Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment

The main aim of this study was to test the hypothesis that neurological soft signs and neuropsychological abnormalities associated with obsessive-compulsive disorder (OCD) predict poor response to behavioural treatment. The design permitted investigation of secondary hypotheses, regarding correlations among these neurological markers and levels of symptomatology, and their stability in relation to changes in levels of symptomatology. Thirty-five participants satisfying DSM-IV diagnostic criteria for OCD were assessed pre- and postbehavioural treatment using a scaled measure of symptom severity, and a battery of tests sensitive to neuropsychological deficits associated with OCD. Eighteen of the participants were also assessed on an inventory of neurological soft signs. Neither neuropsychological test deficits nor neurological soft signs pretreatment predicted response to behavioural treatment. Lower performance on neuropsychological tasks and symptom severity were both significantly correlated with levels of soft signs. Some neurological markers were less severe posttreatment, but these changes were not related to treatment response.     

Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the International Intrusive Thought Interview Schedule

The International Intrusive Thought Interview Schedule (IITIS) was used to assess and compare the unwanted intrusive thoughts (UITs) reported in a group of patients with obsessive compulsive disorder (OCD) and a non-clinical group. Although all participants reported at least one type of intrusion, OCD patients experienced more intrusive thoughts than non-clinical participants, and this difference was statistically significant. In the OCD group, intrusive thoughts were more frequent, interfered more with daily life, were considered to be more important to get out of the mind, and were more difficult to stop than in non-clinical participants. The two groups did not differ significantly in terms of five appraisals of the most distressing intrusive thought. One appraisal (importance) was used far more by the OCD group than the non-clinical group. For three appraisals (intolerance of anxiety, need to control, and intolerance of uncertainty), the difference was smaller. Only two of the strategies for controlling the most upsetting intrusive thought (ritual and avoidance) were of value in differentiating between the two groups. The IITIS (an instrument used to assess intrusions in non-clinical samples) appears to be of value for the assessment of patients with OCD.     

Incidence of neurological soft signs in children with isolated cleft of the lip or palate

The purpose of this study was to assess neurological soft signs in children and adolescents with isolated cleft of the lip or palate (iCL/P) compared with healthy controls. Children with iCL/P were recruited through the university cleft clinic. Control subjects were recruited through advertisements. Of the 166 subjects who participated (age range 7 to 17 years, M = 12.5, SD = 3.2), 77 had iCL/P (48 male) and 89 were healthy controls (44 male). All participants took the Physical and Neurological Examination of Subtle Signs and selected tests of motor coordination. A multivariate analysis of variance assessed differences between subjects with and without iCL/P. Also, a Pearson correlation estimated the relationship between the neurological soft signs and age. Subjects with iCL/P scored significantly higher on all neurological soft signs variables. These higher scores were associated with younger age. Findings lend support to the hypothesis of aberrant brain development in children with iCL/P.     

Development and preliminary validation of the Concise Neuropsychological Screening Inventory (CNSI): A clinical tool for use in psychiatric settings

We describe the development and preliminary validation of the Concise Neuropsychological Screening Inventory (CNSI), designed to afford clinical psychologists working in psychiatric settings a simple, rapid, and objective assessment of 10 vital left- and right-hemisphere brain functions: (1) Receptive and Expressive Language, (2) Orientation, (3) Attention/Concentration/Immediate Memory, (4) Recent Auditory and Visual Memory, (5) Remote Memory, (6) Motor/Sensory/Tactile Functioning, (7) Visual/Spatial/Motor Integration, (8) Academic Functioning, (9) Intellectual Processes, and (10) Judgment and Reasoning. Preliminary findings suggest that the CNSI can discriminate patients diagnosed with organic mental syndrome from patients with various psychiatric disorders, including chronic schizophrenia (i.e., specificity in screening). Moreover, with regard to predicting neuropsychological differences among various diagnostic groups, the CNSI is superior to some of the most commonly employed tests by psychologists in psychiatric settings (e.g., WAIS-R Digit Span, Digit Symbol, and Bender-Gestalt).     

