Was Freud partly right on obsessive-compulsive disorder (OCD)? Investigation of latent aggression in OCD

Inflated responsibility is increasingly regarded a pathogenetic mechanism in obsessive-compulsive disorder (OCD). In seeming contrast, there is mounting evidence that latent aggression is also elevated in OCD. Building upon psychodynamic theories that an altruistic fa?ade including exaggerated concerns for others is partly a defense against latent aggression, evidence was recently obtained for high interpersonal ambivalence in OCD patients relative to psychiatric and healthy controls using a newly developed instrument entitled the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). A total of 46 OCD patients and 23 healthy participants took part in the present study. OCD patients displayed a higher social responsibility than controls. At the same time, patients also disclosed more latent aggression/calculating behavior and interpersonal distrust. While the pathogenic role of latent aggression is still not fully uncovered, it may deserve more consideration in treatment in view of frequent tensions in the families of OCD patients. Longitudinal studies with at-risk sample are needed to assess the relationship between problems with anger expression as well as (exaggerated) moral standards in OCD.     

OCD患者静息时的局部脑血流

ＯＣＤ患者静息时的局部脑血流【英】／ＬｕｃｅｙＪＶ…∥ＢｒＪＰｓｙｃｈｉａｔｒｙ．－１９９５，１６７；－６２９～６３４本文对强迫性障碍（ＯＣＤ）患者与健康对照组的皮质与皮质下的局部脑血流（ｒＣＢＦ）是否有差异进行了测试，并探索了ｒＣＢＦ与ＯＣＤ状态之...     

Are neuropsychological deficits trait markers in OCD?

OBJECTIVE: Neuropsychological deficits are potential endophenotype markers. In obsessive-compulsive disorder (OCD), there is impairment in executive functions and nonverbal memory. However, studies have largely examined neuropsychological functioning in patients during the symptomatic phase. The state independent nature of neuropsychological deficits in OCD is not established. For neuropsychological deficits to be endophenotype markers, they have to be state-independent. We compared neuropsychological functions in recovered OCD patients with matched healthy controls. METHOD: We assessed 30 recovered DSM-IV OCD patients without any concurrent comorbidity or lifetime history of schizophrenia, bipolar disorder, tics and alcohol/substance abuse and 30 healthy controls individually matched for age, sex and education. They were assessed on different neuropsychological dimensions: attention, executive function, memory and intelligence. For between-group comparisons, we employed univariate analyses, and to identify neuropsychological variables that differentiate cases and controls, we used backward conditional logistic regression for matched case-control design. RESULTS: Patients in the recovered phase of the illness had significant deficits in tests of set-shifting ability, alternation, response inhibition and nonverbal memory but had intact performance in other tests. In the logistic regression, scores on the Wisconsin Card Sorting Test 'categories completed' and the Rey's Complex Fig. Test 'delayed recall' were significant after controlling for the possible confounding effects of age and education. There was no correlation between illness-related variables and neuropsychological deficits. CONCLUSIONS: Deficits in certain executive functions and nonverbal memory are possibly state independent. Neuropsychological deficits are possibly candidate endophenotype markers for OCD and may help clarify genetic contributions. Future studies should evaluate unaffected siblings to establish deficits are endophenotype markers. Prospective studies with serial measurements of cognitive deficits are also needed to assess whether these deficits are cumulative with the progression of illness.     

Tic or compulsion?: it's Tourettic OCD

A subgroup of individuals suffering from obsessive-compulsive disorder (OCD) frequently present to treatment with an atypical yet distinguishable array of symptoms akin to both Tourette's disorder (TD) and OCD. These individuals often receive standard treatments for OCD (or less likely, TD) that fail to address the blended features of their presentation. It is argued that these individuals would be better served, both psychotherapeutically and pharmacologically, by the adoption of a Tourettic OCD (TOCD) conceptual framework.     

Are responsibility beliefs inflated in non-checking OCD patients?

