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IntroductionObsessive Compulsive Personality Disorder (OCPD) is a common, highly co-morbid disorder. Subjected to comparatively little research, OCPD shares aspects of phenomenology and neuropsychology with obsessive-compulsive spectrum disorders and neurodevelopmental disorders such as autism spectrum disorder (ASD). A greater understanding of this interrelationship would provide new insights into its diagnostic classification and generate new research and treatment heuristics.AimsTo investigate the distribution of OCPD traits within a cohort of OCD patients. To evaluate the clinical overlap between traits of OCPD, OCD and ASD, as well as level of insight and treatment resistance.MethodWe interviewed 73 consenting patients from a treatment seeking OCD Specialist Service. We evaluated the severity of OCPD traits (Compulsive Personality Assessment Scale; CPAS), OCD symptoms (Yale–Brown Obsessive Compulsive Scale; Y-BOCS), ASD traits (Adult Autism Spectrum Quotient; AQ) and insight (Brown Assessment of Beliefs Scale; BABS).ResultsOut of 67 patients, 24 (36%) met DSM-IV criteria for OCPD, defined using the CPAS. Using Pearson's test, CPAS scores significantly (P < 0.01) correlated with total AQ and selected AQ domains but not with BABS. Borderline significant correlation was observed with Y-BOCS (P = 0.07). OCPD was not over-represented in a highly resistant OCD subgroup.ConclusionDisabling OCPD traits are common in the OCD clinic. They strongly associate with ASD traits, less strongly with OCD severity and do not appear related to poor insight or highly treatment-resistant OCD. The impact of OCPD on OCD treatment outcomes requires further research.Disclosure of interestThis work did not receive funding from external sources. Over the past few years, Dr. Fineberg has received financial support in various forms from the following: Shire, Otsuka, Lundbeck, Glaxo-SmithKline, Servier, Cephalon, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, Novartis, Medical Research Council (UK), National Institute for Health Research (UK), Wellcome Foundation, European College of Neuropsychopharmacology, UK College of Mental Health Pharmacists, British Association for Psychopharmacology, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioural Addiction, World Health Organization, Royal College of Psychiatrists.

IntroductionPrevious studies of concentrations of serotonin reuptake inhibitors (SRIs) versus therapeutic efficacy have yielded inconsistent results. Even if the relationships between the individual's serotonergic system and the clinical symptoms of obsessive-compulsive disorder (OCD) are poorly understood, the SRIs are consistently effective in OCD. However, studies on SRI concentrations in OCD treatment are rare.Objectives/aimsTo identify possible links between paroxetine concentrations and anti-obsessive response.MethodsIn a randomised, double-blind trial, comparing clomipramine, paroxetine and placebo in OCD treatment, serum paroxetine levels were measured after 1 week and after 4 weeks of treatment in 18 patients. Anti-obsessive response was assessed with Yale-Brown obsessive compulsive scale (Y-BOCS) and patients’ global evaluation (PGE), after 12 weeks of treatment.ResultsSerum paroxetine concentrations after 4 weeks suggested a therapeutic interval between 50 and 240 nmol/L (13–63 ng/mL). The mean Y-BOCS decrease was 54% inside versus 7% outside this interval (t = 3.96; P = 0.0011).ConclusionsParoxetine levels seemingly predicted clinical outcome. Studies with a greater number of patients are necessary in order to confirm this finding and to discern whether it is useful in clinical practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionA substantial number of patients suffering from obsessive compulsive disorder (OCD) report a subjective distressing experience prior to the repetitive behavior, known as sensory phenomena(SP).ObjectivesNeed to systematically evaluate SP and the clinical correlates in OCD.AimsAssess prevalence of SP and clinical correlates in OCD.MethodsSubjects (n = 71) fulfilling the criteria for DSM IV-TR OCD were recruited consecutively from a specialty OCD clinic in Southern India and were assessed using the Yale brown obsessive and compulsive scale (YBOCS), dimensional Yale-Brown obsessive compulsive scale (D-YBOCS) and the University of São Paulo Sensory Phenomena Scale (USP-SPS).ResultsThe prevalence of the SP was found to be 50.7%. Prevalence of SP is significantly greater in the patients with early age of onset (P = 0.47). In subtypes of SP, Tactile was 12.7%, “just right” for look was 26.8%, “just right” for sound was 9.9%, “just right” for feeling was 16.9%, feeling of incompleteness leading to repetitive behavior was 22.5%, “energy release” sensation leading to repetitive behavior was 4.2% and “urge only” leading to repetitive behavior was 11.3%. SP was found to have significant correlation with symmetry/ordering/arranging/counting dimension (P = 0.003). Significant positive correlation existed between SP severity and the severity of the compulsions (P = 0.02).ConclusionConsidering its high prevalence in OCD, it might be useful to incorporate SP assessment during the routine clinical assessment of OCD. It might warrant a place in the phenomenological and nosological description of OCD. Additionally, the neurobiological correlates of SP need to be explored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups—matched for sex, age, and medication status—and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Students paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC SCL-90-R GSI, POMS, PSS, and PIL; P.

