强迫症患者脑电图的量化分析

目的 通过对强迫症脑功能损害患和没有出现脑功能损害的惠脑电图(EEG)各频率波进行数量分析，以了解强迫症脑功能损害患的EEG特征性表现。方法 运用A620脑电反馈仪对有脑功能损害的强迫症14例，无脑功能损害的强迫症对照4例进行EEG各频率波的数量观察，进行统计分析，观察强迫症患脑功能损害的EEG各频率波的功率、波幅等的特征性变化。结果 强迫症患脑功能损害组较无脑功能损害组其θ波功率明显增加。结论 强迫症脑功能损害组θ波功率较强迫症无脑功能损害组明显增加，反应了强迫症脑功能损害组患存在额叶功能不良，为额叶在强迫症发病机制中所起作用提供了证据。     

Brief Report: Exposure and Response Prevention for Obsessive Compulsive Disorder in a 12-year-old with Autism

Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2% of children with ASD are also diagnosed with OCD. Although there is extensive research demonstrating the effectiveness of behavioral interventions for pediatric OCD, little is known about how effective these treatments are for children who have a dual diagnosis of OCD and ASD. This report describes a 12-year-old male with Autism who was treated successfully with cognitive behavioral therapy with exposure and response prevention. This case study provides initial support that cognitive-behavioral therapy is effective in symptom reduction for children with comorbid autism and OCD.     

Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder

Objective

We investigated the neurocognitive deficits in schizophrenic patients with and without obsessive-compulsive disorder (OCD).

Methods

We grouped 27 patients as either obsessive-compulsive or non-obsessive-compulsive based on the presence of OCD. The two groups completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Positive and Negative Symptom Scale (PANSS), and Hamilton Depression Scale. The intelligence quotient (IQ) was tested using the Korean Wechsler Adult Intelligence Scale. The memory quotient (MQ) was tested using the Korean-Auditory Verbal Learning and Korean-Complex Figure Test. The executive intelligence quotient (EIQ) was determined using the Kims executive intelligence test (EXIT).

Results

Ten of the 27 patients had OCD. The compulsion score of Y-BOCS was positively correlated with positive symptoms, negative symptoms, and the total scores of PANSS. The OCD-schizophrenia patients had higher IQs. No difference was found in MQ. Although the EIQ did not differ between the two groups, the OCD-schizophrenia patients performed better at the Stroop-interference and verbal fluency tests, which was highly dependent on executive function.

Conclusion

Our findings suggest that OCD may have a protective effect on some cognitive function, at least in relatively early stage of illness. Moreover, based on clinical, neurocognitive features, schizophrenia with OCD could be considered as a distinct subtype of schizophrenia.     

Response of Obsessive Compulsive Disorder to Carbamazepine in Two Patients with Comorbid Epilepsy

An association between epilepsy and obsessive compulsive disorder (OCD) has been noted. The response of two patients with OCD and comorbid epilepsy to carbamazepine is reported. It is hypothesized that obsessive compulsive symptoms may be a variant of epileptiform forced thinking in a subgroup of patients, and may be preferentially responsive to anticonvulsant therapy.     

Relationships among Repetitive Behaviors, Sensory Features, and Executive Functions in High Functioning Autism

This study examined the relationship between repetitive behaviors and sensory processing issues in school-aged children with high functioning autism (HFA). Children with HFA (N = 61) were compared to healthy, typical controls (N = 64) to determine the relationship between these behavioral classes and to examine whether executive dysfunction explained any relationship between the variables. Particular types of repetitive behavior (i.e., stereotypy and compulsions) were related to sensory features in autism; however, executive deficits were only correlated with repetitive behavior. This finding suggests that executive dysfunction is not the shared neurocognitive mechanism that accounts for the relationship between restricted, repetitive behaviors and aberrant sensory features in HFA. Group status, younger chronological age, presence of sensory processing issues, and difficulties with behavior regulation predicted the presence of repetitive behaviors in the HFA group.     

A Comparison of Repetitive Behaviors in Aspergers Disorder and High Functioning Autism

In this study we compared 33 IQ and age matched pairs of individuals with Aspergers Disorder (ASP) and high functioning autism (HFA) on measures of repetitive behavior. On the Repetitive Behavior Scale-Revised (RBS-R), the ASP and HFA groups showed no differences in RBS-R Intensity score (severity) score or Frequency score (number of problems present). This suggests that the two groups are similar with respect to␣the intensity or severity of repetitive behaviors and the presence of repetitive behaviors. At the item level there were no differences on scales typically associated with autism (Stereotyped Behavior) and ASP (Restricted Interests). Similarly, there were no differences between the groups on the Aberrant Behavior Checklist Stereotypy scale. These findings add to the body of literature showing that HFA and ASP fail to differ with respect to repetitive behaviors. The implications of the findings for neurobiologic and genetic studies are discussed.     

Repetitive and Stereotyped Behaviors in Children with Autism Spectrum Disorders in the Second Year of Life

This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, n = 50), developmental delays without ASD (DD; n = 25) and typical development (TD, n = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.     

One-year Change in Repetitive Behaviours in Young Children with Communication Disorders Including Autism

Repetitive behaviours are a relatively neglected area of study in autism. Previous research has concluded that repetitive behaviour is inversely related to ability and that it tends to increase over the preschool years. One-hundred and four children ages 24-48 months, with autism, autism spectrum disorder (ASD) or other disorders, were followed for 13 months. Twelve items from the Autism Diagnostic Interview (ADI-R) were analysed, as well as diagnostic algorithm scores. Ability was related to degree of repetitive behaviours, except for one cluster of relatively able children. ADI-R repetitive behaviour algorithm scores increased over time; however, when all 12 behaviours were considered, there was a general decrease in impact upon the child's and family's activities. Reasons for this decrease are discussed.     

