The aim of the present study was to examine the prevalence of eating disorder symptoms in patients with obsessive-compulsive disorder (OCD). Additional aims were to assess whether having comorbid eating disorders could influence the treatment outcome for OCD, and if symptoms of eating disorders were reduced after treatment for OCD. The sample consisted of 93 patients with a primary diagnosis of OCD. The patients underwent assessment with the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory, and Eating Disorder Inventory both prior to and after treatment. First, the analysis showed that the sample of OCD patients had higher prevalence of eating disorders than a population of physically active students. Moreover, the women in the sample had significantly more symptoms of eating disorders than the men. Correlational analysis showed that eating disorders did not affect the treatment outcome for OCD; the patients generally had a significant improvement of OCD symptoms. On the other hand, symptoms of eating disorders were not significantly reduced after treatment. Summarized, this study concludes that there is a high prevalence of eating disorder symptoms among patients with OCD. It further shows that comorbid eating disorders does not hinder the effect of treatment for OCD. However, as the symptoms of eating disorders persist after such treatment, an implication of the present study is that these symptoms may need closer attention.

Two decades of research on obsessive-compulsive disorder (OCD) has helped us develop a strong understanding of why obsessions are often followed by the performance of a compulsive act. What we have understood less well is why that act is repeated, even though it often results in an increase, rather than decrease, in discomfort. Emergent research on compulsive checking implicates a number of beliefs—including perceived responsibility, perceived harm, need for certainty, and beliefs about one’s memory— that may influence behavioural parameters (e.g., check duration) of checking episodes. Furthermore, it has also been suggested that the act of compulsive checking may recur in part because of a self-perpetuating mechanism in which checking has paradoxical effects on these beliefs. Finally, some researchers have proposed that attentional focus (e.g., focus on threat) during checking may be related these paradoxical outcomes. At present, these ideas are mostly speculative, in part because there have been so few detailed studies of the actual phenomenology of compulsive rituals. The purpose of the present research was to gather phenomenological data on compulsions as performed by a clinical sample under ecologically valid conditions. Study 1 extended emergent research suggesting that compulsions may persist because the act of checking has a number of ironic effects on beliefs. Individuals with a diagnosis of obsessive-compulsive disorder (OCD) and anxious controls (AC) completed a naturalistic stove task in our laboratory kitchen. Participants were fitted with portable eyetracking equipment and left on their own to boil a kettle, turn the stove off, and check to ensure that the stove is safe before leaving the kitchen. Surrounding the stove were household items that are “threatening” (e.g., matches) or “non-threatening” (e.g., mugs). Ratings of mood, responsibility, harm (severity, probability) and memory confidence were taken pre- and post-task and a portable eyetracker was used to monitor attention throughout the stove task. We examined the relations between behavioural indices (check duration, attentional focus) and pre- and post-task ratings of responsibility, perceived harm, mood, and memory confidence. Although we found that OCD (as compared to AC) participants took significantly longer to leave the kitchen after using the stove, we found no evidence that stronger pre-task ratings of responsibility, perceived harm, or memory confidence were associated with longer check duration. However, we found some evidence of an ironic effect whereby greater check duration was associated with greater perceived harm and decreased certainty about having properly ensured the stove was off. Of note, these ironic effects were not unique to participants with OCD, but were also observed in the AC group. With respect to the eyetracking data, we found minimal evidence linking threat fixations and beliefs in participants with OCD. In contrast, a number of interesting relations emerged in the eyetracking data of our anxious control participants. For AC participants, a greater proportion of time spent looking at the stove was associated with greater post-task sense of responsibility for preventing harm, greater post-task harm estimates, decreased certainty (about having ensured the stove was off), and decreased confidence in memory for the task. In Study 2, individuals with a diagnosis of OCD completed a structured diary of their compulsions as they occurred naturally over a three˗day period. Participants recorded the circumstances leading to each compulsion and reported on the acts involved in the compulsive ritual, the duration and repetitiveness of the ritual, and the criteria used to determine completeness of the ritual. The findings of this study suggest that unsuccessful compulsions (i.e., compulsions in which certainty was not achieved) were associated with a longer duration (trend), more repetitions, a higher standard of evidence, and offered little in the way of distress reduction. These findings are discussed within the theoretical context of cognitive˗behavioural model of obsessive˗compulsive disorder and clinical implications are offered.