OBJECTIVE: The aim of our study was to establish the efficacyof CBT on the sample of non-selected medication-resistant patients with OCDand to search for predictors of therapeutic response in such a group. Methods The treatment was carried out under usual conditionsat the department for anxiety disorders. Systematic CBT steps were tailored tothe needs of each patient. Pharmacology treatment remained grosslyunchanged during the trial period. We used the following outcome measures in thestudy: Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS),the Clinical Global Impression – Severity of Illness scale (CGI-S), BeckDepression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatoform DissociationQuestionnaire (SDQ-20) and Dissociative Experience Scale (DES). The primary outcomemeasure was a decrease by 35% in Y-BOCS rating. Remission was defined as a12 point score or lower in Y-BOCS and 1 or 2 points in CGI-S. Results 47 patients completed the study (19 male and 28female). One female patient refused to participate. All patients completed atleast 5 weeks of intensive CBT programme and showed significant improvement on Y-BOCS, CGI-S, and BDI scales. At the end of the treatment 40.4% of the patientsachieved clinical remission according to the CGI-S scale. The maincharacteristics present at the beginning of the trial increasing probability of achievingimprovement or remission during the treatment were a Y-BOCS score lower than 22, goodinsight, higher resistance to symptoms, low level of dissociation, andaggressive obsessions. ¨ Conclusion As negative predictors we identified higherscores in Y-BOCS, poorer insight, low resistance to symptoms, high level ofdissociation, obsessions focused on control/symmetry and obsessiveslowness/ambivalence as associated with poor improvement. Supported by grant IGA MZ CR NT 11047-4/2010

The aim of this study was to explore the possible relationship between plasma clomipramine (CMI) and its major metabolite (DMCMI) levels and related parameters, and clinical features in OCD patients. Twenty-six OCD outpatients (13 men, 13 women), suffering from OCD were consecutively enrolled in the study. The severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The measurements were carried out after four weeks and six months from the beginning of the treatment. The drug levels were measured by a HPLC method developed by us. The correlations between biological and clinical parameters were analyzed by means of the Spearman's correlation coefficient. The Mann-Whitney test was used for comparing biological and clinical variables between men and women. The results showed that CMI levels were related to the doses at the two assessment times. A significant and positive correlation was detected at the beginning between the DMCMI/ratio and the Y-BOCS total score, however this was true only for men, where the similar correlations were measured also with the Y-BOCS subscale. After six months of CMI, men showed a significant improvement of the compulsions. These findings would highlight the potential impact of assessing CMI plasma levels and their relationships with specific symptoms, as well as the influence of the gender on the drug response.

Background most obsessive-compulsive disorder (OCD) patients meet psychiatrists 5 to 10 years after onset of OCD. Its relatively high prevalence ratio and the delay in seeking help suggest that patients with OCD may seek help at nonpsychiatric clinics. the present study was undertaken to provide some epidemiological data on the prevalence and severity of OCD in dermatological patients. Method The participants included 265 consecutive patients with primary dermatologic chief complaint. They were visited by a dermatologist and diagnosis of dermatological lesion was done according to ICD-10. All patients were visited by a psychiatry resident and were screened for OCD using the structured clinical interview for DSM-IV-TR (SCID-I). If the diagnosis of OCD has been made, the Yale-Brown obsessive compulsive scale(Y-BOCS) was used to evaluate the severity of OCD. To analyze the data student t-test for quantitative variables and X 2 tests for categorical variables. Results From the total of 265 patients, 24(9.1%) met the DSM-IV-TR criteria for OCD and 9(37.5%) with OCD had previously been diagnosed with OCD, however, only three were treated pharmacologically. The most symptoms were pathological doubt (29.1%), fear of contamination(29.1%)and washing (54.16%). Severity of OCD according to Y-BOCS was evaluated among patients with OCD. Six (25%) were found with subclinical OCD, 11(45.8%) had mild OCD, six(25%) had moderate OCD, and one (4.2%) was detected with sever OCD. Conclusion prevalence of OCD in dermatology clinic was higher compared with general population.

