Obsessive compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy.

BACKGROUND: The present study examined a group of patients who have obsessive compulsive disorder (OCD) and certain comorbid personality disorders to provide data on types of clinical problems that complicate treatment. Data are presented on patient response to a comprehensive behavior therapy. METHOD: Forty-one consecutively referred, adult, nonpsychotic patients with OCD were evaluated independently by their attending psychiatrist and a consulting psychologist for presence of DSM-III-R personality disorder. Thirty-one of these patients, for whom there was 100% agreement on presence or absence of a comorbid personality disorder, participated in a course of comprehensive behavior therapy. OCD patients with comorbid personality disorder (OCD+PD) were compared with a group of OCD patients without comorbid personality disorder (nonPD OCD) on pretreatment and treatment-related variables. RESULTS: There was significantly high interrater reliability between psychiatrist and psychologist on diagnosis of personality disorder (p < .001). OCD+PD patients demonstrated poorer response to prior psychiatric treatments and greater psychosocial and psychiatric impairment at pretreatment than did nonPD OCD patients. The OCD+PD patients demonstrated a moderate response to comprehensive behavior therapy, but below that of nonPD OCD patients. OCD+PD patients were also rated as more difficult to treat, required more psychiatric hospitalizations during treatment, and were more likely to terminate behavior therapy prematurely than were nonPD OCD patients. CONCLUSION: In modest samples of OCD+PD patients (N = 26), and nonPD OCD patients (N = 5), this study found that OCD patients with personality disorder had greater psychopathology, fewer coping and living skills, and were more resistant to psychiatric treatment than the nonPD OCD patients. In addition, when treated with a comprehensive behavior therapy that focuses on other clinical problems in addition to the OCD symptoms, the OCD+PD patients had an enhanced response to treatment.

Formulation-based treatment of a complex phobia.

This case study describes the treatment of a 22-year-old woman presenting with a complex balloon phobia. She was first treated by the empirically proven method of in vivo exposure and then by a course of behavior therapy based upon the case formulation. Although the exposure resulted in some decrease in phobic symptoms, the formulation-based treatment produced significantly greater clinical improvement in the phobia and also impacted other problem areas. Three-year follow-up data are provided.

Laparoscopic-assisted abdominoperineal resection with pull-through (sphincter saving).

The sphincter-saving pull-through operation for midrectal cancer has never been popularized because it has been considered to be against the principles of sound cancer surgery, because of its technical difficulty, and because of the assumption that sphincter mass is involved even in the early stages of cancer. We have observed, however, that even in far advanced midrectal cancer sphincter mass is rarely involved, primarily because of the basic difference in drainage systems (lymphatic and vascular) of the lower rectum and the midrectum. We believe therefore, that the pull-through operation for an early midrectal cancer (6-12 cm) is an acceptable procedure, especially for patients who adamantly refuse colostomy and have no gross findings of involvement of the sphincter mass. This paper presents our technique of laparoscopic assisted abdominoperineal resection with pull-through. The advantages of this technique are as follows: (a) it avoids colostomy and maintains continence of stool; (b) blind dissection is unnecessary and minimal bleeding occurs; (c) postoperative wound pain is lessened and time to recovery shortened; (d) exposure is excellent throughout the procedure.

Hospital-based behavior therapy services.

Behavior therapy has been underutilized in the private psychiatric hospital setting. A recent survey of member hospitals of the National Association of Private Psychiatric Hospitals (NAPPH) found that fewer than 25 percent of those surveyed provided behavior-therapy consultation for inpatients and fewer than 40 percent had a behavior therapist on staff (1). This situation is unfortunate because behavior therapy has made significant contributions to the mental health field, and the approach offers a research-based system of accountability and cost-efficiency. Moreover, behavior therapy is applicable to a wide range of psychiatric problems, and its methods and procedures provide a practical and effective complement or alternative to a patient's pharmacotherapy and insight-oriented psychotherapy. Clearly, behavior therapy has much to offer the private psychiatric hospital, and this contribution is gradually being recognized. This paper describes the development and growth of a behavioral-consultation and treatment program in a private psychiatric hospital.

Case report of carbamazepine treatment of organic brain syndrome with psychotic features.

Impaired cognitive function in the presence of psychotic symptoms is often difficult to diagnose and treat. Carbamazepine, in a longitudinally controlled fashion, improved orientation, memory, and psychotic symptoms in a patient with previously diagnosed bipolar illness and multi-infarct dementia.

Alcohol use and abuse in college students. II. Social/environmental correlates, methodological issues, and implications for intervention.

This review of alcohol use and abuse in college students presents a summary of the relationships between college student alcohol use and social/environment characteristics. A theoretical integration of the findings of this review with those of Part I of this series supports the prior paper's finding of two patterns of college drinking. This review further suggests that the two types may have differential predictive ability with regard to future problem drinking. Methodological issues in this type of research are reviewed and implications for intervention are considered.

Alcohol use and abuse in college students. I. A review of individual and personality correlates.

This review of alcohol use and abuse in college students presents a summary of the relationships between college student alcohol use and demographic and individual characteristics. A summary of the findings suggests two distinct patterns of alcohol use. For some demographic groups, heavy drinking may be most associated with personal problems, while for others it may be more associated with social and environmental factors. Suggestions for future research of this important issue are presented.

Can migraine headaches be modified by operant pain techniques?

Migraine headaches are a common problem with many individuals and are usually treated by drug and/or biofeedback therapies. The following case history discussed the implementation of an operant approach to the modification of migraine headache, assumed to be associated with secondary gain and unresponsive to other treatment procedures. The operant program described below resulted in the elimination of head pain behaviors and a correlated increase in prosocial and well behaviors.

Menstrual cycle symptomatology: the role of social expectancy and experimental demand characteristics.

The purpose of this study was to examine the effects of experimental demand characteristics and social expectancies on the report and experience of presumed menstrual cycle-related moods and symptoms. Participating in the study were 18 healthy women with regular menstrual cycles who were randomly assigned to either a group told that menstrual cycle symptomatology was the focus of the study or a group to which no interest in menstrual cycle symptoms was communicated. Nine males were also included as a control group. Results indicated that women who were informed of the interest in menstrual cycle symptomatology reported significantly more negative psychologic and somatic symptoms at the premenstrual and menstrual phases than did the women and men not so informed. It appears, therefore, that the report of stereotypic menstrual cycle symptomatology is influenced by social expectancy and experimental demand characteristics.