Anemia is a significant public health issue that affects a great number of people in developed and developing countries. The World Health Organization states when the Hb value is/dL in an adult male and/dL in a nonpregnant female, the individual is considered as anemic. Iron deficiency is one of the most common causes of anemia. Inadequate intake of iron, chronic blood loss, and/or a combination of both factors typically lead to iron deficiency anemia. In developed countries, chronic blood loss from gastrointestinal, genitourinary, and gynecological sources are the most common etiologies of iron deficiency anemia. Although there are reports of iron deficiency anemia leading to self-inflicted skin excoriation, there are few cases of chronic blood loss from skin excoriation resulting in severe iron deficiency anemia. We present a 49 year old female with significant past medical history of depression, anxiety and chronic back pain who presented after she was found to have profound anemia with hemoglobin of 4.1g/dl. During interviewing, she denied hematuria, hemoptysis, hematochezia, and had been without menstrual cycles for the past year. Urinalysis was negative for blood as well as two documented negative fecal occult blood tests. Iron studies completed showed severely reduced iron levels. Upon further interviewing, the patient reported a supposedly self-diagnosed keratin disorder. For the past ten years she has been self-treating the keratin disorder by applying topical tretinoin and then wrapping it in saran wrap. She would then peel off areas of skin over multiple areas of her body including all extremities and her face. Multiple pictures of bloody piles of tissue were shown. The patient required 3 units of packed red blood cells and was started on iron supplementation. Gastroenterology was consulted and agreed there was no GI source of her blood loss. Psychiatry further evaluated the patient and diagnosed her with obsessive-compulsive disorder with somatic delusions. The prevalence of anemia among chronic psychiatric patients is more frequent than general population. This coexistence deteriorates the quality of life of the patients, prolongs the psychiatric treatment period, and could even cause an increase in morbidity and mortality. Treatment-related factors, drugs taken, physical conditions, negative lifestyle habits, and nutritional disorders are the reasons for anemia among chronic psychiatric patients. Even though iron deficiency anemia in developed country is most often caused by chronic blood loss from gastrointestinal, genitourinary, and gynecological causes, it is important to evaluate for other factors when none of these are present. Psychiatric causes when warranted from history including somatic delusions from obsessive-compulsive disorder should be considered on the differential when other etiologies are less clear.

Hoarding is characterized by (a) the persistent difficulty discarding personal items; (b) clutter that interferes with living areas; and (c) significant distress or functional impairment. Hoarding symptoms often emerge in childhood and adolescence, yet very few studies on hoarding in this age group exist. Current models of hoarding emphasize impairments in decision-making, yet the literature on decision-making processes in hoarding presents inconsistent findings. Preliminary cognitive studies in adults suggest that hoarding may be associated with deficits in value attribution (the tendency to assign value to personal items). Thus, we propose that the Endowment Effect (EE), in which ownership of an item increases its perceived value, may be informative for the study of hoarding symptoms. This study investigated the EE in youth (children and adolescents) with Obsessive-Compulsive Disorder (OCD) and hoarding symptoms. Given that hoarding involves significant difficulty discarding personal items, we hypothesized that hoarding in youth is associated with a higher EE. Thirty youth participants with a confirmed DSM-5 diagnosis of OCD completed the Endowment Task, a game script of the EE; the Wisconsin Card Sorting Test (WCST), a test of cognitive flexibility; and the Balloon-Analogue Risk Task (BART), a test of risky decision-making. The Children’s Saving Inventory-Parent Version (CSI) was used to measure severity of hoarding symptoms. We divided our sample into thirds based on CSI scores to create a ‘High Hoarding’ group (HH; n=12; mean CSI (S.D.)=30.83 (5.47446)) and a ‘Low Hoarding’ group (LH; n=10; mean CSI (S.D.)=5.00 (3.16228)). The HH group demonstrated a higher average EE than the LH group (average EE, 3.22 and 1.59, respectively). In contrast, no significant between-group differences were found on the WCST and the BART (t=0.901, p=0.378 and t=0.338, p=0.739, respectively). The results of this thesis suggest that psychological ownership plays an important role in the manifestation of hoarding symptoms. Thus, we propose that hoarding might be associated with a specific decision-making deficit related to personal possessions. / Thesis / Master of Science (MSc)

No description available.