An investigation of self-ambivalence in obsessive-compulsive disorder

Individuals vulnerable to obsessive-compulsive disorder (OCD) are hypothesized to have ambivalence about their self-worth, morality and lovability [Guidano, V., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York: Guildford Press]. The purpose of this study was to examine whether self-ambivalence was associated with OCD phenomena and beliefs relevant to OCD. It also examined whether patients with OCD had higher levels of self-ambivalence compared to non-clinical controls and patients with other anxiety disorders. Participants were 73 OCD patients, 50 patients with another anxiety disorder, 225 non-clinical undergraduate students and 43 non-clinical community controls. They completed measures of self-ambivalence, OCD phenomena, OCD-relevant beliefs, depression, anxiety and self-esteem. Self-ambivalence was significantly associated with OCD phenomena and OCD-relevant beliefs, after controlling for self-esteem, depression and anxiety. Further, OCD participants were significantly more ambivalent than the non-clinical groups, but did not differ from anxious controls. It was argued that these results provide a basis for extending the cognitive-behavioural model of OCD to include ambivalent self-perceptions as a component of the cognitive mechanisms relevant to the disorder.     

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.     

RELAXATION AS THERAPY FOR HYPERACTIVE CHILDREN

The purpose of this study was to determine the effectiveness of a relaxation therapy program with a sample of hyperactive, learning disabled, male children. The sample of 16 boys aged 8 to 12 years-old, from a private school providing special education, was divided randomly into an experimental and a control group. Relaxation procedures based on the theories of Jacobson and Bruno were done twice weekly for 11 weeks, during 20 minute sessions. All children in the experimental and control groups were pretested and posttested on six outcome measures. The Developmental Test of Visual-Motor Integration, Motor Accuracy subtest of the Southern California Sensory Integration Tests, Abbreviated Parent and Teacher Questionnaires, House-Tree Person test, and Sophistication-of-Body Concept Scale were administered. Significannt levels of differences were reported by most of the outcome measures. It was concluded that relaxation therapy has a direct effect upon the hyperactivity syndrome. Implications for use of relaxation therapy as a component of the occupational behavior frame of reference for the occupational therapist are discussed.     

The Expanded Version of the Inferential Confusion Questionnaire: Further Development and Validation in Clinical and Non-Clinical Samples

The current study represents the further development and validation of an expanded version of the Inferential Confusion Questionnaire (ICQ-EV) in non-clinical and clinical samples. Inferential confusion seems to be particularly relevant to Obsessive-Compulsive Disorder (OCD) and is defined as a failure to recognize the unrealistic nature of obsessions due to a subjective form of reasoning. Factor analysis of the item-set of the ICQ-EV indicated a one-dimensional solution in non-clinical and clinical samples. It was hypothesized that inferential confusion as measured by the ICQ-EV would be particularly relevant to participants with OCD. Results confirmed convergent validity with strong relationships between the ICQ-EV and obsessive-compulsive symptoms in all samples independent of other cognitive domains and general distress. In addition, those with OCD scored higher on the ICQ-EV than non-clinical controls and a mixed anxiety disorder group so confirming group-criterion validity. Finally, the ICQ-EV also showed clinical validity with change in ICQ-EV scores during treatment significantly related to successful treatment outcome.     

Inferential confusion in obsessive-compulsive disorder: the inferential confusion questionnaire

The current article represents the further validation of the construct of inferential confusion amongst clinical samples. Inferential confusion is proposed to be a meta-cognitive confusion particularly relevant to obsessive compulsive disorder (OCD) that leads a person to confuse an imagined possibility with an actual probability. As such, it conceptualizes OCD as a form of belief disorder similar to a delusion or overvalued idea that is a product of distorted reasoning processes. In contrast, other cognitive models of OCD emphasize a phobic model of development in OCD, and thus consider the exaggerated interpretation of intrusions as an essential element in OCD. The present study administered a revised version of the Inferential Confusion Questionnaire, and the Obsessive Belief Questionnaire (OBQ), to a total of 183 participants in three clinical groups and a non-clinical control group. Results suggest that OCD, at least in part, follows a non-phobic model of development with inferential confusion significantly related to obsessive-compulsive symptoms independently of cognitive domains as measured by the OBQ, and mood states. Further, scores on inferential confusion were particularly high in those with OCD and delusional disorder as compared to anxious and non-clinical controls.     

