation.     

Altered cingulate sub-region activation accounts for task-related dissociation in ERN amplitude as a function of obsessive-compulsive symptoms

Larger error-related negativities (ERNs) have been consistently found in obsessive-compulsive disorder (OCD) patients, and are thought to reflect the activities of a hyperactive cortico-striatal circuit during action monitoring. We previously observed that obsessive-compulsive (OC) symptomatic students (non-patients) have larger ERNs during errors in a response competition task, yet smaller ERNs in a reinforcement learning task. The finding of a task-specific dissociation suggests that distinct yet partially overlapping medio-frontal systems underlie the ERN in different tasks, and that OC symptoms are associated with functional differences in these systems. Here, we used EEG source localization to identify why OC symptoms are associated with hyperactive ERNs to errors yet hypoactive ERNs when selecting maladaptive actions. At rest, OC symptomatology predicted greater activity in rostral anterior cingulate cortex (rACC) and lower activity in dorsal anterior cingulate cortex (dACC). When compared to a group with low OC symptom scores, the high OC group had greater rACC reactivity during errors in the response competition task and less deactivation of dACC activity during errors in the reinforcement learning task. The degree of activation in these areas correlated with ERN amplitudes during both tasks in the high OC group, but not in the low group. Interactive anterior cingulate cortex (ACC) systems associated avoidance of maladaptive actions were intact in the high OC group, but were related to poorer performance on a third task: probabilistic reversal learning. These novel findings link both tonic and phasic activities in the ACC to action monitoring alterations, including dissociation in performance deficits, in OC symptomatic participants.     

The therapeutic alliance in the cognitive behavioral treatment of pediatric obsessive-compulsive disorder

Although cognitive-behavioral therapy (CBT) for pediatric obsessive–compulsive disorder (OCD) is considered a first-line treatment, not all youth have a positive treatment response, suggesting need for investigating factors that may enhance or reduce treatment effects. Few studies have investigated predictors of treatment response in pediatric OCD, and there is an absence of studies examining the influence of treatment process variables (e.g., therapeutic alliance [TA]) on treatment outcome. Using a multiple-informant and multiple-time point design, the current study examined the role of the TA in family-based CBT for pediatric OCD. Analyses examined (1) the predictive value of the TA on OCD symptom reduction and (2) whether changes in the TA over time predict treatment response. Findings indicated that (1) stronger child-rated, parent-rated, and therapist-rated TAs were predictive of better treatment outcome and (2) larger and more positive early alliance shifts (as rated by changes in child-rated TA between sessions 1 and 5) were predictive of better treatment outcome. Implications for the treatment of youth with OCD within family-based CBT are discussed.     

Evaluation of exposure with response-prevention for obsessive compulsive disorder in childhood and adolescence

The present study was undertaken to estimate the effect of exposure plus response-prevention (E/RP), delivered alone intensively over 5-weeks and without concomitant pharmacotherapy, for children and adolescents with OCD. Twenty children and adolescents with OCD, not receiving medication for this condition, were randomized to E/RP or a wait-list condition. Statistically and clinically significant symptomatic improvement was found in the E/RP group compared with controls, with improvement maintained at follow-up an average of 14 weeks later. Effect size in the main intention-to-treat analysis was 1.23 and in the secondary per protocol analysis was 1.64. This study lends further support to the view that E/RP is an effective treatment for childhood OCD.     

Brief intensive CBT for pediatric OCD with E-therapy maintenance

Cognitive behaviour therapy (CBT), incorporating exposure and response prevention (ERP), has received strong empirical support for the treatment of paediatric OCD, and moreover, is considered the first line treatment of choice (Geller & March, 2012). However, despite the availability of effective treatments for this chronic and debilitating disorder, only a small proportion of youth receive these evidence-based approaches. The present study aimed to examine the effectiveness of an intensive ERP-based treatment for youth OCD, using a multiple baseline controlled design. Children and youth (N = 10; aged 11–16 years) with a primary diagnosis of OCD were randomly assigned to a 1- or 2-week baseline monitoring condition followed by the intervention. The efficacy of the intensive treatment, involving 1 session psychoeducation, 2-sessions ERP plus e-therapy maintenance was examined across parent- child- and clinician-rated measures at post-treatment and 6-month follow-up. Overall, there were significant reductions across time on almost all measures (except self-report anxiety), and moreover, the majority of the sample (80%) were considered reliably improved, and meeting clinically significant change. At post-treatment, 60% were in remission of symptoms, and at 6-month follow-up this increased to 70%. These findings provide strong support for intensive, time-limited approaches to ERP-based CBT for children and youth with OCD.     

