Social anxiety disorder in callers to the Anxiety Disorders Association of America

Social anxiety disorder (SAD) is among the most common anxiety disorders with a lifetime prevalence of up to 16%. Among callers to the Anxiety Disorders Association of America (ADAA), we surveyed 1,000 participants using a 97-item questionnaire to understand the characteristics of participants with SAD and subthreshold SAD (SSAD). Current prevalence rates of SAD (n=295) and SSAD (n=41) were 29.5% and 4.1%, respectively. SAD and SSAD participants were more likely to be younger, single, with less education and lower income than their no axis-I-psychiatric-disorder controls (NAC). In addition, they presented with more psychiatric comorbidity, lifetime numbers of trauma, recent psychotropic use and side effects. Increased medical comorbidity, health service utilization, as well as reduced work productivity were also found, particularly among SAD participants. SSAD participants were comparable to SAD participants for most of the measures with a few exceptions, mainly less psychiatric comorbidity, less medication use for panic attack and social fear, and fewer visits to the health professionals. In conclusion, SAD was highly prevalent among callers to the ADAA. SAD participants were particularly impaired and tended to use the health care system extensively. Although SSAD participants were less impaired than those with SAD, they were disadvantaged in many ways. Early diagnosis and better treatment are urged for reducing costs and improving life. An organization such as ADAA can play a vital role in bringing this about.     

Posttraumatic stress disorder in callers to the Anxiety Disorders Association of America

We surveyed callers to the Anxiety Disorders Association of America (ADAA) with posttraumatic stress disorder (PTSD) and subthreshold PTSD (SPTSD). Most subjects heard about ADAA through media referrals and were satisfied with the service given by the association. The most frequent requests were for written information, learning how to cope with anxiety, and access to a local support group. Among callers, rates of PTSD (n=80) and SPTSD (n=111) were 8.0% and 11.1%, respectively. PTSD or SPTSD subjects were more likely to be younger, female, and with lower income than their no-Axis I psychiatric disorder controls (NAC) who had been exposed to trauma. In addition, they presented with more history of trauma, especially violent trauma, psychiatric comorbidity, recent psychotropic use, and side effects. More medical comorbidity, increased health service use, and reduced work productivity were also found among the PTSD and SPTSD subjects. SPTSD subjects were comparable to PTSD subjects on most of the measures with a few exceptions (more likely to be married, to have less psychiatric comorbidity, less medication use for mood and social fear, and fewer sedation and sexual side effects, and to have less health service use and work impairment). In conclusion, callers to ADAA with PTSD were particularly impaired and used the health care system extensively. Although the SPTSD subjects were not as impaired as those with PTSD, they were disadvantaged in many ways.     

Obsessive-compulsive disorder.

Obsessive-compulsive disorder is a well-defined clinical syndrome that has been difficult to treat with standard psychotherapies and medications. Data accumulated over the last decade have demonstrated that the disorder is relatively common and frequently coexists with phobia, depression, and alcohol abuse. The authors review current studies of the spectrum of obsessive-compulsive disorder and related disorders that respond to the new serotonergic antidepressants and behavioral therapy. Differential diagnosis, epidemiology and comorbidity, etiology, evaluation, and psychologic and pharmacologic treatments are discussed. Most patients with obsessive-compulsive disorder require long-term treatment with drugs, but behavioral therapy has also been used successfully. Serotonin reuptake inhibitors used in the treatment of depression have been found effective; clomipramine has produced the best results in large-scale tests. The fact that serotonin reuptake inhibitors are effective as both antidepressants and antiobsessional agents suggests common biological factors in disorders that respond to these drugs.     

