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The present study aimed at investigating the affects of attachment and thought control strategies in a clinical sample (OCD patients) in Turkey. For these purposes 101 clinical OCD participants completed questionnaires related to research variables. Experience in Close Relationship Scale (Fraley, Waller & Brennan, 2000) to evaluate attachment, Thought Control Strategies Questionnaire (Wells & Davies, 1994) to evaluate thought control and Yale-Brown Obsessive Compulsive Scale (Goodman, Price & Rassmussen, 1989) to evaluate OCD symptoms were used in this study. A series of hierarchical analyses were done. Findings of the analyses revealed that there was significant relation between attachment, thought control strategies and OCD symptoms. Moreover, It is seen that there is a mediating role of punishment between the anxiety level of attachment and the severity of obsessive symptom, the mediating role of worry control strategy between the anxiety level of attachment and pathological responsibility symptoms, and the mediating role of social control management between the avoidance level of attachment and avoidance symptom severity.To sum up according to results of this study attachment and control strategies are important to understand OCD symptoms. The results were discussed in the light of the related literature and dependent recommendations to the area were given. [JCBPR 2018; 7(2.000): 80-91]

Objective: We investigated the diagnostic efficiency and clinical utility of the Dimensional Obsessive–Compulsive Scale (DOCS) and subscales for distinguishing obsessive–compulsive disorder (OCD) from anxiety disorders (ADs). Method: A total of 369 participants (167 male, Mage = 29.61 years) diagnosed with DSM-IV OCD or AD, recruited from specialty clinics across the United States, completed clinical interviews and self-report questionnaires, including the DOCS. Receiver operating characteristic analyses and diagnostic likelihood ratios (DiLRs) determined discriminative validity and provided clinical utility. Logistic regressions tested for incremental validity in the DOCS-total scale and subscales in predicting OCD status. Results: The DOCS-total scale and Contamination subscale performed best in differentiating between OCD and AD diagnosis (DOCS-total: Area under curve [AUC] = .75, p < .001; Contamination: AUC = .70, p < .001) as compared with the other subscales. At high scores (DOCS-total: 28+, Contamination: 6+), Contamination was more effective than the DOCS-total in differentiating OCD from ADs, with high scores in Contamination quadrupling OCD odds and DOCS-total by about threefold (Contamination DiLR+ = 4.04, DOCS-total DiLR+ = 2.82). At low scores (DOCS-total: 0-9, Contamination: 0-2), the converse was true, with low scores in Contamination cutting OCD odds by half and DOCS-total by one fifths (Contamination DiLR− = 0.52, DOCS-total DiLR− = 0.23). Conclusion: At high scores, the Contamination subscale is the most helpful subscale to differentiate OCD and ADs. For low scores, the DOCS-total scale performs the best among the scales.

Previous research using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) suggests that the heterogeneous symptoms of obsessive-compulsive disorder (OCD) may reflect four underlying dimensions. However, past results vary substantially, which may be due to (a) the reliance on aggregated scores, (b) the common use of exploratory factor analyses, and (c) the exclusion of several symptoms. The present study tested the homogeneity of the original Y-BOCS categories using confirmatory factor analysis and modified categories where necessary. To test multidimensional models, data were further analyzed with Bayesian structural equation models, which better capture item heterogeneity in contrast to ordinary factor analysis. All analyses were run with two samples of patients with OCD allowing for cross-validation. Only a minority of the original Y-BOCS categories proved to be homogeneous. Modification yielded 10 homogeneous first-order factors, which can be reduced to four second-order factors: Incompleteness, Taboo Thoughts, Responsibility, and Contamination. This two-level factor model outperformed competing factor structures. The results corroborate the notion of four broader symptom dimensions in OCD, although the specific factor structure deviates from previous research. Differences presumably derive from using the full range of OCD symptoms and the combined exploratory and confirmatory approach with BSEM as a theoretically more appropriate analytical framework.

Studies have confirmed the efficacy of the cognitive intervention Association Splitting (AS) in obsessive-compulsive disorder (OCD) when applied as a self-help technique. AS aims to alter symptom-provoking automated cognitive networks of OC-related stimuli by building new or strengthening established but weak neutral associations. The aim of this study was to investigate the acceptance and benefits of therapist-assisted AS as an add-on to cognitive behavioral therapy (CBT). One hundred and nine patients with OCD who were undergoing CBT were randomly assigned to either AS or cognitive remediation (CR). Both groups were assessed at baseline, 4 weeks and 6 months later. The primary measure was the Yale-Brown Obsessive Compulsive Scale. Although patients’ acceptance of AS was good, AS was not better than CR regarding overall symptom severity. However, a larger decrease was found from baseline to 6 months follow-up in AS regarding avoidance. Moreover, subsidiary analyses excluding control patients who had obtained information about AS indicated its superiority. Because superiority of AS was found in post hoc analyses excluding control patients who had obtained information on AS, we suggest that contagion effects deserve consideration.

Exposure and Response Prevention (ERP) is considered the most effective psychotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). The literature supports its adoption yet results vary and vagueness regarding therapy protocol exists. We present an updated review and meta-analysis to provide clarity in the comparison of strict ERP protocol to control or active therapy groups. Moderator analyses were conducted to investigate treatment effect of cognitive elements, hours of therapy and duration of OCD. A systematic literature search, concluded in January 2021, identified twenty-four studies, published between 1997 and 2018, including a total of 1134 patients. The main analysis assessed the difference between pre-treatment and post-treatment scores compared amongst ERP and the other groups. We found a statistically significant different reduction in pre-treatment to post-treatment Yale-Brown Obsessive Compulsive Scale scores between ERP therapy versus other groups. We also found a statistically significant moderation effect of cognitive elements. The other two moderators, hours of therapy and OCD duration, were non-significant. Our review suggests that ERP was superior to the other groups, including both neutral and active treatments, in reducing OCD symptomatology and should therefore be recommended as an optimal therapy. Future research should focus on tailoring ERP to the individual and investigating further refinements.

Ä°lkay Keleş Altun,1 Emel Uysal,2 Evrim Özkorumak Karagüzel2 1Department of Psychiatry, Kanuni Research and Training Hospital, Trabzon, 2Department of Psychiatry, Karadeniz Technical University, Trabzon, Turkey Background: Obsessive compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions have been classified as autogenous obsessions and reactive obsessions on the basis of the cognitive theory of Lee and Kwon. The aim of this study was to investigate the differences between autogenous groups (AG) and reactive groups (RG) in terms of metacognition and automatic thoughts, for the purpose of investigating the differences of cognitive appraisals.Methods: One hundred and thirty-three patients diagnosed with OCD were included in the study as the patient group. A control group was formed of 133 age, gender and education-matched healthy individuals. The OCD group patients were separated into subgroups according to the primary obsessions. The sociodemographic data, and the Yale–Brown Obsessive Compulsive Scale, Metacognition Questionnaire-30 (MCQ-30), Automatic Thoughts Questionnaire (ATQ), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores of the AG, RG, and control groups were compared.Results: The MCQ-30 (total) and the subscales of MCQ-30 and ATQ scale points were seen to be significantly higher in the AG than in the RG and significantly higher in the RG than in the control group. In the reactive obsession group, the predictive variables of the ATQ points were determined to be MCQ-30 (total), BDI and BAI. In the autogenous obsession group, the predictive variables of the ATQ points were determined to be BDI and BAI.Conclusion: In the current study, differences were determined between the AG and the RG in respect of metacognitions and automatic thoughts. In light of these results, the recommended grouping can be considered useful in the identification of OCD sub-types. There is a need for further studies to identify more homogenous sub-types of OCD. Future multi-centered studies of sub-typing with larger samples using more specific instruments to sub-type and dimensional evaluation will be useful for detailed evaluation and better understanding of the subject. Keywords: obsessive compulsive disorder, autogenous, reactive, obsessions, metacognitions, automatic thoughts

