Clinical characteristics of the obsessive-compulsive disorder patients with hoarding symptoms / 上海交通大学学报（医学版）

Objective • To explore the clinical characteristics of the obsessive-compulsive disorder (OCD) patients with hoarding symptoms and analyze the risk factors related to hoarding symptoms. Methods • A total of 247 OCD patients and 137 healthy controls (HC) were enrolled. The OCD patients were divided into hoarding group and non-hoarding group according to hoarding symptoms. Yale-Brown Obsessive-Compulsive Scale, Hamilton Depression Scale, Hamilton Anxiety Scale, Neuroticism Extraversion Openness Five-Factor Inventory and Obsessive Belief Questionnaire-44 were used to measure the severity of OCD, levels of depression and anxiety, personality characteristics and obsessive-compulsive beliefs of the three groups. The differences among the groups were compared, and Logistic regression was used to analyze the related factors of hoarding symptoms. Results • Regardless of hoarding symptoms, the scores of depression, anxiety, neuroticism and obsessive beliefs in the patients with OCD were significantly higher than those in the healthy controls (all P=0.000). Compared with OCD/non-hoarding group, OCD/hoarding group had a significantly lower level of extroversion (P=0.000), a significantly higher level of perfectionism/certainty (P=0.037), and higher scores in indecisiveness (P=0.003), pathological responsibility (P=0.006) and pathological slowness (P=0.000). There was statistical significance in age (OR=0.94), extraversion score (OR=0.89) and pathological retardation score (OR=2.50) in Logistic regression model (all P<0.05). Conclusion • The risk of hoarding symptoms in the OCD patients decreases with the increase of age and extroversion level, and increases with the increase of pathological retardation level.

Methodological strategies for functional analysis and evaluation of obsessive-compulsive behavior / Estratégias metodológicas para avaliação e análise funcional do comportamento obsessivo-compulsivo / Estrategias metodológicas para evaluación y análisis funcional de la conducta obsesiva-compulsiva

The study aimed to identify the controlling variables of obsessive-compulsive behaviors of an adult participant, based on three evaluation strategies. For the first one, Indirect Functional Assessment, the researchers recovered records of therapy sessions attended by the participant, in which conditions favorable to obsessive-compulsive behaviors were described. For the second one, Descriptive Functional Assessment, the researchers observed the participant's behavior during sessions in which they presented tasks previously mentioned as triggering of the problem behavior. For the third one, Brief Functional Analysis - Single Function Test, the researchers manipulated a demand condition and a control condition, aiming to examine the functional hypothesis that the problem behavior would be maintained by escape/avoidance of tasks. Although dissonant, the results allowed the researchers to discard the negative reinforcement hypothesis. The pertinence of the adoption of different evaluation strategies for clinical practice and the frailties of interventions guided only by verbal reports are discussed.

O estudo teve por objetivo identificar variáveis controladoras de comportamentos obsessivo-compulsivos de um participante adulto, com base em três estratégias de avaliação. Na primeira, Avaliação Funcional Indireta, recuperaram-se registros de sessões de terapia frequentadas pelo participante, em que foram descritas condições favorecedoras dos comportamentos obsessivo-compulsivos. Na segunda, Avaliação Funcional Descritiva, observou-se o comportamento do participante em sessões nas quais se dispunham tarefas antes indicadas como desencadeantes do comportamento-problema. Na terceira, Análise Funcional Breve - Teste de Função Única, foram manipuladas condições de demanda e controle, a fim de examinar a hipótese funcional de que o comportamento-problema seria mantido por fuga/ esquiva de tarefas. Embora divergentes, os resultados das avalições permitiram descartar a hipótese de que o comportamento-alvo seria mantido pela retirada da tarefa. Discutem-se a pertinência da adoção de diferentes estratégias de avaliação no trabalho clínico e a fragilidade de intervenções unicamente orientadas por relatos verbais.

El estudio objetivó identificar variables controladoras de la conducta obsesiva-compulsiva de un participante adulto, basando-se en tres estrategias de evaluación. Por la primera, Evaluación Funcional Indirecta, fueran recuperados registros de sesiones de terapia frecuentadas por el participante, en que se describieron condiciones favorecedoras de los comportamientos obsesivo-compulsivos. Por la segunda, Evaluación Funcional Descriptiva, fue observada la conducta del participante en sesiones en las cuales se disponían tareas indicadas como desencadenantes de la conducta-problema. Por la tercera, Análisis Funcional - Prueba de Función Única, fueran manipuladas condiciones de demanda e control, objetivando examinar la hipótesis funcional de que la conducta problema sería mantenida por fuga/evasión de tareas. Aunque divergentes, los resultados permitirán descartar a la hipótesis de que la conducta objetivo sería mantenida por reforzamiento negativo. Se discute la pertinencia de la adopción de diferentes estrategias de evaluación del trabajo clínico, y debilidades de intervenciones únicamente orientadas por relatos verbales.

