Lateralisation abnormalities in obsessive-compulsive disorder: a line bisection study.

OBJECTIVE: Asymmetry in brain structure and function is implicated in the pathogenesis of psychiatric disorders. Although right hemisphere abnormality has been documented in obsessive-compulsive disorder (OCD), cerebral asymmetry is rarely examined. Therefore, in this study, we examined anomalous cerebral asymmetry in OCD patients using the line bisection task. METHODS: A total of 30 patients with OCD and 30 matched healthy controls were examined using a reliable and valid two-hand line bisection (LBS) task. The comparative profiles of LBS scores were analysed using analysis of covariance. RESULTS: Patients with OCD bisected significantly less number of lines to the left and had significant rightward deviation than controls, indicating right hemisphere dysfunction. The correlations observed in this study suggest that those with impaired laterality had more severe illness at baseline. CONCLUSIONS: The findings of this study indicate abnormal cerebral lateralisation and right hemisphere dysfunction in OCD patients.

Identifying elders with neuropsychiatric problems in a clinical setting.

OBJECTIVE: Multiple health problems among the elderly necessitate a comprehensive enquiry to detect problems early and also initiate treatment. We utilized available validated instruments to comprehensively identify older persons with neuro-psychiatric problems including dementia and comorbid medical ailments in the screening desk of the geriatric clinic. MATERIALS AND METHODS: Individuals aged 60 years and above seeking outpatient care at NIMHANS during a 2-year period (October 2008-September 2010) participated. We used General Health Questionnaire (12-item), AD8, questions to identify psychoses and neurological problems and a checklist of common medical ailments. A probable clinical diagnosis was made at the end by medical personnel based on ICD-10. RESULTS: A total of 5,260 individuals were screened and more than one-third (36.7%) were women. About 50% had psychological distress (≥2 on GHQ-12), 20.1% had probable cognitive impairment (≥2 on AD8) and about 17% had symptoms suggestive of psychoses (≥1 on Psychoses screener). More than 65% had either a neurological or neurosurgical problems (≥1 on Neurological screener) and headache was the commonest complaint. At probable diagnosis, more than 50% had a neurological problem and over 30% had psychiatric disorders. Of these the most common psychiatric illnesses were psychotic disorders (22.0%), mood disorders (21.4%) and dementia (14.4%). The most common medical comorbidity included hypertension (36.4%), visual impairment (31.8%) and joint pains (30.5%). Nearly 80% had one or more medical comorbidity in addition to psychiatric illness. The overall set of instruments took about 15-20 minutes. It systematically and comprehensively guided in evaluating the elderly for neuropsychiatric problems and hence was collated to constitute the Instruments for Comprehensive Evaluation of the Elderly (ICE-E). CONCLUSIONS: ICE-E was brief, easy to administer and improved decision making even by personnel from a non-medical background. The instrument aided in systematically detecting neuro-psychiatric problems among the elderly (including psychological distress and cognitive changes) and other medical comorbidities.

Emotional interference in obsessive-compulsive disorder: a neuropsychological study using optimized emotional Stroop test.

Contents related to threat and associated cognitive processes are proposed to be the central characteristic of obsessive-compulsive disorder (OCD) according to 'threat-relatedness hypothesis'. However, evidence for attention bias toward emotionally salient stimuli using the emotional Stroop test is equivocal. This discrepancy could be due to methodological issues, mainly differences in the lexical characters of words. Fifty Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) OCD patients (23 washers and 27 checkers) and 50 age-, handedness- and sex-matched healthy controls were examined with an optimized version of the emotional Stroop test (i.e., with lexically matched words) and color-Stroop test. Twenty-four patients were clinically symptomatic and 26 were remitted. OCD patients had significantly higher attention bias only for negative OCD stimuli as calculated by negatively valenced OCD interference score but not for neutral or non-OCD emotional stimuli. Symptomatic patients had significantly higher bias, but not the remitted patients. There were no significant correlations between other illness-related variables (age at onset, illness duration, and medication dose) and Stroop test performance. Study findings suggest the presence of selective emotional bias for OCD relevant stimuli in these patients and this bias is potentially related to symptomatic status. These observations are in tune with the threat-relatedness hypothesis.