Background: This study was carried out to enumerate the level of difference in functional impairment and quality of life (QOL) in obsessive-compulsive disorder (OCD) patients and normal control group to find out the relationship among ICD functional impairment and QOL. Methodology: Thirty patients diagnosed with OCD as per International Classification of Diseases Diagnostic Criteria for Research-10 were taken for study. The control group consists of 30 normal participants from the community. Functional impairment and QOL questionnaires were administered on both groups to measure functional impairment and QOL in OCD. Results: The mean age of onset of OCD was (23.8 ± 7.25), mean duration of illness was (6.3 ± 4.47), and mean duration of treatment was (2.56 ± 2.47). It was also observed that total score as well as all the domains of the World Health Organization QOL-BREF, OCD patients scored significantly less (P < 0.001) compared to normal controls. Dysfunctional Analysis Questionnaire (DAQ)-Social area and DAQ-Personal area had statistically significant positive correlation (P < 0.05) with an obsessive subscale of Yale–Brown Obsessive Compulsive Scale (Y-BOCS) whereas DAQ-social area (P < 0.05), DAQ-Personal Area (P < 0.05) had statistically significant positive correlation with a total score of Y-BOCS. Conclusion: The presence of functional impairment leads to poor QOL in the persons with OCD.

This pilot study was conducted to evaluate the feasibility and efficacy of exposure and response prevention therapy in Japanese patients with obsessive-compulsive disorder. This study was the first to examine the effectiveness of exposure and response prevention therapy provided by Japanese clinical psychologists. The sample comprised 37 adults (male = 17, female = 20, mean age = 35.7 years, standard deviation [ SD ] = 10, mean Yale-Brown Obsessive Compulsive Scale score = 26.9, SD = 23.35) with a diagnosis of obsessive-compulsive disorder receiving treatment. Individually administrated exposure and response prevention was provided to the 37 patients with obsessive-compulsive disorder. We evaluated the feasibility and safety of the program using the dropout rate and adverse events. The primary outcome was the reduction of the Yale-Brown Obsessive Compulsive Scale score between the pre- and post-treatment periods. Secondary outcomes were depression, anxiety, and quality of life. Of the 37 patients, 5 (14%) dropped out and 32 (86%) completed the entire program. No severe adverse event was observed. The patients reported significant reductions in the Yale-Brown Obsessive Compulsive Scale score (obsession: Hedges’ g = 2.11, 95% CI [1.57, 2.68]; compulsion: Hedges’ g = 2.05, 95% CI [1.41, 2.56]). Some secondary outcomes (depression and quality of life) also showed significant change. The results suggest that the exposure and response prevention program provided by Japanese clinical psychologists is an efficacious and feasible treatment approach for Japanese patients with obsessive-compulsive disorder.

Trichotillomania (TTM) and eating disorders (ED) share many phenomenological similarities, including ritualized compulsive behaviors. Given this, and that comorbid EDs may represent additional functional burden to hair pullers, we sought to identify factors that predict diagnosis of an ED in a TTM population. Subjects included 555 adult females (age range 18–65) with DSM-IV-TR TTM or chronic hair pullers recruited from multiple sites. 7.2% (N = 40) of our TTM subjects met criteria for an ED in their lifetime. In univariable regression analysis, obsessive-compulsive disorder (OCD), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) worst-ever compulsion and total scores, certain obsessive-compulsive spectrum disorders, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and substance disorder all met the pre-specified criteria for inclusion in the multivariable analysis. In the final multivariable model, diagnosis of OCD (OR: 5.68, 95% CI: 2.2–15.0) and diagnosis of an additional body-focused repetitive behavior disorder (BFRB) (OR: 2.69, 95% CI: 1.1–6.8) were both associated with increased risk of ED in TTM. Overall, our results provide further support of the relatedness between ED and TTM. This finding highlights the importance of assessing for comorbid OCD and additional BFRBs in those with TTM. Future research is needed to identify additional predictors of comorbid disorders and to better understand the complex relationships between BFRBs, OCD and EDs.

There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.

BACKGROUND: Patients with obsessive compulsive disorder (OCD) frequently show traits of autism spectrum disorders (ASD). This is one of the first studies to explore the clinical impact of the overlap between OCD and ASD as a categorical diagnosis. METHODS: A cross-sectional survey in 73 adult outpatients with DSM-IV OCD. Autistic traits were measured using the Autism-Spectrum Quotient (AQ). A clinical estimate ASD diagnosis was made by interview using DSM-IV-TR criteria. OCD patients with and without autistic traits or ASD were compared on demographic and clinical parameters and level of OCD treatment-resistance based on treatment history. RESULTS: Thirty-four (47%) patients scored above the clinical threshold on the AQ (> =26) and 21 (27.8%) met diagnostic criteria for ASD. These diagnoses had not been made before. Patients with autistic traits showed a borderline significant increase in OCD symptom-severity (Yale-Brown Obsessive Compulsive Scale (Y-BOCS); p=.054) and significantly increased impairment of insight (Brown Assessment of Beliefs Scale; p=.01). There was a positive correlation between AQ and Y-BOCS scores (p =.04), but not with OCD treatment resistance. CONCLUSION: There is a high prevalence of previously undiagnosed ASD in patients with OCD. ASD traits are associated with greater OCD symptom-severity and poor insight.

Background: This study aimed to evaluate eye-movement desensitisation and reprocessing (EMDR) as a treatment for obsessive-compulsive disorder (OCD), by comparison to cognitive behavioural therapy (CBT) based on exposure and response prevention.\ud \ud Method: This was a pragmatic, feasibility randomised controlled trial in which 55 participants with OCD were randomised to EMDR (n = 29) or CBT (n = 26). The Yale-Brown obsessive compulsive scale (YBOCS) was completed at baseline, after treatment and at 6 months follow-up. Treatment completion and response rates were compared using chi square tests. Effect size was examined using Cohen’s d and multilevel modelling.\ud \ud Results: Overall, 61.8% completed treatment and 30.2% attained reliable and clinically significant improvement in OCD symptoms, with no significant differences between groups (p > .05). There were no significant differences between groups in YBOCS severity post-treatment (d = -0.24, p = .38) or at 6 months follow-up (d = -0.03, p = .90).\ud \ud Conclusions: EMDR and CBT had comparable completion rates and clinical outcomes.

