强迫症症状维度的相关研究

强迫症是以反复出现强迫观念、强迫行为为基本特征的一类神经症,在全世界人口中的患病率约为2% ～ 3%[1].其病程常迁延,治疗效果欠佳,对患者的社会功能造成损害,被世界卫生组织列为十大致残疾病之一[2].强迫症临床表现变异性较大,越来越多的证据支持其可能是一个异源性障碍,这种异源性可能会导致研究结果的分歧,因而学者们一直致力于寻找同质性更好的亚型.近年来有一种假说认为强迫症是一个多维度的异源性障碍,将症状归为不同的症状维度.本文将对此做一综述.     

Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome

OBJECTIVE: A significant number of patients with obsessive-compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. METHOD: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive-Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. RESULTS: The most frequent OCD symptoms were aggressive and contamination obsessions, and compulsive checking and cleaning. Patients with hoarding symptoms at baseline (n = 19) were significantly less likely to become treatment responders as compared to patients without these symptoms. Patients with sexual and religious obsessions tended to respond less frequently, although this failed to reach statistical significance (P = 0.07). Regression analyses revealed that higher scores on the hoarding dimension were predictive of non-response, even after controlling for possible confounding variables. CONCLUSION: Our results strongly indicate that in-patients with obsessive-compulsive hoarding respond poorly to CBT.     

Symptom dimensions and cognitive-behavioural therapy outcome for pediatric obsessive-compulsive disorder

Objective: To examine whether obsessive‐compulsive disorder (OCD) symptom subtypes are associated with response rates to cognitive‐behavioural therapy (CBT) among pediatric patients. Method: Ninety‐two children and adolescents with OCD (range = 7–19 years) received 14 sessions of weekly or intensive (daily psychotherapy sessions) family‐based CBT. Assessments were conducted at baseline and post‐treatment. Primary outcomes included scores on the Children’s Yale‐Brown Obsessive‐Compulsive Scale (CY‐BOCS), remission status, and ratings on the Clinical Global Improvement (CGI) and Clinical Global Impression – Severity (CGI‐Severity) scales. Results: Seventy‐six per cent of study participants (n = 70) were classified as treatment responders. Patients with aggressive/checking symptoms at baseline showed a trend (P = 0.06) toward improved treatment response and exhibited greater pre/post‐treatment CGI‐Severity change than those who endorsed only non‐aggressive/checking symptoms. Step‐wise linear regression analysis indicated higher scores on the aggressive/checking dimension were predictive of treatment‐related change in the CGI‐Severity index. Regression analysis with CY‐BOCS score as the dependent variable showed no difference between OCD subtypes. Conclusion: Response to CBT in pediatric OCD patients does not differ substantially across subtypes.     

Symptom dimensions and subtypes of obsessive-compulsive disorder: a developmental perspective

In the absence of definitive etiological markers for obsessive-compulsive disorder (OCD), obsessive-compulsive (OC) symptom dimensions may offer a fruitful point of orientation. These dimensions can be understood as defining potentially overlapping clinical features that may be continuous with “normal” worries first evident in childhood. Although the understanding of the dimensional structure of OC symptoms is still imperfect, a recent large-scale meta-analysis has confirmed the presence of at least four separable symptom dimensions in children, as well as adults, with OCD, A dimensional approach does not exclude other methods to parse OCD. Thus far, a pediatric age of onset, the presence of other family members with OCD, and the individual''s “ticrelated” status appear to be potentially useful categorical distinctions. Although the OC symptom dimensions appear to be valid for all ages, it is unlikely that the underlying genetic vulnerability factors and neurobiological substrates for each of these symptom dimensions are the same across the course of development.     

Symptom dimensions in obsessive-compulsive disorder: from normal cognitive intrusions to clinical obsessions

Cognitive behavioral models of obsessive-compulsive disorder (OCD) assume continuity between normal obsessional intrusive thoughts (OITs) and obsessions. However, this assumption has recently been criticized. This article examines this issue using a new instrument (the Obsessional Intrusive Thoughts Inventory, INPIOS) specifically designed to assess the frequency and content of 48 OITs, which was completed by 734 community subjects and 55 OCD patients. Confirmatory factor analysis suggests six first-order factors included in two second-order factors, one containing aggressive, sexual, religious, immoral and repugnant OITs, and the other containing contamination, doubts and checking, symmetry and order, and superstition OITs. This structure integrates the research on OC symptoms and OITs. The INPIOS showed excellent known-groups validity, and it adequately represented obsessions as well as OITs. OCD and community subjects experience OITs representative of all types of obsessional contents. The dimensional structure is discussed in terms of OIT/obsessive-compulsive symptom structures currently proposed.     