Quality of Life and Suicidality in Obsessive Compulsive Disorder as Evaluated by WHO BREF

Obsessive Compulsive Disorder (OCD) is a chronic, distressing, anxiety disorder associated with significant functional impairment. Patient with OCD often suffer from one or more co-morbid disorders. Major depression has been the most common co-morbid syndrome. OCD in association with comorbid depressive and anxiety symptoms, increased severity of obsessions, feelings of hopelessness and past history of suicide attempts have been associated with worsening levels of suicidality. As per data Thirty-six percent of the patients of OCD report lifetime suicidal thoughts and 11% have a history of attempted suicide. There is a reasonable probability that the patient of OCD has suicidal thoughts, plans or a suicidal attempt in the past. Methods: This study was conducted on 50 patients diagnosed with OCD as per ICD 10 criteria, both outpatient & indoor, from department of psychiatry, Teerthanker Mahaveer Medical College & Hospital, Moradabad, Uttar Pradesh, India. A socio-demographic proforma, Hamilton Depression rating scale, Yale Brown Obsessive Compulsive Scale and WHOQOL-BREF-Hindi version were administered. Results: The majority of the patients suffering from OCD were below 40 years of age. The prevalence of OCD was maximum in housewives and they mostly belonged to 25-34 years age group. All the patients who had current suicidal ideation showed low scores on all the domains of Quality of life. Also, the patients who had attempted suicide in the past showed same low scores on all domains of Quality of life and both results were statistically significant. Conclusion: Hence the assessment of Quality of life in OCD patient is a strong predictor of suicidality in these patients

Efficacy and cost-effectiveness of internet-based cognitive behavioral therapy for obsessive-compulsive disorder / 上海交通大学学报（医学版）

Objective • To compare the therapeutic effect, cost, cost-effectiveness and utility between internet-based cognitive behavioral therapy (ICBT) and cognitive behavioral group therapy (CBGT) in the patients with obsessive-compulsive disorder (OCD). Methods • Twenty-eight patients who met the OCD diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were assigned to ICBT group (n=16) and CBGT group (n=12) according to the patients' willingness. Both groups were treated for 6 weeks. The study compared differences in the severity of OCD and symptoms of anxiety and depressive at baseline, during treatment and after treatment, as well as differences in cost, cost-effectiveness and utility between two groups. Results • There was no significant difference in the scores of Yale-Brown Obsessive Compulsive Scale (YBOCS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Visual Analog Scale (VAS) [a component of EuroQol Five Dimensions Questionnaire, (EQ-5D)] between the two groups at baseline (P=0.291, P=0.114, P=0.478, P=0.799). After treatment, the YBOCS scores decreased compared to pre-treatment in two groups. There was no statistical difference in subtraction rate of YBOCS between the two groups (P=0.291). The SDS scores of ICBT group also decreased after treatment compared to pre-treatment (P=0.003). The average cost per patient in ICBT group was 2 710.50 yuan less than that in CBGT group. When one YBOCS score per patient reduced, ICBT group spent 281.33 yuan less than CBGT group. The VAS scores were significantly improved after 6-week treatment and ICBT group has a more significant improvement. Conclusion • ICBT and CBGT have comparable and significant efficacy. And ICBT is a lower cost and more cost-effectiveness and utility treatment than CBGT.

Progress in augmentation therapy mechanism of obsessive compulsive disorder / 上海交通大学学报（医学版）

Administration of selective serotonin reuptake inhibitors (SSRI) is a widely used pharmacotherapeutic approach for obsessive-compulsive disorder (OCD) today. However, nearly half of the OCD patients do not respond to SSRI. It has been shown that some antipsychotic drugs can augment the therapeutic effect of SSRI in the patients with OCD, but the augmentation’s effect is still ineffective for some patients. Therefore, it is of great significance to explore the augmentation’s mechanism for further improvement of the clinical treatment. This article reviews some common used augmentation for OCD and discusses the underlying mechanisms.