Clinical obsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: where are the differences?

Contemporary cognitive models of obsessive-compulsive disorder (OCD) assume that clinical obsessions evolve from some modalities of intrusive thoughts (ITs) that are experienced by the vast majority of the population. These approaches also consider that the differences between "abnormal" obsessions and "normal" ITs rely on quantitative parameters rather than qualitative. The present paper examines the frequency, contents, emotional impact, consequences, cognitive appraisals and control strategies associated with clinical obsessions in a group of 31 OCD patients compared with the obsession-relevant ITs in three control groups: 22 depressed patients, 31 non-obsessive anxious patients, and 30 non-clinical community subjects. Between-group differences indicated that the ITs frequency, the unpleasantness and uncontrollability of having the IT, and the avoidance of thought triggers obtained the highest effect sizes, and they were specific to OCD patients. Moreover, two dysfunctional appraisals (worry that the thought will come true, and the importance of controlling thoughts) were specific to OCD patients. The OCD and depressed patients shared some dysfunctional appraisals about their most disturbing obsession or IT (guilt, unacceptability, likelihood thought would come true, danger, and responsibility for having the IT), whereas the non-obsessive anxious were nearer to the non-clinical participants than to the other two groups of patients. The OCD patients showed an increased use of thought control strategies, with overt neutralizing, thought suppression, and searching for reassurance being highly specific to this group.     

Feasibility and acceptability of an exergame intervention for schizophrenia

ObjectivesTo evaluate the feasibility and acceptability of an exergame intervention as a tool to promote physical activity in outpatients with schizophrenia.DesignFeasibility/Acceptability Study and Quasi-Experimental Trial.MethodSixteen outpatients with schizophrenia received treatment as usual and they all completed an 8-week exergame intervention using Microsoft Kinect^® (20 min sessions, biweekly). Participants completed pre and post treatment assessments regarding functional mobility (Timed Up and Go Test), functional fitness performance (Senior Fitness Test), motor neurological soft signs (Brief Motor Scale), hand grip strength (digital dynamometer), static balance (force plate), speed of processing (Trail Making Test), schizophrenia-related symptoms (Positive and Negative Syndrome Scale) and functioning (Personal and Social Performance Scale). The EG group completed an acceptability questionnaire after the intervention.ResultsAttrition rate was 18.75% and 69.23% of the participants completed the intervention within the proposed schedule. Baseline clinical traits were not related to game performance indicators. Over 90% of the participants rated the intervention as satisfactory and interactive. Most participants (76.9%) agreed that this intervention promotes healthier lifestyles and is an acceptable alternative to perform physical activity. Repeated-measures MANOVA analyses found no significant multivariate effects for combined outcomes.ConclusionThis study established the feasibility and acceptability of an exergame intervention for outpatients with schizophrenia. The intervention proved to be an appealing alternative to physical activity. Future trials should include larger sample sizes, explore patients' adherence to home-based exergames and consider greater intervention dosage (length, session duration, and/or frequency) in order to achieve potential effects.     

Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study

OBJECTIVE: To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample.MethodA cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS: The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n = 236), with 8.9% (n = 72) presenting Tourette syndrome, 17.3% (n = 141) chronic motor tic disorder, and 2.8% (n = 23) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD + TD group. Compared to OCD patients without comorbid TD, those with TD (OCD + TD group, n = 236) were more likely to be males (49.2% vs. 38.5%, p < .005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the "aggressive," "sexual/religious," and "hoarding" symptom dimensions were more severe in the OCD + TD group.ConclusionTic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.     

