A retrospective review of clinical characteristics and treatment response in body dysmorphic disorder versus obsessive-compulsive disorder

BACKGROUND: Although body dysmorphic disorder (BDD) has many features in common with obsessive-compulsive disorder (OCD) and is frequently comorbid with OCD, few studies have directly compared the 2 disorders. Although BDD and OCD respond to similar medications and cognitive-behavioral therapy (CBT), their response to treatment has never been directly compared. METHOD: We studied 107 consecutive patients with DSM-III-R OCD (N = 96) or BDD (N = 11) treated openly for 6 weeks with intensive CBT, medication, and psychosocial rehabilitation, in a specialized partial hospitalization program for severely ill OCD patients. All patients were assessed, before and after treatment, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). Retrospectively, we compared the clinical characteristics, symptom severity, and response to treatment of BDD patients with those of OCD patients. RESULTS: BDD patients and OCD patients had similar sex ratio, age, treatment duration, prevalence of comorbid major depression, and pretreatment Y-BOCS and GAS scores. BDD patients had significantly higher pretreatment HAM-D and HAM-A scores. The proportions of patients treated with serotonin reuptake inhibitors and antipsychotics did not differ between groups. Both groups improved with treatment, with significant (p < .001) changes in Y-BOCS, HAM-D, HAM-A, and GAS scores. Change in Y-BOCS did not differ between groups, but changes in HAM-D and HAM-A were significantly greater in BDD patients than in OCD patients. CONCLUSION: While BDD may be associated with greater severity of depressive and anxiety symptoms than OCD, this study suggests that BDD may respond to intensive, multimodal treatment.     

Obsessive-compulsive hoarding: symptom severity and response to multimodal treatment

BACKGROUND: Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to medications and cognitive-behavioral therapy (CBT). We sought to determine whether patients with the compulsive hoarding syndrome had more severe symptoms and functional impairment than nonhoarding OCD patients and whether they would respond to intensive, multimodal treatment previously found to be effective for treatment-refractory OCD. METHOD: We studied 190 consecutive patients with DSM-IV OCD treated openly for approximately 6 weeks with intensive CBT, medication, and psychosocial rehabilitation in a partial hospitalization program for severely ill OCD patients. Twenty of the 190 patients (11%) were identified as having the compulsive hoarding syndrome. All patients were assessed before and after treatment with the Yale-Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D). Hamilton Rating Scale for Anxiety (HAM-A). and Global Assessment Scale (GAS). We compared the symptom severity and response to treatment of compulsive hoarders versus nonhoarding OCD patients. RESULTS: Compulsive hoarders were significantly older than nonhoarders (p < .001). Hoarders had significantly lower GAS scores and higher HAM-A scores than nonhoarders both before (p = .04) and after (p = .002) treatment, but had similar pretreatment YBOCS scores. Both groups improved significantly with treatment as assessed by YBOCS score (p < .001), but nonhoarders had significantly greater decreases in YBOCS scores than hoarders (p = .02). CONCLUSION: While the compulsive hoarding syndrome appears to be a distinct, more disabling, variant of OCD that does not respond as robustly to treatment, it may still improve significantly with intensive, multimodal treatment tailored to its specific features and associated deficits.     

Can memory and executive functions in patients with obsessive–compulsive disorder predict outcome of cognitive behavioural therapy?

Background: Most studies find that patients with obsessive–compulsive disorder (OCD) have impaired memory and executive functions. Cognitive behavioural therapy (CBT) is the recommended psychotherapeutic treatment of patients with OCD. We hypothesized that impairments in memory and executive functions would predict poor outcome of CBT. Aim: To investigate whether memory and executive functions in patients with OCD could predict outcome of CBT. Methods: We assessed 39 patients with OCD before CBT with neuropsychological tests of memory and executive functions, the Hamilton Depression Rating Scale, and the Global Assessment of Functioning Scale. Furthermore, we assessed severity of OCD symptoms before and after CBT using the Yale–Brown Obsessive Compulsive Scale. Results: There were no statistically significant differences between recovered (41%) and non-recovered patients (59%) on any neuropsychological test variables or on any baseline demographic variables. Furthermore, change in OCD symptoms was not predicted by neuropsychological test performances or baseline severity of OCD symptoms. The only statistically significant finding was that non-recovered patients had lower social functioning before CBT than recovered patients (p = 0.018, d = 0.797). Conclusions: Memory and executive functions in patients with OCD could not predict outcome of CBT, but level of social functioning may be a predictor of CBT outcome. Some of the main clinical implications are that we cannot use memory and executive functions, or baseline severity of OCD symptoms to determine which patients should be offered CBT.     