Application of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder / 上海交通大学学报（医学版）

At present, a considerable proportion of patients with obsessive-compulsive disorder (OCD) cannot be effectively relieved by standard drug and psychotherapy, so researchers have turned their attention to new directions of physiotherapy. Repetitive transcranial magnetic stimulation (rTMS), as an adjuvant therapy for refractory OCD, is a non-invasive nerve stimulation technique. Many studies have shown that rTMS is effective in the treatment of OCD. However, there were also disputes in the selection of stimulation targets, parameter settings and so on. This article systematically combs the setting and application of standard rTMS in the treatment of OCD, and comprehensive therapeutic effect of rTMS, and then discusses the deficiency of treatment so far, in order to put forward the future development direction and promote clinical treatment progress.

Association of serotonin transporter gene polymorphisms with obsessive-compulsive disorder (OCD) in a south Indian population.

Background and Objectives: Serotonin transporter polymorphisms, 5-HTTVNTR and 5-HTTLPR, have been found to be associated with obsessive-compulsive disorder (OCD) and particularly with neurotic characteristics. In the present study we looked for an association between OCD and these polymorphisms in OCD patients and controls of south Indian origin. Methods: 5-HTTVNTR and 5-HTTLPR/rs25531 were genotyped in 93 OCD patients and 92 healthy controls. The allelic distribution and genotype frequency in cases and controls were compared using chi square test. In order to test for the effects of genotype on heterogeneity of the illness, linear regression analysis was undertaken for co-morbid depression status and YBOCS score (severity index). Results: There was no significant association with the 5-HTTVNTR or the 5-HTTLPR polymorphism. No significant association of OCD with the 5-HTTLPR genotype was found even on inclusion of the rs25531 locus, which is part of the transcription factor binding site as reported in earlier studies. However, severity of the illness showed a modest association with the dominant model. Interpretation & conclusions: Our data show that genetic variation in the SLC6A4 gene regulatory region may not have a significant effect on OCD in the present population. Further replication in a large and independent cohort with an equal number of female subjects would help to ascertain if the absence of association in this cohort is due to the nullifying effect of the larger proportion of male subjects in our sample population. The marginal effect of the 5-HTTLPR (A/G) genotype obtained on linear regression with disease severity is suggestive of a potential role for this locus in the disease process.

A randomized controlled trial of sertraline combining with quetiapine in treatment of obsessive-compulsive disorder / 中国心理卫生杂志

Objective: To investigate the efficacy and safety of sertraline combining with quetiapine in the treatment of obsessive-compulsive disorder (OCD) .Methods: A total of 86 patients who met the criteria for OCD in International Classification of Diseases (ICD-10) were randomly assigned to two groups. One group was treated with sertraline combining with quetiapine and die other with sertraline only for 8 weeks. The efficacy was measured wim the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Depression Scale (HAMD) . The side effects were assessed with the Treatment Emergent Symptoms Scale (TESS) . Results: One patient in sertraline group fell off and was out of statistical analysis. At endpoint the significant improvement rate in the combining group was higher than that in the sertraline group (72.1% vs. 47.6% , P = 0.021) . In combining group, the YBOCS score [(25.00 ± 5.19) vs. (11.74 ± 4.50), P < 0.01] and HAMD score [(14.47 ± 4.05) vs. (6. 86 ±2.61), P < 0.001] were decreased after treatment In sertraline group, the YBOCS score [(24.55 ± 3.60) vs. (14.38±4.18), P<0.001] and HAMA score [(14.79 ± 3.77) vs. (8.29 ±3.04), P <0.001] were also decreased after treatment There were significant differences between the two groups (Ps < 0.05) . There were no significant differences between the two groups in the TESS score at the end of 2, 4, 6 and 8 weeks (Ps > 0.05) . The incidence of drowsiness and tachy-heart rate in the combining group was high than that in the control group (37.2% vs. 4.8% , P <0.001; 27.9% vs. 4. 8% , P=0.004) . But most patients with these two kinds of side effects were disappeared in 2 weeks. There were no significant differences between the two groups in other side effects such as nausea, anxiety, headache, and constipation (Ps > 0.05) .Conclusion: The addition of quetiap-ine to sertraline therapy has been found to be effective and well-tolerated approach in patients with OCD.

Obsessive Compulsive Schizophrenia (OCS) Revisited : A Five-Year Case Report

Objective: This is a case report discussing the comorbidity of obsessive compulsive disorder (OCD) and schizophrenia. Such clinical phenomenon merits recognition as a distinct subgroup of schizophrenia with unique challenges and treatment needs. Method: A case report presenting schizophrenia with preceding obsessive-compulsive disorder over five years. Results: This report describes the clinical course and treatment challenges of a patient with obsessive compulsive schizophrenia (OCS). Conclusion: This case illustrates that OCS is a complex disorder with atypical clinical characteristics. In managing this patient, several clinical dilemmas including diagnostic ambiguity, problems with pharmacotherapy and difficulties in his rehabilitation were highlighted.

