Neurological soft signs in schizophrenic patients with obsessive-compulsive disorder

The purpose of this study was to examine neurological soft signs (NSS) in schizophrenic patients with obsessive-compulsive disorder (OCD). Neurological soft signs were assessed in 15 schizophrenic patients with OCD (OCD-schizophrenia), 38 schizophrenia patients without OCD (non-OCD-schizophrenia), and 24 healthy controls (HC) by means of the Neurological Evaluation Scale (NES). The OCD-schizophrenia group had significantly higher scores on total and subscales of 'sensory integration' and 'others' of NES than the HC group. Subscale scores of 'sequencing of motor acts' in-non-OCD-schizophrenia patients were significantly higher compared to OCD-schizophrenia patients. Total NES scores of both groups were significantly correlated with Scale for the Assessment of Negative Symptoms (SANS) scores. Only the subscale of 'sequencing of motor acts' was significantly correlated with SANS within the OCD-schizophrenia group. These results suggest that NSS do not significantly differ between schizophrenia patients with and without OCD, contrary to expectations. The NES scores in OCD-schizophrenic patients do not appear to be related to a more severe form of schizophrenia. Neurological signs and negative symptoms in schizophrenia patients with and without OCD may be considered as neurodevelopmental predisposing factors. Further research is required in schizophrenia patients with OCD to investigate the relationships between NSS and several neuroimaging or neuropsychological findings, constituting a subgroup within the schizophrenia spectrum.     

强迫障碍的临床表现和同病研究

目的：研究强迫障碍的现象学和病程。方法：对同时符合ＣＣＭＤ－２Ｒ及ＤＳＭ－Ⅲ强迫障碍诊断标准的患者进行动态ＡＤＩＳ－Ｐ,简明精神病评定量表（ＢＰＲＳ）,汉密尔顿焦虑量表（ＨＡＭＡ）,同的阳性精神障碍家族史,起病早,就诊迟,Ｂｅａｒ分别中Ⅱ型（污染／检查型）最多,同经高。治疗上均用氯丙咪嗪或ＳＳＲＩｓ联用或不联用其它精神药物。似以药物加心理治疗效果较好。结论：强迫障碍的现象学表现较为复杂,应引起重视     

强迫症与焦虑的关系及临床类型的研究

目的调查强迫症状与焦虑的关系及其临床类型。方法将１００例强迫症患者按症状自评量表的焦虑因子分分为高、低、无焦虑３组,以Ｆｏａ的强迫症８种类型对其临床诸方面进行分类和比较。结果１００例患者中伴焦虑者为６５％,伴抑郁者为６７％。高焦虑组的病程长于低焦虑组（Ｐ＜０．０５）。在Ｆｏａ的分型中,高焦虑组以Ⅰ、Ⅱ、Ⅵ型较多。结论强迫症与焦虑的关系可有８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的性质和强度与减焦虑性强迫反应相互作用的结果。     

强迫症共病皮肤搔抓障碍的临床访谈

本文对一例强迫及相关障碍的咨客进行了案例访谈报告,目的是提高精神科医疗工作者的临床访谈技巧和诊疗水平。一位17岁的男性咨客因难以自控地在街上抢女士的高跟鞋、引起群众恐慌而来访。他的行为极具违法的风险,警察已经多次上门问询。咨客被诊断为强迫症共病皮肤搔抓障碍,采取生物-心理-社会的整合式治疗进行干预。咨客既往使用氟西汀时造成肝功能损害,需要调整用药。运用认知行为疗法(CBT)治疗强迫症状。本案例中涉及了司法精神医学的相关知识,为临床访谈提供一定的借鉴。     

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.     