myo-lnositol (mIns), a natural component of the human diet and essential precursor of several signalling pathways, including that of G protein-coupled receptors, has also been shown to be effective in the treatment of psychiatric disorders such as depression, obsessive compulsive disorder and panic disorder. Most likely since mlns is a simple isomer of glucose, no serious side effects have been reported with its use, even at high oral doses of mlns. Previous studies suggest that the therapeutic action of mlns may include reduced serotonin 5HTzA and muscarinic acetylcholine receptor function. An important signal transduction system that may possibly be involved in the mechanism of action of antidepressants is phosphoinositide (PI) turnover. In this signalling system PI-phospholipase C (PLCpl), that is implicated in the in the mechanism of action of antidepressants and anxiolytics, is activated. The mechanism of action of mlns, however, still remains elusive and needs further investigation. In this study a possible modulatory role of 24-hour pre-treatment of human neuroblastoma cell line (SH-SY5Y) with mlns on mRNA levels and protein expression of phospholipase C-p1 (PLCP1) and glycogen synthase kinase 3P (GSK3p) was investigated. The effects of mlns were also compared to that of other prototype antidepressants, such as fluoxetine (a selective serotonin reuptake inhibitor), imipramine (a tricyclic antidepressant), lithium and another drug with potential antidepressant effects, sildenafil (phosphodiesterase 5-type (PDE5) inhibitor). Real-time reverse transcription Polymerase Chain Reaction (RTPCR) was performed in order to investigate the mRNA levels, while protein expression in membranes and the cytosol fraction of cells were quantified with Western blots. The expression of PLCPl was decreased after pre-treatments with imipramine or myoinositol in combination with fluoxetine. In addition, sildenafil alone or in combination with myo-inositol, also decreased the expression of membrane-bound PLCp1. However, a 24- hour pre-treatment with lithium did not alter PLCPl expression significantly. Determined mRNA levels for the expression of PLCPl were consistent in these findings, except for the inhibition of the mRNA for the expression of PLCPl also after lithium treatment. The reduced PLCpl mRNA levels after lithium pre-treatment may suggest the involvement of posttranscriptional modification (or delayed translational effects) of PLCpl after lithium treatment. The data from the current study suggest that antidepressant action may include downregulation of PLCPl expression and that modulators of the nitric oxidecGMP pathway (e.g. sildenafil as a PDE5 inhibitor) may exhibit similar properties. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

[Truncated abstract] Auditory hallucinations are some of the most distressing and disabling symptoms of schizophrenia. However very little is known about the exact processes responsible for auditory hallucinations. The aim of this thesis is to provide a new perspective on the nature of the cognitive deficits underlying auditory hallucinations in schizophrenia. As a preliminary study to the investigation of auditory hallucinations in schizophrenia, a factor analysis of a measure of hallucinatory predisposition, the Launay- Slade Hallucination Scale-Revised (Bentall & Slade, 1985), was carried out on data from a large sample of undergraduate students (N = 562). An overlap in characteristics between hallucinatory-like experiences in normal individuals and auditory hallucinations in schizophrenia should draw attention to factors that are important to the hallucinatory experience in general. One of the findings from this study was that intrusiveness is a commonly reported characteristic of hallucinatory-like experiences in normal individuals. Intrusiveness is also one of the defining features of auditory hallucinations in schizophrenia. Since the process of inhibition is essential for suppressing unwanted thoughts, the first set of two studies using patients with schizophrenia (N = 43) investigated the presence of an (intentional) inhibition failure in auditory hallucinations using the Hayling Sentence Completion Test (HSCT; Burgess & Shallice, 1996) and the Inhibition of Currently Irrelevant Memories Task (ICIM; Schnider & Ptak, 1999). It was found that auditory hallucinations were linked to a deficit in intentional inhibition as measured by these tasks. The process of inhibition was further investigated using the Affective Shifting task, but auditory hallucinations were not associated with a deficit on this task. Possible differences in the inhibitory demands of the HSCT, ICIM and Affective Shifting tasks are discussed.

Thesis (M.A.)--University of Toronto, 2005.

Thesis (M.A.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 47-48).

Thesis (M.A.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 47-48). Also available in print.

