Crossed obsessive-compulsive personality disorder and impaired theory of mind in temporal lobe epilepsy.

People with epilepsy often suffer psychiatric symptoms or exhibit maladaptive personality characteristics which can impact them more than seizures. This case illustrates a selective association of a Theory of Mind dysfunction, including an impaired comparison of reality and others' behavior, with an obsessive-compulsive personality disorder in a patient with left temporal lobe epilepsy and crossed cognitive functions. The patient revealed visual memory deficits and impaired interpretation of other people's behavior, mental rigidity, and a tendency to formulate inflexible judgements. Moreover, she shows impairment in understanding and sharing the emotional states of others in reference to herself (Empathic Quotient); her social relations are limited to her parents. Patients with right temporal lobe epilepsy frequently report persistent and rigid actions and thoughts, and this can have substantial psychological and social consequences for everyday life. We suggest that this could be a case of crossed cognitive functions, in particular ToM, and crossed psychobehavioral functions linked to right-hemisphere damage.

Eventos traumáticos en pacientes con trastorno obsesivocompulsivo: implicaciones etiopatogénicas, nosológicas y terapéuticas / Traumatic events in patients with obsessive-compulsive disorder: Etiopathogenic, nosological, and therapeutic implications

INTRODUCCIÓN. El trastorno obsesivo-compulsivo (TOC) es una patología neuropsiquiátrica en donde se propugna un papel accesorio de los factores de riesgo psicosociales. A pesar de ello, existe un subgrupo de pacientes cuya etiopatogenia, fenomenología, diagnóstico y terapéutica se halla condicionada por la presencia de eventos traumáticos (ET). CASO CLÍNICO. Se expone el caso de una mujer adulta joven que desarrolló una psicopatología compatible con TOC y trastorno por estrés postraumático (TEPT) tras sufrir abusos sexuales durante la adolescencia temprana. Aunque se implementaron tratamientos farmacológicos y psicoterapéuticos convencionales, su curso fue fluctuante, exacerbándose en el contexto de una nueva agresión sexual. CONCLUSIONES. Los ET constituyen un factor de riesgo inespecífico para el TOC, ya sea como variable predisponente o precipitante. Adicionalmente, pueden determinar su patoplastia, siendo el ejemplo más paradigmático la presencia de obsesiones de “polución mental” tras sufrir abusos sexuales. A nivel nosológico, existen evidencias preliminares para postular una entidad clínica nueva (“trastorno obsesivo-compulsivo postraumático”), la cual englobe aquellos sujetos con comorbilidad entre TOC y TEPT tras un ET. En el plano interventivo, los pacientes con obsesiones de “polución mental” precisan estrategias psicoterapéuticas adicionales a las implementadas en sus homólogos de naturaleza más neurobiológica (AU)

INTRODUCTION. Obsessivecompulsive disorder (OCD) is a neuropsychiatric condition where an accessory role of psychosocial risk factors is advocated. However, there is a subgroup of obsessive patients whose etiology, phenomenology, diagnosis and therapeutic features are conditioned by the presence of traumatic events (TE). CLINICAL CASE. A young adult woman developed OCD and posttraumatic stress disorder (PTSD) after suffering sexual abuse during early adolescence. Although psychotropic and psychotherapeutic conventional treatments were implemented, the course was fluctuating, exacerbated in the context of a new sexual assault. CONCLUSIONS. TE constitute a nonspecific risk factor for OCD, either predisposing or precipitating variable. Additionally, they can determine their pathoplasty, the best example being the presence of “mental pollution” obsessions after suffering sexual abuse. There is preliminary evidence to postulate a new clinical entity (“posttraumatic obsessive-compulsive disorder”), which encompasses subjects with OCD and PTSD comorbidity after TE. Obsessions in patients with “mental pollution” require additional psychotherapeutic strategies compared to neurobiological homonyms (AU)

[Inbred disgust propensity in the aspect of the development of pathological personality].

Correlations between inborn (constituional) disgust propensity, dynamics of personality disorders and development of contamination fear in obsessive-compulsive disorder (OCD) were studied in 54 patients with milder forms of mysophobia. Three types of contamination fear characterized by different combinations of disgust propensity and personality traits were singled out. Clinical features of OCD were shown to correspond to premorbid personality while denotative characteristics of OCD were correlated with constituional phenomenon of disgust propensity. The results suggest that disgust propensity is a stable personality dimension contributing to the development of contamination fear.

Etiology of obsessive-compulsive symptoms and obsessive-compulsive personality traits: common genes, mostly different environments.

BACKGROUND: Little is known about the etiologic relationship between obsessive-compulsive (OC) symptoms and traits of OC personality disorder. The traits include perfectionism and rigidity. Some theorists have proposed that OC personality disorder is one of several disorders falling within an OC spectrum. This implies that OC personality traits and symptoms should have etiologic factors in common, and this should not be simply because symptoms and traits are both shaped by nonspecific etiological influences, such as those shaping negative emotionality (neuroticism). METHODS: To investigate these issues, a community sample of 307 pairs of monozygotic and dizygotic adult twins provided scores on six types of OC-related symptoms, two markers of negative emotionality, and a measure of OC personality traits. RESULTS: Analyses indicated that symptoms and traits arose from a combination of genetic and nonshared environmental factors. A matrix of genetic correlations was computed among the variables, which represented the correlations between the genetic components of pairs of variables. A matrix of environmental correlations was similarly computed. Each matrix was factor analyzed. One genetic factor was obtained, indicating that all variables were influenced by a common genetic factor. Three environmental factors were obtained, with salient loadings on either (a) all six OC symptoms, (b) negative emotionality and obsessing, or (c) OC personality traits and ordering. CONCLUSIONS: OC symptoms and traits were etiologically related primarily because they are shaped by the same nonspecific genetic factor that influenced negative emotionality. Implications for the concept of the OC spectrum are discussed.

