Personality disorders in obsessive compulsive disorder.

Standardized structured interview personality scales are now available that provide better reliability than clinician interview, but are still imperfect. These scales diagnose DSM III-R personality disorders, which are more illness-oriented than Freudian notions. Use of these scales has found that the majority of patients with OCD have at least one Axis II personality disorder, with most falling in cluster C. Obsessive compulsive personality disorder, as described in DSM-III-R, is, in most samples studied, present in the minority of patients with OCD, and is often less common than other personality disorders such as mixed, dependent, avoidant, and histrionic. The prevalence of this personality disorder as modified in DSM-III-R (making it easier for a patient to qualify for this personality disorder diagnosis) appears to be higher, although still present in a minority of patients with OCD. Obsessive compulsive personality disorder (along with the other cluster B and C personality disorders) has not been reported to have a consistent relation to treatment outcome. There is evidence that in some cases, obsessive compulsive personality disorder may be secondary to OCD. Swedo et al hypothesized that some children may develop compulsive personality traits as an adaptive mechanism to deal with OCD. This hypothesis is in accord with our finding that OCD often predates compulsive personality disorder and that mixed personality disorder may develop over time, possibly secondary to OCD. We found in our sample of 96 adult patients with OCD that the presence of mixed personality disorder was more likely with longer duration of OCD, suggesting that patients who do not have premorbid personality disorders may develop significant personality traits (especially avoidant, compulsive, and dependent), which may be related to behavioral and life-style changes that are secondary to OCD. This hypothesis is strengthened by our finding that patients with one of these personality disorders at baseline tended to no longer meet criteria for them following successful treatment of their OCD. It now appears that schizotypal personality disorder, which is thought to be related genetically to schizophrenia (e.g., in three male identical twin pairs concordant for OCD but discordant for schizophrenia or schizoaffective disorder, the nonpsychotic co-twins all had schizotypal personality disorder), is the only consistent personality disorder predictor of poorer outcome in OCD. These traits may help explain other proposed poor predictors of treatment outcome such as overvalued beliefs, poor compliance, and chaotic family situations.(ABSTRACT TRUNCATED AT 400 WORDS)     

Impulse control disorders in adults with obsessive compulsive disorder

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

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.     

Substance use disorders in an obsessive compulsive disorder clinical sample

The prevalence and clinical correlates of substance use disorders (SUDs) were examined in a clinical sample of Obsessive Compulsive Disorder (OCD). As part of their intake interview into an observational study of the course of OCD, 323 participants completed a battery of standardized measures. Twenty-seven percent of the sample met lifetime criteria for a SUD. 70% of participants with comorbid SUDs reported that OCD preceded SUD onset by at least one year. Younger age at OCD onset and presence of Borderline Personality Disorder (BPD) were each associated with increased risk of alcohol use disorders but only BPD was associated with increased risk of drug use disorders. SUDs affect more than one-quarter of individuals who seek treatment for OCD. Individuals with a juvenile-onset of OCD or comorbid BPD may be especially vulnerable to SUDs. Further research is needed to identify risk factors for SUDs and to better understand their impact on OCD course.     

Involuntary social cue integration in patients with obsessive compulsive disorder

Objective

Patients with obsessive compulsive disorder (OCD) have inferior social functioning compared to healthy controls, but the exact nature of these social deficits, and the underpinning mechanisms, are unknown. We sought to investigate social functioning in patients with OCD by measuring their involuntary/spontaneous processing of social cues using a specifically designed test, which might reveal deficits in these patients that explicit voluntary tasks do not detect.

Methods

The sample of the study consisted of an OCD group (n = 25) and a control group (n = 26). Both groups performed an adaptation of the Social Distance Judgment Task (SDJT; Jellema et al., 2009), in which participants have to judge the geometrical distance between two human cartoon figures presented on a computer screen. Head/gaze direction and body direction were manipulated to be either compatible, i.e. both directed to the left or to the right (Compatible condition) or incompatible, i.e. body directed toward the observer (frontal view) and head/gaze directed to the left or right (Incompatible condition).

Results

In the Compatible condition, controls nor OCD patients were influenced by the social cues in their judgments of the geometrical distances. However, in the Incompatible condition, where the attentional cue was more conspicuous, both groups were influenced by the cues, but the controls to a significantly larger extent than the OCD patients.

Conclusions

This study showed that patients with OCD are less likely, compared to controls, to automatically/spontaneously integrate the other’s direction of attention into their visual percept. This may have resulted in their judgments of the geometrical distances between the agents to be more accurate than those of controls. The suggested impairment in automatically integrating social cues may have important repercussions for the social functioning of OCD patients.     

Buspirone augmentation of fluoxetine in patients with obsessive compulsive disorder

Twenty patients with obsessive compulsive disorder were treated openly with fluoxetine for 20 weeks. In 10 of the patients, addition of buspirone during the last 8 weeks improved clinical response. The role of augmenting strategies is discussed.     