Background: OCD is a debilitating mental health condition. Poor access to evidence-based psychological treatment has motivated the implementation of low intensity interventions in UK mental health services for OCD. Around one half of those accessing care remain clinically unwell. Service users, providers, and treatment decision-makers could benefit from understanding users' views of low intensity interventions and knowing which users are more likely to benefit from diverse low intensity approaches in order to match individuals with treatments of known efficacy. Aim and objectives: The primary aim of this research was to determine user characteristics associated with engagement and outcome in low intensity interventions for OCD. The objectives of the study were: 1) to review the published literature on predictors of psychological therapy outcome in OCD, 2) to explore individual variation in intervention acceptability, uptake, and engagement, and 3) to identify user characteristics, which moderate intervention engagement and outcome. Methods: This mixed methods thesis was conducted in three parts. Firstly, a systematic review of published trial data was conducted to identify predictors of therapy outcome. Secondly, primary data were collected as part of a large effectiveness trial: 1) qualitative interviews with 36 trial participants, randomised to one of two low intensity interventions (guided self-help; cCBT); and 2) quantitative trial assessments conducted at baseline and at 3-months follow-up. Data from the systematic review and the qualitative study were used to identify possible moderators of outcome. Confirmatory analyses were then conducted on these variables, using data from the quantitative assessments. Results: Objective 1: The systematic review identified 43 studies, examining predictors of outcome. Robust effects were rare and the applied utility of these findings is limited by methodological weaknesses. Objective 2: Six themes were identified from the qualitative study, three relate to the general acceptability of low intensity interventions: 1) Predisposing concepts of high quality psychological therapies, 2) Engaging with low intensity interventions, and 3) The perceived value of therapist support. Three are specific to individuals with OCD: 4) Positive aspects of OCD, 5) Recognition and accommodation of OCD users' needs, and 6) OCD disclosure. Objective 3: User attachment style, expressed emotion, OCD symptom subtype, and prior help seeking for OCD were examined in confirmatory interaction tests. Symmetry/order/exactness symptoms were associated with a greater likelihood of engagement in guided self-help than cCBT. Contamination/washing symptoms were associated with improved outcome in guided self-help over cCBT. Conclusions: This study has made an original contribution through using a mixed methods design to identify individual differences in response to low intensity interventions in OCD. There is significant individual variation in the acceptability of, and engagement with, low-intensity interventions for OCD, linked to the mode and intensity of therapist support preferable to the individual user. However, few moderators could be identified. Future research should focus on maximising the reliability of stratified medicine research to allow related findings to inform clinical decision-making.

No description available.

