Can the Yale-Brown Obsessive Compulsive Scale be used to assess trichotillomania? A preliminary report.

Given recent conceptualizations of trichotillomania (TM) as a variant of obsessive compulsive disorder (OCD), clinician-rated measures of obsessive compulsive symptoms have been adapted for use in the assessment of TM. Although the reliability and validity of these instruments have been well-documented in patients with OCD, psychometric properties have not been examined systematically in patients with TM. Here, we evaluate the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in a sample of 11 patients with a primary diagnosis of TM. Data addressed the utility of the Y-BOCS for evaluating symptoms of TM, and provided information regarding the proposed overlap between OCD and TM. Initial analyses suggested that interrater reliability, internal consistency, and test-retest reliability for the total score were adequate. However, the range of scores was somewhat restricted, and suggested in particular that interference in daily functioning from TM symptoms is quite low. Both internal consistency and test-retest reliability for the Target Behaviors subscale were inadequate, suggesting that this combined score is inappropriate for use with TM patients. Concurrent validity data using the total score were mixed, although the Y-BOCS did appear to be sensitive to change in TM symptoms over treatment. Implications for the use of the Y-BOCS with TM patients and hypothesized phenomenological differences between TM and OCD are discussed.

The relationship of ovarian steroids, headache activity and menstrual distress: a pilot study with female migraineurs.

Fourteen female volunteers who met diagnostic criteria for migraine headache monitored their headache activity and menstrual distress symptoms for one menstrual cycle. Serum estradiol and progesterone levels, and menstrual distress measures were collected at four points of the menstrual cycle: menstrual, ovulatory, luteal and premenstrual. Results indicated that one patient (7.1%) had menstrual migraine, 10 patients (71.4%) had menstrually-related headache and 3 (21.4%) had migraine headache unrelated to their menstrual cycle: subsequent analyses were conducted with the first two groups. Headache activity for the sample was highest during the premenstrual phase. Headache activity during the luteal and premenstrual phases was related to luteal phase progesterone levels. Menstrual distress was highest during the menstrual and premenstrual phases of the cycle, and these symptoms were related to higher estradiol levels, higher estradiol/progesterone ratios, and increased headache activity. These results indicated that for women with menstrual migraine or menstrually-related migraine, luteal progesterone and estradiol and the estradiol/progesterone ratio may be significantly related to menstrual distress during the premenstrual phase of the cycle. The estradiol/progesterone ratio was not more related to headache or menstrual distress than either of these ovarian hormones alone. Suggestions for future research in this area are offered.

An uncontrolled evaluation of inpatient and outpatient cognitive-behavior therapy for bulimia nervosa.

Inpatient (n = 27) and outpatient (n = 22) cognitive-behavior therapy programs for bulimia nervosa were evaluated in an uncontrolled experiment. Both treatment conditions included exposure with response prevention and cognitive restructuring. Inpatient treatment had a mean length of stay of 5 weeks. Outpatient treatment lasted 15 weeks. Both groups were followed after the end of treatment. The results showed that both programs were effective in reducing problems associated with bulimia nervosa. The inpatient program led to very rapid progress, whereas the outpatient program led to more gradual improvement. There was, however, a trend toward relapse for inpatients. Other psychological disturbances, (e.g., depression) were improved after inpatient, but not outpatient, treatment. These data were discussed in terms of their implications for treatment planning for cases of bulimia nervosa.

Sexual dysfunction in the diabetes female: a review.

Numerous studies have substantiated the presence of sexual dysfunction related neuropathy in the diabetic male. Studies concerning the sexual dysfunction of the diabetic female are few and inconclusive. Controlled research using objective physiological measures is needed to test the hypothesis that the diabetic female is at equal risk of developing neuropathic-related sexual dysfunction.