Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.

Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder / Resultados de la Nursing Outcomes Classification/NOC para pacientes con trastorno obsesivo-compulsivo / Resultados da Nursing Outcomes Classification/NOC para pacientes com transtorno obsessivo-compulsivo

ABSTRACT Objective: To analyze the application of nursing outcomes and indicators selected from the Nursing Outcomes Classification (NOC) to evaluate patients with obsessive-compulsive disorder (OCD) in outpatient follow-up. Method: Outcome-based research. First, a consensus was achieved between nurses specialized in mental health (MH) and in the nursing process to select NOC-related outcomes and indicators, followed by the elaboration of their conceptual and operational definitions. Then, an instrument was created with these, which was tested in a pilot group of six patients treated at a MH outpatient clinic. The instrument was applied to patients with OCD undergoing Group Cognitive Behavioral Therapy (GCBT). The study was approved by the Research Ethics Committee of the institution. Results: Four NOC outcomes and 17 indicators were selected. There was a significant change in the scores of nine indicators after CBGT. Conclusion: The study showed feasibility for evaluating symptoms of patients with OCD through NOC outcomes and indicators in an outpatient situation.

RESUMEN Objetivo: Evaluar la aplicación de resultados e indicadores de enfermería seleccionados en la Nursing Outcomes Classification (NOC) para examinar a los pacientes con Trastorno Obsesivo-Compulsivo (TOC) en seguimiento ambulatorio. Método: Investigación de resultados. Primeramente, se realizó un acuerdo entre enfermeros expertos en salud mental (SM) y en proceso de enfermería para seleccionar los resultados e indicadores de la NOC, seguido de la elaboración de sus definiciones conceptuales y operativas. Después, se construyó un instrumento con las informaciones recolectadas, y lo aplicaron a un grupo piloto con seis pacientes, que recibían atención en el ambulatorio de SM. Se aplicó el instrumento a los pacientes con TOC, sometidos a Terapia Cognitivo-Conductual en Grupo (TCCG). Estudio aprobado por el Comité de Ética en Investigación de la institución. Resultados: Se seleccionaron cuatro resultados y 17 indicadores NOC. Se observó una modificación significativa de los puntajes de nueve indicadores después de la TCCG. Conclusión: El estudio apuntó la viabilidad de evaluación de los síntomas de pacientes con TOC por medio de los resultados e indicadores de la NOC en el ámbito ambulatorio.

RESUMO Objetivo: Analisar a aplicação de resultados e indicadores de enfermagem selecionados na Nursing Outcomes Classification (NOC) para avaliar pacientes com Transtorno Obsessivo-Compulsivo (TOC) em acompanhamento ambulatorial. Método: Pesquisa de resultados. Primeiro, realizou-se consenso entre enfermeiros especialistas em saúde mental (SM) e em processo de enfermagem para seleção de resultados e indicadores da NOC, seguido da elaboração das suas definições conceituais e operacionais. Depois, construiu-se um instrumento com estes, que foi testado em grupo piloto de seis pacientes atendidos em ambulatório de SM. O instrumento foi aplicado aos pacientes com TOC submetidos a Terapia Cognitivo-Comportamental em Grupo (TCCG). Estudo aprovado pelo Comitê de Ética em Pesquisa da instituição. Resultados: Foram selecionados quatro resultados e 17 indicadores NOC. Observou-se modificação significativa dos escores de nove indicadores após a TCCG. Conclusão: O estudo apontou viabilidade de avaliação dos sintomas de pacientes com TOC através dos resultados e indicadores da NOC em cenário ambulatorial.

Trastorno obsesivo compulsivo y trastornos relacionados: un nuevo capítulo en el DSM-5 / [DSM-5: OCD and related disorders].

DSM-5 moved OCD out from under the Anxiety Disorder section, into a new category: Obsessive Compulsive and Related Disorders and added two new specifiers. Specifically a modification of one specifier (insight) and the addition of a new tic specifier. DSM-5 redefined obsessions and recognizes the importance of avoidance and thought stopping beyond compulsions as other strategies to deal with obsessions. OCD related disorders include: Trichotillomania, Hoarding Disorder, Skin Picking Disorder, and Body Dysmorphic Disorder.

Obsessive-compulsive (anankastic) personality disorder: toward the ICD-11 classification

Obsessive-compulsive personality disorder (OCPD) is an early-onset disorder characterized by perfectionism, need for control, and cognitive rigidity. Its nosological status is currently under review. Historically, OCPD has been conceptualized as bearing a close relationship with obsessive-compulsive disorder (OCD). In this article, we discuss the diagnosis of OCPD in anticipation of its review for the ICD-11, from the perspective of clinical utility, global applicability, and research planning. Considering the recent establishment of an obsessive-compulsive and related disorders (OCRD) category in DSM-5, we focus on the relationship between OCPD and the disorders that are currently thought to bear a close relationship with OCD, including DSM-5 OCRD, and other compulsive disorders such as eating disorder and autistic spectrum disorder (that were not included in the DSM-5 OCRD category), as well as with the personality disorders, focusing on nosological determinants such as phenomenology, course of illness, heritability, environmental risk factors, comorbidity, neurocognitive endophenotypes, and treatment response. Based on this analysis, we attempt to draw conclusions as to its optimal placement in diagnostic systems and draw attention to key research questions that could be explored in field trials.

