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Zhang C, Zhang Z, Gao R, Chen Y, Cao X, Yi X, Fan Q. Obsessive-Compulsive Disorder Comorbid with or without Obsessive-Compulsive Personality Disorder: Conceptual Implications, Clinical Correlates and Brain Morphometries. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00278-7. [PMID: 39349177 DOI: 10.1016/j.bpsc.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is often comorbid with obsessive-compulsive personality disorder (OCPD). The relationship between OCD and OCPD is complex, and the impact of comorbid OCPD on OCD remains underexplored, necessitating further research.. This study aims to investigate the clinical correlates and brain morphometries associated with comorbid OCPD in a large sample of unmedicated OCD patients. METHODS A total of 248 unmedicated patients diagnosed with OCD (45 comorbid with OCPD) were included in this study. All participants were assessed for OCD symptoms, OCPD traits, obsessive beliefs, depression and anxiety. Among them, 145 patients (23 comorbid with OCPD) volunteered to receive magnetic resonance imaging (MRI) brain scans. RESULTS Approximately 18% (45/248) of OCD patients were comorbid with OCPD. OCD comorbid with OCPD (OCD+OCPD) exhibited more severe OCD symptoms, obsessive beliefs, depression and anxiety than OCD comorbid without OCPD. Additionally, the severity of OCPD was positively correlated with OCD symptoms and obsessive beliefs. Furthermore, OCD+OCPD patients exhibited increased cortical complexity in the left superior parietal lobule and left precuneus, which mediated the relationship between OCPD and OCD symptoms only in OCD patients comorbid without OCPD. CONCLUSIONS The co-occurrence of OCPD may contribute to the heightened severity of psychopathological symptoms and associated brain morphological alterations in OCD patients, indicating distinct but interrelated constructs between these two disorders.
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Affiliation(s)
- Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongfeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Rui Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongjun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xuan Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Clinical Psychology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianghan Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; Center of Yuanshen Rehabilitation Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Jankovsky A, Zaboski B, Pittenger C. Pharmacotherapy for comorbid antisocial personality and obsessive-compulsive disorder: A case report. PSYCHIATRY RESEARCH CASE REPORTS 2023; 2:100139. [PMID: 38240012 PMCID: PMC10795765 DOI: 10.1016/j.psycr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
| | - Brian Zaboski
- Yale University, 34 Park St, New Haven, CT 06511, United States
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Pampaloni I, Marriott S, Pessina E, Fisher C, Govender A, Mohamed H, Chandler A, Tyagi H, Morris L, Pallanti S. The global assessment of OCD. Compr Psychiatry 2022; 118:152342. [PMID: 36007341 DOI: 10.1016/j.comppsych.2022.152342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
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Affiliation(s)
- Ilenia Pampaloni
- South West London and St Georges Mental Health Trust, London, UK.
| | - Sabina Marriott
- South West London and St Georges Mental Health Trust, London, UK
| | | | - Claire Fisher
- South West London and St Georges Mental Health Trust, London, UK
| | - Anusha Govender
- South West London and St Georges Mental Health Trust, London, UK
| | - Heba Mohamed
- South West London and St Georges Mental Health Trust, London, UK
| | - Augusta Chandler
- South West London and St Georges Mental Health Trust, London, UK
| | - Himanshu Tyagi
- University College London Hospital NHS foundation Trust, London, UK
| | - Lucy Morris
- South West London and St Georges Mental Health Trust, London, UK
| | - Stefano Pallanti
- Albert Einstein Institute, New York, USA; Istututo di Neuroscienze, Firenze, Italy
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Gecaite-Stonciene J, Williams T, Lochner C, Hoffman J, Stein DJ. Efficacy and tolerability of pharmacotherapy for obsessive-compulsive personality disorder: a systematic review of randomized controlled trials. Expert Opin Pharmacother 2022; 23:1351-1358. [PMID: 35818708 DOI: 10.1080/14656566.2022.2100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although obsessive-compulsive personality disorder (OCPD) is one of the most prevalent personality disorders, it is one of the least studied. There is debate as to whether pharmacotherapy is efficacious for OCPD. We aimed to systematically evaluate the efficacy and tolerability of pharmacotherapy for OCPD. AREAS COVERED This systematic review found two randomized controlled trials investigating pharmacotherapy of OCPD. In a study of major depression (n = 308) with comorbid OCPD (n = 71), citalopram was more effective for OCPD than sertraline with fewer drop-outs from treatment. In a small study of OCPD (n = 24), fluvoxamine was more effective than placebo, and there was a low drop-out rate. Risk of bias and quality assessment of these studies was not possible, and findings have very low levels of certainty. EXPERT OPINION Two studies provide preliminary evidence in support of citalopram and fluvoxamine for OCPD. Further randomized controlled trials are required before firm conclusions can be drawn regarding efficacy of pharmacotherapy for OCPD.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Taryn Williams
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Jacob Hoffman
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Saini B, Bansal PD, Bahetra M, Sharma A, Bansal P, Singh B, Moria K, Kumar R. Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study. Indian J Psychol Med 2021; 43:516-524. [PMID: 35210680 PMCID: PMC8826195 DOI: 10.1177/0253717621999537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. METHODS This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18-45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. RESULTS Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. CONCLUSIONS PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.