Clinical outcome in patients with obsessive-compulsive disorder after discontinuation of SRI treatment: results from a two–year follow–up

BACKGROUND: Combined treatment with serotonin-reuptake inhibitors (SRI) and cognitive-behavioral therapy (CBT) is a common therapy approach for obsessive-compulsive disorder (OCD). However, it is a matter of debate whether discontinuation of SRI after combined treatment leads to relapse. METHOD: Seventy-four consecutively admitted patients suffering from OCD were included in the study. Thirty-seven patients were treated with CBT alone, and 37 patients received combined CBT and SRI treatment. Of these latter patients, seventeen discontinued SRI treatment during the follow-up period (1 and 2 years after inpatient treatment). OCD symptom severity was determined by Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and mood was assessed by Hamilton Depression Rating Scale (HDRS). RESULTS: During the initial treatment, scores for Y-BOCS (p < 0.001), HDRS (p < 0.001) and the Global Assessment of Functioning Scale (GAF) (p < 0.001) improved significantly in all groups. Reassessment two years later revealed that a) OCD symptom severity and depression scores were similar between the groups and b) discontinuation of SRI did not prompt by a recurrence of symptoms. CONCLUSIONS: We interpret our results as suggesting that discontinuation of SRI treatment may be considered in formerly combined treated OCD patients after stable remission.     

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [(18)F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P=0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P=0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.     

Paroxetine treatment of compulsive hoarding

OBJECTIVE: Compulsive hoarding, found in many patients with obsessive-compulsive disorder (OCD), has been associated with poor response to serotonin reuptake inhibitor (SRI) medications in some reports. However, no prior study has quantitatively measured response to standardized pharmacotherapy in compulsive hoarders. We sought to determine whether compulsive hoarders would respond as well as non-hoarding OCD patients to the SRI, paroxetine. METHODS: Seventy-nine patients with OCD (32 patients with the compulsive hoarding syndrome and 47 patients without prominent hoarding symptoms) were treated openly with paroxetine (mean dose 41.6+/-12.8 mg/day; mean duration 80.4+/-23.5 days) according to a standardized protocol, from 3/1993 to 7/2005. All subjects were free of psychotropic medication for at least four weeks prior to study entry. No psychotherapy or psychotropic medications except paroxetine were allowed during the study period. Subjects were assessed before and after treatment with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Scale (Ham-A), Global Assessment Scale (GAS), and Clinical Global Impression/Improvement (CGI) scale. RESULTS: Both compulsive hoarders and non-hoarding OCD patients improved significantly with treatment (p<0.001), with nearly identical changes in Y-BOCS, HDRS, Ham-A, and GAS scores. There were no significant differences between groups in the proportions of patients who completed or responded to treatment. Hoarding symptoms improved as much as other OCD symptoms. CONCLUSIONS: Compulsive hoarders responded as well to paroxetine treatment as non-hoarding OCD patients, suggesting that SRI medications are effective for compulsive hoarding. Controlled trials of SRI medications for compulsive hoarding are now warranted.     

Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behavior therapy

BACKGROUND: Functional imaging studies of major depressive disorder demonstrate response-specific regional changes following various modes of antidepressant treatment. OBJECTIVE: To examine changes associated with cognitive behavior therapy (CBT). METHODS: Brain changes underlying response to CBT were examined using resting-state fluorine-18-labeled deoxyglucose positron emission tomography. Seventeen unmedicated, unipolar depressed outpatients (mean +/- SD age, 41 +/- 9 years; mean +/- SD initial 17-item Hamilton Depression Rating Scale score, 20 +/- 3) were scanned before and after a 15- to 20-session course of outpatient CBT. Whole-brain, voxel-based methods were used to assess response-specific CBT effects. A post hoc comparison to an independent group of 13 paroxetine-treated responders was also performed to interpret the specificity of identified CBT effects. RESULTS: A full course of CBT resulted in significant clinical improvement in the 14 study completers (mean +/- SD posttreatment Hamilton Depression Rating Scale score of 6.7 +/- 4). Treatment response was associated with significant metabolic changes: increases in hippocampus and dorsal cingulate (Brodmann area [BA] 24) and decreases in dorsal (BA 9/46), ventral (BA 47/11), and medial (BA 9/10/11) frontal cortex. This pattern is distinct from that seen with paroxetine-facilitated clinical recovery where prefrontal increases and hippocampal and subgenual cingulate decreases were seen. CONCLUSIONS: Like other antidepressant treatments, CBT seems to affect clinical recovery by modulating the functioning of specific sites in limbic and cortical regions. Unique directional changes in frontal cortex, cingulate, and hippocampus with CBT relative to paroxetine may reflect modality-specific effects with implications for understanding mechanisms underlying different treatment strategies.     