Trauma and posttraumatic stress in users of the Anxiety Disorders Association of America Web site

The Web site for the Anxiety Disorders Association of America (ADAA) receives more than 5 million visits per month and thus represents a unique medium for the study of anxiety disorders. ADAA Web site users from October 2002 to January 2003 were invited to complete a survey oriented toward trauma history and psychiatric sequelae. A diagnostic approximation of posttraumatic stress disorder (PTSD) was based on responses to the Trauma Questionnaire, the Davidson Trauma Scale, and questions about impairment. The Connor-Davidson Resilience Scale was also used. Variables were tested for their association with PTSD. Among 1558 participants, 87% had a history of trauma, and 38% had current PTSD. The population was comprised predominantly of white middle-class women, half of whom were married. More than 90% were first-time users of the site. Factors associated with PTSD included death of, or harm to, a loved one; personal history of incest, rape, or physical abuse; lower age; lower income; unemployment; missed work; increased medical care; dissatisfaction with psychotropic medication; depressive symptoms; and lower resilience. In this selective convenience sample, there were high rates of traumatization and PTSD. The demographics of this group are similar to those seen in previously studied populations that had contacted the ADAA. Furthermore, the factors associated with PTSD were like those in many community surveys. The ADAA Web site has the opportunity to benefit large numbers of highly distressed individuals.     

Obsessive-compulsive disorder in children.

Childhood OCD is a chronic and commonly disabling disorder with a lifetime prevalence of 2% to 3%. Traditionally OCD was a neglected diagnosis, but renewed research interest over the past decade has led to significant advances in the understanding of the disorder in young people. OCD is relatively consistent across the age span in terms of prevalence, phenomenology, etiology, and response to treatment. Comorbidity, especially depression and other anxiety disorders, is common in children with OCD and may exert a negative influence on treatment response and long-term outcome. Nevertheless, CBT and SSRI therapy have been shown to be effective and well-tolerated therapies for children with OCD.     

Obsessive-compulsive disorder in Huntington's disease.

Two patients with Huntington's disease (HD) and obsessive-compulsive disorder (OCD) are reported. The OCD was manifested by repetitive, stereotyped, complex, egodystonic behaviors that were disabling. These cases and other neurological syndromes with OCD (Gilles de la Tourette syndrome, neuroacanthocytosis, postencephalitic parkinsonism, caudate infarction, carbon monoxide poisoning, manganese intoxication, anoxia, progressive supranuclear palsy, Sydenham's chorea, and frontal lobe lesions) indicate that the frontal lobe, caudate nucleus, and globus pallidus are members of a complex circuit that plays a key role in mediating the symptoms of OCD. Evidence of excitatory subcortical output to cortex is shared by many neurological disorders manifesting OCD.     

Obsessive-compulsive disorder in schizophrenia

OBJECTIVE: To examine the differences in demographic and clinical features of patients with schizophrenia, with or without comorbid obsessive-compulsive disorder (OCD). METHODS: Fifty-two subjects were recruited from clinical services in the city of Edmonton, Alberta and assessed for schizophrenia and OCD with structured clinical interviews and standardized clinical rating scales. RESULTS: The prevalence of OCD in individuals meeting criteria for schizophrenia was 25%. Those subjects having both schizophrenia and OCD scored significantly higher on the Y-BOCS, Hollingshead scale, and GAF; plus significantly lower PANSS negative symptoms and a trend in increased Parkinsonian symptoms compared with individuals with schizophrenia alone. CONCLUSION: Our preliminary findings indicate that patients with schizophrenia and OCD vary in selected demographic and clinical measures when compared to patients with schizophrenia alone. Patients with schizophrenia and OCD appear to have less negative symptoms, which may thus be reflected in the decreased GAF scores. It is speculated that patients with schizophrenia and OCD may have a greater propensity to basal ganglia dysfunction than those with schizophrenia alone resulting in increased Parkinsonian symptoms.     

Obsessive-compulsive disorder apparently related to abortion

This case study presents a young woman who developed a severe obsessive-compulsive disorder after a routine medical procedure. It is suggested that this procedure brought back repressed guilt from three abortions and thus led to the onset of symptoms. The case is discussed in relationship to available research and theory.     

Obsessive-compulsive disorder in Tourette syndrome

Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder.     