The aim of the study was to assess the efficacy of the in-patients therapeutic program for in patients suffering with pharmacoresistant OCD patients. The therapy was conducted in a group setting and systematic CBT steps were adapted to each individual patient in the group. Pharmacological treatment underwent no or minimal changes during the trial period. Outcome measures included the Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS), the Clinical Global Impressions-Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Dissociative Experience Scale (DES). The primary outcome measure for treatment response was a rating of 35% improvement in Y-BOCS. A remission was defined by S-Y-BOCS score 12 and lower or by CGI-S scores 1 or 2. Results 66 patients completed trial. Three patients refused the protocol. All patients finished minimum of 6 weeks of CBT and showed statistically significant improvement on S-Y-BOCS, CGI-S and BDI scales. The main predictors of achieving the response or remission were scores in S-Y-BOCS lower than 24, good insight, high resistance against symptoms, low level of dissociation, and aggressive character of obsessions. The negative predictors of achieving the response or remission were control/symmetry obsession and compulsions, and obsessive slowness/ambivalence. Supported by IGA MZ CR NT 11047-4/2010

Introduction Obsessive Compulsive Disorder (OCD) is an anxiety disorder which is usually characterized by two types of symptoms, namely.obsessions and compulsions. Objectives Psychosomatic disorders include psycho-cutaneous disease, obsessive-compulsive disorde r(OCD) might be expressed as dermatological lesion and are known as dermo-OCD. Aims The aim of this study were to determine the prevalence and severity of OCD and its relationship with dermatological disease in sari, Iran, 2011. Method The sample consisted of 265 consecutively presenting dermatological patients who agreed to participate in the study, the subjects were assessed with structured clinical interview (SCID-I) by psychiatrist resident and also completed the yalebrown obsessive compulsive scale(Y-BOCS). T-test and chi-square were used to analyze of data. Results Of the 265 dermatological patients, 24(9.1%) met DSM-IV criteria for OCD. Only 9(37.5%) of them had previousely been diagnosed as OCD. The most common obsession were washing 13(54.1) and pathological doubt 7 (25%), contamination7 (25%), checking 7(25%). Conclusion There is a high prevalence of OCD in dermatological patients and with considerating of importance of OCD with comorbitiy of skin disease, dermatologist must be aware about relationship between two disorders and referring OCD patients to psychiatrist.

Introduction Augmentation treatment has been the subject of several studies in treatment-resistant obsessive compulsive disorder (OCD). We hypothesized that medications with a dual action on the melatoninergic and serotoninergic systems may be of use in treatment-resistant OCD. Objectives/aims In this open label study we investigated the efficacy and safety of agomelatine augmentation in treatmentresistant OCD. Methods Twelve patients, aged 18–50, fulfilling OCD criteria, with no response to a 16-week or longer treatment with a selective serotonine reuptake inhibitor (SSRI) at the indicated dose, were assigned to receive agomelatine augmentation. Subjects were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and were screened for treatmentemergent side effects at baseline, week 8 and week 12 of treatment. Results The overall Y-BOCS score fell during the duration of the study (all comparisons among baseline, 8 th week and 16 th week were statistically significant, p th week of the study (p th week of the study (p Conclusion Agomelatine could be efficacious and well tolerated as an augmenting agent in refractory to treatment OCD. Further controlled studies are warranted to explore the efficacy of agomelatine, as well as the potential role of circadian rhythm modulation both in the pathophysiology and treatment of OCD.