The prevalence rate for Obsessive-Compulsive Disorder (OCD) is between 0.8% to 2%. Many of these individuals experience scrupulosity or religious obsessive-compulsive disorder. Although scrupulosity is a salient theme for those who suffer from OCD, there is limited amount of research on scrupulosity across cultures. Research is particularly limited in relation to individuals from Latin American countries, including Mexico. In response to this limitation, the purpose of this study is to determine if there is a significant difference in symptoms of scrupulosity in non-referred samples of college students from the U.S. and Mexico. Results indicated that scrupulosity is a valid and reliable construct in the Mexican sample, not different in structure or intensity relative to an American sample.

No description available.

The overall goal of the present study was to demonstrate that intolerance of uncertainty (IU) is a key feature in both generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). More specifically, I wanted to test certain portions of the conceptual models proposed for the study suggesting that when participants with GAD or OCD are faced with situations that tap into their idiographic concerns, they experience an increase in IU and subsequently either worry or obsessing/ritualizing. College students who met predetermined cutoff scores on study measures were assigned to analogue GAD, OCD, or control groups. The stimuli consisted of scripts that were generated to induce a sense of uncertainty in participants. It was anticipated that, when faced with material related to their idiographic concerns, the experience of uncertainty would lead them to become intolerant of the uncertain thoughts and feelings, thereby leading to increased worry, obsessing and/or ritualizing, and/or negative affect. Each script was 349 words in length and described one of 20 GAD and OCD themes commonly occurring in the literature. Participants' levels of worry, obsessing and/or ritualizing, negative affect, and IU were assessed before and after the scripts were administered. The study design included three levels of group (GAD, OCD, Control) and two levels of script (matched vs. mismatched). Half the participants in analogue GAD and OCD groups were administered scripts associated with their specific concerns (i.e., matched), and the other half were administered scripts that were mismatched. Half of the Control group was administered scripts that were assigned to the GAD matched group and the other half received scripts assigned to the OCD matched group. The study examined several different hypotheses. IU and negative affect increased from pretest to posttest assessment. However, worry and obsessing and/or ritualizing did not. Posttest IU significantly predicted worry and obsessing and/or ritualizing. However, there were no significant differences between the three groups, nor were there any significant differences as a function of matching vs. mismatching of idiographic concerns. The present study did not find any support for a hypothesized mediational role of IU in the relationship between type of script and worry, obsessing and/or ritualizing, or negative affect. Moreover, there were no significant differences between the GAD, OCD, and Control groups in worry, obsessing and/or ritualizing, negative affect, or IU. These findings did not provide support for the proposed mixed moderation-mediation model. IU was associated with worry, OC, and negative affect, but it may not be the motivational mechanism behind changes in those constructs. / Psychology

Objectives: The first objective of this research was to examine whether symptom dimensions in obsessive-compulsive disorder (OCD) are associated with unique neuropsychological performance profiles. The second objective of this research was to further understand the strengths and weaknesses of two models of symptom dimensions in OCD from a quantitative perspective—conventional subtyping by overt symptom, and the core dimensions model. Finally, the third objective of this research was to investigate the efficacy and treatment acceptability of a cognitive remediation program targeting neurocognitive deficits associated with OCD. Methods: Study 1 reviewed critically studies describing the assessment of differences in neuropsychological functioning between symptom dimensions of OCD, the results of which informed succeeding studies examining: i) the characterization of symptom dimensions in OCD and; ii) the remediation of neuropsychological domains commonly affected in OCD. Accordingly, study 2 compared the suitability of two common statistical approaches, factor analysis and cluster