强迫症共病疾病焦虑障碍的临床访谈

为了提高广大精神心理科医务工作者的临床访谈及诊断技能,本文对一例较特殊的合并了两种强迫谱系障碍的患者进行了案例访谈报告。这是一位27岁的男性患者,执着于练习弹钢琴十几年,仪式化的行为与执着让患者不能正常工作,成为大家眼中的怪人。离职后逐渐开始关注排便问题,纠结于便秘、腹胀等感受问题,总认为自己患有肛肠疾病,开始反复检查就诊。在检查无明显异常的情况下,反复要求行手术治疗四次以解决肛肠问题,结果越治越难受。本案例患者被诊断为强迫症共病疾病焦虑障碍,需要采取生物-心理-社会的综合治疗。调整以往用药,加强运动,调整饮食结构。施行强迫症一线治疗方案,焦虑缓解后进行认知行为疗法(CBT)来改善自我认知,减轻心理压力。今后工作中放弃不切实际的想法,学习应对策略,合理安排工作和生活。     

强迫症的局部脑血流动态显像研究

目的　探讨强迫症患者各脑叶的代谢状态及脑功能异常与其发病的关系。　　方法　采用单光子发射计算机扫描 (SPECT)技术 ,对未服药的 2 2例强迫症患者于静息及症状诱发状态下行局部脑血流 (rCBF)动态显像研究。　　结果　 1 8例有rCBF异常 ,表现为皮层内局限性放射性分布稀疏、缺损区 ,异常脑叶主要为顶叶、额叶、颞叶 ,并发现脑功能异常与强迫症状的严重程度及药物治疗反应有关。　　结论　大脑顶叶、额叶等脑叶的功能异常是部分强迫症发病的神经病理学基础     

Dysregulation of neurosteroids in obsessive compulsive disorder

Alterations in hormone concentrations, including adrenocorticotropin, corticotropin releasing hormone, and cortisol have been reported in patients with obsessive compulsive disorder (OCD). Dehydroepiandrosterone (DHEA) and its sulfated metabolite, DHEA-S, have not been assessed in patients with OCD. We report 24-h serum DHEA, DHEA-S, and cortisol concentrations in a young man with OCD and 15 healthy young men. Circadian patterns of DHEA and cortisol were markedly different in the subject with OCD than in the control subjects. DHEA and DHEA-S concentrations were substantially higher in the OCD subject than in the control subjects. In contrast, cortisol concentrations were similar in the OCD subject and the control subjects. Future clinical studies are needed to evaluate the significance of DHEA and DHEA-S in OCD.     

Perceived parental characteristics of patients with obsessive compulsive disorder,depression, and panic disorder

It has been hypothesized that parents of patients with obsessive compulsive disorder exhibit specific traits. 320 consecutive inpatient admissions who met criteria for OCD, depression, and panic disorder checked a list of adjectives to describe their parents. Patients with OCD were 1) less likely to perceive their mothers as disorganized than depressives, 2) more likely to perceive their mothers as overprotective than depressives and 3) less likely to perceive their fathers as demanding than patients with panic.     

Increased nocturnal secretion of ACTH and cortisol in obsessive compulsive disorder

Information on the function of the hypothalamic-pituitary-adrenal (HPA) axis, the main mammalian system of stress response, in obsessive compulsive disorder (OCD) is inconsistent. In this study, nine inpatients with a DSM-IV diagnosis of OCD without comorbid major depression (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score >15; HAMD-21 total score 16) and nine healthy matched controls were included. Blood of patients (seven males; 31.8 +/- 9.3 years, Y-BOCS: 27.3 +/- 4.3, HAMD-21: 13.3 +/-1.9) and controls (seven males, 31.6 +/- 9.1 years) was drawn every 20 min between 23:00 and 7:00 h during sleep using a long catheter for later ACTH and cortisol analysis. Secretion patterns of cortisol and ACTH were similar in both groups, in OCD, however, at a higher level. Area under the curve plasma concentrations of both ACTH (p<0.05) and cortisol (p<0.005) were significantly greater in patients with OCD (ACTH: 674.3 +/- 57.4; cortisol: 2148.4 +/-271.7) than in controls (ACTH: 460.2 +/- 61.0; cortisol: 1191.2 +/- 124.1). In conclusion, our findings suggest that the activity of the HPA axis in patients with OCD is increased compared to healthy controls.     

Dysregulation in pediatric obsessive compulsive disorder

Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.     

强迫症预后的有关因素分析

目的:探讨影响强迫症疗效的相关因素.方法:对出院时不同疗效的强迫症病人的临床资料进行对照研究.结果:文化程度较高,脑力劳动者,病前强迫人格,有心理社会诱因,伴消极观念的强迫症病人疗效较好,结论:知识分子,社会心理因素促发和病中有抑郁症状者预后好.     