Abnormal structure of frontostriatal brain systems is associated with aspects of impulsivity and compulsivity in cocaine dependence.

A growing body of preclinical evidence indicates that addiction to cocaine is associated with neuroadaptive changes in frontostriatal brain systems. Human studies in cocaine-dependent individuals have shown alterations in brain structure, but it is less clear how these changes may be related to the clinical phenotype of cocaine dependence characterized by impulsive behaviours and compulsive drug-taking. Here we compared self-report, behavioural and structural magnetic resonance imaging data on a relatively large sample of cocaine-dependent individuals (n = 60) with data on healthy volunteers (n = 60); and we investigated the relationships between grey matter volume variation, duration of cocaine use, and measures of impulsivity and compulsivity in the cocaine-dependent group. Cocaine dependence was associated with an extensive system of abnormally decreased grey matter volume in orbitofrontal, cingulate, insular, temporoparietal and cerebellar cortex, and with a more localized increase in grey matter volume in the basal ganglia. Greater duration of cocaine dependence was correlated with greater grey matter volume reduction in orbitofrontal, cingulate and insular cortex. Greater impairment of attentional control was associated with reduced volume in insular cortex and increased volume of caudate nucleus. Greater compulsivity of drug use was associated with reduced volume in orbitofrontal cortex. Cocaine-dependent individuals had abnormal structure of corticostriatal systems, and variability in the extent of anatomical changes in orbitofrontal, insular and striatal structures was related to individual differences in duration of dependence, inattention and compulsivity of cocaine consumption.

Suppression of obsessive-compulsive symptoms after epilepsy surgery.

We report two male patients with medically intractable epilepsy and obsessive-compulsive disorder (OCD) symptoms. Both patients experienced remission of obsessive-compulsive symptoms after surgical treatment of epilepsy. Although the surgeries targeted different brain regions, the two patients had in common unilateral anterior cingulate cortex ablation. On the basis of these observations, we discuss the pathophysiology of OCD symptoms, emphasizing the role of corticosubcortical pathways in their genesis. Our data suggest that surgeries that affect neural loops associated with obsessive-compulsive symptoms can lead to an improvement of OCD; however, the structures responsible for this effect cannot be conclusively determined.

The sexual addict: a challenge for the primary care provider.

Sexual compulsion is now recognized as a true addictive process that may manifest itself through a wide range of behaviors. Recognition of this disorder in primary care settings may be difficult because of the ego defenses of denial and rationalization that characterize this disorder. Cues in the medical and sexual history as well as behavioral cues may suggest the presence of sexual addiction. The alert primary care provider should play a significant role in the recognition of sexual addiction.

[Porphyria and psychiatric manifestations. Apropos of a case]. / Porphyrie et manifestation psychiatrique. A propos d'un cas.

Porphyrias is a group of metabolic diseases with different clinical aspects. However, the following case suggests that psychodynamic assumptions might be considered to explain a part of the symptomatology.

[Extrapyramidal syndrome after cardiocirculatory incompetence]. / Syndrome extra-pyramidal après incompétence cardio-circulatoire.

A 43 year-old woman suffered a cardio-circulatory arrest with a post-anoxic coma during 24 hours. This was followed by and akinetic-hypertonic syndrome. There was also dystonia of both hands and of right big toe. After and initial mutism, the patient spoke with dysarthria, a monotonous weak voice of poor timbre and low vocal volume. She had in addition mood disturbances with indifference to her condition and compulsive activity. Extrapyramidal syndromes after ischemic anoxia are rare, when compared to their relative frequency after carbon monoxide poisoning. Early CT scan with contrast can identify symmetrical and bilateral lenticulocaudal high densities and MRI is also useful for the diagnosis.

[Comparative effectiveness of the combined use of fenazepam, haloperidol, lithium and metabolic preparations in treating the psychopathologic disorders with obsessions in slowly progressive schizophrenia]. / Sravnitel'naia éffektivnost' kompleksnogo primeneniia fenazepama, galoperidola, litiia i metabolicheskikh preparatov v lechenii psikhopatologicheskikh rasstroistv s naviazchivostiami pri maloprogredientnoi shizofrenii.

The effectiveness of combined phenazepam, lithium, haloperidol and metabolic drugs (alpha-tocopherol, pyridoxal phosphate, nicotinamide) treatment of patients with slow progredient schizophrenia is analyzed. The psychotropic drugs were administered at doses lower below mean therapeutic ones by 1/2 to 1/3. Combined therapy proved effective even in the cases resistant to active antipsychotic treatment. No considerable untoward effects (extrapyramidal disorders) were found. The therapy had a differentiated impact on the obsessive syndrome and other borderline psychopathologic states. These advantages allow one to recommend the therapy for long-term support in schizophrenic patients with benign course of the disease.