The aims of this study were to evaluate alexithymia subscales [i.e. difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally-oriented thinking (EOT)] in patients with obsessive-compulsive disorder (OCD) and to clarify the relationships of alexithymia subscales to obsessive-compulsive (OC) symptom dimensions and other clinical variables. One hundred fifteen OCD outpatients and two control groups including 80 normal controls and 100 alcoholic patients participated in this study. The data were collected by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R), the Farsi version of the Toronto Alexithymia Scale (FTAS-20) and the Depression Anxiety Stress Scales (DASS-21). 60.7% of OCD patients and 48% of alcoholics were classified as alexithymics. Those with OCD revealed significantly higher scores on alexithymia and its subscales than alcoholics and normal controls. OCD patients with alexithymia showed higher means in Y-BOCS and its subscales as well as the OC dimensions of mental neutralizing and obsessing than non-alexithymics. DIF and EOT were significantly correlated with obsessing and mental neutralizing respectively. DDF and EOT were related to OCD severity. It was concluded that DIF and EOT may be specific to obsessing and mental neutralizing in OCD patients.

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Treatment usually consists of serotonergic medications along with exposure therapies. Danger ideation reduction therapy (DIRT) is an alternative therapy predominantly for washing compulsions and focuses on reduction of danger ideations. DIRT was tried on Ms. S. with a history of OCD for 15 years and improvement was noticed on Yale–Brown Obsessive Compulsive Scale, Padua Inventory, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale after 15 sessions of DIRT though she was not fully symptom-free. Thus, DIRT was found to improve OCD symptoms and improved her insight into illness.

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale–Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.

Obsessive-compulsive disorder (OCD) is a heterogeneous condition characterized by largely variable phenotypic expressions. Previous findings suggested that gender may be a relevant factor in mediating this heterogeneity. The present study aimed at exploring gender differences in a large clinical sample of Italian OCD patients.Socio-demographic and clinical variables of a sample of 229 consecutive OCD outpatients were included in a common database. Patients were assessed through structured clinical interviews, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale.Female OCD patients were more likely than males to have lifetime psychiatric comorbidities (72.6% vs 56.9%; p 0.05), poly-comorbidities being twice as high compared to males. The female group also showed a significant later onset of symptoms (63.7% vs 44.8%; p 0.005) and a higher age at first treatment (30.98 ± 13.1 years vs 27.81 ± 11.3; p 0.005). Moreover, the female subgroup presented higher rates of cleaning and washing compulsions, compared to the male subgroup (28.7% vs 12.6% in the male group; p 0.005).The current study supports the notion that OCD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to male patients. These findings should be considered in epidemiologic and therapeutic perspectives.

Contains fulltext : 219241.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients' care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators. METHODS: We used the baseline, two and four-year data of 382 adult OCD patients participating in the naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Remission was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Predictors of outcome were assessed at baseline, via clinician-rated and self-report instruments. RESULTS: Remission at two and at four-year follow-up ranged from 11% to 26%. Early age of onset and the presence of childhood trauma predicted a worse four-year course. Secure attachment style emerged as a protective predictor of improved outcome. LIMITATIONS: The naturalistic design of our study did not enable a systematic estimation the effect of treatments received during the follow-up period. Furthermore, age of onset and childhood trauma were assessed retrospectively, which may contribute to recall bias. CONCLUSION: Results coincide with previous prediction research and stress the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed. 9 p.

Background: The aim of this study was to test, through a chronobiologic approach, the existence of a significant circannual rhythm of tics and obsessive-compulsive symptoms in patients with Obsessive-Compulsive Tic Disorder (OCTD). The chronotype effect on tics and OC symptoms during seasons was also studied. Methods: Patients with a diagnosis of OCTD (N = 37; mean age = 18.78 ± 8.61) underwent four clinical evaluations: Winter (WIN), Spring (SPR), Summer (SUM) and Autumn (AUT). Tics were evaluated through Yale Global Tic Severity Scale (YGTSS) and OC symptoms through Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Patients’ chronotype was assessed by the Horne-Ostberg morningness-eveningness questionnaire (MEQ), which categorizes subjects according to the individuals'chronotype, being morning-type, evening-type, and neither-type. Results: A statistically significant circannual rhythm was observed for OC symptoms (p = 0.007), with the acrophase occurring between AUT and WIN. Y-BOCS differed along the year (p = 0.0003 and η2p = 0.40) with lower results in SUM compared to WIN (p < 0.05) and AUT (p < 0.01). Tics displayed no circannual rhythm and YGTSS scores were comparable among seasons. Patients were classified as 15 morning-types (40.5%) 15 neither-types (40.5%) and 7 evening-types (19.0%). YGTSS data were similar for all chronotypes while Y-BOCS results were greater during SUM in evening-types than morning-type patients (p < 0.05; 15.7 ± 5.2 vs 3.4 ± 6.0). Limitations: It is essential to investigate the existence of tics and OC symptoms circannual rhythms over the course of more than one year with a larger sample. Conclusions: OC symptoms displayed a significant circannual rhythm and were influenced by patients’ chronotype. On the contrary, tics resulted similar among seasons and chronotypes.

A considerable proportion of obsessive-compulsive disorder (OCD) patients receiving first-line pharmacological therapy, fail to fully respond to treatment and continue to exhibit significant symptoms. In this systematic review, we evaluate the efficacy of memantine, as a glutamate-modulating agent, in moderate to severe OCD. Single and double blinded as well as open-label trials of memantine augmentation in adults with OCD were considered. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. The electronic databases of PubMed, Scopus, Embase and Google Scholar were searched for relevant trials using keywords ‘obsessive-compulsive disorder OR OCD’ AND ‘memantine’. The meta-analysis of eight studies involving 125 OCD subjects receiving memantine augmentation exhibited a significant overall mean reduction of 11.73 points in Y-BOCS scores. The categorical analysis of treatment response (a minimum of 35% reduction in Y-BOCS) in four double-blind placebo-controlled studies indicated that OCD patients receiving memantine augmentation were 3.61 times more likely to respond to treatment than those receiving placebo. We found that 20 mg/day memantine augmentation to first-line pharmacological treatment for a period of at least 8 weeks is a safe and effective intervention for moderate to severe OCD.

Objective: Obsessions have been categorized as autogenous obsessions and reactive obsessions on the original of the cognitive theory and this study aimed to evaluate whether differences are found between obsessive compulsive disorder (OCD) subgroups in terms of biochemical markers. Methods: Thirty patients with obsessions defined as autogenous, 30 patients with obsessions defined as reactive group and 30 healthy volunteers were consisted the sample of the study. Sociodemographic Data Form, Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) were filled to the participants. The activity of paraoxanase, prolidase and Hs-CRP and brain-derived neurotrophic factor (BDNF) levels were detected. Results: There was no any statistically significant difference between autogenous and reactive obsession groups in terms of total mean score of Y-BOCS, BDI and BAI. Paraoxanase activity did not statistically significant difference between all groups. Prolidase activity showed significantly higher in reactive group than autogenous obsession and control groups. Serum Hs-CRP levels were not statistically different among participants of autogenous group, reactive group and control groups. Serum BDNF levels were significantly lower in autogenous obsession group rather than reactive obsession and control groups. Conclusion: This finding indicates that neurobiological pro-cesses have important role in the pathophysiology of autogenous obsessions.