Cognitive models of obsessive-compulsive disorder [e.g., Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37(Suppl. 1), S29-S52] propose a key role for inflated responsibility for harm. Studies evaluating such beliefs typically use heterogeneous samples including several OCD subtypes. A recent investigation by Foa et al. [Foa, E. B., Sacks, M. B., Tolin, D. F., Prezworski, A., & Amir, N. (2002). Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension. Journal of Anxiety Disorders, 16(4), 443-453] found responsibility to be elevated in OC checkers, but not in non-checking OCD patients, relative to non-anxious controls. In that study, the responsibility measure included checking scenarios, thus leaving the possibility that these findings may have been due to criterion contamination. The present study investigated responsibility beliefs in OC checkers (n=39) and non-checkers (n=20), anxious controls (n=22), and non-clinical controls (n=69), using measures of responsibility which do not have item overlap with OCD symptoms. Results indicated that both OC groups showed greater responsibility beliefs relative to anxious and non-anxious controls. OC checkers endorsed greater responsibility appraisals than anxious and non-clinical control groups. In contrast, non-checking OCs reported greater responsibility appraisals than non-clinical controls, but did not differ from anxious controls and OC checkers. Results are discussed in the context of the cognitive model of OCD.     

OCD病人用芬氟拉明后的皮质醇和催乳素变化

采用神经内分泌方法探究强迫症(OCD)患者内分泌激素与5-HT功能的关系的研究已有许多,本文为首次在OCD病人中使用右旋芬氟拉明的研究,以探究5-HT在OCD的病理生理中所起的作用。方法:研究对象为30例男性,其中20例为病例组,10例为健康对照组。全部受试者躯体健康,无过度肥胖,均自愿入组。10例OCD样本均符合DSM-Ⅲ-R的诊断标准,年龄为22～47岁(平均34.1±9.2岁)。至少在实验前6周未用过药,症状至少持续一年,严重程度至少中等,平均发病年龄为18±2.2岁,平均病程为17±2.6年,其中6例有     

氯丙咪嗪治疗前后OCD病人的生理表现

氯丙咪嗪治疗前后ＯＣＤ病人的生理表现【英】／Ｈｏｅｈｎ－ＳａｒｉｃＲ…／／Ｊ　ＣｌｉｎＰｓｙｃｈｉａｔｒｙ。－１９９３，５４（７）：－２７２～２７６本文目的是要确定用氯丙咪嗪治疗的强迫症（ＯＣＤ）病人，自主神经活动水平是否降低，以及自主神经系统对非特...     

氯丙咪嗪去甲丙咪嗪治疗儿童OCD

强迫障碍(OCD)的研究是新近的一个热门课题,它的发病率约占普通人群的1%～3%,三环类抗抑郁剂盐酸氯丙咪嗪(CMI)可有效地治疗这一障碍。为了使研究更具说服力,本文选取了一组较大样本的严重原发性 OCD 的儿童,用 CMI 与 DMI(去甲丙咪嗪)双盲交叉对照研究,旨在阐明这两种药物治疗 OCD 疗效是否不同;若有差异,那么,     

Obsessive-compulsive personality traits: how are they related to OCD severity?

Previous research has demonstrated that comorbid obsessive–compulsive personality disorder (OCPD) in patients with obsessive–compulsive disorder (OCD) is associated with greater overall OCD severity, functional impairment, and poorer treatment outcomes ( [Coles et al., 2008] , [0145] and [0225] ). However, research has only examined the effects of OCPD categorically and has yet to thoroughly examine the impact of individual OCPD characteristics dimensionally. Thus, the present study sought to investigate the relationships between various OCPD-related dimensions (e.g., perfectionism, rigidity) and OCD symptomology and severity. The study recruited a sample of OCD patients (n = 51) in the OCD units of two residential treatment facilities. Findings yielded significant relationships between OCD severity and the following OCPD dimensions: flexibility, doubts about actions (a dimension of perfectionism), and hoarding. Interpretations of these results and the implications for diagnosis, prognosis, and treatment outcome are discussed. Furthermore, the current study provides insight into a unique perspective which leaves room for more symptom overlap and variability between OCD and OCPD.     