盐酸氟西汀联合认知行为疗法治疗产后抑郁症疗效观察

目的 探讨盐酸氟西汀联合认知行为疗法治疗产后抑郁症的临床疗效及不良反应.方法 入组103例产后抑郁症患者分为2组,联合治疗组53例接受盐酸氟西汀联合认知行为疗法,对照组50例仅接受盐酸氟西汀治疗.2组均治疗6周.然后采用汉密尔顿抑郁量表（HAMD）评价治疗效果,同时采用不良反应量表（TESS）评价盐酸氟西汀的不良反应.结果 联合治疗组总有效率84.9%,远高于对照组68.0%（P〈0.05）.联合治疗组治疗后HAMD评分低于对照组（P〈0.05）.2组药物不良反应比较差异无统计学意义（P〉0.05）.结论 盐酸氟西汀联合认知行为疗法治疗产后抑郁症的临床疗效优于单用盐酸氟西汀,而不良反应并未增加.     

Sleep disturbance and obsessive-compulsive symptoms: Results from the national comorbidity survey replication

A small body of developing research has found evidence for sleep disturbance in obsessive-compulsive disorder (OCD) and links between sleep disturbance and obsessive-compulsive symptoms (OCS) in unselected samples. However, the link between sleep disturbance and OCS is yet to be examined in a nationally representative sample. Furthermore, the extent to which the link between sleep disturbance and OCS is accounted for by symptoms of depression remains unclear. To address this gap in the literature, the present study examined the relationship between sleep disturbance and OCS in a nationally representative sample. Participants were assessed in the National Comorbidity Survey Replication (NCS-R; n = 2073). Consistent with predictions, results revealed that individuals with sleep disturbance reported increased OCS severity compared to individuals without sleep disturbance. Further, sleep disturbance severity was associated with OCS severity, even when controlling for depression (and other anxiety-related disorders). This study is the first to link sleep disturbance and OCS in a nationally representative sample, and these findings highlight the unique role of sleep disturbance in the experience of OCS. Future research is necessary to delineate specific mechanisms that may account for this relationship.     

Specificity and structure of obsessive-compulsive disorder symptoms

Research in obsessive-compulsive disorder (OCD) shows heterogeneous symptoms. No longer satisfied with categorizations of obsessions or compulsions, contemporary symptom measures are multidimensional and assess specific symptoms (e.g., checking, washing) as well as experiences bearing a putative relation to OCD (e.g., hoarding). This two-study correlational design examined three OCD measures in student samples (total N=805). Objectives were to evaluate (a) the measures' joint factor structure; (b) specificity of relations between OCD and symptoms of general distress, panic, and depression; and (c) the pattern of convergent and discriminant relations among OCD scales after accounting for general distress. Results were that both exploratory and confirmatory factor analyses supported a five-factor structure: checking, contamination, rituals, impulses, and hoarding. Scales showed meaningful patterns of relations with general distress, panic, and depression. That is, OCD symptoms correlated moderately with general distress and panic, but related more weakly to depression. Parallel scales measuring the five domains were reliable and showed strong convergence across instruments. After accounting for general distress, discriminant validity was found: Mono-trait correlations between instruments were the highest correlations overall and were substantially higher than hetero-trait values either within or between instruments. We discuss the importance of understanding relations among OCD measures, between OCD and other symptoms, and implications of this type of analysis for defining OCD.     