analysis, commonly used in the existing literature to define symptom dimensions based on responses collected from the industry-standard symptom questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), in characterizing symptom dimensions in OCD. Neuropsychological task data were then used to examine the validity of an alternative model of symptom dimensions in OCD (Study 3). Finally, we conducted a feasibility study (Study 4) examining the use of an established cognitive remediation protocol, Goal Management Training (GMT), to target the deficits in neurocognitive function identified in the preceding studies. Results: Much of the existing literature on neuropsychological task performance differences between symptom dimensions of OCD is limited by methodological issues, primarily those concerning methods for defining symptom dimensions. Here, a comparison of the two most common methods for defining dimensions revealed that neither cluster analysis nor factor analysis produced conceptually meaningful subgroups. By exemplifying differences in neuropsychological task performance between those with harm avoidance and those with incompleteness symptoms, however, concrete evidence was provided to support the core dimensions model of OCD. Pilot data point towards the feasibility and efficacy of GMT as a cognitive remediation program for OCD. Conclusions: Pursuing the definition of meaningful, distinct symptom dimensions of OCD is not recommended with the combination of current statistical practices and symptom measures. The early evidence presented here shows promise for the validity of the core dimensions model. Preliminary evidence suggests that the neuropsychological impairments observed in this population, although subtle, may be effectively addressed using Goal Management Training. / Thesis / Doctor of Philosophy (PhD)

The need for effective treatments and treatment accessibility for obsessive-compulsive disorder (OCD) in childhood is evident given that as many as 50% of individuals with OCD report symptom onset before age 15. Despite the growing evidence supporting the efficacy of Exposure and Response Prevention (ERP) for youth with OCD, children seeking services for their OCD symptoms often do not receive ERP. Intensive treatment programs may be a feasible treatment option for children and their families who do not have access to ERP treatment and/or live in an area where therapists trained in ERP are limited. Preliminary studies have shown initial promise for 5-day intensive treatment programs, which have collapsed one-month intensive programs into an even shorter duration. This study serves as the first controlled, one-week intensive intervention for pediatric OCD. To evaluate the efficacy, feasibility, and acceptability of this brief, one-week intensive ERP program for pediatric OCD, nine children with OCD were randomized to a one-week, two-week, or three-week baseline period in a single-case, non-concurrent multiple baseline experimental design. Although symptoms were relatively stable during the baseline period, most participants showed reductions in OCD symptoms with the implementation of treatment. Treatment gains were maintained at a 3-month follow-up assessment; 67% of children were considered treatment responders. Children and families perceived the program to be acceptable, feasible, and beneficial. This study provides support for the efficacy and feasibility of a 5-day intensive treatment program for pediatric OCD. / Ph. D.

Thesis (PhD)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Investigations into the neurobiology of obsessive-compulsive disorder (OCD) have provided useful insights into this prevalent and disabling disorder in recent decades. Encouraging advances have also been made in the pharmacological treatment of OCD. This has improved the quality of life for many who typically endure chronic unremitting symptoms. Despite the widespread use of first-line agents selective for the serotonergic system in OCD, relatively little is known about the neurobiology of treatment response, the specific components of the serotonin system involved in symptom modulation, and the overlapping and distinct brain regions impacted by alternative treatment options. Despite the advance that selective serotonin re-uptake inhibitors have been, a significant proportion of patients still fail to respond adequately to these agents, and alternative pharmacological interventions are required. The use of dopamine antagonists, a strategy which until recently has had only limited supporting data, presents one such alternative. Little however, is known about which subsets of patients are most likely to