Neurosurgical approaches to intractable obsessive-compulsive disorder

Although significant progress has been made over the last decade in the treatment of obsessive-compulsive disorder (OCD), approximately 20% of OCD patients remain refractory to nonsurgical therapies, including pharmacologic and cognitive-behavioral therapy. Because a number of neural circuits involving the basal ganglia, thalamus, limbic system, and frontal lobes have been implicated in the pathophysiology of OCD, the need for an effective intervention in these patients has brought the focus on surgical approaches, including cingulotomy and capsulotomy procedures. Unlike free-hand surgical approaches used in the past, current neurosurgical interventions have been greatly enhanced by advances in technology, which allow lesioning to an accuracy of 1 mm. Today's neurosurgical approaches have shown significant benefit in as many as 60% of refractory patients, while preserving personality and cognitive functioning and limiting morbidity. A study of gamma knife capsulotomy conducted at Brown University School of Medicine showed that 40% of patients undergoing two lesioning procedures were much or very much improved 2 years postsurgery. The inherent obstacles to conducting placebo-controlled studies in these severely ill patients mean that further study is required to identify optimal candidates for surgical intervention.     

Evaluating the interdependence of aging-related changes in visual and auditory acuity,balance, and cognitive functioning

High proportions of shared age-related variance are found among measures of perceptual acuity, balance, muscle strength, and cognitive capabilities in age-heterogeneous, cross-sectional studies. Reliance on cross-sectional studies is problematic, however, because associations may arise from age-related mean trends. Narrow age-cohort samples provide an alternative basis for testing hypotheses regarding associations among rates of change. Cross-domain associations were evaluated in combined 75-year-old cohort samples from Denmark, Finland, and Sweden. In general, no consistent associations were found across sensory, balance, strength, and cognitive domains. These findings indicate that the effects of aging on sensory acuity, balance, and cognitive functioning are likely to be largely independent, multidimensional, and complex at the level of the individual.     

Parental Accommodation Predicts Symptom Severity at Long-Term Follow-Up in Children with Obsessive–Compulsive Disorder: A Preliminary Investigation

Pediatric obsessive–compulsive disorder (OCD) is a chronic condition affecting millions of children. Though well intentioned, accommodation (i.e., a parent’s attempt to assuage their child’s distress and anxiety) is thought to increase OCD symptom severity and may cause greater OCD-related impairment. The present study sought to examine the relative contribution of parental accommodation in predicting OCD symptom severity. Children between the ages of 6 and 18 (and their parents) participated in a prospective, longitudinal study investigating the course of pediatric OCD utilizing a longitudinal design. Data was collected at intake (n = 30) and two-years (n = 22) post-intake controlling for age, anxiety and depression. Parental accommodation (measured at intake) significantly predicted OCD symptom severity and was the strongest predictor at both intake and two-year follow-up. These preliminary findings highlight the importance of further research seeking to delineate factors relevant to the development and maintenance of accommodation as well as parent-level variables that might mediate the relationship between accommodation and OCD symptom severity.     

Trust as an Explanation for Relational Differences in Revenge

We present 4 experiments that explore relational differences in how individuals respond to the harmful behavior of others, finding that revenge is less likely against romantic partners than against various other kinds of offenders (i.e., strangers, coworkers, roommates) both for a laboratory provocation and using hypothetical vignettes. We also implicate trust as a viable explanation for these findings, showing that individuals view the actions of a trusted other (i.e., a romantic partner) as less intentional relative to a less trusted other (i.e., a coworker) and that an experimental manipulation of trust in an offender alters levels of vengeful desires.     

Stabilizing and Changing Phenomenal Worlds: Ludwik Fleck and Thomas Kuhn on Scientific Literature

In the work of both Ludwik Fleck and Thomas Kuhn the scientific literature plays important roles for stability and change of scientific phenomenal worlds. In this article we shall introduce the analyses of scientific literature provided by Fleck and Kuhn, respectively. From this background we shall discuss the problem of how divergent thinking can emerge in a dogmatic atmosphere. We shall argue that in their accounts of the factors inducing changes of scientific phenomenal worlds Fleck and Kuhn offer substantially different approaches, and we shall discuss in which respects their approaches may be compatible. This revised version was published online in August 2006 with corrections to the Cover Date.     

Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study

Hoarding behavior occurs frequently in obsessive-compulsive disorder (OCD). Results from previous studies suggest that individuals with OCD who have hoarding symptoms are clinically different than non-hoarders and may represent a distinct clinical group. In the present study, we compared 235 hoarding to 389 non-hoarding participants, all of whom had OCD, collected in the course of the OCD Collaborative Genetics Study. We found that, compared to non-hoarding individuals, hoarders were more likely to have symmetry obsessions and repeating, counting, and ordering compulsions; poorer insight; more severe illness; difficulty initiating or completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-compulsive and dependent personality disorders. Five personality traits were independently associated with hoarding: miserliness, preoccupation with details, difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding and indecision were more prevalent in the relatives of hoarding than of non-hoarding probands. Hoarding in relatives was associated with indecision in probands, independently of proband hoarding status. The findings suggest that hoarding behavior may help differentiate a distinct clinical subgroup of people with OCD and may aggregate in some OCD families. Indecision may be a risk factor for hoarding in these families.     

Do targets of workplace bullying portray a general victim personality profile?

The aim of this study is to examine differences in personality between a group of bullied victims and a non-bullied group. The 144 participants, comprising of 72 victims and a matched contrast group of 72 respondents, completed Goldberg's (1999) International Personality Item Pool (IPIP). Significant differences emerged between victims and non-victims on four out of five personality dimensions. Victims tended to be more neurotic and less agreeable, conscientious and extravert than non-victims. However, a cluster analysis revealed that the victim sample can be divided into two personality groups. One cluster, which comprised 64% of the victim sample, do not differ from non-victims as far as personality is concerned. Hence, the results indicate that there is no such thing as a general victim personality profile. However, a small cluster of victims tended to be less extrovert, less agreeable, less conscientious, and less open to experience but more emotional unstable than victims in the major cluster and the control group. Further, both clusters of victims scored higher than non-victims on emotional instability, indicating that personality should not be neglected as being a factor in understanding the bullying phenomenon.     

Boundaries, Exclusion, and Oppression in “The Psychological Basis of Homophobia: Cultural Construction of a Barrier”

This essay takes up Madureira's exploration (Integrative Psychological and Behavioral Science, 2007, doi:10.1007/s12124-007-9024-9) of the relationship between homophobia and sexism, and more broadly, also examines other domains of prejudice, exclusion, and oppression. I identify important questions raised by Madureira, and suggest some additional concepts and frameworks that yield further insights into these issues. I focus primarily upon gender and sexuality theories, but also examine some additional studies of other constructions of difference and variants of prejudice, scapegoating, and boundarism: namely, racism, religious bigotry, and "witch-cleansing," I show how, despite their apparently disparate ideologies, these latter exclusionary practices are on some levels similar to homophobia and sexism, though these phenomena are neither identical nor exactly analogous. I also explore the uses and limitations of psychological, social and cultural analyses of these diverse forms of oppression, with particular emphasis upon homophobia and sexism.     

QUANTIFICATION OF ETHANOL'S ANTIPUNISHMENT EFFECT IN HUMANS USING THE GENERALIZED MATCHING EQUATION

Increases in rates of punished behavior by the administration of anxiolytic drugs (called antipunishment effects) are well established in animals but not humans. The present study examined antipunishment effects of ethanol in humans using a choice procedure. The behavior of 5 participants was placed under six concurrent variable‐interval schedules of monetary reinforcement. In three of the six concurrent schedules, punishment, in the form of monetary loss, was superimposed on one alternative. Data were analyzed according to the generalized matching equation which distinguishes between bias (allocation of behavior beyond what matching to relative reinforcer densities would predict) and sensitivity to reinforcement (how well behavior tracks relative reinforcer densities). In addition, participants completed a pencil‐tapping test. Under placebo punishment conditions, all participants demonstrated low response rates and a bias against the alternative associated with punishment, despite a resultant loss of available reinforcers. Bias against the punished alternative was dose‐dependently reduced in participants shown to be most sensitive to ethanol (0.6, 1.2, and 1.8 g/kg) in measures of overall responding and on the pencil‐tapping test. No ethanol‐induced change in bias was noted when punishment was not imposed. Sensitivity to reinforcement also decreased for participants shown to be sensitive to ethanol. In addition to extending antipunishment effects to humans, these results also show that antipunishment effects can be quantified via the matching equation.