The current study examined the temporal precedence of change in obsessive-compulsive symptoms and change in depressive symptoms during the course of an Exposure and Response Prevention (ERP) for pediatric OCD. Participants included 142 children and adolescents (7–17 years; mean age = 12.39, SD = 2.92; 51.40% female; 60.40% Non-Hispanic White) with a primary or co-primary diagnosis of OCD who received ERP in a two-site randomized controlled trial on d -cycloserine augmentation of CBT for pediatric OCD. Participants completed clinician-administered assessments of OC symptoms (Children's Yale-Brown Obsessive Compulsive Scale) and depressive symptoms (Children's Depression Rating Scale-Revised) from baseline to post-treatment follow-up. Lagged mediational analyses did not yield evidence in support of a mediating role for the change in OC symptoms in the effect of ERP on the change in depressive symptoms. In contrast, change in depressive symptoms mediated the effect of ERP treatment on the subsequent change in OC symptoms (95% confidence interval for indirect effect = −0.04 to −0.001), though the effect size was small. Controlling for the prior levels of the depressive symptoms this indirect effect became non-significant. Theoretical and clinical implications of the findings for the youth with OCD and comorbid depression are discussed.

Introduction.Bipolar disorder (BD) and obsessive compulsive disorder (OCD) are prevalent, comorbid, and disabling conditions, often characterized by early onset and chronic course. When comorbid, OCD and BD can determine a more pernicious course of illness, posing therapeutic challenges for clinicians. Available reports on prevalence and clinical characteristics of comorbidity between BD and OCD showed mixed results, likely depending on the primary diagnosis of analyzed samples.Methods.We assessed prevalence and clinical characteristics of BD comorbidity in a large international sample of patients with primary OCD (n = 401), through the International College of Obsessive–Compulsive Spectrum Disorders (ICOCS) snapshot database, by comparing OCD subjects with vs without BD comorbidity.Results.Among primary OCD patients, 6.2% showed comorbidity with BD. OCD patients with vs without BD comorbidity more frequently had a previous hospitalization (p < 0.001) and current augmentation therapies (p < 0.001). They also showed greater severity of OCD (p < 0.001), as measured by the Yale–Brown Obsessive Compulsive Scale (Y-BOCS).Conclusion.These findings from a large international sample indicate that approximately 1 out of 16 patients with primary OCD may additionally have BD comorbidity along with other specific clinical characteristics, including more frequent previous hospitalizations, more complex therapeutic regimens, and a greater severity of OCD. Prospective international studies are needed to confirm our findings.

Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition. Specific patterns of psychiatric comorbidity, early age at onset, long duration of illness (DI) and untreated illness (DUI) have been associated with poor outcome in OCD. The present study was aimed to explore sociodemographic and clinical characteristics associated with increased severity of illness in a sample of OCD patients.A total of 124 OCD outpatients were recruited and divided into two groups on the basis of their severity of illness, as assessed through the Yale-Brown Obsessive Compulsive Scale (24). Chi-squared test and t-test for independent samples were performed to compare sociodemographic and clinical variables between the two groups.The group with increased severity of illness had a younger age, an earlier age at onset and age at first pharmacological treatment (p .05). In addition, the same group showed a longer DI but a shorter DUI (p .01). Moreover, significantly higher rates of psychiatric comorbidities (p .01) were observed in the higher severity group.Earlier age, age at onset and age at first pharmacological treatment, longer DI, shorter DUI and higher rate of psychiatric comorbidities were associated with increased severity of OCD. Further studies on larger samples are warranted to confirm the reported results.

IntroductionWe previously reported that deep brain stimulation (DBS) in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) is effective in reducing symptoms in severe treatment-resistant obsessive-compulsive disorder patients.ObjectiveTo examine the long-term evolution of obsessive compulsive disorder (OCD) symptoms in 24 patients treated with chronic electrical stimulation in IC/BST.AimsWe aimed to examine the evolution of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and to determine if a number of predictors assessed before surgery are significantly related to this evolution.MethodsWe used a linear mixed model to investigate the evolution of the Y-BOCS in 24 patients. Data was collected in a naturalistic manner. Seven hundred measurements, taken during a total of 1836 follow-up months, are included in this analysis.ResultsOur analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms stay relatively stable. In addition, results show a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Beside the ON/OFF effect of stimulation, the surgery itself has no additional effect on OCD symptoms. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time.ConclusionElectrical stimulation in the IC/BST has a fast and sustained effect on OCD symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The aim of the study was to determine whether the general intelligence, cognitive processes, school achievement, and intelligence-achievement relationship of adolescents with subclinical levels of obsessive-compulsive symptoms differed from those of their normal counterparts. From an initial large pool of 14-year-old Bengali students in eighth grade, 110 girls and 100 boys were finally selected. The Children's Yale-Brown Obsessive Compulsive Scale and the Children's Obsessional Compulsive Inventory were used to exclude those with clinical levels of obsessive-compulsive disorder, and to identify those with subclinical levels of obsessive-compulsive symptoms as differentiated from the typically developed adolescents. The participants were administered the Standard Progressive Matrices for assessing general intelligence and Sumon's Attention Memory Module to assess memory-related variables and span of attention. School achievement was assessed from school records from the last two years. Intelligence-achieve...

Self-help resources are frequently sought out by individuals with obsessive-compulsive disorder (OCD); however their efficacy has rarely been evaluated in randomized controlled trials, despite frequently bold claims for their efficacy. In the present study, we examined if a metacognitive self-help manual called myMCT (for “my Metacognitive Training”), which encompasses exercises from cognitive-behavioral therapy (CBT) and its "third wave", is superior to a wait-list control group in reducing OCD symptoms. Further, we examined whether an individually adapted version of the manual suited to personal problems would yield larger effects than the full manual. Methods A total of 89 individuals with OCD symptoms participated in the online study. Participants were randomly assigned to three conditions; patients either received the full myMCT manual (sent via email attachment), an individually adapted myMCT version, or were allocated to a wait-list control group. Before randomization (pre-assessment) and six weeks later (post-assessment), individuals were asked to fill out several questionnaires tapping obsessive-compulsive and depressive symptoms. Results Individuals in the two myMCT conditions improved significantly more on the Yale-Brown Obsessive Compulsive Scale and Obsessive-Compulsive Inventory-Revised total scores than the wait-list control group (between-group comparison), with a medium to large effect size. Subsidiary analyses showed that improvements were particularly pronounced for obsessions, while effects on compulsions were mainly small and insignificant. Contrary to our expectation, the adapted version did not lead to better outcomes than the full version. Discussion The present study supports the feasibility of a bibliotherapeutic metacognitive approach for the treatment of obsessive thoughts. While results confirm prior reports that metacognitive training is effective in OCD, results are limited by a rather high non-completion rate. Further studies should investigate the long-term effectiveness of the approach and its utility in the framework of guided self-help or face-to-face treatment.