Symptom dimensions,clinical course and comorbidity in men and women with obsessive-compulsive disorder

The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18–77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and “compulsive” buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups.     

Personality dimensions in pathological gambling disorder and obsessive-compulsive disorder.

This study was conducted to investigate the similarities and differences in the personality dimensions of patients with pathological gambling disorder (PGD) and obsessive-compulsive disorder (OCD). Thirty-three subjects with PGD, 41 with OCD and 40 normal controls were assessed with the Tridimensional Personality Questionnaire (TPQ), which assesses three personality dimensions: novelty seeking, reward dependence, and harm avoidance. Compared with OCD subjects, PGD subjects expressed significantly greater novelty seeking, impulsiveness, and extravagance. The PGD subjects also reported significantly less anticipatory worry, fear of uncertainty, and harm avoidance than the OCD subjects. Compared with controls, the PGD subjects expressed significantly greater novelty seeking, impulsiveness, and extravagance. These results suggest that the personality dimensions of pathological gamblers may differ significantly from both those of OCD patients and normal controls.     

不同症状群强迫症患者的生活质量比较

目的探讨强迫症患者的症状群对其生活质量的影响。方法收集78例门诊强迫症患者（病例组）及60名正常对照,采用世界卫生组织生存质量测定量表简表（WHOQOL-BREF）中文版调查生活质量。对强迫症患者的耶鲁-布朗强迫症状检查提纲评分进行分析。结果病例组WHOQOL-BREF量表的生理领域、心理领域、社会关系领域、环境领域得分[分别为（64.7±10.3）分、（47.6±11.5）分、（53.1±12.2）分、（63.7±10.6）分]均低于正常对照组[分别为（79.2±9.6）分、（71.2±10.4）分、（74.1±9.8）、（75.1±10.3）分],差异有统计学意义（t值分别为-8.3、-12.5、-10.9、-6.3,P值均〈0.001）。根据患者的主要症状分为洗涤组、检查组、贮物组、对称组。方差分析显示4组患者WHOQOL-BREF各领域得分均存在差异（P〈0.05）。结论强迫症患者生活质量低于正常人群。不同症状群强迫症患者的生活质量受损害的领域存在差异。     

Alexithymia in obsessive-compulsive disorder: clinical correlates and symptom dimensions

Previous studies have indicated that obsessive-compulsive disorder (OCD) is associated with alexithymic traits. The purpose of the current study was to evaluate the difference of alexithymia in OCD patients and healthy controls. This study was also designed to elucidate a specific link between certain OCD symptom dimensions and alexithymia. Forty-five patients with OCD and 45 healthy controls completed measures of the OCD symptom severity, alexithymia, anxiety, and depression. Patients with OCD had significantly higher scores of alexithymia than did the healthy controls. Multiple regression analysis revealed that age at onset and the level of anxiety were significantly associated with alexithymia. "Sexual/religious obsessions" was the only symptom dimension that showed a positive association with alexithymia in OCD patients. These findings suggest that OCD patients with a high level of anxiety and an early age of onset may have greater alexithymic tendency. We also found the first evidence for a specific link between sexual/religious obsessions and alexithymia in patients with OCD.     

Symptom structure in Japanese patients with obsessive-compulsive disorder

OBJECTIVE: Obsessive-compulsive disorder (OCD) comprises a number of specific symptom dimensions. The authors factor analyzed data on the Yale-Brown Obsessive Compulsive Scale symptom checklist in a large group of Japanese OCD patients to examine whether symptom dimensions were stable across cultures. METHOD: A principal components analysis of Yale-Brown Obsessive Compulsive Scale major symptom categories was performed on Japanese OCD patients (N=343). The association between symptom dimensions and clinical variables, including 1-year outcome after combination treatment, was also examined using Pearson correlations. RESULTS: Four factors explaining 57.7% of the variance were identified: 1) contamination/washing, 2) hoarding, 3) symmetry/repeating and ordering, and 4) aggressive/checking symptoms. The symmetry dimension was associated with early age at onset, and both the symmetry and hoarding dimensions were associated with decreased functioning and treatment resistance. CONCLUSIONS: The findings in this study support transcultural stability in the symptom structure of OCD, which is consistent with the hypothesis that OCD is mediated by universal psychobiological mechanisms.     