Evaluación neuropsicológica y neurocirugía psiquiátrica

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Abstract: Neuropsychology, as a part of cognitive neurosciences should be incorporated to the process of evaluation of any patient considered to be needing psychiatric neurosurgery, in order to obtain objective information of the processes and functions that shape each one's cognitive system and of the changes that may take place after surgery. To attain this objective, the neuropsychologist doing the evaluation should be experienced in assessing patients with psychiatric disorders, as it is necessary to have a deep knowledge not only of the clinical characteristics of these ailments but also of the information processing models that typify each entity. Thus, by making an evaluation within a conceptual and empirical frame, an adequate interpretation of the results may be attained. At the same time it is necessary to know the neurochirugical techniques being applied in each case and also to be aware of the possible side effects that may take place. The need for this type of assessments is due to two reasons: to find the possible damage that surgery may cause and to consider the improvement that follows the decrease of clinical symptoms. The previous two facts are associated to clinical improvement as both have different temporal courses. The first will produce a behavioural effect more evident during the first post operative year while at further stages, the second will be made more evident with the decrease of clinical symptoms, thus reflecting on the neuropsychological performance. Another possibility to be considered in this type of cases is that the cerebral systems related with psychopathology as well as those underlying executive and cognitive performance will be distributed differently in the brain and, therefore, with this kind of treatment they will be affected in a different way, this makes it necessary to do not only previous but subsequent evaluations in order to asses accurately the changes in the cognitive processes. Also, should there be found more severe neuropsychological alterations than those expected for a specific psychiatric disorder, there is a risk of increasing post operative changes because any adverse surgical effect may interact or be added to the cognitive failures that typify the illness and, thus, prognosis will be worsened. Regarding the most relevant research on this field, Dougherty et al. report that 20% of their 44 patients with obsessive compulsive disorder (OCD) mentioned at least one adverse effect; of these patients 5% reported a loss of memory that was corrected after six to 12 months. Among the writings that include neuropsychological evaluation as such, it was found that Nyman's group in Sweden, proposes that, independently form the neurosurgical technique used in patients with OCD, the main objective of the operation is to counteract the lack of balance between the frontal sector and the sub cortical regions, as well as that of the basal nuclei and the limbic structures. Therefore, as a proposal, they explore the functions pertaining to the frontal region because they believe that following surgery there must be failures in this area. This belief is also based on a previous research in which they found that five from ten patients presented after surgery a larger number of preservative answers in the Wisconsin Card Sorting Test (WCST), a fact that points out a dysfunction in the encephalon's anterior sector. Nevertheless, they consider that this preservative pattern of responses in the WCST is not permanent; on the contrary, there is improvement after capsulotomy, as shown when the evaluation results are compared to other patients' evaluations, previous to capsulotomy. In another study they reported different failures depending of the surgical strategy being used; thus with frontal ventromedial lesion no alterations were found although when the ventral striated was involved, there were differences as to the number of categories and the conceptual level in WCST. Besides, the group with the worst ranging was the one with large lesions at dorsal level which gave place to visual spatial perception alterations, as well as to psychomotor slowness in a sequence task, and to intrusions in an associated learning task. This finding was expected because the extent of the regions affected by the lesion corresponds to the alterations observed. No differences were reported in another research, as to the WAIS ratings or the Memory Scale of Wechsler, neither before nor after the operation. Nevertheless, the WCST showed some differences in regard to the categories established in respect to the control group, which were interpreted as a lack of abstract reasoning and cognitive flexibility. In schizophrenic patients submitted to leucotomy because of their aggressive behaviour and lack of impulse control, follow up, while comparing their cognitive performance to that of other schizophrenic subjects who had not been operated, showed that there were negative effects on different cognitive aspects, although these, as part of the dysfunction expected for schizophrenia, were not caused by surgery. Up to this moment, in Mexico there is not an evaluation protocol for patients needing psychiatric neurosurgery , and therefore, solid and objective standards should be established for this purpose. For more than a decade, the Instituto Nacional de Psiquiatría Ramón de la Fuente (INPRF), has used neuropsychologic exploration protocols which are based not only on a wide clinical experience in the field of psychiatric disorders but also on the research carried out by our institution. Besides, integration of neuropsychological studies is based on international parameters designed to apply and interpret these instruments. As well, with the same tests it is possible to distinguish between the alterations pertaining to illness and those resulting from neurosurgery. This, in turn will be considered for establishing, if required, reasoned rehabilitation techniques. This battery is composed by the following tests: Wechsler Adult Intelligence Scale (WAIS), Integrated Program for Neuropsychological Exploration Test of Barcelona (Short Version), Rey's Complex Figure (Standarization for Mexican Population, Instituto Nacional de Psiquiatría), and Verbal Learning Test Spain Complutense (TAVEC). This battery must be applied before the procedure, and follow up should be made for a period of between three, six to eight months, continuing with this evaluation protocol for at least three years. Nevertheless, flexibility may be allowed in case there should be complaints from the patient that justify making an evaluation before the given time. On the other hand, considering the position and vulnerable condition in this type of surgical procedures paradigms that evaluate different functions of the frontal sector are proposed in order to obtain specific information of their functioning before and after intervention. We propose to use the Wisconsing Card Sorting Test (WCST), the Stroop Test and the Trail Making B. In addition to the previous statements, the personality changes that may appear ought to be considered, because some personality alterations associated with hypo-frontality have been reported in patients submitted to capsulotomty, although such alterations may be due to judgement errors that are typical of cognitive damage. Finally, we consider that within the selection and interdisci-plinary handling process for patients who may need psychiatric neurosurgery, information obtained from neuropsychological evaluation is necessary. Besides, it will allow the neuropsychologist, as part of the team in charge of these patients, not only to make realistic and objective suggestions regarding the therapeutic strate-gies to be used in each particular case, but also, to advise their relatives.