Neuropsychological performance in OCD: a study in medication-naïve patients

Background

Obsessive-compulsive disorder (OCD) is associated with impairments in multiple neuropsychological domains but the findings are rather inconsistent across studies. One potential reason for poor replication is the confounding influence of medications. There is limited research on neuropsychological performance in medication-naïve, never treated OCD patients.

Methods

In this study, we assessed 31 medication-naïve, never-treated, DSM-IV OCD patients free of comorbid major depression and 31 healthy controls individually matched for age, gender and years of education, with tests of attention, executive function, memory reasoning and visuo-spatial function.

Results

Medication-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Patients performed somewhat poorly only on the highest goal hierarchy of the Tower of London (TOL) test (p = 0.001, effect size = 0.68).

Conclusions

It is intriguing to find that symptomatic, drug-naïve OCD patients did not significantly differ from healthy controls on most neuropsychological tests. Our finding of medium effect size on TOL highest goal hierarchy test suggests that brain regions outside the affective orbitofrontal loop may also be perhaps involved in OCD. This finding however needs replication because of modest effect size. Future studies should focus on studying medication-naïve, co-morbidity-free patients and relatives using symptom dimensions for consistent and robust findings.     

Reduced serotonin transporter–availability in obsessive–compulsive disorder (OCD)

Abstract. We investigated the availability of brain serotonin transporters in 10 drug–free patients with obsessive–compulsive disorder (OCD) and age–matched healthy controls in vivo using single–photon emission computed tomography (SPECT) and the radioligand [¹²³I]–2–carbomethoxy–3–(4–idiophenyl)-tropane ([¹²³I]–CIT). For quantification of regional serotonin transporter a ratio of specific to non–specific [¹²³I]–CIT–binding was used. The availability of serotonin transporter was calculated using regions of interests (ROI) for thalamus/hypothalamus, midbrain, brainstem (highest density of serotonin transporter) and cerebellum as a reference. The mean specific to non–specific [¹²³I]–CIT binding ratios in the thalamic/hypothalamic ROI were 4.95 ± 0.57 (OCD patients), and 5.48 ± 0.87 (control group). The mean ratios in the midbrain ROI were 3.51 ± 0.45 (OCD patients) and 4.89 ± 1.23 (controls) and in the brainstem ROI the ratios were 2.38 ± 0.76 (OCD patients) and 3.53 ± 1.01 (controls). This in vivo finding of significant reduced serotonin transporter availability in midbrain/brainstem using [¹²³I] –CIT SPECT further supports the serotonin deficit hypothesis of OCD.     

Moral thought–action fusion and OCD symptoms: The moderating role of religious affiliation

The empirical literature on the relationship between moral thought–action fusion (TAF) and obsessive-compulsive disorder (OCD) is characterized by mixed findings. Previous studies have reported religious group differences in moral TAF and the relationship between moral TAF and religiosity. In light of those studies and considering the apparent role of moral TAF in scrupulosity, the purpose of this investigation was to evaluate the possible role of religion as a moderator of the relationship between moral TAF and OCD symptoms. The results revealed that (a) Christians endorsed higher levels of moral TAF than did Jews independent of OCD symptoms; (b) religiosity was correlated with moral TAF in Christians but not in Jews, suggesting that Christian religious adherence is related to beliefs about the moral import of thoughts; and (c) moral TAF was related to OCD symptoms only in Jews. That is, for Christians, moral TAF was related to religiosity but not OCD symptoms, and for Jews, moral TAF was related to OCD symptoms but not religiosity. These results imply that moral TAF is only a marker of pathology when such beliefs are not culturally normative (e.g., as a function of religious teaching or doctrine).     

How is the COVID-19 pandemic affecting individuals with obsessive-compulsive disorder (OCD) symptoms?