Background Although antipsychotics are commonly employed in treatment augmentation strategies for severe obsessive-compulsive disorder (OCD) among adolescents, the role of atypical neuroleptics is still unclear (1.2.). Since our clinical practice suggest that in some cases small amount of olanzapine was helpful for patient with resistance to SSRI mono therapy (specially added to fluvoxamine mono therapy) we tested the hypothesis that olanzapine augmentation would be beneficial in treatment-unresponsive OCD. Method 8-week trial, we recruited 11 adolescents (mean age 14,7) with OCD (DSM-IV criteria), unresponsive to Fluvoxamine (≥100 mg/day) for ≥ 10 weeks, which was continued throughout the trial. Subjects had OCD for ≥ 2 year, a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score typically was of ≥ 18, and no other primary Axis I disorder is exist. After 10 week Fluvoxamine therapy Olanzapine was added in minimal therapeutic amount of 2,5 mg daily. After 6 week combination therapy the symptoms was evaluated by Y-BOCS. Results Preliminary analyses of data of these patients demonstrate a statistically and clinically significant improvement in OCD symptoms (50%–60% mean improvement in general, Y-BOCS scores dropped 68%, 30%, and 30%,). Combo treatment for adolescents was well tolerated and safety.

The aim of this study was to explore the possible relationship between plasma clomipramine (CMI) and its major metabolite (DMCMI) levels and related parameters, and clinical features in OCD patients. Twenty-six OCD outpatients (13 men, 13 women), suffering from OCD were consecutively enrolled in the study. The severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The measuremts were carried out after four weeks and six months from the beginning of the treatment: The drug levels were measured by a HPLC method developed by us. The correlations between biological and clinical parameters were analyzed by means of Spearman's correlation coefficient. The Mann-Whitney test was used for comparing biological and clinical variables between men and women. The results showed that CMI levels were related to the doses at the two assessment times. A significant and positive correlation was detected at the beginning between the DMCMI/ratio and the Y-BOCS total score, however this was true only for men, where the similar correlations were mesaured also with the Y-BOCS subscale. After six months of CMI, men showed a significant improvement of the compulsions. These findings would highlight the potential impact of assessing CMI plasma levels and their relationships with specific symptoms that seem to be gender-related.

Background The duration of untreated illness (DUI), defined as the interval between the onset of a disorder and the first adequate treatment, has been increasingly investigated as a predictor of outcome in psychotic disorders. However, few data are available on the impact of DUI on the outcome of the obsessive-compulsive disorder. Objectives This study aimed at investigating: 1) patients'socio-demographic and clinical characteristics which influence duration of untreated illness in OCD; 2) the effect of duration of untreated illness on outcome. Methods Eighty-three outpatients fulfilling DSM-IV criteria for OCD were recruited and prospectively followed up for 3 years. Baseline information, demographic and clinical characteristics, were collected by standardized instruments. Obsessive-compulsive symptoms were assessed using Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Fifty-nine patients completed the follow-up. Results Recruited patients were predominantly male (52%), with a mean age of 31.5 (SD = 10.2) years, 11.2 (SD = 3.9) years spent in general education. Fifty-two per cent of them were married and 50.6% were employed. The mean DUI was 7.3 (SD = 5.8) years. Patients with a DUI > 2 years had a later onset of OCD, a familiarity for affective disorders, and showed an higher frequency of aggressive obsessions. At completion of the follow-up, these patients showed a worse clinical outcome and more frequently did not achieve remission. Conclusions DUI has a considerable impact on outcome of obsessive-compulsive disorder. Being DUI a modifiable prognostic factor, programs aimed to early detection and treatment of OCD could substantially reduce personal, social and economical burden related to this disorder.

IntroductionThe study evaluates a central hypothesis of synergetic psychotherapy research according to which a marked instability in the psychotherapeutic process is associated with high response rates.Methods14 patients with obsessive-compulsive disorder (OCD) successfully completed an eight-week in-patient course of multi-modal behavior therapy with exposure exercises followed by response management. The instability during the course of the therapy was recorded by daily self-assessment by the patient using the Synergetic Navigation System (SNS), an Internet-based real-time monitoring procedure.ResultsThere was a negative correlation between the degree of the instability and the percentage reduction in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (r = −0.395; P = 0.199), the “Global Severity Index” (GSI) of the symptom check-list (SCL-90-R) (r = −0.718; P = 0.013), the scale value for obsessive-compulsiveness in the SCL-90-R (r = −0.782; P = 0.004) and the remaining sub-scales of this data-gathering instrument.ConclusionsAn unstable progress of the psychotherapy causes a smaller reduction in symptoms than a stable one. The contradiction relative to the study hypothesis is possibly based on the special features of OCD, with a high level of patient insecurity when anticipating new, non-obsessive-compulsive ways of thought and behavior. The relationships between instability and reduction in symptoms appear to be diagnosis-specific.