舍曲林联合喹硫平对强迫症的疗效分析

目的评价舍曲林联合喹硫平治疗强迫症的疗效及安全性。方法采用Excel将96例符合《国际疾病分类(第10版)》(ICD-10)诊断标准的强迫症患者随机分为研究组和对照组各48例。研究组采用舍曲林联合喹硫平治疗,对照组单用舍曲林治疗,两组均治疗8周,于治疗前后采用耶鲁布朗强迫症状量表(Y-BOCS)和汉密尔顿焦虑量表(HAMA)评定疗效,采用药物不良反应量表(TESS)评估不良反应。结果治疗后,研究组总有效率高于对照组(95.83%vs.68.75%,P0.05);研究组Y-BOCS和HAMA评分均低于对照组,差异有统计学意义[(8.4±1.6)分vs.(15.4±2.1)分、(6.5±1.1)分vs.(10.8±1.2)分,P均0.05];研究组与对照组不良反应发生率差异无统计学意义(6.25%vs.8.33%,P0.05)。结论舍曲林联合喹硫平治疗强迫症疗效优于单用舍曲林,安全性相当。     

Impulsivity,hostility and suicidality in patients diagnosed with obsessive compulsive disorder

Abstract

Background: There are limited data on suicidal behaviour in obsessive-compulsive disorder (OCD). This study aimed to evaluate several aspects affecting suicidality in OCD patients and determine whether impulsivity or hostility are associated with suicide attempts in this vulnerable group.

Methods: Eighty-one patients with OCD were assessed by structured clinical interview for DSM-IV (SCID I), Yale-Brown Obsessive–Compulsive Scale (Y-BOCS), Suicide Probability Scale (SPS), Barratt impulsivity scale-11 (BIS) and Scale for suicide ideation (SSI).

Results: Of the 81 patients, 22 (27%) had suicide ideation, 29 (33%) attempted suicides with OCD and 30 (37%) OCD patients who never experienced suicide ideation nor attempted suicide. Suicide ideation was associated with high hopelessness, higher severity of OCD and the presence of aggressive obsessions. On the other hand, suicide attempts were associated with longer duration of untreated illness, cognitive impulsivity, higher severity of OCD symptoms and the presence of religious obsessions.

Conclusion: Higher severity of OCD symptoms is associated with both suicide ideation and attempts. And while hopelessness was related to suicidal thoughts, cognitive impulsivity may have acted as a facilitating factor for suicide attempts. Higher frequency of symptoms like religious/ aggressive obsessions was also associated with suicidality. It is vital that patients with OCD undergo detailed assessment for suicide risk.

• Key points

• OCD is associated with a high risk for suicidal behaviour.

• Suicide ideation was associated with high levels of hopelessness, OCD severity, and the presence of aggressive obsessions.

• Suicide attempts were associated with longer duration of untreated illness, cognitive impulsivity, severity of OCD, and the presence of religious obsessions.

     

Clinical features associated with increased severity of illness in tertiary clinic referred patients with obsessive compulsive disorder

Objective: Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition. Specific patterns of psychiatric comorbidity, early age at onset, long duration of illness (DI) and untreated illness (DUI) have been associated with poor outcome in OCD. The present study was aimed to explore sociodemographic and clinical characteristics associated with increased severity of illness in a sample of OCD patients.

Methods: A total of 124 OCD outpatients were recruited and divided into two groups on the basis of their severity of illness, as assessed through the Yale-Brown Obsessive Compulsive Scale (>24). Chi-squared test and t-test for independent samples were performed to compare sociodemographic and clinical variables between the two groups.

Results: The group with increased severity of illness had a younger age, an earlier age at onset and age at first pharmacological treatment (p?p?p?Conclusions: Earlier age, age at onset and age at first pharmacological treatment, longer DI, shorter DUI and higher rate of psychiatric comorbidities were associated with increased severity of OCD. Further studies on larger samples are warranted to confirm the reported results.     

Psychic euosmia and obsessive compulsive personality disorder

Patients with obsessive compulsive personality disorder (OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.     