The novel coronavirus disease (COVID-19) pandemic has caused substantial public health burden and widespread anxiety. The adverse mental health effects caused by COVID-19 may be particularly acute for individuals with obsessive-compulsive disorder (OCD). For the present study, we developed an online survey to investigate how COVID-19 has affected the OCD community. The survey included both quantitative and qualitative questions to assess multiple facets of how the pandemic has affected individuals with OCD symptoms. Responses were collected from adults with self-identified OCD recruited from OCD-specific forums and websites (n = 252). The majority (76.2 %) of respondents reported that their OCD symptoms had worsened since the outbreak, though there was substantial variability in individual responses. Negative effects of COVID-19 were more strongly linked to contamination and responsibility for harm symptoms than for other symptom dimensions. The self-identified OCD group also reported heightened concerns about COVID-19 compared to a community control sample recruited through Amazon’s Mechanical Turk (MTurk). Lastly, many participants reported that the pandemic had interfered with their OCD treatment, yet they remained mostly satisfied with how their treatment providers had handled the crisis. These results highlight the importance of considering how COVID-19 has affected the OCD community, with possible implications for treatment providers.     

How frequently are atypical antipsychotics used to treat OCD in a British community mental health team?

Obsessive compulsive disorder (OCD) is a condition with a prevalence of around 1-2% (3-4% in some studies) with a recognised protocol for its treatment produced by the national institute for health and clinical excellence (NICE). NICE recommends that all patients with OCD are first offered treatment with cognitive behavioural therapy (CBT) concentrating on exposure and response prevention (ERP) before proceeding to selective serotonin re-uptake inhibitors (SSRIs). Treatment may later be augmented with clomipramine and/or an antipsychotic. This study focuses on the biological treatment received after, or in parallel to, the psychological. We aimed to collate and evaluate the levels of biological treatment currently received by OCD outpatients in the Bedford East catchment area of SEPT. In particular we wished to establish how many of the patients were receiving an atypical antipsychotic as well as maximal SSRIs. Hence we have attempted to assess the types of treatment received by patients under our care, and the difficulties associated with the treatment of this illness.     

Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences?

Gilles de la Tourette Syndrome (GTS) and obsessive-compulsive disorder (OCD) share obsessive-compulsive phenomena. The aims of this study were to compare the OC symptom distribution between GTS and OCD and to investigate whether a subdivision of these phenomena into obsessions, compulsions and 'impulsions' is useful in distinguishing GTS and OCD patients. Thirty-two GTS, 31 OCD (10 with tics, 21 without tics) and 29 control subjects were studied using the Leiden repetitive behaviors semi-structured interview to assess GTS as well as OCD-related behaviors. Each reported repetitive thought or action was evaluated on the presence of anxiety and on goal-directedness. This information was used to define whether the behavior was an obsession, compulsion, or 'impulsion'. Both the GTS and OCD study groups showed higher scores than control subjects on rating scales measuring depression, OC behavior and anxiety. In GTS, Y-BOCS severity scores and trait anxiety were lower than in the OCD groups. Furthermore, GTS patients differed from OCD patients in the distribution of symptoms. Aggressive repetitive thoughts, contamination worries and washing behaviors were reported more frequently by tic-free OCD, while mental play, echophenomena, touching and (self)-injurious behaviors were reported more frequently by GTS. OCD individuals with tics were intermediate, but closer to tic-free OCD. GTS individuals reported significantly more 'impulsions' and fewer obsessions and compulsions than OCD individuals with and without tics. Factor analysis revealed three factors accounting for 44% of the variance, resulting in an 'impulsive' factor related to GTS, a 'compulsive' factor related to OCD and an 'obsessive' factor related to tic-free OCD. In conclusion, OCD individuals reported more anxiety and goal-directedness associated with their behaviors than did GTS subjects. The distinction between obsessions, compulsions and impulsions is of importance in identifying Tourette-related vs. non-Tourette-related repetitions.