Related Factors of Obsessive-compulsive Disorder's Quality of Life / 中国临床心理学杂志

Objective;To investigate the situation of Obsessive-Compulsive Disorder's quality of life,and explored the related factors.Methods;60 OCD patients were tested with the general question lists,Yale-Brown Obsessive Compulsive Scale(YBOCS),Hamilton Rating Scale for Depression(HAMD).Health related quality of life was measured by the Self-administered global QOL scale(SF-36).Results;There were significant differences between OCD patients and the norm of China general population in all SF-36 subscales except those related to physical health and pain(P

Tratamiento del trastorno obsesivo-compulsivo / Treatment of obsessive-compulsive disorder

El trastorno obsesivo-compulsivo (TOC) es una delas patologías más subdiagnosticadas y tratadasde forma equivocada en las últimas décadas.Como resultado hoy nos encontramos con unimportante número de pacientes que tienen altaresistencia a los tratamientos convencionales,presentándose un cuadro particular al quese denomina trastorno obsesivo-compulsivoresistente. En este trabajo queremos transmitir nuestra forma de pensar y abordar el tratamiento del TOC.

he Obsessive-CompulsiveDisorder is one of themost subdiagnosed and inadequately treateddisease of the last decades; therefore, nowadaysthere is an important number of patients thatoffer resistance to conventional treatments,arranging a particular clinical status namedObsessive-Compulsive Resistant Disorder. Inthis paper we wanted to share our way to think and treat the OCD.

Comorbid Axis-II Disorders in Patients with Obsessive-Compulsive Disorder / 신경정신의학

The purpose of this study was to assess the comorbid axis-II disorders of obsessive compulsive disorder(OCD) patients and to investigate the relationship between symptoms of OCD and the comorbid personality traits. The subjects were 59 patients who met DSM-IV criteria for obsessive-compulsive disorder and 32 normal controls. All subjects completed Personality Disorder Questionnaire-IV(PDQ-IV). The patients completed Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI), and were rated with Yale-Brown Obsessive Compulsive Scale(YBOCS). The results were as follows. 1) The OCD patients showed significantly higher prevalence of avoidant, depresssive and borderline personality disorder(p<0.01) compared to controls. 2) The BAI score had significant effect on the avoidant personality score(t=3.23, p<0.003). The BDI score had significant effect on the depressive personality score(t=3.08, p=0.004). The YBOCS(t=2.10, p=0.043) and BAI(t=2.60, p=0.014)scores had significant effects on the borderline personality score. We found that OCD patients had higher prevalence of avoidant, depressive, and borderline personality disorders. We also found that obsessive-compulsive symptoms have significant effect on the severity of borderline personalty traits. We suggest that it would be very helpful to consider Axis-II disorders for managing patients with obsessive-compulsive disorder.