Intolerance of uncertainty and obsessive-compulsive disorder dimensions

Intolerance of uncertainty (IU), which can include prospective (i.e., desire for predictability) and inhibitory (i.e., uncertainty paralysis) IU, is widely understood to be a central underlying component of obsessive-compulsive disorder (OCD). IU has several treatment implications, yet research on the differences in IU underlying OCD dimensions is limited and does not account for covarying effects of overlapping symptoms, shared variance in IU, demographic variables, and comorbid psychiatric conditions like generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). A sample of 974 patients with diagnosed OCD enrolled in residential, partial hospitalization, and intensive outpatient treatment programs for OCD and anxiety completed self-report measures of OCD symptoms and IU at admission. Structural equation modeling included prospective. inhibitory IU, and common IU and covariates (i.e., race, ethnicity, level of care, and comorbid GAD and PTSD) as predictors of four common OCD dimensions found that contamination and unacceptable thoughts symptoms evidenced a unique relationship with IU. Specifically, whereas a common IU factor predicted all four OCD symptom dimensions, inhibitory IU uniquely predicted contamination and unacceptable thoughts symptoms over and above covarying effects. Individuals with contamination and unacceptable thoughts symptoms may be more likely to feel “paralyzed” by uncertainty due to overreliance on overt immediate rituals, outright avoidance, rumination, or difficulties with emotion regulation, and may benefit from additional psychoeducation, problem-solving, and accountability. Broadly, individuals with OCD may benefit from explicit discussions about IU-related expectancies and disconfirmation of fears.     

Psychosocial remission in schizophrenia: developing a clinician-rated scale

Background

There is a growing awareness of the importance of psychosocial factors incorporated in treatment goals in schizophrenic patients. Remission, both symptomatic and psychosocial, is now an achievable goal in a substantial proportion of patients. Thus, the development of handy tools to quantify outcomes is called for.

Objective

To develop a brief, clinician-rated scale for the assessment of psychosocial remission in schizophrenia (the Psychosocial Remission in Schizophrenia [PSRS] Scale). The scale is to match the quantification of symptomatic remission as delineated by the American Psychiatric Association task force.

Method

A “bank” of 124 questions pertaining to psychosocial remission was derived from published scales reflecting 2 domains: quality of life and activities of daily living. Psychiatrists, residents, psychiatric nurses, and community nurses were presented with the questions. All were asked to choose the 8 items they considered as reflecting the essence of psychosocial remission. Interrater reliability of the final scale version was assessed among psychiatrists.

Results

The questions' bank was reviewed by 429 mental health professionals. The 4 items found to be most frequently sanctioned in the quality-of-life domain were (a) familial relations (endorsed by 78% of participants), (b) understanding and self-awareness (46%), (c) energy (58%), and (d) interest in everyday life (38%). The 4 items sanctioned in the instrumental activities of daily living domain were (a) self-care (86%), (b) activism (65%), (c) responsibility for medications (54%), and (d) use of community services (32%). Interrater reliability among 70 psychiatrists ranged from 0.67 to 0.83.

Conclusion

The PSRS is an 8-item scale quantifying psychosocial remission in schizophrenia in a manner that complements symptomatic assessment of remission. The PSRS may be useful for both research and clinical evaluation.     

Relationship between self-report and clinician-rated impairment in depressed outpatients

This study examined the potential of using the Global Assessment of Functioning (GAF) scale as a valid measure of patient-reported status and predictor of three-month outcomes for 59 patients seeking outpatient treatment for depression. A moderate relationship between the GAF and patient report at baseline and follow-up suggests it may be clinically useful for routine monitoring of depressed patients.     