Oxidative imbalance in child and adolescent patients with obsessive compulsive disorder

Various psychological, social, genetic and biochemical factors are thought to be involved in etiology of obsessive–compulsive disorder (OCD). To the best of our knowledge there are no studies investigating the effects of free radicals in children and adolescents with OCD. This study evaluated total oxidant and antioxidant status, oxidative stress index, and arylesterase and paraoxonase activity in children and adolescents with OCD. The study included 28 patients diagnosed with OCD and 36 healthy children as an age- and sex-matched control group. Their serum total oxidant status (TOS) and total antioxidant status (TAS) were measured and the oxidative stress index (OSI) was calculated. Although serum TOS and OSI values in the OCD patients were significantly higher than those in the control group (p = 0.008, p < 0.001, respectively), TAS and paraxonase activity were significantly lower ( p < 0.001 for both). However, no statistically significant difference in arylesterase activity was found (p > 0.05). The increase in oxidative status and decrease in antioxidants in patients with OCD demonstrate that oxidative stress may have an important role in the pathophysiology of the disease. It has been suggested that drugs that contain antioxidants should be added to conventional pharmacotherapy during follow-up.     

Autism spectrum disorders in adult outpatients with obsessive compulsive disorder in the UK

Objectives: Patients with obsessive compulsive disorder (OCD) frequently show traits of autism spectrum disorders (ASD). This is one of the first studies to explore the clinical impact of the overlap between OCD and ASD as a categorical diagnosis.

Methods: A cross-sectional survey in 73 adult outpatients with DSM-IV OCD. Autistic traits were measured using the Autism-Spectrum Quotient (AQ). A clinical estimate ASD diagnosis was made by interview using DSM-IV-TR criteria. OCD patients with and without autistic traits or ASD were compared on demographic and clinical parameters and level of OCD treatment-resistance based on treatment history.

Results: Thirty-four (47%) patients scored above the clinical threshold on the AQ (≥26) and 21 (27.8%) met diagnostic criteria for ASD. These diagnoses had not been made before. Patients with autistic traits showed a borderline significant increase in OCD symptom-severity (Yale-Brown Obsessive Compulsive Scale (Y-BOCS); p?=?.054) and significantly increased impairment of insight (Brown Assessment of Beliefs Scale; p?=?.01). There was a positive correlation between AQ and Y-BOCS scores (p?=?.04), but not with OCD treatment resistance.

Conclusion: There is a high prevalence of previously undiagnosed ASD in patients with OCD. ASD traits are associated with greater OCD symptom-severity and poor insight.     

强迫症状对强迫症患者睡眠的影响

目的了解无共病强迫症患者睡眠持续性和睡眠结构。方法采用随机数字表法选择2013年5月-2015年3月在无锡市精神卫生中心住院和门诊治疗的强迫症患者20例,同时纳入健康对照组20例,使用美国Embla多导睡眠监测仪监测研究对象睡眠持续性和睡眠结构。结果与对照组比较,强迫症患者非快速眼动睡眠4期时间减少(P0.05),快速眼动睡眠潜伏期缩短(P0.05),两组总睡眠时间、觉醒时间、快速眼动睡眠、睡眠效率等差异均无统计学意义(P均0.05)。OCD组Y-BOCS评分与总睡眠时间、睡眠效率呈负相关(r=-0.492,-0.543,P均0.05)。结论强迫症患者存在睡眠结构损害,强迫症状严重程度影响患者总睡眠时间和睡眠效率。     

Anxiety disorders and obsessive compulsive disorder 9 months after perinatal loss

ObjectivePerinatal loss (stillbirth after 20 weeks of gestational age or infant death in the first month) impacts one to two infants per hundred live births in the United States and can be a devastating experience for parents. We assessed prevalence of anxiety disorders and obsessive compulsive disorder (OCD) among bereaved and live-birth mothers.MethodsWe collaborated with the Michigan Department of Community Health to survey Michigan mothers with perinatal death or live birth. We measured symptoms of generalized anxiety disorder, social phobia, panic disorder and OCD using validated written self-report screens and collected data on maternal demographics, psychiatric history, social support and intimate partner violence.ResultsA total 609/1400 mothers (44%) participated, returning surveys 9 months postdelivery. Two hundred thirty-two mothers had live birth, and 377 had perinatal loss. In unadjusted analyses, bereaved mothers had higher odds of all four disorders. In logistic regression adjusted for covariates, bereaved mothers still had higher odds of moderate–severe generalized anxiety disorder [odds ratio (OR): 2.39, confidence interval (CI): 1.10–5.18, P= .028] and social phobia (OR: 2.32, CI: 1.52–3.54, P< .0005) but not panic disorder or OCD.ConclusionBereaved mothers struggle with clinically significant anxiety disorders in the first year after perinatal loss; improved identification and treatment are essential to improve mental health for this vulnerable population.     

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.     

Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder

The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed.     

Psychiatric disorders in first degree relatives of children and adolescents with obsessive compulsive disorder

One hundred and forty-five first-degree relatives (89 parents [96%] and 56 siblings [98%]) of 46 children and adolescents with severe primary obsessive compulsive disorder (OCD) were personally interviewed with clinical and structured psychiatric interviews. Parent interviews were scored by a rater blind to proband diagnosis. Thirty percent of probands had at least one first-degree relative with OCD: 25% of fathers and 9% of mothers received this diagnosis. Forty-five percent of fathers and 65% of mothers received one or more other psychiatric diagnoses. The increased familial rate of OCD over that expected from a general population, and over that found in parents of conduct disordered patients, is consistent with a genetic factor in OCD. Presenting obsessive compulsive symptoms of probands and their parents were usually dissimilar, arguing against any simple social or cultural transmission.     

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.     

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.