利培酮与喹硫平联合氯米帕明治疗难治性强迫症的疗效比较

目的比较利培酮和喹硫平分别联合氯米帕明治疗难治性强迫症的疗效。方法将62例难治性强迫症患者随机分为利培酮联合氯米帕明组和喹硫平联合氯米帕明组,于治疗前和治疗后第8、及24周末16分别使用Yale-Brown量表(Y-BOCS)、汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)进行评分,以Y-BOCS减分率评定疗效。结果两组治疗后第8、及24周末各量表评分较疗前均有明显下降,差异具有显16著性(P<0.01);两组同期比较,喹硫平联合氯米帕明组评分明显低于利培酮联合氯米帕明组,差异具有显著性(P<0.01);治疗第24周末喹硫平联合氯米帕明组的显效率明显高于利培酮联合氯米帕明组,差异有显著性(P<0.01)。结论氯米帕明联合利培酮或喹硫平均能有效治疗难治性强迫症,联合喹硫平的疗效优于联合利培酮。     

阿立哌唑作为增效剂治疗强迫症的随机对照研究

目的探讨小剂量阿立哌唑作为增效剂治疗强迫症的疗效及安全性。方法 64例强迫症患者在帕罗西汀治疗的基础上,双盲、随机分为合用组[帕罗西汀合并阿立哌唑,阿立哌唑平均剂量（标准差）为7.9（1.3）mg/d]及对照组（帕罗西汀合并维生素C）,治疗8周。于治疗前及治疗后分别采用Yale-Brow强迫量表、治疗时出现的症状量表（TESS）评定药物疗效及不良反应。结果治疗前合用组和对照组帕罗西汀的平均剂量（标准差）分别为30.2（5.1）mg/d、29.6（6.1）mg/d,差异无统计学意义（t=0.86,P=0.291）;合用组和对照组Y-BOCS评分的均分（标准差）分别为25.0（2.4）、25.1（2.6）,差异无统计学意义（t=0.89,P=0.379）,治疗后两组的评分分别为17.9（3.3）、23.0（2.5）,差异有统计学意义（t=15.89,P〈0.001）。治疗后两组TESS评分无统计学差异。结论小剂量阿立哌唑可作为增效剂治疗强迫症,8周治疗后未见严重不良反应。     

Neurological soft signs in schizophrenia and obsessive compulsive disorder spectrum

Obsessive compulsive symptoms are more frequent in patients with schizophrenia compared to normal population. Patients with obsessive compulsive disorder may also exhibit psychosis-like symptoms. Based on these findings, it has been suggested that there is a spectrum of disorders between OCD and schizophrenia. We compared two OCD groups (with good and poor insight) and two schizophrenia groups (with and without OCD) in this recommended spectrum especially in terms of neurological soft signs (NSSs) associated with sensory integration. The schizophrenia with OCD (schizo-obsessive) group exhibited worse performance than the schizophrenia group (p = 0.002) in only graphesthesia tasks. Moreover, schizo-obsessive patients exhibited worse performance compared to OCD patients in terms of graphesthesia (p = 0.001) and audiovisual integration (p = 0.001). Interestingly, OCD patients with poor insight tended to exhibit graphesthesia deficit in a similar manner to schizo-obsessive patients rather than OCD patients. According to our results, graphesthesia disorder is strongly associated both with OCD and schizophrenia. This suggests that neurodevelopmental disorders that lead to graphesthesia disorder overlap in comorbid OCD and schizophrenia patients.     

Secondary outcomes from the pediatric obsessive compulsive disorder treatment study II

The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from significant comorbid symptoms and impaired quality of life, the current study examined POTS II data for effects on secondary outcomes. Participants were 124 youth ages 7–17 years with a primary diagnosis of OCD who were partial responders to an adequate SRI trial. Participants were randomized to medication management, medication management plus instructions in cognitive behavioral therapy (CBT), or medication management plus full CBT. Acute effects on non-OCD anxiety, depression, inattention, hyperactivity, and quality of life were examined across treatment conditions. Improvement across treatment was observed for non-OCD anxiety, inattention, hyperactivity, and quality of life. Changes were generally significantly greater in the group receiving full CBT. Child-rated depression was not found to change. OCD-focused treatment lead to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI monotherapy, augmentation with full CBT may yield the greatest benefit on these secondary outcomes.Clinical trials registrationTreatment of Pediatric OCD for SRI Partial Responders, Clinicaltrials.gov Identifier: NCT00074815, http://clinicaltrials.gov/show/NCT00074815.