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Affiliation(s)
- Bhavneesh Saini
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Pir Dutt Bansal
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Mamta Bahetra
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Arvind Sharma
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Priyanka Bansal
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Baltej Singh
- Dept. of Community Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Kavita Moria
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rakesh Kumar
- Dept. of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.
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Kart A, Yucens B. Personality Beliefs in Obsessive-Compulsive Disorder: How Are They Related to Symptom Severity? Psychiatry Investig 2020; 17:822-828. [PMID: 32750759 PMCID: PMC7449831 DOI: 10.30773/pi.2020.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The comorbidity of obsessive-compulsive disorder (OCD) and personality disorders (PDs) is frequent but there are conflicting findings about which PDs are the most common. This study aimed to investigate the personality beliefs that exist on a more pathological level among OCD patients, to explore the association between personality beliefs and OCD severity, and to clarify the mediator effect of depression in this relationship. METHODS 202 OCD patients and 76 healthy controls with similar sociodemographic features were included in the study. The Personality Belief Questionnaire-Short Form was administered to both groups. The Yale-Brown Obsessions and Compulsions Scale, Beck Depression Inventory, and the Beck Anxiety Inventory were administered only to the clinical sample. RESULTS The dependent, histrionic, paranoid, borderline, and avoidant personality subscale scores were significantly higher in the OCD group than in the control group. There was an association only between OCD severity and narcissistic personality beliefs, also depression mediated the relationship between narcissistic personality and OCD severity. CONCLUSION Some personality beliefs at a pathological level are more common among OCD patients. Personality beliefs, as well as depression, should be routinely assessed, as they may affect OCD severity, help-seeking behavior, and response to treatment.
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Affiliation(s)
- Aysegul Kart
- Department of Psychiatry, Bakirkoy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Bengu Yucens
- Department of Psychiatry, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Gadelkarim W, Shahper S, Reid J, Wikramanayake M, Kaur S, Kolli S, Osman S, Fineberg NA. Overlap of obsessive-compulsive personality disorder and autism spectrum disorder traits among OCD outpatients: an exploratory study. Int J Psychiatry Clin Pract 2019; 23:297-306. [PMID: 31375037 DOI: 10.1080/13651501.2019.1638939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Whereas the phenomenology of obsessive-compulsive personality disorder (OCPD) shows similarities to that of obsessive compulsive and related disorders (OCRDs) as well as with autism spectrum disorder (ASD), the relationship between these disorders is poorly understood.Aims: Within a clinical sample, we aimed to investigate the distribution of OCD, OCPD and ASD symptoms and traits and their interrelationship, as well as to evaluate insight and treatment refractoriness.Methods: Consecutive adult OCD outpatients were assessed for OCPD traits (Compulsive Personality Assessment Scale (CPAS)), OCD symptoms (Yale-Brown Obsessive Compulsive Scale (Y-BOCS)), ASD traits (Autism Spectrum Quotient (AQ)), insight (Brown Assessment of Beliefs Scale (BABS)) and treatment resistance (clinical records). Those scoring highly on the AQ underwent a diagnostic interview for ASD.Results: Sixty-seven consenting individuals completed the CPAS, BABS and AQ, and 65 completed the Y-BOCS. Twenty-four patients (35.8%) were diagnosed with OCPD. Patients with OCPD were less likely to be employed (p=.04). They demonstrated elevated AQ scores (p=.004) and rates of ASD diagnosis (54.2%) (p <.001). OCPD traits (CPAS) showed a highly significant correlation with ASD traits (AQ) (p<.001), and no association with Y-BOCS, BABS or treatment resistance.Conclusions: In an OCD cohort limited by small size, OCPD associated strongly with unemployment and ASD, with implications for diagnosis, treatment and outcome.KEY POINTSClinicians should exercise a high level of vigilance for OCPD and ASD in patients presenting with obsessive compulsive symptoms.The presence of OCPD may indicate a likelihood of disabling ASD traits, including cognitive inflexibility, poor central coherence and poor social communication.These neuropsychological factors may require separate clinical intervention strategies.
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Affiliation(s)
- W Gadelkarim
- Rosanne House, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Derwent Centre, Essex Partnership University NHS Foundation Trust, Harlow, UK
| | - S Shahper
- Department of Life and Medical Science, University of Hertfordshire, Hatfield, UK
| | - J Reid
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - M Wikramanayake
- Cavell Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Peterborough, UK
| | - S Kaur
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - S Kolli
- East London NHS Foundation Trust, Bedford, UK
| | - S Osman
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - N A Fineberg
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK.,University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Torres-Prioris MJ, López-Barroso D, Paredes-Pacheco J, Roé-Vellvé N, Dawid-Milner MS, Berthier ML. Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia. Front Psychol 2019; 10:678. [PMID: 31133908 PMCID: PMC6517493 DOI: 10.3389/fpsyg.2019.00678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/11/2019] [Indexed: 12/30/2022] Open
Abstract
Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A's husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.