Validation of Symptom Dimensions and Sub-Type Responses in Cognitive Behavioral Therapy in Obsessive Compulsive Disorder: A Systemic Review and Meta-Analysis

Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition without a conclusive subtype dimension. This study will focus on the meta-analysis of the clinical responses of OCD subtypes to cognitive behavioral therapy (CBT), which might clarify this issue. Methods: We performed a systematic search and a meta-analysis for the studies of OCD subtypes and the response to CBT in PubMed, ScienceDirect, Embase, Web of Science, and Scopus databases. The selective criteria were the OCD without significant medical or psychiatric co-morbidities and pre-and post-treatment changes in scores of OCD dimension. In addition, different subtypes of OCD in symptom dimensions, such as symmetry, contamination, unacceptable thoughts, and hoarding, were compared to find the most significant subtype using the treatment response parameters by CBT. After limited selection, four studies and 479 OCD subjects were enrolled. The meta-analysis was performed by Review Manager 5.4, and only significant results were reported. Results: Among the OCD subtypes, the meta-analysis favors the hoarding subtype with poorer responses to CBT than symmetry, contamination, and unacceptable thoughts. The meta-analysis results were negative mean differences, significant tests for overall effect, and limited heterogeneities in the random effects model. In addition, the results were more significant when the hoarding subtype was compared with non-hoarding subtypes. Conclusion: The hoarding subtype might be the most significant representative subtype of OCD symptom dimension under the impression of unfavorable clinical response to CBT. However, future studies with more treatment parameters will be warranted to confirm this finding.     

Yale-Brown Obsessive Compulsive Scale: the dimensional structure revisited

The factor structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) has been examined in a number of prior investigations; however, findings have not consistently yielded a stable factor solution. The present study therefore tested the fit of each previously reported factor structure. One hundred thirty-one adults with obsessive-compulsive disorder (OCD) were administered the Y-BOCS; a portion of these participants completed self-report measures of depression and obsessive-compulsive symptoms and were rated on a global impairment index. Consistent with the originally proposed structure, confirmatory factor analyses supported a factor structure comprised of obsession and compulsion factors. Reliability and convergent validity of these factors were generally satisfactory, although divergent validity was not entirely supported. Implications of these findings on scoring the Y-BOCS are discussed.     

Obsessive compulsive disorder arising in a 75-year-old woman

Presented is the case of a 75-year-old woman with obsessive compulsive disorder with an unusual age of onset at age 72 years. The patient was resistant to various treatments, but responded to lithium augmentation of fluoxetine.     

双侧内囊前肢和扣带回毁损术治疗难治性强迫症(附34例临床分析)

目的 探讨双侧内囊前肢和双侧扣带回毁损术治疗难治性强迫症的临床疗效.方法 对34例难治性强迫症患者,采用立体定向双侧内囊前肢与扣带回前部毁损术,并分别在术前与术后2周、6个月、1年、2年由精神科医师进行YBOCS、HAMA、HAMD量表评定以及术后疗效评定.5例患者在术后6个月因疗效不佳而接受二次手术.结果 难治性强迫症患者术后各期YBOCS、HAMA、HAMD评分与术前比较均明显下降.术后6个月的总有效率(70.6%)明显低于术后2周的总有效率(94.1%),但术后1年、2年的总有效率与术后6个月的总有效率比较无明显差异.结论 立体定向双侧内囊前肢与双侧扣带回前部毁损术对难治性强迫症患者疗效显著,并可保持较好的远期疗效.     

Brief Report: Cross-Cultural Evidence for the Heterogeneity of the Restricted,Repetitive Behaviours and Interests Domain of Autism: A Greek Study

Recent studies provide evidence that the Restricted, Repetitive Behaviours, and Interests (RRBI) domain of autism is heterogeneous, consisting of at least two factors: Insistence on Sameness (IS) and Repetitive Sensory and Motor Behaviours and Interests (RSMB) [Cuccaro et al. (Child Psychiatry and Human Development, 34, 3–7, 2003; Szatmari et al. (Journal of Child Psychology and Psychiatry, 47, 582–590, 2006)]. The main objective of this study was to replicate this two-factor structure in an independent sample of 153 Greek individuals with a diagnosis of Pervasive Developmental Disorder (PDD). Principal Component Analysis was used to analyze the data. Our findings confirmed the two-factor structure (accounting for 52% of the variance), providing evidence for the cross-cultural heterogeneity of the RRBI domain of autism and the clear distinction between IS and RSMB symptoms in individuals with PDD.     

Delayed Self-recognition in Children with Autism Spectrum Disorder

This study aimed to investigate temporally extended self-awareness (awareness of one’s place in and continued existence through time) in autism spectrum disorder (ASD), using the delayed self-recognition (DSR) paradigm (Povinelli et al., Child Development 67:1540–1554, 1996). Relative to age and verbal ability matched comparison children, children with ASD showed unattenuated performance on the DSR task, despite showing significant impairments in theory-of-mind task performance, and a reduced propensity to use personal pronouns to refer to themselves. The results may indicate intact temporally extended self-awareness in ASD. However, it may be that the DSR task is not an unambiguous measure of temporally extended self-awareness and it can be passed through strategies which do not require the possession of a temporally extended self-concept.