respond to these agents. In this thesis, I will present a series of six studies that use pharmacological treatments and single photon emission computed tomography (SPECT) to make contributions to three primary areas in OCD namely; neurobiology, treatment and the intersection of the two. First, I address OCD neurobiology by examining the impact of OCD on resting brain function. I then examine the effects of pharmacological challenge of the serotonin 1B receptor using sumatriptan on regional cerebral blood flow (rCBF) and clinical symptomatology. Second, I examine the intersection of neurobiology and treatment as I explore the changes in rCBF in response to treatment with inositol, a precursor of the phosphoinositol second messenger system. I then examine the distinct and overlapping effects on rCBF of treatment for 12 weeks with the selective serotonin re-uptake inhibitor (SSRI) citalopram across anxiety disorders. Third, I address treatment of OCD by examining the efficacy of controlled augmentation of serotonin re-uptake inhibitors with quetiapine, a dopamine antagonist, in treatment refractory OCD. I then combine this data with a second similar dataset to derive a predictive model for treatment outcome with quetiapine augmentation of SRIs. I demonstrate that rCBF in OCD differs significantly from normal controls, is correlated with severity in frontal brain regions, and remains an important line of investigation for OCD pathophysiology that has yet to fully delineated. Pharmacological challenge of the 5HT1B autoreceptor with the selective agonist sumatriptan results in heterogeneous behavioural and regional brain perfusion changes in OCD. Attenuation of pre-frontal perfusion following 5HT1B agonist administration is in line with the effects of SRIs. This work suggests that direct or indirect effects of SRIs on the 5HT1B receptor may be involved in mediating a clinical response in OCD. In the section exploring the intersection of neurobiology and treatment, I show that changes in rCBF partially parallel treatment response to SSRIs across a range of anxiety disorders. These data suggest that a degree of overlap exists in the neurobiology of treatment response or indeed core neurobiology across different anxiety disorders. I then show that effective treatment with inositol in OCD results in rCBF changes that are partially in line with the effects of SRIs on brain perfusion. These data support suggestions that second messengers may form part of the common pathway of action for effective anti-obsessional compounds. In the study in which we augmented SRIs with quetiapine, no advantage over placebo was found. This data has, however, recently been combined with similar data in meta-analyses and demonstrated a benefit over placebo. Finally, we found that patients who have failed fewer SRI trials, have more severe illness, and clinical dimensions with a putative dopaminergic underpinning, may derive preferential benefit from serotonin/dopamine antagonist augmentation of SRIs. Through this series of clinical treatment and functional brain imaging studies in OCD, I have contributed to the neurobiological understanding of OCD, and its treatment in refractory populations. In addition I have explored the intersection of these two domains using novel as well as conventional treatment across other anxiety disorders. Treatment and pharmacological challenges used, either directly or indirectly impacted the monoamine systems serotonin and dopamine and advanced our understanding of their involvement in symptom generation. Future work should focus on the functional intersection of brain function, treatment response, and functional genetic polymorphisms within the monoamine systems of the brain. / AFRIKAANSE OPSOMMING: Ondersoek na die neurobiologie van obsessief-kompulsiewe steuring (OKS) het in die afgelope dekades sinvolle bydraes gelewer tot die begrip van hierdie algemene en verminkende steuring. Bemoedigende vordering is ook in die farmakologiese behandeling van OKS gemaak. Dit het tot ’n verbetering in kwalitiet van lewe van meeste pasiënte gelei wat normaalweg kronies en onophoudelike simptome moet verduur. Ten spyte van die uiteenlopende gebruik van eerste-linie behandeling wat spesifiek inwerk op die serotonien sisteem in OKS, is relatief min bekend oor die neurobiologie van respons op behandeling. So ook is min bekend oor; eerstens die spesifieke komponente van die serotonien sisteem wat betrokke is by simptoom modulasie, en tweedens die gedeeltelik samevallende en afsonderlike brein streke wat deur alternatiewe farmakologiese behandelings beïnvloed word. Ten spyte van die vooruitgang wat die selektiewe serotonien heropname