Body dysmorphic disorder (BDD) is a relatively common and severe disorder that typically onsets in adolescence, but often goes unrecognized. Despite BDD's severity and early onset, treatment outcome research on adolescent BDD is scarce. Cognitive-behavioral therapy is the gold-standard psychosocial treatment for BDD in adults and has shown promise in adolescents. The current study examined the development and testing of a new CBT for adolescents with BDD. We tested feasibility, acceptability, and treatment outcome in a sample of 13 adolescents (mean age 15.23years, range: 13-17) with primary BDD. Treatment was delivered in 12-22 weekly individual sessions. Standardized clinician ratings and self-report measures were used to assess BDD and related symptoms pre- and posttreatment and at 3- and 6-months follow-up. At posttreatment, BDD and related symptoms (e.g., insight, mood) were significantly improved. Scores on the Yale-Brown Obsessive Compulsive Scale for BDD indicated a 50% (intent-to-treat) and 68% (completer) improvement in BDD symptoms. Seventy-five percent of adolescents who started treatment and 100% of completers were considered treatment responders. Treatment gains were maintained at follow-up. High patient satisfaction ratings and patient feedback indicated that treatment was acceptable. This represents the largest study of a psychosocial treatment for adolescent BDD.

Over the last two decades, deep brain stimulation (DBS) has gained popularity as a treatment of severe and medically refractory obsessive-compulsive disorder (OCD), often using brain targets informed by historical lesional neurosurgical procedures. Paradoxically, the use of DBS in OCD has led some multidisciplinary teams to revisit the use of lesional procedures, especially anterior capsulotomy (AC), although significant aversion still exists toward the use of lesional neurosurgery for psychiatric disorders. This paper aims to review all literature on the use of AC for OCD to examine its effectiveness and safety profile.All publications on AC for OCD were searched. In total 512 patients were identified in 25 publications spanning 1961–2018. In papers where a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was available, 73% of patients had a clinical response (i.e., > 35% improvement in Y-BOCS score) and 24% patients went into remission (Y-BOCS score < 8). In the older publications, published when the Y-BOCS was not yet available, 90% of patients were deemed to have had a significant clinical response and 39% of patients were considered symptom free. The rate of serious complications was low.In summary, AC is a safe, well-tolerated, and efficacious therapy. Its underuse is likely a result of historical prejudice rather than lack of clinical effectiveness.

ObjectiveIn this study, it is aimed to determine obsessive compulsive-related disorders (OCRDs) comorbidity among the patients with obsessive compulsive disorder (OCD) and compare patients with OCD with or without comorbid OCRDs in terms of the severity of their OCD symptoms, symptom dimensions, and comorbidity with other axis I disorders.MethodsThe study included 90 patients diagnosed as having OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for OCRDs were used to determine the presence of OCRDs. In order to determine the symptom dimensions and severity of these individuals' OCD symptoms, we administered the Dimensional Obsessive Compulsive Scale (DOCS) and The Yale-Brown Obsessive Compulsive Scale (Y-BOCS).ResultsIn our study, 20% of the patients with OCD simultaneously met the criteria for at least one OCRD, we also found that a significantly greater proportion of this group were men. None of the mentioned disorders was associated with any symptom dimensions we evaluated using DOCS. In addition, no differences were found in the severity of OCD symptoms and comorbid axis I disorders between the group with comorbid OCRDs and the group without comorbid OCRDs.DiscussionThere was no significant relationship between the symptom dimensions of OCD and OCRDs. It is found that OCRD comorbidity does not increase the severity of OCD symptoms and the prevalence of an axis I diagnosis.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report measure of the severity of obsessive-compulsive symptoms (OCS) along with four dimensions. The aim of this study was to assess the factor structure, reliability and validity of the Persian version of the DOCS (P-OCDS) among patients with obsessive-compulsive disorder (OCD). A total of 764 outpatients with a DSM-IV diagnosis of OCD completed the P-DOCS, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Vancouver Obsessive-Compulsive Inventory (VOCI), the Obsessive-Compulsive Inventory-Revised (OCI-R), the Penn State Worry Questionnaire-Short Form (PSWQ-SF), and the Beck Depression Inventory-II (BDI-II). Similar to the original version of the DOCS, results showed that the P-DOCS had a four-factor structure. Also, the P-DOCS showed good reliability through calculating McDonald's Omega and test-retest. In addition, convergent and discriminant validity of the P-DOCS was confirmed through its strong and weak correlations with other OCD measures and measures of global psychological distress respectively. Findings indicate that the DOCS is a reliable scale to use in Iranian clinical samples with OCD.

The Vancouver Obsessional-Compulsive Inventory (VOCI) was validated in Iranian non-clinical individuals, but not in patients with obsessive-compulsive disorder (OCD). Accordingly, this study aims to further evaluate the six-factor first-order and one-factor second-order structures, validity, and reliability of the scale and also to adapt this scale to the DSM-5 recommendations regarding hoarding behavior in Iranian OCD patients. Three hundred and sixty patients completed the VOCI, the Dimensional Obsessive-Compulsive Scale (DOCS), the Yale-Brown Obsessive Compulsive Scale checklist (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R); the Penn State Worry Questionnaire (PSWQ-SF), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Results showed that the six-factor first-order model of the VOCI had acceptable fit, while the five-factor first-order model had more appropriate fit by deleting the hoarding subscale's items. Also, one-factor second-order structure of the scale has been found to have an adequate fit. In addition, reliability and convergent and discriminant validity of the VOCI have been found to be good. The findings indicate that although the VOCI with the six-factor first-order and one-factor second-order structures is a valid scale in Iranian OCD patients, the VOCI adapted to the DSM-5 is more reliable to be used in Iranian community.

A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.

Background: Cases of obsessive-compulsive disorder (OCD) following cerebrovascular accident (CVA) have rarely been reported. Methods: Case report and literature review. Results: We describe the case of a 58-year-old, right-handed man developed OCD 17 months after stroke resulting from lesion of the right middle cerebral artery infarction. The patient was successfully treated with sertraline up to 50 mg per day. His OCD behaviors largely reduced in 6 weeks, and the Yale-Brown Obsessive Compulsive Scale score was reduced from 29 to 12 in 1 year. A literature review revealed 21 previous cases of OCD following CVA. Among these, consistent with our case, the basal ganglia was the most common site of the lesion responsible for the development of this rare disorder. We discuss the patient's treatment and outcomes. Conclusions: Our present case and a literature review suggest that OCD can manifest following CVA, although further studies are necessary. Selective serotonin reuptake inhibitors appear to be effective in treating this rare disorder.