Impact d’une thérapie comportementale et cognitive sur la qualité de vie perçue de patients bipolaires

ObjectivesThe treatment of bipolar disorder is mainly dominated prophylaxis. However, although mood stabilizers are effective for more than half the cases, a high proportion of patients continue to have mood swings persistent and debilitating. We propose in this paper to evaluate specifically the impact of group CBT on the quality of life in bipolar patients.Patients and methodsEighty patients with bipolar I (CBT group) received CBT in addition to mood stabilizer treatment, 23 patients (control group) continued their usual treatment. Clinical assessment and quality of life was performed at baseline and after treatment using the following tools: World Health Organization Quality Of Life-26, Hamilton Depression Rating Scale, Beck Depression Inventory, Mania Rating Scale, Hamilton Anxiety Rating Scale, Rosenberg Self-Esteem Scale, Dysfunctional Attitudes Scale.ResultsOur results show a significant improvement of the quality of life for patients following CBT, particularly in terms of physical health, psychological health and social relationships, regardless the improvement of mood symptoms.ConclusionCognitive changes made during therapy, their enactment by active participation in the group, increasing interpersonal skills will therefore contribute to some, beyond reduced depressive symptoms, improving the perceived quality life, particularly in psychosocial domains.     

Cognitive-behavioral therapy as an adjunct to serotonin reuptake inhibitors in obsessive-compulsive disorder: an open trial.

BACKGROUND: We report the results of an open trial of cognitive-behavioral therapy (CBT) using exposure and ritual prevention as an adjunct to serotonin reuptake inhibitors (SRIs) in obsessive-compulsive disorder (OCD). We hypothesized that exposure and ritual prevention would significantly reduce OCD symptoms in patients who remained symptomatic despite an adequate trial of an SRI and enable patients to discontinue their medication. METHOD: OCD patients taking an adequate dose of an SRI > or = 12 weeks who remained symptomatic (i.e., a Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score > or = 16) were eligible. While taking a stable dose of an SRI, patients received 17 sessions of exposure and ritual prevention. For the intent-to-treat group, the paired t test was used to compare scores on the Y-BOCS, the National Institute of Mental Health (NIMH) Global OCD scale, the Clinical Global Impressions scale, and the Hamilton Rating Scale for Depression before and after exposure and ritual prevention. RESULTS: Six of 7 eligible patients entered the study, and 5 completed it. All 6 improved on all OCD measures. The mean +/- SD Y-BOCS score was 23.8 +/- 2.6 prior to exposure and ritual prevention and 12.2 +/- 4.3 after it (p < .001). The mean percentage decrease on the Y-BOCS was 49% (range, 26%-61%). Patients were rated by the therapist and rated themselves as much (N = 4) or very much (N = 2) improved. Blood drug levels did not change in most patients during exposure and ritual prevention; thus, the improvement was attributed to this type of therapy. No patients discontinued their medication. CONCLUSION: This open trial suggests that CBT using exposure and ritual prevention can lead to a significant reduction in OCD symptoms in patients who remain symptomatic despite an adequate trial of an SRI.     

Effect of levetiracetam on depression and anxiety in adult epileptic patients

BACKGROUND: Interictal depression is common in patients with epilepsy and it significantly impacts quality of life. Some studies indicate that levetiracetam (LEV) may have mood stabilizing properties. METHODS: Twenty-five adults with uncontrolled partial seizures and concomitant depressive symptoms were treated with LEV. Patients were evaluated for depression and anxiety with several psychometric measures, including: Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Depression Rating Scale (HDRS), Zung Self-rating Scale for Depression (Z-SDS), Hamilton Anxiety Rating Scale (HARS), Zung Self-rating Scale for Anxiety (Z-SAS). RESULTS: Evaluations after 5 weeks and after 3 months of LEV treatment demonstrated significant improvement in depression and anxiety. CONCLUSIONS: This uncontrolled study suggests that treatment with LEV may also improve depression and anxiety in patients with partial seizures. However, the sample of patients is limited and the possibility of a placebo effect cannot be excluded. These findings must be considered preliminary and should be replicated under placebo-controlled conditions.     