inhibeerders tot gevolg gehad het, is daar nog altyd ‘n betekenisvolle proporsie van pasiënte wat nie voldoende respondeer op hierdie behandelings opsie nie. Dus word alternatiewe opsies benodig. Een so ‘n opsie is die klas dopamien reseptor blokkeerders wat tot onlangs min ondersteunende data gehad het. So ook, is min bekend oor die subgroepe van pasiënte wat die meeste voordeel uit hierdie alternatief sal trek. In hierdie proefskrif sal ek ‘n reeks van ses studies wat farmakologiese middels en enkel foton emissie rekenaar tomografie (EFERT) gebruik om ‘n bydra tot kennis in drie primêre areas van OKS te maak. By name; neurobiologie, behandeling, en die kruispunt van die twee. Eerstens spreek ek neurobiologie aan deur middel van ’n studie wat rustende brein bloed vloei (rBBV) in OKS ondersoek. Hierna ondersoek ek veranderings op rBBV en simptome na eenmalige toediening van ‘n serotonien 1B reseptor agonis, sumatriptan. Tweedens ondersoek ek die kruispunt van neurobiologie en behandeling deur die effek van behandeling met inositol, ‘n voorloper van die fosfoinositol tweedeboodskapper sisteem, op rBBV. Ek ondersoek dan die rBBV patroon van veranderinge in brein streke wat deur twaalf weke van behandeling met die selektiewe serotonien heropname inhibeerder citalopram in verskeie angversteurings bewerkstellig word. Laastens, spreek ek behandeling van OKS aan deur middel van ‘n gekontroleerde studie wat ondersoek instel na die effektiwiteit van die byvoeging van quetiapien, ‘n dopamien reseptor antagonis, tot serotonien heropname inhibeerders in behandelingsweerstandige OKS. Ek kombineer dan hierdie data met ’n soortgelyke datastel om ‘n model af te lei wat kliniese uitkoms vir hierdie behandelings opsie voorspel. Ek het gedemonstreer dat rBBV in OKS betekenisvol verskil van gesonde vergelykbare kontroles. Hierdie verskille het gekorreleer met ernstigheid van OKS in frontale brein streke. Dus bly hierdie tipe studies ’n belangrike rigting van ondersoek in OKS patofisiologie wat tot op hede nie tenvolle uitgewerk is nie. Eenmalige toediening van sumatriptan, het heterogene gedrags en rBBV veranderings in OKS tot gevolg gehad. Pre-frontale verhogings in rBBV voor behandeling is met 5HT1B sumatriptan toediening verminder, ’n effek wat in lyn staan met die effek van selektiewe serotonien heropname inhibeerders. Hierdie werk stel voor dat direkte of indirekte effekte van selektiewe serotonien heropname inhibeerders op die 5HT1B reseptore betrokke mag wees by die meganisme van behandelingsrespons in OKS. In die afdeling waarin ek die kruispunt van neurobiologie en behandeling ondersoek, demonstreer ek dat rBBV veranderings gedeeltelik oorvleuel met dié wat deur selektiewe serotonien heropname inhibeerders veroorsaak word in verskeie angsversteurings. Hierdie data stel voor dat oorvleueling in die neurbiologie van beide behandelingsrespons en kern neurobiologie van hierdie angversteurings ’n waarskynlikheid is. Ek wys ook dat effektiewe behandeling met inositol in OKS ook veranderings in rBBV bewerkstellig wat gedeeltelik in lyn staan met dié van die selektiewe serotonien heropname inhibeerders. Hierdie data ondersteun dus hipoteses van ‘n gemeenskaplike meganisme, wat tweede boodskapper sisteme insluit, wat in die behandelings respons van effektiewe anti-obsessionale middels betrokke is. Die finale deel van hierdie proefskrif handel oor behandeling van OKS. Ten spyte van die onvermoë om ‘n verskil tussen quetiapien en plasebo te demonstreer, het ons onlangs met hierdie data in ‘n reeks meta-analises wel ‘n voordeel vir hierdie intervensie getoon. Ten slote, het ons gevind dat (1) pasiënte wat minder kursusse selektiewe serotonien heropname inhibeerders gefaal het; (2) voor behandeling ‘n erger vorm van OKS gehad het, en (3) ook voordoen met simptoom dimensies wat oënskynlik ‘n dopaminerge basis het, die grootste waarskynlikheid toon om met quetiapien byvoeging tot selektiewe serotonien heropname inhibeerders te respondeer. Met hierdie reeks behandelings en funksionele breinbeeldings ondersoeke, lewer ek ‘n bydra tot die begrip van OKS. Spesifiek dra ek by tot die begrip van die neurobiologie, hantering van behandelingsweerstandige OKS asook die kruispunt van die twee. Farmakologiese middels wat ons óf eenmalig óf vir ‘n volle behandelingskursus toegedien het, het direkte of indirekte uitwerkings op die serotonien and dopamien sisteme gehad, en dus dra hierdie werk ook by tot kennis oor dié se betrokkenheid al dan nie in simptoom modulasie in OKS. Toekomstige werk in die area sal in die breë fokus op die kruispunt van breinfunksie, behandelingsrespons en funksionele genetiese polimorfismes van die monoamien sisteem.