Background and objectives: Some individuals with Obsessive Compulsive Disorder (OCD) may experience recurrent intrusive distressing images, which may be emotionally linked to past aversive memories. Our aim was to investigate whether Imagery Rescripting was an effective intervention for such individuals with OCD. Method: Twelve cases who experienced intrusive distressing images are presented in a A1BA2CA3 single case experimental design. After a baseline of Compulsive Scale, with a decrease from a mean of 24.1 to 10.7. Reliable symptom monitoring (A1), participants had a control intervention of talking about the memory related image (B), followed by symptom monitoring (A2), a single session of Imagery Rescripting (C) and further monitoring for up to 3 months (A3). Results: Minimal change was seen following the control intervention. However, at 3 months following ImRs, there was a drop in the Yale-Brown Obsessive improvement was achieved in 9 out of the 12 cases and clinically significant change in 7 out of 12 at 3-month follow up. The limitations are that all cases were selected on the basis that they had an aversive memory linked to their imagery. Conclusions: Imagery Rescripting is a promising therapeutic technique for OCD as an adjunct to CBT where intrusive images are linked to aversive memories.

The literature on subclinical autism spectrum (ASD) symptoms in pediatric obsessive-compulsive disorder (OCD) is scarce, and it remains unclear whether ASD symptoms are related to OCD severity. The aims of the present study were to assess the prevalence of ASD symptoms and age and sex differences in children and adolescents with OCD, and to explore the relation between ASD symptoms and OCD severity. This is the largest study of ASD symptoms in an OCD population to date, and the first directly aimed at elucidating sex and age differences in this matter. The study used baseline data from the Nordic Long-term OCD Treatment Study in which parents of 257 children and adolescents with OCD aged 7-17 completed the Autism Spectrum Screening Questionnaire. OCD severity was assessed with the Children's Yale-Brown Obsessive Compulsive Scale. Pediatric OCD patients were found to exhibit elevated rates of ASD symptoms compared to a norm group of school-age children. ASD symptoms were concentrated in a subgroup with a prevalence of 10-17 %. This subgroup was characterized by a male preponderance with a sex ratio of approximately 2.6:1, while children versus adolescents with OCD exhibited similar rates. Autism-specific social and communication difficulties were not related to OCD severity, while restricted repetitive behavior was positively related to OCD severity. The results indicate that clinicians need to be aware of ASD symptoms in children and adolescents with OCD since one out of ten exhibits such symptoms at a clinical sub-threshold.

Broad and narrow specificity are current issues within cognitive models of psychopathology. The aim of this study was to describe the nature of the relationship between inflated responsibility (measured with the Responsibility Attitudes Scale [RAS]) and obsessive-compulsive symptoms (measured with the Yale-Brown Obsessive Compulsive Scale self-report [Y-BOCS]) and between intolerance of uncertainty (measured with the Intolerance of Uncertainty Scale [IUS]) and generalized anxiety symptoms (measured with the Worry and Anxiety Questionnaire [WAQ]). A sample consisting of undergraduates was used in both cases. Hierarchical regression analysis and a methodological approach proposed by Garber and Hollon (1991) were used. The results showed that responsibility was relevant to, and specific to, obsessive-compulsive symptoms even when other associated variables were controlled for. Intolerance of uncertainty was relevant to, but not specific to, generalized anxiety symptoms. These results clarify the roles of bot...

Pediatric obsessive–compulsive disorder (OCD) is a disorder associated with distress and impairment in many domains. Moreover, there is a high risk of relapse and developing a chronic illness. Randomized-controlled trails (RCT), the gold-standard for evaluating treatments, show treatments to be efficacious, yet little is known about their generalizability and long-term durability in “usual-care” settings. The aim of the present study is to evaluate the feasibility and effectiveness of evidence-based pediatric OCD-treatments in regular practice. Participants were 109 children (aged 7–17 years) with a primary diagnosis of OCD, recruited from a specialized OCD-clinic in Sweden. Few exclusion criteria were applied. The youths were assessed at baseline, 6 and 12 months following the first assessment, using Children׳s Yale-Brown Obsessive Compulsive Scale and Children׳s OCD Impact Scale. They were treated with Cognitive Behavior Therapy, augmented with SSRI when indicated. The majority responded well to treatment i.e. were free from OCD or in remission at 12 month evaluation. Moreover, the participants psychosocial functioning significantly improved from baseline to evaluation at 6 and 12 months.

The OCD Challenge is an interactive self-help website for obsessive compulsive disorder (OCD). OCD is often untreated and many barriers prohibit access to an evidence-based intervention including cost, lack of providers, and stigma. Analysis of 436 website participant's demographic data revealed that 63.1% were female, 80.5% were Caucasian, the mean age was 33.37 and the mean age of onset was 15.37. Results of the 436 website users showed a significant positive correlation between Yale-Brown Obsessive Compulsive Scale (YBOCS) assessment scores and disability as well as anxiety and stress scores. Future studies should examine the feasibility of the OCD Challenge at decreasing OCD, disability, depression, anxiety, and stress scores.

Randomised and sham-controlled trials (RCTs) of repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) have yielded conflicting results, which may be due to the variability in rTMS parameters used. We performed an updated systematic review and meta-analysis on the effectiveness of rTMS for the treatment of OCD and aimed to determine whether certain rTMS parameters, such as cortical target, may be associated with higher treatment effectiveness. After conducting a systematic literature review for RCTs on rTMS for OCD through to 1 December 2016 using MEDLINE, PubMed, Web of Science, PsycINFO, Google, and Google Scholar, we performed a random-effects meta-analysis with the outcome measure as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To determine whether rTMS parameters may have influenced treatment effectiveness, studies were further analysed according to cortical target, stimulation frequency, and length of follow-up. Data were obtained from 18 RCTs on rTMS in the treatment of OCD. Overall, rTMS yielded a modest effect in reducing Y-BOCS scores with Hedge's g of 0.79 (95% CI = 0.43-1.15, p

The present research aimed to investigate the difficulties in emotion regulation (DER) among patients with obsessive-compulsive disorder (OCD) and to predict obsessive-compulsive (OC) symptom dimensions based on DER dimensions. Eighty outpatients with OCD and 80 normal controls completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Obsessive Compulsive Inventory-Revised (OCI-R), the Difficulties in Emotion Regulation Scale (DERS) and the Depression Anxiety Stress Scales (DASS-21). OCD patients revealed significantly higher scores on DER dimensions including lack of emotional clarity, limited access to emotion regulation strategies and non-acceptance of emotional responses than healthy controls. Partial correlations indicated significant associations between OC dimensions such as checking/doubting, obsessing, mental neutralizing, and ordering with non-acceptance of emotional responses, checking/doubting with lack of emotional awareness, and ordering with limited access to emotion regulation strategies. Results indicated that non-acceptance of emotional responses was a significant predictor of checking/doubting, obsessing, mental neutralizing and ordering. These findings revealed that DER, especially non-acceptance of emotional responses, may constitute evidence to improve our understanding of OCD.