Obsessive-compulsive disorder for ICD-11: proposed changes to the diagnostic guidelines and specifiers

Since the approval of the ICD-10 by the World Health Organization (WHO) in 1990, global research on obsessive-compulsive disorder (OCD) has expanded dramatically. This article evaluates what changes may be needed to enhance the scientific validity, clinical utility, and global applicability of OCD diagnostic guidelines in preparation for ICD-11. Existing diagnostic guidelines for OCD were compared. Key issues pertaining to clinical description, differential diagnosis, and specifiers were identified and critically reviewed on the basis of the current literature. Specific modifications to ICD guidelines are recommended, including: clarifying the definition of obsessions (i.e., that obsessions can be thoughts, images, or impulses/urges) and compulsions (i.e., clarifying that these can be behaviors or mental acts and not calling these “stereotyped”); stating that compulsions are often associated with obsessions; and removing the ICD-10 duration requirement of at least 2 weeks. In addition, a diagnosis of OCD should no longer be excluded if comorbid with Tourette syndrome, schizophrenia, or depressive disorders. Moreover, the ICD-10 specifiers (i.e., predominantly obsessional thoughts, compulsive acts, or mixed) should be replaced with a specifier for insight. Based on new research, modifications to the ICD-10 diagnostic guidelines for OCD are recommended for ICD-11.

Body-focused repetitive behavior disorders in ICD-11

This article addresses the question of how body-focused repetitive behavior disorders (e.g., trichotillomania and skin-picking disorder) should be characterized in ICD-11. The article reviews the historical nosology of the two disorders and the current approaches in DSM-5 and ICD-10. Although data are limited and mixed regarding the optimal relationship between body-focused repetitive behavior disorders and nosological categories, these conditions should be included within the obsessive-compulsive and related disorders category, as this is how most clinicians see these behaviors, and as this may optimize clinical utility. The descriptions of these disorders should largely mirror those in DSM-5, given the evidence from recent field surveys. The recommendations regarding ICD-11 and body-focused repetitive behavior disorders should promote the global identification and treatment of these conditions in primary care settings.

Body dysmorphic disorder and olfactory reference disorder: proposals for ICD-11

The article reviews the historical background and symptoms of body dysmorphic disorder (BDD) and olfactory reference disorder, and describes the proposals of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders related to these categories. This paper examines the possible classification of BDD symptoms in ICD-10. Four different possible diagnoses are found (hypochondriacal disorder, schizotypal disorder, delusional disorder, or other persistent delusional disorder). This has led to significant confusion and lack of clear identification in ICD-10. Olfactory reference disorder can also be classified as a delusional disorder in ICD-10, but there is no diagnosis for non-delusional cases. The Working Group reviewed the classification and diagnostic criteria of BDD in DSM-5, as well as cultural variations of BDD and olfactory reference disorder that include Taijin Kyofusho. The Working Group has proposed the inclusion of both BDD and olfactory reference disorder in ICD-11, and has provided diagnostic guidelines and guidance on differential diagnosis. The Working Group's proposals for ICD-11 related to BDD and olfactory reference disorder are consistent with available global evidence and current understanding of common mechanisms in obsessive-compulsive and related disorders, and resolve considerable confusion inherent in ICD-10. The proposals explicitly recognize cultural factors. They are intended to improve clinical utility related to appropriate identification, treatment, and resource allocation related to these disorders.

Tourette and tic disorders in ICD-11: standing at the diagnostic crossroads

This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections.

Hypochondriasis: considerations for ICD-11

The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors) and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic). This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

Tique e TOC / Tic and OCD

Tique psíquico e TOC (transtorno obsessivo-compulsivo) compõe a "síndrome auto-obsessiva" com duas modalidades: psicomotora e psicoatuante, respectivamente, que aparentam uma auto-hipnose inconsciente. Esquisitices e algumas neuroses nem sempre são bem distintas, e casos de pessoas célebres são apresentados. Confirma-se a falta de lesões anatômicas evidentes nesta síndrome, se bem que a bioquímica e o mapeamento eletrônico das zonas cerebrais possam denotar hiperatividade. "Egrégora" é a condensação de pensamentos, por afinidade, de várias pessoas, ou de fluido-magnetismo de muitos animais afins, e que pode justificar, além da visão, a "contaminação" da "SAO", principalmente dos tiques.

