Obsessive-Compulsive Symptoms and Their Impacts on Psychosocial Functioning in People with Epilepsy

BACKGROUND AND PURPOSE: Obsessive-compulsive symptoms (OCS) in people with epilepsy (PWE) have not been studied systematically. We evaluated the severity, predictors, and psychosocial impact of OCS in PWE. METHODS: We recruited PWE who visited our epilepsy clinic and age-, gender-, and education-matched healthy controls. Both PWE and healthy controls completed the Maudsley Obsessional-Compulsive Inventory (MOCI), which measures OCS. PWE also completed the Beck Depression Inventory (BDI) and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). We examined the severity of OCS in PWE relative to healthy controls. Predictors of OCS and the QOLIE-31 score were measured by regression analyses. A path analysis model was constructed to verify interrelations between the variables. RESULTS: The MOCI total score was significantly higher in PWE than in healthy controls (p=0.002). OCS were found in 20% of eligible patients. The strongest predictor of the MOCI total score was the BDI score (beta=0.417, p<0.001), followed by EEG abnormality (beta=0.194, p<0.001) and etiology (beta=0.107, p=0.031). Epileptic syndrome, the side of the epileptic focus, and action mechanisms of antiepileptic drugs did not affect the MOCI total score. The strongest predictor of the QOLIE-31 overall score was the BDI score (beta=-0.569, p<0.001), followed by seizure control (beta=-0.163, p<0.001) and the MOCI total score (beta=-0.148, p=0.001). The MOCI total score directly affected the QOLIE-31 overall score and also exerted indirect effects on the QOLIE-31 overall score through seizure control and the BDI score. CONCLUSIONS: OCS are more likely to develop in PWE than in healthy people. The development of OCS appears to elicit psychosocial problems directly or indirectly by provoking depression or uncontrolled seizures.

The analysis survey of 4335 children and adolescents with leyton obsessional inventory-child version / 中华行为医学与脑科学杂志

ObjectiveTosurvey obsessive-compulsivesymptomof childrenandadolescents.Methods4335 children and adolescents aged ( 13.88 ± 2.44) year-old (47.7％ male) were measured with leyton obsessional inventory-child version (LOI-CV).ResultsThe frequency of total yes/no score of LOI-CV manifests as normal distribution,while the frequency of total interfering score manifests as J curve.Total yes/no scores of female were higher than that of male ( ( 8.55 ± 3.87 ),(8.21 ± 3.99),t =2.86,P ＜ 0.01 ) ; the difference of country and city were not significant ( ( 8.57 ± 3.86),( 8.35 ± 3.9 ),t =1.32,P ＞ 0.05 ).Primary school ( n =937 ),junior high school ( n =1906 ),senior high school ( n =1492 ) exited significant difference ( (7.86 ± 3.82),( 8.52 ± 3.93 ),( 8.55 ± 3.891 ) respectively,F =11.03,P ＜ 0.01 ).The total interfering scores of male were higher than that of female ( ( 11.35 ± 9.10),( 10.76 ± 8.84),t =2.18,P =0.03 ).The total interfering scores of country were higher than that of city( ( 11.86 ±9.18),( 10.88 ±8.92),t=2.61,P＜0.01 ) ;the difference of primary school,junior high school and senior high school were significant ( ( 10.05 ± 8.76 ),( 11.73 ± 9.17),( 10.77 ± 8.76),F =12.088,P ＜ 0.01 ).The total interfering score from grade four of primary school to grade three of senior high school were( 10.0 ± 8.78),( 10.01 ± 8.64),( 10.19 ± 8.92),( 11.43 ±9.16),(11.40 ±8.67),(12.58 ±9.76),(10.32 ±8.42),(10.19 ±8.38),(12.48 ±9.69) respectively(F=5.90,P＜0.01 ).The two grades of the highest total interfering score were grade three of junior high school and grade three of senior high school.ConclusionObsessive-compulsive symptom are common in children and adolescents.Children and adolescents of male grade three of junior high school or senior high school in the country are more probably interfered by obsessive-compulsive symptom.

Investigation of attentional bias in high obsessive compulsive symptom individuals / 中华行为医学与脑科学杂志

Objective To explore the attentional biases in individuals with different types of obsessivecompulsive symptom and the correlations between the attentional bias of high obsessive compulsive symptom (HOC) and symptoms. Methods 22 individuals with HOC and 38 individuals with low obsessive compulsive (LOC) symptom completed the Chinese Emotional Stroop task that assessed the attentional bias. Comparisons were made between HOC and LOC and in different types of HOC, and the correlations between the attentional bias of HOC and symptom severity scores were searched for. Results The comparison between HOC and LOC on the reaction time of neutral, negative and disgust-related words were not significant. The contamination/washing subtype in HOC showed faster reaction time on negative and disgust-related words compared to that of neutral words,and its attentional bias exhibited significant correlation with symptom severity scores( r= -0. 648, P=0. 031 ). Conclusion Such information point out the contamination/washing subtype may have a different neural mechanism compared to the other subtypes of OCD.