Oculomotor delayed response abnormalities in young offspring and siblings at risk for schizophrenia

Individuals with schizophrenia are know to demonstrate cognitive and behavioral difficulties, particularly alterations in executive functions, including working memory. It is unclear whether these deficits reflect trait-related vulnerability to schizophrenia indicators and can be assessed by studying nonpsychotic relatives of patients with schizophrenia. In this study, we used an oculomotor delayed response (ODR) paradigm to examine spatial working memory in 37 "high-risk" child and adolescent offspring and siblings (age range=6-25 years) of patients with schizophrenia or schizoaffective disorder. Compared with 37 age- and sex-matched healthy controls (age range=6-23 years), high-risk subjects showed nonsignificantly greater errors in the ODR task at longer delay intervals. Statistical analyses suggested that performance improved with age in healthy control subjects, whereas it worsened with age in high-risk subjects. In both groups, the ODR errors were generally associated with poorer sustained attention (Continuous Performance Test: visuospatial d prime), somewhat poorer executive function (Wisconsin Card Sorting Test), and elevated Heinrichs-Buchanan neurological soft signs scores. These findings indicate the presence of spatial working memory abnormalities in individuals at risk for schizophrenia. Furthermore, these abnormalities may be progressive in nature. The ODR task is a valuable indicator of prefrontal cortical function and spatial working memory and may be a potentially valuable marker for familial risk of schizophrenia.     

Implicit awareness of ambiguity: a role in the development of obsessive-compulsive disorder

The cognitive-behavioral model of obsessive-compulsive disorder proposes that obsessional symptoms are the consequence of the manner in which intrusive cognitions are interpreted [e.g., Salkovskis, P. M. (1998). Cognitive-behavioral approach to understanding obsessional thinking. British Journal of Psychiatry, 173(35S), 53-63]. The present study suggests that this may be attributable to maladaptive implicit cognitive processing, a deficit that results in the explicit awareness of ambiguity in idiographic obsessive-compulsive disorder (OCD) stimuli. The present study examines decision-making responses of low and high OCD scorers in a non-clinical undergraduate sample. Via a computer console, participants were shown sentence statements for three levels of ambiguity. They were then presented with a propositional statement for which they had to indicate agreement or disagreement for sentences of varying ambiguity. After this, the participants indicated whether they were completely confident or unconfident as regards their previous agree-disagree decisions. Results indicate that the high compared to the low OCD scoring group had less agreement and subsequent less confidence in decisions made for sentences of varying ambiguity. Response latencies partially fitted the predicted hypotheses. Consequently, an addition to Salkovskis, Forester, and Richards' [1998. Cognitive-behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry, 173(35S), 53-63] model of OCD is suggested: namely that an implicit ambiguity deficit mediates the likelihood of normally occurring intrusions developing into abnormal obsessions. Methodological limitations and future research are considered.     

Maternal Representations of Patients with Schizophrenia as Measured by the Parental Bonding Instrument

Maternal perceptions were assessed, using the Parental Bonding Instrument (PBI) in 19 subjects with schizophrenia, 14 subjects with borderline personality disorder and 15 non-clinical subjects. Subjects with schizophrenia and subjects with borderline personality disorder reported significantly less care and more overprotection than did non-clinical subjects. No significant differences were found in representations by subjects with schizophrenia and subjects with borderline personality disorders. To the extent that the reported negative maternal behaviour gives a true picture of childhood and adolescent experiences, it does not seem to be specific for schizophrenia, but may be one factor in the development of severe mental disorders.     

The status of hoarding as a symptom of obsessive-compulsive disorder

Hoarding is considered by many to be a symptom of obsessive-compulsive disorder (OCD). Yet although it is observed in people with OCD, hoarding symptoms also appear in a number of other psychological and psychiatric conditions. The present studies were conducted using samples of OCD patients, patients with other anxiety disorders, and a non-clinical sample to further elucidate the relationship between hoarding and OCD. Across two investigations, we found that (a) whereas OCD patients had higher scores than the other groups on non-hoarding symptoms, this was not the case for hoarding symptoms; (b) hoarding tended to correlate more weakly with other OCD symptoms (e.g., washing, checking) than these other symptoms intercorrelated; (c) items measuring hoarding had the weakest factor loadings when a measure of OCD symptoms was submitted to factor analysis; (d) hoarding symptoms were not correlated with global OCD or anxiety severity, whereas other OCD symptoms were; and (e) hoarding did not show consistent relationships with OCD-related cognitive variables. These results do not support a specific relationship between hoarding and OCD; and they call into question hoarding's status as a specific symptom of OCD. Results are also discussed in terms of the importance of functional assessment of hoarding and OCD symptoms.     