O transtorno obsessivo-compulsivo (TOC) é uma doença crônica que causa prejuízos para o paciente, bem como para a maioria dos familiares. Frequentemente interfere no funcionamento familiar, pois muitas vezes os membros da família modificam suas rotinas devido aos sintomas do paciente. Esses comportamentos observados nos familiares são chamados de acomodação familiar (AF). Os comportamentos de AF podem reforçar os sintomas do paciente e, consequentemente, contribuir para a manutenção da doença. A AF tem sido correlacionada com maior gravidade dos sintomas obsessivo-compulsivos e está associada a resposta menos satisfatória a tratamento, por exemplo, terapia cognitivo-comportamental. No entanto, estudos que avaliam o impacto de intervenções para o TOC na AF em curto e longo prazos ainda são escassos. Esta tese é composta de três artigos com os seguintes objetivos: 1) analisar as propriedades psicométricas da versão adaptada para o Brasil da Escala de Acomodação Familiar para o TOC – versão pontuada pelo entrevistador (FAS-IR); 2) verificar o impacto da terapia cognitivo-comportamental em grupo (TCCG), com duas sessões destinadas a família, na AF e identificar as variáveis sociodemográficas e clínicas preditoras de redução da AF após as 12 sessões de tratamento (curto prazo); e 3) avaliar o impacto da TCCG na AF 3 anos após o término do tratamento e verificar a correlação entre a gravidade dos sintomas do TOC e AF em longo prazo. Trata-se de um estudo com pacientes com diagnóstico de TOC e seus respectivos familiares. Para a avaliação dos sintomas obsessivo-compulsivos, foram aplicados os seguintes instrumentos: Inventário de Obsessões e Compulsões – Revisado (OCI-R), Escala Obsessivo-Compulsivo de Yale-Brown (Y-BOCS) e Escala de Impressão Clínica Global (CGI). Também foram aplicados os Inventários de Beck para Depressão (BDI) e Ansiedade (BAI), além da Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, Versão Clínica (SCID-I), para a verificação de possíveis comorbidades. Para a avaliação da AF, a FAS-IR foi aplicada nos familiares. Após o estudo de validação da FAS-IR, foi realizado um ensaio clínico randomizado com alocação aleatória dos pacientes para o grupo intervenção (12 sessões de TCCG, sendo duas com a participação dos familiares) ou para o grupo controle (lista de espera). Por fim, foi realizado um estudo de seguimento naturalístico 3 anos após o término da TCCG. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. Observou-se que a versão da FAS-IR em português brasileiro apresenta propriedades psicométricas satisfatórias, reforçando que este instrumento se mostra confiável para avaliar a participação e modificação da rotina dos familiares em decorrência dos sintomas dos pacientes. No que se refere ao tratamento realizado, o ensaio clínico randomizado compreendeu uma amostra de 98 pares de pacientes com TOC e seus respectivos familiares, sendo que 52 (53.1%) foram randomicamente alocados para o grupo intervenção e 46 (46.9%) para a lista de espera. Houve melhora significativa de todos os sintomas de TOC e também da AF após TCCG no grupo intervenção quando comparado ao grupo controle (p < 0,001). As seguintes variáveis foram preditoras de redução da AF após a análise multivariada: características dos pacientes – ausência de comorbidade com transtorno unipolar (β = 0,338; p = 0,014), pontuação mais baixa de obsessão (β = 0,244; p = 0,045) e maior nível de escolaridade (β = -0,351; p = 0,006); e características dos familiares – pontuação mais elevada de sintomas de colecionismo (β = -0,461; p = 0,001). O modelo explicou 47,2% da variação na AF após a TCCG. No estudo de seguimento, foi observado que os resultados de redução na AF obtidos ao final da TCCG se mantiveram ao longo do tempo (3 anos). Os resultados do presente estudo somam-se às evidências atuais, não somente confirmando que a TCCG é efetiva na redução dos sintomas do TOC, mas também por mostrar que a TCCG com uma breve participação dos familiares com foco na AF contribui para reduzir os níveis de envolvimento da família nos sintomas do paciente, e que esses resultados se mantêm ao longo do tempo. Algumas características dos pacientes e dos familiares foram preditoras da redução da AF, um resultado que pode contribuir para a qualificação dos protocolos de TCCG atualmente empregados. Este é o primeiro estudo a avaliar o impacto da TCCG (com a participação da família em duas sessões) na AF em curto e longo prazos. A partir dos resultados, pode-se concluir que é importante avaliar a AF permanentemente, assim como incluir a família no tratamento para o TOC. / Obsessive-compulsive disorder (OCD) is a chronic illness that negatively affects the lives of patients and usually of family members as well. It frequently interferes with family functioning, as very often family members modify their routines because of the patient’s symptoms. These behaviors observed among family members are referred to as family accommodation (FA). FA behaviors can reinforce the patient’s symptoms and thus contribute to maintain the disorder. FA has been correlated with an increased severity of obsessive-compulsive symptoms and is associated with poorer response to treatment approaches, e.g., cognitive-behavioral therapy. However, there is a scarcity of studies designed to assess the impact of interventions for OCD on FA in both short and long terms. The present thesis includes three research articles, which had the following objectives: 1) to analyze the psychometric properties of the Brazilian version of the Family Accommodation Scale for OCD – Interviewer-Rated (FAS-IR); 2) to assess the impact of cognitive-behavioral group therapy (CBGT) with the involvement of family members in two sessions on FA and to identify sociodemographic and clinical variables predictive of FA reduction after the 12 treatment sessions (short term); and 3) to assess the impact of CBGT on FA 3 years after completion of the program and to investigate the correlation between severity of OCD symptoms and FA in the long term. The study included patients with a diagnosis of OCD and their family members. Obsessive-compulsive symptoms were assessed using the following instruments: Obsessive-Compulsive Inventory – Revised (OCI-R), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and Clinical Global Impressions Scale (CGI). Beck Depression (BDI) and Anxiety (BAI) Inventories, as well as the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I), were also administered to investigate the presence of possible comorbidities. FA was assessed using the FAS-IR, administered to family members. Upon completion of the FAS-IR validation study, a randomized clinical trial was conducted, randomly assigning patients to either the intervention group (12 sessions of CBGT, of which two involved family members) or to a control group (waiting list). Finally, a naturalistic follow-up study was conducted 3 years after completion of the CBGT program. The study was approved by the Research Ethics Committee of Hospital de Clínicas de Porto Alegre. We found that the Brazilian Portuguese version of the FAS-IR had sound psychometric properties, reinforcing that this is a reliable instrument for assessing the participation and modifications of the routines of family members as a result of the patient’s symptoms. With regard to treatment outcomes, the randomized clinical trial included a sample of 98 pairs of patients with OCD and their family members, of which 52 (53.1%) were randomly allocated to the intervention group and 46 (46.9%) to the waiting list. There was a significant improvement of all OCD symptoms and also of FA levels after CBGT in the intervention group when compared to the control group (p < 0.001). The following variables were predictors of FA reduction after the multivariate analysis: patient characteristics – absence of comorbid unipolar disorder (β = 0.338; p = 0.014), a lower obsession score (β = 0.244; p = 0.045), and higher education level (β = -0.351; p = 0.006); and family member characteristics – a higher hoarding score (β = -0.461; p = 0.001). The model explained 47.2% of the variance in FA scores after CBGT. Finally, in the follow-up study, the FA reduction results obtained at the end of CBGT were found to remain in the long term (3 years). These results add to the current body of evidence not only by confirming that CBGT is effective in reducing OCD symptoms, but also by showing that CBGT with a brief family intervention focused on FA contributes to reduce the level of involvement of family members in the patient’s symptoms, and that these results are maintained over time. Some patient and family member characteristics were found to predict FA reduction, a finding that can contribute to qualify the CBGT protocols currently employed. This is the first study to assess the impact of CBGT (with the participation of family members in two sessions) on FA in both short and long terms. These findings underscore the importance of permanently assessing FA, as well as of involving family members in the treatment of patients with OCD.