Effects of behavioral therapy or pharmacotherapy on brain glucose metabolism in subjects with obsessive-compulsive disorder as assessed by brain FDG PET

This prospective study investigated the effect of pharmacotherapy (PT) and cognitive behavioral therapy (CBT) on cerebral glucose metabolism in adults with obsessive-compulsive disorder (OCD). Dynamic positron emission tomography (PET) of the brain with F-18-fluorodeoxyglucose (FDG) was performed before and after treatment in 16 subjects diagnosed for OCD for at least 2 years (PT: n=7). Pre-to-post-treatment change of scaled local metabolic rate of glucose (SLMRGlc) was assessed separately in therapy responders and non-responders. Correlation was tested between SLMRGlc change and change of OCD, depression, or anxiety symptoms. SLMRGlc increased in the right caudate after successful therapy. The increase tended to correlate with the improvement of OCD symptom severity. The finding of increased local caudate activity after successful therapy is in contrast to most previous studies. Possible explanations include effects of therapy on concomitant depression symptoms and/or the large proportion of early-onset OCD in the present sample.     

Individual versus group cognitive behavioral treatment for obsessive–compulsive disorder: Follow up

Aim: To compare the effectiveness of two forms of cognitive behavioral treatment (CBT; group and individual) in a sample of patients with obsessive–compulsive disorder (OCD) at 6‐month and 12‐month follow up. Method: Thirty‐eight subjects meeting DSM‐IV‐TR OCD criteria completed 20 sessions of individual and group CBT. They were assessed using the Yale–Brown Obsessive–Compulsive Scale and the Hamilton Anxiety and Depression Scales at baseline, after treatment and at 6‐month and 12‐month follow up. Results: The clinical improvement obtained at the end of the treatment was maintained at 6‐month and 12‐month follow up. The clinical outcome of the individual treatment (IT) and the group treatment (GT) was the same. The dropout rates were significantly higher in women than in men, but were similar for IT and GT. Conclusions: CBT was effective in a sample of OCD patients. Individual and group CBT had similar results at 6‐month and 12‐month follow up. The clinical implications of these findings are discussed.     

Manual-Driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study.

OBJECTIVE: Concerns about isolation, compromised development, partial pharmacotherapy response, therapist scarcity, and inadequate cognitive-behavioral therapy (CBT) adherence led the authors to adapt a CBT protocol to a group format for adolescents with obsessive-compulsive disorder (OCD). A naturalistic, open trial of group CBT for adolescent OCD is described. The authors predicted symptom improvement and format acceptability. METHOD: Over a 1 -year period, 18 adolescents aged 13 to 17 years with OCD received 14-week group CBT based on March and Mulle's OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual in four consecutive sessions of five to nine patients. Eighty-three percent had undergone at least one medication trial, and 78% had previous CBT experience. RESULTS: OCD symptoms measured by the Children's Yale-Brown Obsessive Compulsive Scale improved significantly, both statistically and clinically. Adolescents consistently shared information and designed exposure interventions for themselves and others during sessions. Repeated self-report measures confirmed adolescents' satisfaction with therapy. CONCLUSIONS: This pilot study demonstrates that a manual-based treatment protocol may be exported for clinical use, adaptable for the end-user's needs, and palatable to adolescent patients. Clinical improvement and patient satisfaction justify further investigation in a controlled study.     

Group behavioral therapy for adolescents with tic-related and non-tic-related obsessive-compulsive disorder

Prior research supports the distinction between tic-related and non-tic-related obsessive-compulsive disorder (OCD) based on phenomenologic, etiologic, and neurobehavioral data. The present study examines whether response to psychosocial treatment differs in adolescents, depending on the presence of comorbid tics. Nineteen adolescents, 12-17 years of age, participated in 7-week, uncontrolled trial of group cognitive-behavioral treatment (CBT) for OCD. Eight of the patients had tic-related and eleven had non-tic-related OCD. The group CBT program included psycho-education, exposure and response prevention, cognitive strategies, and family involvement. Significant improvement was observed for all subjects on the Yale-Brown Obsessive Compulsive Scale ratings of obsessions, compulsions, and total OCD symptoms. Outcomes were similar for subjects with tic-related and non-tic-related OCD. These preliminary results suggest that the presence of comorbid tic disorders may not attenuate response to behavioral group treatment among adolescents.     