Background and Objectives: Recent studies explored the relationships between metacognitive beliefs and body dysmorphic disorder. The purpose of this study was to develop and validate one self-report scale of metacognitive factor about body dysmorphic. Methods: Development of this scale involved three steps: 1) items generated from a qualitative study with lecture and care professionals, 2) expert panel review, and 3) pilot test. A factor analysis of the responses from 600 participants suggested the creation of a 25-item scale. Results: Study showed that scores on the 25-item measure correlated with five theoretically related constructs, including positive and negative metacognitive beliefs about body dysmorphic, thought-fusion and metacognitive control strategies. Convergent validity of Body Dysmorphic Metacognitive Scale (BDMCS) with Yale-Brown Obsessive Compulsive Scale was modified for Body Dysmorphic Disorder (BDD) and Thought Fusion Instrument (r = 0.44, r = 0.52, P

BACKGROUND AND OBJECTIVE The present study attempted to assess childhood trauma events and dissociative symptoms in patients with obsessive compulsive disorder (OCD). METHOD The study included all patients who were admitted for the first time to the psychiatric outpatient unit over a 24-month period. Seventy-eight patients were diagnosed as having OCD during the two-year study period. Childhood traumatic events were assessed with a Childhood Trauma Questionnaire (CTQ). Obsessive compulsive disorder symptoms were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). A Dissociation Questionnaire (DIS-Q) was also used to measure dissociative symptoms. RESULTS The mean of Y-BOCS points were 23.37 +/- 7.27. Dissociation questionnaire scores were between 0.40 and 3.87 and the mean was 2.23 +/- 0.76. Childhood trauma points were 1.27-4.77 and the mean was 2.38 +/- 0.56. There was no statistically significant relationship between Y-BOCS points and childhood trauma points (p > 0.05). There was a statistically significant positive relationship between Y-BOCS points and DIS-Q points. There was no statistically significant relationship between DIS-Q points and childhood trauma points (p > 0.05). CONCLUSION Childhood trauma questionnaire points might be significant clinically, although there was not a statistically significant correlation in our study. We also conclude that dissociative symptoms among patients with OCD should alert clinicians to treatment of the disorder.

OBJECTIVE: Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by tics and frequent comorbidities. Although tics often improve during adolescence, recent studies suggest that comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) tend to persist. This large prospective follow-up study describes the clinical course of tics and comorbidities during adolescence and the prevalence of coexisting psychopathologies.METHOD: The clinical cohort was recruited at the Danish National Tourette Clinic, and data were collected at baseline (n = 314, age range 5-19 years) and at follow-up 6 years later (n = 227) to establish the persistence and severity of tics and comorbidities. During follow-up, the Development and Well-Being Assessment (DAWBA) was used to diagnose coexisting psychopathologies. Repeated measures of severity scores were modeled using mixed effects models.RESULTS: Tic severity declined yearly (0.8 points, CI: 0.58-1.01, on the Yale Global Tic Severity Scale [YGTSS]) during adolescence; 17.7% of participants above age 16 years had no tics, whereas 59.5% had minimal or mild tics, and 22.8% had moderate or severe tics. Similarly, significant yearly declines in severity of both OCD (0.24, CI: 0.09-0.39, on the Yale-Brown Obsessive Compulsive Scale for Adults [Y-BOCS] and Yale-Brown Obsessive Compulsive Scale for Children [CY-BOCS]) and ADHD (0.42, CI: 0.32-0.52, DSM-IV) were recorded. At follow-up, 63.0% of participants had comorbidities or coexistent psychopathologies, whereas 37.0% had pure TS.CONCLUSION: Severity of tics, OCD, and ADHD were significantly associated with age and declined during adolescence. However, considerable comorbidities and coexisting psychopathologies persist throughout adolescence and require monitoring by clinicians.

About one third of patients with obsessive-compulsive disorder (OCD) fail to experience significant clinical benefit from currently available treatments. Hyperactivity of the presupplementary motor area (pre-SMA) has been detected in OCD patients, but it is not clear whether it is the primary cause or a secondary compensatory mechanism in OCD pathophysiology. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique with polarity-dependent effects on motor cortical excitability. A 33-year-old woman with treatment-resistant OCD received 20 daily consecutive 2 mA/20 min tDCS sessions with the active electrode placed on the pre-SMA, according to the 10-20 EEG system, and the reference electrode on the right deltoid. The first 10 sessions were anodal, while the last 10 were cathodal. Symptoms severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) severity score. In the end of anodal stimulation, OCD symptoms had worsened. Subsequent cathodal stimulation induced a dramatic clinical improvement, which led to an overall 30% reduction in baseline symptoms severity score on the Y-BOCS. Our study supports the hypothesis that pre-SMA hyperfunction might be responsible for OCD symptoms and shows that cathodal inhibitory tDCS over this area might be an option when dealing with treatment-resistant OCD.

Background: Family accommodation (FA) is a phenomenon whereby caregivers assist/facilitate rituals or behaviors related to obsessive–compulsive disorder (OCD). FA, however, has been explored primarily in the Western population, and it is unclear to what extent it might be present in diverse cultural settings. At present, little is known about the extent and predictors of FA among caregivers of adult OCD patients in India. Aims: The study aims to assess the extent, clinical correlates, and predictors of FA in the caregivers of adults with OCD. Settings and Design: Cross-sectional study conducted in an outpatient setting in a tertiary-care hospital. Materials and Methods: Hundred and one adult patients of either gender with Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis of OCD and 101 caregivers were included. The patients were assessed using Yale–Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), World Health Organization Disability Assessment Schedule Version 2.0 12-item version (WHO-DAS 2.0.12), Clinical Global Impressions Scale for Severity (CGI-S), and Clinical Global Impressions Scale for Improvement. The FA Scale-Self Rated Version (FAS-SR) was applied on caregivers after Hindi translation. Statistical Analysis: Descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Multiple linear regression modeling was performed with the total FAS-SR score as the dependent variable. Results: About 92% of caregivers displayed at least some form of FA. Higher scores on HAM-D, YBOCS, WHODAS, and CGI-S were associated with higher scores on FAS-SR scale, which reached statistical significance (P < 0.01). Conclusions: FA in OCD appears to be a frequent phenomenon. Higher FA is associated with higher symptom severity and disability, emphasizing its clinical and research relevance for future studies.

Objective: The primary aim of this study is to evaluate the possible relationship between obsessive-compulsive symptoms (OCS) and traumatic life events (TLEs) in this clinical sample of adolescents. The secondary objective is to evaluate the relationship between different clinical presentations and severities of OCS and specific TLEs. Methods: The study included 60 adolescents between 12-16 ages, with obsessive-compulsive disorder (OCD) ac-cording to DSM-V and 60 adolescents without any psychiatric diagnosis. Sociodemographic characteristics of cases were evaluated with detailed form; in addition, neuropsychological tests were applied to investigate development of intelligence and trauma characteristics of childhood. Turkish version of Schedule for Affective Disorders and Schizo-phrenia for School-Age-Children Present and lifetime version, Children's Yale-Brown Obsessive Compulsive Scale, Children's Depression Inventory and Childhood Trauma Questionnaire-short form were applied in order to assess psychopathology. Intelligence level of patients were assessed with Wechsler Intelligence Scale for Children-Re-vised. Results: It was determined that there was a strong relationship between TLEs and OCS in adolescents, especially in females. TLEs were associated with all OCS manifestations, most prominently with sexual, religious and harm obsessions. The sexual abuse showed stronger associations with OCS compared with other TLEs. Dis-cussion: Due to limited number of patients, our findings couldn’t be generalized to all adolescents with OCS; there-fore there is a need for more studies in this area.