Sintomas obsessivo-compulsivos nas demências: [revisão] / Obsessive-compulsive symptoms in dementia: [review]

CONTEXTO: Demências são cada vez mais prevalentes na população. Sintomas cognitivos costumam ser acompanhados de sintomas comportamentais e psicológicos das demências (SCPD), causando aumento do custo dos cuidados e da carga do cuidador. OBJETIVOS: Identificar na literatura indexada até junho de 2008 artigos relacionados a estudos sobre a ocorrência de sintomas obsessivo-compulsivos (SOC) nas diversas síndromes demenciais para identificar prevalência, características e impacto nos cuidadores em termos de carga, qualidade de vida ou custo socioeconômico. MÉTODOS: Procedeu-se à busca sistemática nos indexadores PubMed e LILACS, utilizando as palavras-chave obsessive, compulsive, obsession, compulsion e dementia, identificando-se 10 artigos. RESULTADOS: Desses, cinco enfocavam primariamente os SOC, enquanto, nos outros cinco, SOC eram objetivos secundários; oito estudos relatavam exames de neuroimagem; oito relataram sintomas compulsivos; dois relataram sintomas obsessivos e compulsivos, enquanto nenhum trouxe sintoma simplesmente obsessivo. A maioria dos estudos aborda pacientes com demência frontotemporal. CONCLUSÃO: A análise dos 10 artigos evidenciou a escassez de investigação de SOC nas demências, a importância da neuroimagem para esse tipo de estudo e grande diversidade de instrumentos para avaliar os SOC. Nenhum artigo avaliou impacto dos SOC nos cuidadores, o que pode direcionar estudos futuros.

BACKGROUND: Dementia is increasingly prevalent in the population. Cognitive symptoms are usually accompanied by behavioral and psychological symptoms of dementia (BPSD), causing an increase in the cost of care and the burden of the caregiver. OBJECTIVES: To search in the indexed literature until June 2008 articles related to studies on the occurrence of obsessive-compulsive symptoms (OCS) and trying to identify their prevalence, characteristics and impact on caregivers in terms of loading, quality of life and socioeconomic cost. METHODS: A systematic search was performed in the PubMed and LILACS indexing services, using the keywords: obsessive, compulsive, obsession, compulsion and dementia, having been identified 10 articles. RESULTS: Among those, five focused on primary OCS, while in the other five OCS were a secondary objective; eight studies reported test of neuroimaging procedures; eight reported compulsive symptoms; two reported both an obsessive and compulsive symptoms, while no study reported only obsesssion. The majority of the studies reported cases of frontotemporal dementia patients. DISCUSSION: The analysis of the 10 articles denified in our search highlighted the scarcity on research on OCS and dementia, the importance of associating neuroimaging to this kind of research and the diversity of trials to evaluate OCS. No article evaluated the impact of OCS in caregivers, which could be a suggestion for future studies.

Hypersexuality and Obsessive-Compulsive Behaviors in a Stroke Patient with the Left Mesial Frontal Cortex and Both Basal Ganglia Lesion

Hyposexuality after stroke has been frequently observed, but hypersexuality as a sequela of stroke has not been commonly documented. We report a patient who exhibited hypersexuality and obsessive-compulsive behaviors after stroke in the region of the left mesial frontal cortex and both basal ganglia. At 2 months after stroke, he visited psychiatric unit due to these symptoms. His motor function was almost full recovered. He was treated with fluvoxamine and perphenazine, With two-month medication, his hypersexuality and obsessive-compulsive behavior disappeared. This case may indicate that basal ganglia-thalamocortical circuit plays an important role in the mediation of sexual behavior and obsessive-compulsive behavior. Since changes in sexual activity may not be spontaneously reported, a systemic inquiry into patient's sexual functioning after infarction in frontal lobe or basal ganglia is warranted.

Inherent Characteristics of Obsessive-Compulsive Symptoms Associated with Clozapine Treatment in Schizophrenia / 신경정신의학

OBJECTIVES: Despite stockpiled case reports of obsessive-compulsive symptoms (O-C symptoms) in schizophrenic patients associated with clozapine, it is still difficult to explain the complex interplay between psychotic symptoms, O-C symptoms and clozapine. The main difficulty lies in building an integrated hypothesis for a complex manifestation as O-C symptoms accompanied by psychotic symptoms. Thus we assumed that O-C symptoms shown in schizophrenic patients have diverse mechanisms in symptom formation, and that O-C symptoms developed after clozapine administration have various mechanisms as well. METHODS: We reviewed charts of all the DSM-IV schizophrenic patients from the Refractory Schizophrenia Clinic of Seoul National University Hospital, who are currently using clozapine or has previously used clozapine. Then, we classified the patients into four types implicating different mechanisms of O-C symptom formation. RESULTS: O-C symptoms of first two cases implicating diverse mechanisms in symptom formation clearly showed clinical discrepancies, mainly the relationship with psychotic symptoms, responsiveness to clozapine use and therapeutic approach to O-C symptom per se. And the other two cases implying various mechanisms in O-C symptoms newly developed during clozapine use, also showed obvious differences in the relationship with psychotic symptoms, dose-dependent pattern of O-C symptom during clozapine use and timing of onset of O-C symptom after clozapine administration. CONCLUSIONS: In order to explain the diversity of clinical manifestations of these 4 cases, we have paid attention to inherent characteristics reflecting the differentiation process of symptom structure rather than the complex phenotype of O-C symptoms, and made explanatory model by applying and integrating several useful concepts, the 'symptom conceptualization' proposed by Berrios, 'personal illness hierarchy' proposed by Foulds and 'structural dynamics of O-C phenomena' proposed by Shoda. By proposing this model, we intend to describe the interplay between O-C symptoms, psychotic symptoms and clozapine treatment. This study is based on interpretations of the cases selected out of a great number of patients, and so it is hard to generalize. But we think it is worthwhile to build a hypothetical model for understanding the intricate manifestations of O-C symptoms in light of not only the phenotype but also the internal symptom structure.