The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial

BACKGROUND: Approximately 10% to 16% of women experience a major depressive episode after childbirth. A significant proportion of these women also suffer from comorbid anxiety disorders. The purpose of this study was to evaluate whether the addition of cognitive-behavioral therapy (CBT) to standard antidepressant therapy offers additional benefits in the treatment of post-partum depression with comorbid anxiety disorders. METHOD: Thirty-five women referred to a tertiary care hospital outpatient program with a DSM-IV diagnosis of postpartum depression with comorbid anxiety disorder were randomly assigned to 1 of 2 treatment groups-paroxetine-only monotherapy group (N = 16) or paroxetine plus 12 sessions of CBT combination therapy group (N = 19)-for a 12-week trial. Progress was monitored by a psychiatrist blinded to treatment group, using the Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, Yale-Brown Obsessive Compulsive Scale, Clinical Global Impressions scale, and Edinburgh Postnatal Depression Scale. Data were analyzed using 2-tailed statistical tests at an alpha level of.05. The study was conducted from April 1, 2002, to June 30, 2003. RESULTS: Both treatment groups showed a highly significant improvement (p <.01) in mood and anxiety symptoms. Groups did not differ significantly in week of recovery, dose of paroxetine at remission, or measures of depression, anxiety, and obsessive-compulsive symptoms at outcome. CONCLUSION: Antidepressant monotherapy and combination therapy with antidepressants and CBT were both efficacious in reducing depression and anxiety symptoms. However, in this sample of acutely depressed/anxious postpartum women, there were no additional benefits from combining the 2 treatment modalities. Further research into the efficacy of combination therapy in the treatment of moderate-to-severe depression with comorbid disorders in postpartum women is recommended.     

Differential brain metabolic predictors of response to paroxetine in obsessive-compulsive disorder versus major depression

OBJECTIVE: Serotonin reuptake inhibitor (SRI) medications are effective in the treatment of both major depressive disorder and obsessive-compulsive disorder (OCD), but it is unknown whether the neural substrates of treatment response for the two disorders are the same or different. The authors sought to identify pretreatment cerebral glucose metabolic markers of responsiveness to SRI treatment in patients with OCD versus major depressive disorder and to determine whether the pretreatment patterns associated with improvement of OCD symptoms were the same as or different from those associated with improvement of major depressive disorder symptoms. METHOD: [(18)F]Fluorodeoxyglucose positron emission tomography was used to measure cerebral glucose metabolism in 27 patients with OCD alone, 27 with major depressive disorder alone, and 17 with concurrent OCD and major depressive disorder, who were all then treated with 30-60 mg/day of paroxetine for 8-12 weeks. Correlations were calculated between pretreatment regional metabolism and pre- to posttreatment changes in the severity of OCD symptoms, depressive symptoms, and overall functioning. RESULTS: While improvement of OCD symptoms was significantly correlated with higher pretreatment glucose metabolism in the right caudate nucleus (partial r=-0.53), improvement of major depressive disorder symptoms was significantly correlated with lower pretreatment metabolism in the amygdala (partial r=0.71) and thalamus (partial r=0.34) and with higher pretreatment metabolism in the medial prefrontal cortex and rostral anterior cingulate gyrus (Talairach coordinates: x=0, y=62, z=10) (z=2.91). CONCLUSIONS: These findings suggest that, although both OCD and major depressive disorder respond to SRIs, the two syndromes have different neurobiological substrates for response. Elevated activity in the right caudate may be a marker of responsiveness to antiobsessional treatment, while lower right amygdala activity and higher midline prefrontal activity may be required for response of depressive symptoms to treatment.     