Lifetime-comorbidity of obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany

Objective Inspite of the worldwide relevance of obsessive-compulsive disorder (OCD), there is a substantial lack of data on comorbidity in OCD and subclinical OCD in the general population. Methods German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 persons aged 18–64 years, living in a northern German region. Results In both genders, high rates of comorbid depressive disorders were found in OCD and subclinical OCD, whereas somatoform pain disorder was only associated with OCD. In female subjects, OCD was additionally associated with social and specific phobias, alcohol, nicotine and sedative dependence, PTSD and atypical eating disorder. Conclusion Due to low comorbidity rates, subclinical OCD seems to represent an independent syndrome not restricted to the presence of other axis-I diagnoses. Comorbidity patterns show a disposition to anxiety and to depressive disorders in OCD and subclinical OCD. A broad association with obsessive-compulsive spectrum disorders could not be confirmed in our general population sample. Received: 24 July 2000 / Accepted: 16 May 2001     

The differential impact of executive attention dysfunction on episodic memory in obsessive-compulsive disorder patients with checking symptoms vs. those with washing symptoms

Neuropsychological studies of obsessive-compulsive disorder (OCD) have pointed to memory and attention deficits among its sufferers, but these reports have largely ignored the possibility that cognitive disturbances may vary across OCD clinical subtypes, or that their interactions may differ between subtypes. The purpose of the present study was to determine whether "checkers" and "washers" demonstrate differences in their memory and executive attention function. Fifty-three outpatients with primary DSM-IV diagnosis of OCD with typical checking (n=27) or washing (n=26) rituals participated in the study. Patients were administered the Wechsler Memory Scale-Revised and a comprehensive neuropsychological battery to assess executive attention function. Various neuropsychological tests were then subjected to factor analysis. Neuropsychological test results and obtained factor scores were compared between "washers" and "checkers". Effects of these factor scores on memory by OCD subtypes were examined. No significant difference in terms of demographic and clinical variables was found between the two groups. Checkers displayed performance deficits on Stroop test, Trail Making Test, GO/NO GO test (commission errors) and category fluency. Three factors, inhibition, cognitive flexibility, and multi-tasking, were obtained. Statistically significant differences were observed between the two groups on the inhibition and the cognitive flexibility scores, but not on the general memory or the multi-tasking score. There was a statistically significant interaction between groups and the inhibition score. Only among "checkers", a significant correlation was noted between the inhibition factor and the general memory, while no such correlation was observed among "washers". Among "checkers", poor general memory was related to inhibition deficits.     

Cognitive behavioral treatment for young children with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a distressing and functionally impairing disorder that can emerge as early as age 4. Cognitive behavior therapy (CBT) for OCD in youth shows great promise for amelioration of symptoms and associated functional impairment. However, the empirical evidence base for the efficacy of CBT in youth has some significant limitations, particularly as related to treating the very young child with OCD. This report includes a quantitative review of existing child CBT studies to evaluate evidence for the efficacy of CBT for OCD. It identifies gaps in the literature that, when addressed, would enhance the understanding of effective treatment in pediatric OCD. Finally, it presents a proposed research agenda for addressing the unique concerns of the young child with OCD.     

Difficult delivery and some selected factors as predictors of early postpartum psychological symptoms among Nigerian women

Objectives

The objectives of this study were to compare depressive and anxiety symptoms between Nigerian women with a difficult delivery (cesarean or instrumental) and those with an unassisted vaginal delivery during the puerperium and to highlight other factors of predictive value for symptoms.

Methods

Women (n=83) who had a difficult delivery (index group) were compared with matched control subjects (n=83) who had an unassisted vaginal delivery. They were all evaluated using the State-Trait Anxiety Inventory (state form) and Zung's Self-Rating Depression Scale. Information was also collected on their sociodemographic characteristics, obstetric factors, and general health problems.