Dissertation (PhD)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts (obsessions) and repetiti ve mental acts or behaviours (compulsions) . For many years, it was considered a rather uncommon condition, caused by unconscious conflict, and somewhat resistant to treatment. In recent decades, however, it has emerged that OCD is a highly prevalent disorder, mediated by particular neuroanatomical circuits (e.g. striatal pathways) and neurochemical systems (e.g. the serotonin system), and responsive to treatment with serotonin reuptake inhibitors (SRIs) . Nevertheless, many questions remain; about the specificity of neuroanatomical findings to OCD, about the role of the multiple serotonin (5-HT) receptor subtypes (e.g. 5-HT10)' and about the appropriate pharmacotherapy for patients resistent to SRI treatment? In a series of studies, 1) the neuroanatomy of OCD was assessed by means of magnetic resonance imaging and neuropsychological testing, 2) the neurochemistry of OCD was assessed by means of functional brain imaging after administration of a 5-HT10 agonist, and 3) the pharmacotherapy of OCD was explored in a series of treatment-refractory OCD and OCD spectrum disorder patients using SRI augmentation with a dopamine blocker. Although no significant difference was found in the volume of the caudate in women with OCD and controls, there was a significant correlation between caudate volume and neuropsychological dysfunction in patients, consistent with evidence of striatal involvement in OCD. Functional imaging demonstrated behavioural heterogeneity, but brain-behaviour correlations were positive, consistent with preclinical evidence of a role for the 5-HTlD receptor in the mediation of OCD. Finally, preliminary treatment findings with dopamine blocker augmentation of a SRI were promising, consistent with preclinical understandings of the interactions between the dopamine and serotonin systems. Although oeD is a complex disorder, a number of future research avenues hold promise for providing a thorough delineation of its pathogenesis. / AFRIKAANSE OPSOMMING: Obsessief-kompulsiewe steuring (OKS) word gekenmerk deur indringende gedagtes (obsessies) en herhalende gedagtes of gedrag (kompulsies). Vir baie jare is dit beskou as 'n redelik seldsame toestand wat veroorsaak word deur onbewustelike konflik, en wat in 'n mate teen behandeling weerstandig is. Meer onlangs het dit egter na vore getree as 'n toestand wat baie dikwels voorkom, wat deur spesifieke neuroanatomiese siklusse (bv. striatale bane) en neurochemiese sisteme (bv. die serotonien-sisteem) teweeg gebring word, en wat op behandeling met serotonien heropname inhibeerders (SHIs) reageer. Nogtans is daar steeds baie vrae; oor die spesifisiteit van neuroanatomiese bevindinge vir OKS, oor die rol van die veelvuldige serotonien (5-HT) reseptor subtipes (bv. 5- HT1D), en oor die toepaslike farmakoterapie vir pasiënte wat weerstandig is vir SHI behandeling. In' n reeks van navorsingstudies, is 1.) die neuroanatomie van OKS deur middel van magnetiese resonans beelding en neurosielkundige toetse ondersoek, 2. ) die neurochemie van OKS deur middel van funksionele breinbeelding na toediening van 'n 5-HT1D agonis bepaal, en 3.) die farmakoterapie van OKS in 'n reeks van behandelingsweerstandige OKS en OKS-spektrum steuring pasiënte - waar gebruik gemaak is van SHI aanvulling met 'n dopamien-blokker - ondersoek. Alhoewel daar geen beduidende verskil in die volume van die caudata in vroue met OKS en kontroles gevind is nie, was daar 'n beduidende korrelasie tussen die caudata volume en neurosielkundige wanfunksionering in pasiënte, in ooreenstemming met striatale betrokkenheid in OKS. Funksionele beelding het positief, in demonstreer, maar ooreenstemming met brein-gedrag pre-kliniese heterogeneïteit korrelasies was in gedrag bewyse vir 'n rol vir die 5-HT1D reseptor in die bemiddeling van OKS. Ten laaste, voorlopige behandelingsbevindinge oor dopamienblokker aanvulling van 'n SHI is belowend, in ooreenstemming met v