Comorbidity of obsessive-compulsive disorder and depression: prevalence,symptom severity,and treatment effect

BACKGROUND: The goal of this study was to investigate the co-occurrence of depressive disorders in obsessive-compulsive disorder (OCD) and the effect of these disorders on combined pharmacologic and behavioral treatment for OCD. METHOD: A retrospective chart analysis was performed on baseline ratings of 120 OCD patients and posttreatment ratings of 72 of these patients. For depressive symptoms, the Montgomery-Asberg Depression Rating Scale and the Self-Rating Depression Scale were applied; for obsessive-compulsive symptoms, the Yale-Brown Obsessive Compulsive Scale and the Maudsley Obsessive Compulsive Inventory were used; and for general anxiety symptoms, the Self-Rating Anxiety Scale, the Clinical Anxiety Scale, and the State-Trait Anxiety Inventory were given. RESULTS: One third of the OCD patients in our sample were found to be depressed. Symptom severity on OCD symptoms at baseline did not differ between depressed and nondepressed OCD patients; on general anxiety symptoms, the comorbid group was more severely affected. Both depressed and nondepressed OCD patients responded well to treatment, as reflected in assessments for depressive, obsessive-compulsive, and general anxiety symptoms. However, comorbid depression had a negative effect on treatment: depressed OCD patients showed less improvement than nondepressed OCD patients on most scales. CONCLUSION: Depression frequently accompanies OCD and appears to affect treatment outcome negatively. While both groups of patients improved with combination treatment, the OCD-alone group had more improvement than the group that had comorbid depression.     

Decreased suicidal ideation in depressed patients with or without comorbid posttraumatic stress disorder treated with selective serotonin reuptake inhibitors: an open study

Comorbidity of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is associated with higher morbidity including suicidal ideation and behavior. Selective serotonin reuptake inhibitors (SSRIs) are a known treatment for PTSD, MDD and comorbid PTSD and MDD. Since the patients with comorbid MDD and PTSD (PTSD-MDD) are sicker, we hypothesize a poorer response to treatment compared to patients with MDD only. Ninety-six MDD patients were included in the study: 76 with MDD only and 20 with PTSD-MDD. Demographic and clinical parameters at baseline were assessed. We examined clinical parameters before and after 3 months of open SSRI treatment in subjects with PTSD-MDD and compared this group to individuals with MDD only. At baseline, PTSD-MDD patients had higher Hamilton Depression Rating Scale and Buss-Durkee Hostility Scale scores compared with MDD only subjects. There was a significant decrease in scores on the Hamilton Depression Rating Scale, Beck Depression Inventory, Beck Hopelessness Scale, and Beck Scale for Suicidal Ideation after 3 months of treatment with SSRIs in both groups. The magnitude of improvement in Beck Scale for Suicidal Ideation scores was greater in the PTSD-MDD group compared to the MDD only subjects. Symptoms of depression including suicidal ideation improved in MDD patients with or without comorbid PTSD after 3 months of treatment with SSRIs but improvement in suicidal ideation was greater in the PTSD-MDD group. Our finding has not supported the hypothesis that a response to treatment is poorer in the PTSD-MDD group which may indicate that sicker patients benefit more from the treatment.     

The impact of cognitive behavioral therapy on IL-6 levels in unmedicated women experiencing the first episode of depression: A pilot study

A group of 11 women (18–29 years old) in the first episode of depression was evaluated before and after cognitive behavioral therapy (CBT). Depressive scores, assessed by Hamilton Rating Scale (HRSD), and serum IL-6 levels significantly decreased after the seventh session. These results suggest that CBT reduced both depressive symptoms and the inflammatory state in women.     

强迫症患者持续性注意功能的相关性研究

目的了解强迫症（OCD）持续性注意功能损害情况及其相关因素。方法对65例OCD患者在入组时进行连续操作试验（CPT）测试，以65例正常健康人进行对照，采用耶鲁-布朗强迫量表（Y—BOCS）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评定病情与情绪，并对测试结果与病程、年龄、病情严重度和焦虑、抑郁情绪等进行回归分析。结果OCD患者CPT视觉单目标持续性注意测验（VOT）、视觉连续目标持续性注意测验（VST）、听觉持续性注意测验（ET）均高于正常对照组（z=3．79～8．62，P〈0．05），CPT评分与病程、年龄无关（标准化回归系数Beta=0．012—0．198，P〉0．05），与病情严重度和情绪有相关性（VOTCV Beta=0．566，VOTHAMA Beta=0．382，VOTHAMD Beta0．294，P〈0．05）。结论OCD患者存在一定的注意损害，注意损害与病情严重度和情绪有关。