Attentional control in OCD and GAD: specificity and associations with core cognitive symptoms

Obsessive–compulsive disorder (OCD) and generalized anxiety disorder (GAD) are both defined by excessive negatively-valenced cognitions. Although obsessional thoughts are considered essential to OCD and perseverative worry is considered essential to GAD, these excessive cognitions have been found to co-occur in both disorders. Accordingly, a common diathesis may influence the emergence of excessive thoughts in both disorders. The present study examined deficits in attentional control as a cognitive vulnerability that may contribute to both obsessional thought and perseverative worry. Patients with OCD (n = 30), GAD (n = 29), and non-clinical controls (NCC; n = 29) completed measures of obsessional thoughts, perseverative worry, and attentional control. Deficits in self-reported attentional control were found in both OCD and GAD relative to the NCC. However, attentional control was only related to excessive cognition in the GAD patient group, where deficits were associated with increased perseverative worry. Mediational modeling suggested that trait anxiety mediated the relationship between attentional control and perseverative worry in GAD. Implications of these findings for conceptualizing the role of attentional control in the genesis of excessive cognitions in OCD and GAD are discussed.     

Schizophrenic performance on form E of Cattell's 16PF test.

Form E of Cattell's 16PF test was administered to 515 hospitalized schizophrenics. This sample was compared to Cattell's standardization population for both raw scores and sten scores. Comparisons were made between males and females, acute patients and chronic patients, and amongst three categories of schizophrenia (paranoid, undifferentiated, schizo-affectives). The results indicate that the "schizophrenic profile," reported in previous research with Form A, did not obtain expected differentiations among schizophrenic categories. The question of the usefulness of Form E in diagnosing schizophrenia was raised.     

高强迫症状个体对图片刺激的注意偏向

以往强迫症注意偏向研究呈现出不一致的结果。为探索研究结果的不一致性是否由于被试取样和刺激选择所导致,当前研究改用非临床强迫症状个体作为研究对象,采用图片作为刺激来引发被试的反应和脑电波的变化。研究采用2(高强迫症状组、低强迫症状组)×3(中性图片、一般威胁图片和强迫相关图片)的混合实验设计,因变量为反应时和相关的脑电成分,结果显示:高强迫症状组较低强迫症状组对强迫相关图片表现出了更大幅度的P2波幅的变化。从而可以推断出,高强迫症状个体对强迫相关图片表现出了明显的注意偏向,其成分为注意脱困,主要发生在早期自动化加工阶段。     

Experimental manipulations of responsibility: An analogue test for models of Obsessive-Compulsive Disorder

Several authors attribute excessive responsibility a predominant role in Obsessive-Compulsive Disorder (OCD) [Salkovskis, P. M. (1985) Behaviour Research and Therapy, 23, 571–583; Rachman, S. (1993) Behaviour Research and Therapy, 31, 149–154; van Oppen, P. & Arntz, A. (1994) Behaviour Research and Therapy, 32, 79–87]. The present studies aimed at demonstrating the link between different levels of perceived responsibility and checking behaviors by experimentally manipulating responsibility in non-clinical Ss. In the first study, a sound recognition task was used to compare checking behaviors in Ss with high (HR) and low (LR) perceived responsibility. Only one variable was significantly different, Ss from the HR group reporting more anxiety during the task than Ss from the LR group. Results did not support a link between responsibility and checking behavior. In a second study HR and LR Ss were compared on a manual classification task. Subjects from the HR group hesitated and checked more, and reported more preoccupation with errors and anxiety during the task than Ss from the LR group. Since perceived severity of the outcome was the most variable affected by the manipulation, the implications for current models of OCD are discussed and an alternative explanation is attempted. Finally, clinical implications are examined and suggestions are made for future directions of research.