强迫症与焦虑关系的临床研究

目的探讨强迫与焦虑的关系，为探索心理治疗策略提供依据。方法采用Foa的八型分类，将100例强迫症患者按焦虑程度（SCL-90焦虑因子分）分三组追行比较研究。结果100例患者中伴焦虑者占79%，伴抑郁者占74％；高焦虑组病程长于低焦虑组（P〈0.05）；Foa分型中，高焦虑组以Ⅰ、Ⅱ和Ⅵ型多见；临床症状中以强迫恐惧的焦虑分高于污染／检查、强迫意象／表象、强迫思考、强迫性犹豫不决和强迫观念（P〈0.01）。结论强迫症与焦虑的关系确有Foa等人提出的八种临床类型；强迫症患者伴焦虑的程度并不完全取决于病程，而是致焦虑性强迫想法与减焦虑性强迫反应相互作用的结果。     

Obsessive-compulsive disorder in dermatology outpatients

Introduction. Epidemiological findings have suggested that a large number of obsessional patients refer initially to dermatologists for their problems and their obsessions go undiagnosed. The goal of the present study is to investigate the frequency of OCD in a group of dermatology outpatients. Method. A total of 144 outpatients of a dermatology clinic in a general hospital who agreed to participate in the study were selected. The patients were screened for DSM-IV OCD using item H of the Mini-International Neuropsychiatric Interview. Those who were OCD-positives on the interview were then screened and rated for severity on the Yale–Brown Obsessive-Compulsive Scale (YBOCS). Results. A total of 20 patients (14%) qualified for a diagnosis of OCD. Somatic obsessions and washing compulsions were the most reported symptoms. The majority of OCD-positive patients suffered from acne. Conclusion. The frequency of OCD in the dermatology population may be 4–5 times higher than in the general population. Identification and referral for psychiatric consultation may aid in better management of both disorders.     

Obsessive-compulsive symptoms in panic disorder

Previous reports have noted an increased prevalence of obsessive-compulsive symptoms in patients with panic disorder. The authors found a prevalence of obsessive-compulsive symptoms in 19 (27%) of 70 patients with panic disorder. Compared to a subgroup of 25 patients with classic features of panic disorder and no obsessive-compulsive symptoms, the subgroup with obsessive-compulsive symptoms had an earlier onset of illness, were more likely to have personal and family histories of major depression and substance abuse, and showed a poorer outcome after treatment.     

Obsessive-compulsive disorder in chronic epilepsy

There is a long-recognized association between obsessive–compulsive disorder (OCD) and chronic epilepsy, most notably refractory temporal lobe epilepsy (TLE). The literature documents this association with case reports, patient series, and some larger controlled studies that reveal that almost a quarter of patients with TLE exhibit OCD features, which may go unrecognized. Obsession features with ordering, symmetry, exactness, handwashing, and religiosity occur more often in persons with right- or left-sided epileptic foci than in those with idiopathic generalized epilepsies or controls. Neurobiological and social factors suggest abnormalities of the frontal–thalamic–pallidal–striatal–anterior cingulate–frontal circuits stemming from the observation that certain diseases, damage, or surgery along these circuits may produce or, conversely, reduce OCD in TLE. This review explores the literature on case reports, case series, and larger retrospective controlled studies and looks at the associations of epilepsy with OCD. Contemporary speculation on the theoretical neurobiological underpinnings provides some basis on how and where to direct treatment. Invasive deep brain stimulation has triggered recent controversy on newer treatment modalities.     

Obsessive-compulsive disorder support groups: the Iowa model.

Obsessive-compulsive disorder (OCD) is a distressing and potentially disabling disorder characterized by intrusive obsessional thoughts and repetitive ritualistic behaviors. In recent years, OCD has been recognized as a relatively common condition that responds well to treatment, usually a combination of medication and behavioral therapy. Support groups, usually patient-generated, have become popular adjuncts to the treatment of a variety of conditions. Their applicability to OCD is explored in this report and a successful model developed by the authors is described. The model emphasizes patient education and emotional support. A similar group for family members is also described. Both groups have provided interdisciplinary training experiences for resident physicians in psychiatry, medical and nursing students, and social work practicum students.