Results

After delivery, 19 subjects from the index group (22.9%) obtained scores higher than the threshold for significant depressive symptoms, as compared with 13 subjects from the control group (15.7%). Six weeks later, the rates were 10 (12.0%) and 8 (9.6%), respectively. The mean anxiety and depressive symptom scores for the difficulty delivery group were significantly higher at birth. Although both groups improved over time, the differences were still significant after 6 weeks. Using stepwise regression analysis, we observed cesarean delivery and polygamy to predict depressive symptoms after birth but not after 6 weeks. Previous induced abortions were also observed to predict anxiety and depressive symptoms throughout. Depressive symptoms at 6 weeks were predicted by depressive symptoms at birth and by anxiety symptoms at 6 weeks. The same pattern was observed for anxiety symptoms.

Conclusion

Although difficult delivery was associated with higher levels of symptoms, it was not predictive of postpartum depressive and anxiety symptoms at 6 weeks. Also, of other possible risk factors studied, only illegal abortions were observed to be important in the study population during the puerperium.     

Evidence for successful implementation of exposure and response prevention in a naturalistic group format for pediatric OCD

Background: Although exposure and response prevention (ERP) is an effective treatment for youth with obsessive–compulsive disorder (OCD), the majority of studies, randomized clinical trials of individual therapy, find variability in treatment response. We evaluated the potential role of individual differences in OCD presentation, comorbid disorders, age, and gender on treatment effects. Moreover, we examined these potential effects in a group format in a naturalistic, clinic‐based sample of patients. Methods: Pediatric patients with a DSM‐IV diagnosis of OCD ( n =41) were treated with ERP in an intensive outpatient community‐based program. OCD, mood, and anxiety symptom severity was measured at baseline, during treatment, and at discharge. Trajectories and predictors of treatment outcome were measured using linear growth models. Results: We found that group‐based ERP was effective in reducing pediatric OCD symptom severity in a naturalistic treatment setting irrespective of age or gender. Furthermore, ERP was found to be effective at reducing depressive symptoms but not other anxiety symptoms. We also found inter‐individual variability in the discharge levels of contamination, symmetry, and intrusive sexual thoughts and in the rate of severity reduction of intrusive sexual thoughts. Conclusion: Group‐based ERP is an effective treatment for children and adolescents with OCD. Several factors, including symptom dimensions and comorbid psychopathology, are associated with treatment response and outcome in this pediatric population. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Elucidating the mechanism of uncertainty and doubt in obsessive-compulsive checkers

The article presents three studies that explore the scope and mechanism of reduced confidence in obsessive-compulsive (OC) checkers. In the first study OC checkers, but not panic disorder patients, reported less confidence in their answers to a general knowledge test compared to non-anxious (NA) participants. The second study replicated these findings, but contrary to our prediction, the reduced confidence in OC checkers was not reflected in a disconfirmation bias in this population when both types of evidence were available. The third study found that when the same questions were repeated three times, the confidence of OC checkers progressively decreased, while that of the NA participants progressively increased.     

Turning the pink cloud grey: Dampening of positive affect predicts postpartum depressive symptoms

Objective

Maladaptive response styles to negative affect have been shown to be associated with prospective (postpartum) depression. Whether maladaptive styles to positive affect are also critically involved is understudied, even though anhedonia (a correlate of low positive affectivity) is a cardinal symptom of depression. The present study is the first to investigate the predictive value of cognitive response styles to both negative (depressive rumination) and positive affect (dampening) for postpartum depressive symptoms.

Methods

During the third trimester of pregnancy, 210 women completed self-report instruments assessing depression (symptom severity and current and/or past episodes) and scales gauging the presence of depressive rumination and dampening. Of these women, 187 were retained for postpartum follow-up, with depressive symptoms being reassessed at 12 (n = 171) and 24 (n = 176) weeks after delivery.

Results

Regression analyses showed that higher levels of dampening of positive affect during pregnancy predicted higher levels of depressive symptoms at 12 and 24 weeks postpartum, irrespective of initial symptom severity, past history of depression and levels of rumination to negative affect. Prepartum trait levels of rumination, however, did not predict postpartum symptomatology when controlled for baseline symptoms and history of major depressive episode(s).

Conclusions

The results of this investigation suggest that the way women cognitively respond to positive affect contributes perhaps even more to the development of postpartum depression than maladaptive response styles to negative affect.