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Affiliation(s)
- María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit (UNCA), Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga - IBIMA, University of Málaga, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit (UNCA), Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga - IBIMA, University of Málaga, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - José Paredes-Pacheco
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of Malaga, Málaga, Spain.,Molecular Imaging and Medical Physics Group, Department of Psychiatry, Radiology and Public Health, University of Compostela, Santiago de Compostela, Spain
| | - Núria Roé-Vellvé
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of Malaga, Málaga, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Marc S Dawid-Milner
- Neurophysiology of Autonomic Nervous System Laboratory, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit (UNCA), Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga - IBIMA, University of Málaga, Málaga, Spain
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10
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Abstract
The current paper was aimed at: (1) investigating the comorbidity between obsessive-compulsive disorder (OCD) and personality disorders (PDs) using an OCD sample and clinician-administered structured interviews; (2) exploring the associations of different cluster comorbid PDs with the specific symptom dimensions of OCD; (3) analyzing the variables which could play a significant role in the probability of having at least one comorbid PD, controlling for confounding variables. The SCID-II and Y-BOCS, together with a series of self-report measures of OCD, depression and anxiety symptoms were administered to a clinical sample of 159 patients with a primary diagnosis of OCD. 20.8 % of the participants suffered from at least one comorbid PD; the most common was obsessive-compulsive PD (9.4 %), followed by narcissistic PD (6.3 %). In OCD patients with comorbid cluster C PDs, the percentage of responsibility for harm, injury, or bad luck symptoms was significantly greater than other OCD symptom dimensions (p < .005). Logistic regression found some evidence supporting the association between severity of OCD symptoms and comorbid PDs. PDs are prevalent among Italian people with OCD and should be routinely assessed, as comorbidity may affect help-seeking behaviour and response to treatment.
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Vyskocilova J, Prasko J, Sipek J. Cognitive behavioral therapy in pharmacoresistant obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2016; 12:625-39. [PMID: 27042074 PMCID: PMC4798215 DOI: 10.2147/ndt.s101721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study was to determine whether patients with obsessive-compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioral therapy (CBT) lasting for 6 weeks, and whether it is possible to predict the therapeutic effect using demographic, clinical, and selected psychological characteristics at baseline. METHODS Sixty-six OCD patients were included in the study, of which 57 completed the program. The diagnosis was confirmed using the structured Mini International Neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale-Brown Obsessive Compulsive Scale, objective and subjective forms of the Clinical Global Impression, Beck Anxiety Inventory, Beck Depression Inventory, Dissociative Experiences Scale, 20-item Somatoform Dissociation Questionnaire, and the Sheehan Disability Scale before their treatment, and with subjective Yale-Brown Obsessive Compulsive Scale, objective and subjective Clinical Global Impression, Beck Anxiety Inventory, and Beck Depression Inventory at the end of the treatment. Patients were treated with antidepressants and daily intensive group CBT for the 6-week period. RESULTS During the 6-week intensive CBT program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decrease in the scores assessing the severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who 1) showed fewer OCD themes in symptomatology, 2) showed a higher level of somatoform dissociation, 3) had poor insight, and 4) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who had 1) good insight, 2) a lower initial level of anxiety, and 3) no comorbid depressive disorder.
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Affiliation(s)
- Jana Vyskocilova
- Faculty of Humanities, Charles University in Prague, Prague, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Sipek
- Department of Psychology, Faculty of Arts, Charles University in Prague, Prague, Czech Republic
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12
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Trillini MO, Müller-Vahl KR. Patients with Gilles de la Tourette syndrome have widespread personality differences. Psychiatry Res 2015; 228:765-73. [PMID: 26112450 DOI: 10.1016/j.psychres.2015.04.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/09/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
Only little is known about pathological personality traits in patients with Gilles de la Tourette syndrome (GTS). The aim of this study was to further investigate the prevalence of personality traits in adults with GTS. We used a variety of rating scales to assess not only personality traits, but also severity of tics, quality of life, and comorbidities (obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), depression), in a large group (n=50) of patients. Our major finding was that pathological personality traits are very common in patients with GTS encompassing a wide range of different personality traits, but most typically personality traits related to cluster C. Demand-anxious was the most common personality trait, while histrionic personality trait was absent. Patients' quality of life was more impaired by personality traits than comorbidities. Personality traits were more common in patients with comorbid OCD and depression, while comorbid ADHD had no influence. Our findings, therefore, corroborate the hypothesis that GTS plus OCD represents a more severe subtype of GTS, and support the assumption that OCD and depression, but not ADHD, are part of the GTS spectrum.
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Affiliation(s)
- Morounke O Trillini
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
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