OZET Calismamizda OKB hastalari ile saǧlikli bireylerin aleksitimi duzeyleri karsilastirilip aralarinda anlamli bir fark olup olmadiǧi incelenmistir. Bununla birlikte kisilerin bazi sosyodemografik ozelliklerinin de OKB ve aleksitimi duzeyleri uzerinde etkili olup olmadiǧi arastirilmistir. Calismaya, Istanbul ilindeki Uskudar Universitesi NP Feneryolu Tip Merkezi'nde tani almis ve tedavileri halen devam eden, yaslari 18-45 araliǧinda olan 25'i kadin 15'i erkek olmak uzere 40 gonullu OKB hastasi ile Istanbul ilinde yasayan rastgele secilmis, herhangi bir psikiyatrik tanisi bulunmayan, yaslari 18-45 araliǧinda olan 25'i kadin 15'i erkek olmak uzere 40 gonullu saǧlikli birey katilmistir. Katilimcilar oncelikle calisma ve kisisel bilgilerin gizliliǧi konusunda bilgilendirilmistir. Arastirmada elde edilecek verileri toplamak amaciyla, 80 katilimciya, “Sosyodemografik Veri Formu, Toronto Aleksitimi Olceǧi (TAO-20) ve Yale-Brown Obsesyon Kompulsiyon Olceǧi ve Semptom Listesi (Y-BOCS)” uygulanmistir. Bu olceklerden elde edilen veriler ise SSPS v. 21 (Statistical Package for Social Sciences) programi ile istatistiksel analize tabi tutulmustur. Surekli deǧiskenlerin normallik daǧilimi Skewness-Kurtosis deǧerlerinin -1.5 ve +1.5 araliǧinda olusuna gore deǧerlendirilmistir. OKB tanili hastalarla saǧlikli kontrollerin olceklerden aldiklari puanlarin karsilastirilmasinda baǧimsiz orneklem t testi yurutulmustur. Sosyodemografik deǧiskenler bakimindan yurutulen gruplar arasi karsilastirmalarda baǧimsiz orneklem Mann Whintey U testi yurutulmustur. Olceklerden alinan puanlar arasindaki korelasyon deǧerleri ise puanlarin normal daǧiliyor olmasi nedeniyle Pearson korelasyon analizi ile yurutulmustur. Yapilan calismanin sonuclarina gore; OKB hastalarinin aleksitimi duzeyleri saǧlikli bireylerin aleksitimi duzeylerine gore anlamli bir bicimde daha yuksek bulunmustur. OKB hastalarinin TAO-20'nin alt boyutlari olan duygu ifadesinde zorluk puanlari ile duygu tanimlamada zorluk puanlari arasinda pozitif yonde anlamli iliski bulunmustur. Anahtar kelimeler: Aleksitimi, obsesif kompulsif bozukluk, OKB In this study, we compared the levels of alexithymia in healthy individuals with OCD patients and investigated whether there is a significant difference between them. Furthermore, some of the sociodemographic characteristics of the subjects were also examined to determine whether they had an effect on OCD and alexithymia levels. 40 volunteer OCD patients, 25 of whom were women and 15 men, aged 18-45 years, who were diagnosed at the NP Feneryolu Medical Center of Uskudar University, Istanbul, and who were randomly selected and living in Istanbul, 40 volunteer healthy individuals, 25 of whom are women and 15 of whom are men and whose ages are between 18 and 45, are attended to this study. Participants were first informed about the privacy of work and personal information. “Sociodemographic Data Form, Toronto Alexithymia Scale (TAS-20) and Yale-Brown Obsessive Compulsive Scale and Symptom List (Y-BOCS)” were applied to all 80 participants in order to collect the data obtained in the study. The data obtained from these scales were subjected to statistical analysis with the SSPS v. 21 (Statistical Package for Social Sciences) program. The normality distribution of continuous variables was evaluated according to the occurrence of Skewness-Kurtosis values in the range of -1.5 and +1.5. An independent sample t-test was conducted to compare the scores of healthy controls and OCD patients. Independent sample Mann Whintey U test was performed among the groups in terms of demographic variables. Correlation values between the scores obtained from the scales were analyzed by Pearson correlation analysis because the scores were normally distributed. According to the results of this study; a significant difference was found between the levels of alexithymia of healthy individuals and OCD patients. The levels of alexithymia in OCD patients were significantly higher than those of healthy individuals. Apart from this, there was a significant positive correlation between the difficulty describing feelings scores of OCD patients and the their difficulty identifying feelings scores of the TAS-20 subscales. In addition, a number of suggestions have been added in order to make contribution to the literature of this research which is also included in similar studies.

The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is the most commonly used instrument to assess the symptoms and severity of pediatric obsessive compulsive disorder (OCD). However, only one prior study has evaluated the psychometric properties of the CY-BOCS for assessing young children, ages 5 to 8 years. The limited available evidence suggests that psychometric properties are less favorable with younger children. Thus, the present study aimed to re-examine the technical qualities of the CY-BOCS in a sample of 5 to 8 year olds with early-onset OCD. The sample consisted of 127 younger children, enrolled in a multi-site randomized controlled trial comparing the efficacy of family-based cognitive behavioral therapy to relaxation therapy. The CY-BOCS Total score demonstrated adequate internal consistency, although at a lower level than is typically reported in studies of older children. Internal consistency of the Obsessions and Compulsions subscales was poor. The Total and subscale scores demonstrated good temporal stability over 5 weeks. Agreement between clinician and parent versions was poor at baseline but improved substantially throughout the course of the trial. Results also indicated that the CY-BOCS had good convergent and discriminant validity. Further, certain CY-BOCS items appear more reliable indicators of OCD severity in younger children than others. Limitations, implications, and future directions are discussed, including the potential for further developmentally sensitive refinement of the CY-BOCS for this age group.

The aim of this study is to investigate the effects of obsessive-compulsive symptoms (OCS) on quality of life (QoL) and to identify the OCS with a particular effect on QoL, and whether there are any such symptoms for patients with schizophrenia.We studied three groups of patients with schizophrenia. One group of patients (n = 45) without OCS or obsessive-compulsive disorder (OCD), one group with OCS, not fulfilling the diagnostic criteria for OCD (n = 31), and one group with OCD as a comorbid condition (n = 24). Severity of clinical symptoms was evaluated with the Positive and Negative Symptom Scale and OCS was examined using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist. We also administered the Y-BOCS. The patients' QoL was assessed using the Quality of Life Scale (QLS).QLS interpersonal relationships subscale scores of those with OCS were lower than those without OCS. There was no difference among OCS, non-OCS, and OCD groups in terms of QoL. There was no relationship between QLS scores and symmetry, contamination and causing harm obsessions, but those with cleaning and repeating compulsions had lower QoL.Questioning of comorbid OCS and treatment with specific medication in schizophrenia patients may increase QoL.