Personality dimensions in obsessive-compulsive disorder: relation to clinical variables

Research on the relationship between personality factors and obsessive-compulsive disorder (OCD) has proved difficult to interpret due to conceptual problems including a lack of consensus on the model of personality employed as a framework as well as a failure to consider the clinical heterogeneity of the disorder. The aim of this study was to examine the dimensional personality profile associated with OCD and to determine whether any relationship exists between personality factors and clinical variables in a sample of 60 OCD outpatients who were administered Cloninger's Temperament and Character Inventory (TCI). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS) and the Y-BOCS symptom checklist were used to assess the severity of obsessive-compulsive and depressive symptoms and the presence of the main OCD symptom dimensions. OCD patients showed significantly higher scores in harm avoidance and lower scores in novelty-seeking, self-directedness and cooperativeness than healthy subjects. These results remained unchanged when only pure OCD patients without comorbid psychiatric conditions were considered. Comorbid depressive symptoms and hoarding obsessions and compulsions were significantly associated with high harm avoidance scores. These results support the existence of a dimensional personality profile associated with OCD and characterized by high harm avoidance and low novelty-seeking, self-directedness and cooperativeness scores, but also emphasize the importance of considering the influence of comorbid clinical conditions or symptom subtypes in addressing the role of personality factors in OCD.     

White matter structure and symptom dimensions in obsessive-compulsive disorder

There is evidence that the different symptom dimensions in obsessive-compulsive disorder (OCD) may be mediated by partially distinct neural systems. This DTI study investigated the relationship between symptom dimensions and white matter microstructure. Fractional anisotropy (FA), axial and radial diffusivity was analyzed in relation to the main OCD symptom dimensions. Symptom severity on the obsessing dimension was negatively correlated with FA in the corpus callosum and the cingulate bundle. Severity on the ordering dimension was negatively correlated with FA in, amongst others, the right inferior fronto-occipital fasciculus and the right optic radiation. All correlations were ascribable to alterations in radial diffusivity while there was no association between symptoms and axial diffusivity. Present results illustrate an association between alterations in visual processing tracts and ordering symptoms which are characterized by altered visual processing and increased attention towards irrelevant detail. They also indicate an association between obsessive thoughts and alterations in structures known to be relevant for cognitive control and inhibition. Hence, different symptom dimensions must be taken into account in order to disentangle the neurobiological underpinnings of OCD.     

Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study

OBJECTIVE: Little is known about the longitudinal course of symptoms in adult patients with obsessive-compulsive disorder (OCD), although some evidence exists regarding symptom stability in children and adolescents. This study systematically investigated the temporal stability of individual symptoms and symptom dimensions of OCD in adult patients who were followed prospectively for 2 years. METHOD: One hundred seventeen adult outpatients with OCD from three U.S. sites were administered the Yale-Brown Obsessive Compulsive Scale symptom checklist four times over a period of 2 years. Eighty-one (69%), 83 (71%), and 67 (57%) patients were available 6 months, 1 year, and 2 years after initial screening, respectively. Different analytic methods assessed the stability of OCD symptoms within and between previously identified symptom dimensions. RESULTS: For the most part, patients maintained their symptoms throughout follow-up, although some symptoms were more stable than others. For the symptoms that changed, changes occurred within rather than between symptom dimensions; qualitative shifts from one dimension to another were rare. The strongest predictor of the presence of a particular symptom was having had that symptom in the past. Although most patients had received pharmacological and behavioral treatment during the follow-up period, changes within symptom dimensions could not be explained by overall clinical improvement over time. CONCLUSIONS: Symptoms of adult patients with OCD might be more stable across time than previously thought, with some symptoms waxing and waning within symptom dimensions and rarely involving shifts between dimensions. Longer follow-up studies involving larger samples are needed to better understand the fluctuations of OCD symptoms across time.     

Symptom subtypes of obsessive-compulsive disorder and their relation to dissociation

We examined relations between obsessive-compulsive disorder (OCD) symptoms and dissociation in three studies. Studies 1 and 2 established a strong level of convergence between our two OCD symptom measures. Specific types of symptoms showed a clear convergent/discriminant pattern, indicating that they can be meaningfully distinguished from one another. In both studies, dissociation correlated more strongly with checking and obsessive intrusions than with cleaning, ordering, and hoarding. Moreover, these associations remained substantial even after controlling for neuroticism (Study 1) and other types of anxiety (Study 2). In Study 3, we replicated our key findings in a psychiatric outpatient sample, indicating that they are generalizable to clinical participants. Taken together, our results (a) establish a strong link between dissociation and OCD, and (b) illustrate the importance of analyzing different types of OCD symptoms separately.