ObjectivesObsessive-compulsive (OC) symptoms are common in both children and adults with Prader-Willi Syndrome (PWS), to the degree that they are considered central to the syndrome's behavioral phenotype and constitute diagnostic criteria for the disorder. Although efficacious behavioral treatments (e.g., exposure and response prevention) exist for OC symptoms in typically developing youth, these treatments are not tailored to meet the specific needs of youth with PWS and their families. The purpose of the current study is to report on a modified CBT protocol that addresses obsessive-compulsive symptoms in youth with PWS.MethodsThree children received a modified version of cognitive-behavioral therapy targeting obsessive-compulsive symptoms in PWS. Measures were administered at screening, baseline, and post-treatment and included the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS), Family Accommodation Scale, Clinical Global Impression - Severity (CGI-S), Clinical Global Improvement (CGI), and measures of impairment and adaptive functioning. Treatment consisted for 12 family-based CBT sessions that included exposure and response prevention; cognitive restructuring; and other operant treatment elements.ResultsParticipants experienced reduced CYBOCS scores at baseline to post-treatment, 25 to 15.3. All three youth were considered treatment responders on the CGI-Improvement scale. Similar reductions on secondary variables such as OCD impairment were reported.ConclusionsAlthough these results are preliminary, initial results suggest that behavioral treatment of OC symptoms may be effective in the PWS population. This treatment holds promise for being a safe and tolerable method for reducing compulsive symptoms in youth with PWS.

AimThe study's aim was the comparison of OCD patients treated with Sertraline toward those treated with Clomipramine, divided in two subgroups with gender related symptoms differences.MethodThe study was focused on the inpatients and outpatients presented at Psychiatric Clinic, diagnosed with OCD during September 2005-March 2006. The criteria of being selected were randomization of those with > 20 points according to Yale-Brown Obsessive Compulsive Scale and > 4 points according to Clinical Global Impression Scale. There were two groups: first group was treated with clomipramine and the second with sertraline. Sertraline doses were 50 and 200 mg/day and clomipramine 100, 125 and 150 mg/day. The study was conducted during a period of 12 weeks including three evaluations through YBO C scale and CGI.Results91.8% of the patients completed the study. Men had a higher frequency of sexual symptoms, symmetry and exacteness obsessions, while women suffered a later onset of the disorder and presented a higher rate of aggressive obsessions. The patients treated with sertraline reported less side effects frequency and intensity and more tolerance than the patients treated with clomipramine.ConclusionsBoth treatments showed therapeutic efficacy in treating the OCD symptoms, but depends on symptoms and gender. Clomipramine caused more side effects and the number of patients dismissed from the study was higher in the group of clomipramine. Sertraline is as effective as clomipramine for treating the OCD but has more compliance and less side effects.

Objective:The aim of our study was to evaluate relationships between alexithymia and suicidal ideation a sample of adult outpatients with obsessive-compulsive disorder (OCD).Methods:A sample of 86 adult outpatients with OCD (44 females and 42 males), was evaluated with a series of rating scales such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Toronto Alexithymia Scale (TAS-20), the Scale for Suicide Ideation (SSI) and Montgomery-Åsberg Depression Rating Scale (MADRS). the score of item #11 on the Y-BOCS was considered as a measure of insight.Results:Alexithymics showed a more early onset, a longer duration of illness and were more suitable to have a chronic course than nonalexithymics; they also reported higher MADRS and SSI scores. Alexithymics without insight (n=21) reported higher SSI scores than alexithymics with insight, nonalexythimics without insight and nonalexithymics with insight. A linear regression showed that chronic OCD course together with DIF dimension of TAS-20 and higher MADRS scores were significantly associated with higher suicide risk.Conclusions:Alexithymia and depressive symptoms were highly correlated in OCD patients and were significantly associated with higher suicide risk. DIF dimension of TAS-20 seems to be significantly associated with presence of suicidal ideation as well as chronic course of disorder. However, further longitudinal studies on larger samples are needed to definitely clarify this topic.