Psychic tic and obsessive compulsive disturbance (OCD) compound the "auto-obsessive syndrome" that has two forms: psychomotor and psychoactive, respectively, and both seem an unconscious auto-hipnosis. Queerness and some neurosis are not always well distinguishable, and a few cases of celebrated persons are presented. The lack of anatomic lesions is confirmed in this syndrome, although the biochemistry and the map of the cerebral zones can denote hyperactivity. "Égregora" is a condensation of thinking, byaffinity, from various persons, or of fluid-magnetism from many related animals, and that can justify, in addition to the vision, the "contamination" of the "AOS", mainly in the tics.

Esquizofrenia con síntomas obsesivos compulsivos o el grupo de las Esquizofrenias Esquizoobsesivas: características clínicas y pronósticas / Schizophrenia with obsessive-compulsive symptoms or the group of schizo-obsessive schizophrenias: clinical characteristics and prognosis

Este trabajo es una revisión bibliográfica crítica de lo publicado a la fecha acerca de la Esquizofrenia Esquizoobsesiva o el grupo de las Esquizofrenias Esquizoobsesivas, en el cual se repasan las características clínicas, neuropsicológicas y pronósticas. Se discute además la replicabilidad de los hallazgos publicados y se propone un esquema nosológico de integración.

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this paper, the rate of occurrence of OCS and OCD in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms, depressive symptoms, cognitive function and age are reviewed. The author proposes to use the term "group of schizo-obsessive disorders" and proposes an integrate classification system.

Escalas de avalicao do transtorno obsessivo-compulsivo em adultos / Rating scales for obsessive compulsive disorder in adults

Ate recentemente escalas de avaliacao validas e confiaveis na avaliacao do transtorno obsessivo-compulsivo (TOC) nao estavam disponiveis. Os instrumentos ate entao utilizados, como o Maudsley Obsessive Complusive Inventory e o Leighton Inventory escala, apresentavam problemas como falta de especificidade, alem de nao serem abrangentes para todas as formas clinicas do quadro de TOC (exemplo colecionismo). A escala de YBOCS e NIMH OC, desenvolvidas a partir do anos 80, procuram corrigir esses problemas tendo demonstrado em diversos estudos controlados serem um instrumento confiavel e valido para aplicacao em ensaios clinicos com TOC

Escalas de avaliacao de transtorno obsessivo-compulsivo na infancia e adolescencia / Rating scales for obsessive compulsive disorder in children and adolescents

Instrumentos especificos de avaliacao de sintomas obsessivo-compulsivos (SOC) em criancas e adolescentes sao escassos, sendo derivados de versoes originalmente desenvolvidas para adultos. Vantagens e limitacoes dos principais instrumentos utilizados para avaliacao dos diversos tipos de SOC e sua intensidade, as versoes para criancas do inventario de obsessoes de Leyton de 44 itens e da escala Yale-Brown de obsessoes e compulsoes, sao discutidas. Por fim, ressalta-se a utilizacao da escala global de obsessoes e compulsoes do NIMH como medida secundaria de gravidade de SOC

Distúrbio obsessivo-compulsivo: características sócio-demográficas e clínicas de 50 pacientes através de seus prontuários - Segunda parte: epidemiologia e características clínicas / Obsessive-compulsive disorder (OCD): the social-demographic and clinical characteristics of 50 patients

O Distúrbio Obsessivo-Compulsivo (DOC) é um dos quadros psiquiátricos de mais difícil compreensão. Os estudos que caracterizam os pacientes adultos com DOC são poucos e esse número é ainda mais limitado quando nos referimos a pacientes com diagnóstico de DOC pelo DSM-III-R. Diante disso, o presente estudo foi realizado com o objetivo de descrever as características sócio-demográficas e clínicas de 50 pacientes. Apesar das limitações do nosso estudo, os resultados foram, em geral, consistentes com os achados prévios da literatura, mostrando uma consciência entre as culturas

Trastorno obsesivo compulsivo

Este niño consultó por múltiples dolores cambiantes y por incomodidad en la vida social del colegio porque tenía dificultades con profesores y compañeros. Se empezó su estudio determinando que padecía de un trastorno de ansiedad, relacionado con su discapacidad para la educación física, la cual no informó y mantuvo en silencio por su competitividad. Entre los antecedentes tuvo una hemorragia cerebral del lactante y como secuela una hemiparesia. Se encontró que padecía una psicopatología estable y crónica que es el trastorno obsesivo-compulsivo desde los cinco años de edad. Respondió con remisión al tratamiento disminuyendo la angustia pero persistiendo los fenómenos obsesivos-compulsivos

Trastornos obsesivo-compulsivo

El trastorno obsesivo-compulsivo (TOC) es una patología frecuente. Como sucede en medicina, sino se explora su presencia no va ha encontrarse. La naturaleza del cuadro es tan intensamente perturbadora y los hallazgos terapéuticos tan prometedores, que indagar por su presencia pueden ser de gran beneficio para quien lo padece. A propósito de la descripción de un caso clínico se revisan los antecedentes hitóricos, epidemiología, criterios de diagnóstico diferencial y tratamiento de este tipo de desórdenes psiquiátricos.