Diogenes' syndrome — a load of old rubbish?

AbstractObjective: It has been suggested that presentation with self-neglect, domestic squalor and hoarding, represents a distinct syndrome, widely known as Diogenes' syndrome. The validity of this syndrome is controversial and we suggest that in previous series of such patients other psychiatric diagnoses, particularly obsessive compulsive disorder (OCD), may have been missed.Method: A series of 50 patients admitted for treatment of OCD were examined, looking for presentation with self-neglect, domestic squalor and hoarding. Response to treatment was also measured by comparing pre and post-treatment scores on the Beck Depression Inventory and Activity Checklist.Results: Of the sample 8% presented with all three features. This sub-group of patient had a poorer outcome than other patients with OCD.Conclusion: Presentation with self-neglect, domestic squalor and hoarding is not uncommon in patients with severe OCD and this supports the suggestion that patients previously described as having Diogenes' syndrome may have had undiagnosed OCD.

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Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

Journal of Neurosurgery ◽

10.3171/2014.2.jns131423 ◽

2014 ◽

Vol 121 (1) ◽

pp. 123-130 ◽

Cited By ~ 19

Author(s):

Andre F. Gentil ◽

Antonio C. Lopes ◽

Darin D. Dougherty ◽

Christian Rück ◽

David Mataix-Cols ◽

...

Keyword(s):

Clinical Outcome ◽

Obsessive Compulsive Disorder ◽

Limbic System ◽

Sao Paulo ◽

Response To Treatment ◽

São Paulo ◽

Obsessive Compulsive ◽

Symptom Dimensions ◽

Compulsive Disorder ◽

Treatment Refractory

Object Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%–41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

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Computer-delivered cognitive-behavioural treatments for obsessive compulsive disorder: preliminary meta-analysis of randomized and non-randomized effectiveness trials

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x1400021x ◽

2014 ◽

Vol 7 ◽

Cited By ~ 1

Author(s):

Andrea Pozza ◽

Gerhard Andersson ◽

Paolo Antonelli ◽

Davide Dèttore

Keyword(s):

Obsessive Compulsive Disorder ◽

Interactive Voice Response ◽

Meta Analysis ◽

Analytical Techniques ◽

Post Treatment ◽

Depression Symptom ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Cognitive Behavioural ◽

Interactive Voice Response Systems

AbstractCognitive behavioural treatments (CBTs) are well-established for obsessive compulsive disorder (OCD). However, few patients receive CBT, due to factors like geographical limitations, perceived stigmatization, and lack of CBT services. Some evidence suggests that computer-delivered cognitive-behavioural treatments (CCBTs) could be an effective strategy to improve patients’ access to CBT. To date a meta-analysis on effectiveness of CCBTs for OCD has not been conducted. The present study used meta-analytical techniques to summarize evidence on CCBTs for OCD on OCD and depression symptom outcomes at post-treatment and follow-up. A meta-analysis was conducted according to PRISMA guidelines. Treatments were classified as CCBTs if including evidence-based cognitive-behavioural components for OCD (psychoeducation, exposure and response prevention, cognitive restructuring), delivered through devices like computers, palmtops, telephone-interactive voice-response systems, CD-ROMS, and cell phones. Studies were included if they used validated outcomes for OCD. Eight studies met inclusion criteria (n= 392). A large effect favouring CCBTs over control conditions was found for OCD symptoms at post-treatment (d= 0.82,p= 0.001), but not for depression symptom outcomes (d= 0.15,p= 0.20). Theoretical implications and directions for research are discussed. A larger number of randomized controlled trials is required.

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A Pilot Study of Computer-Aided Vicarious Exposure for Obsessive-Compulsive Disorder

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679809062738 ◽

1998 ◽

Vol 32 (2) ◽

pp. 268-275 ◽

Cited By ~ 46

Author(s):

Augustino Clark ◽

Kenneth C. Kirkby ◽

Brett A. Daniels ◽

Isaac M. Marks

Keyword(s):

Pilot Study ◽

Computer Program ◽

Obsessive Compulsive Disorder ◽

Beck Depression Inventory ◽

Behaviour Therapy ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Interactive Computer Program ◽

Computer Aided

Objective: This study reports the use of an interactive computer program to instruct vicarious exposure and ritual prevention for obsessive-compulsive disorder (OCD). Method: Thirteen OCD volunteers and 10 non-OCD volunteers completed three 45-minute sessions at weekly intervals. Subjects with OCD completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI) and the Beck Depression Inventory (BDI) 1 week prior to and 1 week after the three computer treatment sessions. Non-OCD subjects only completed these measures at baseline, allowing confirmation that they had no significant level of OCD symptomatology. Results: In the OCD subjects, scores fell significantly on the PI and BDI, and Y-BOCS scores fell non-significantly. Engagement in vicarious exposure with ritual prevention improved from sessions 1–3. Compared to the non-OCD participants, OCD subjects did less vicarious exposure in session 1 but not sessions 2 and 3. Performance of vicarious exposure by OCD subjects in session 1 correlated with pre-post improvement in PI and BDI scores. Conclusions: The vicarious exposure program may have a role to play as an adjunct in behaviour therapy.

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Study of oxidative stress in obsessive compulsive disorder in response to treatment with Fluoxetine

Indian Journal of Clinical Biochemistry ◽

10.1007/s12291-009-0035-9 ◽

2009 ◽

Vol 24 (2) ◽

pp. 194-197 ◽

Cited By ~ 11

Author(s):

Sutirtha Chakraborty ◽

Anindya Dasgupta ◽

Harendra Nath Das ◽

Om Prakash Singh ◽

Asok Kumar Mandal ◽

...

Keyword(s):

Oxidative Stress ◽

Obsessive Compulsive Disorder ◽

Response To Treatment ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Post-treatment effects of exposure therapy and clomipramine in obsessive-compulsive disorder

Depression and Anxiety ◽

10.1002/da.20003 ◽

2004 ◽

Vol 19 (4) ◽

pp. 225-233 ◽

Cited By ~ 74

Author(s):

H. Blair Simpson ◽

Michael R. Liebowitz ◽

Edna B. Foa ◽

Michael J. Kozak ◽

Andrew B. Schmidt ◽

...

Keyword(s):

Obsessive Compulsive Disorder ◽

Treatment Effects ◽

Exposure Therapy ◽

Post Treatment ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Prevalence and Associated Factors for Suicidal Ideation and Behaviors in Obsessive-Compulsive Disorder

CNS Spectrums ◽

10.1017/s1092852900015467 ◽

2007 ◽

Vol 12 (10) ◽

pp. 771-778 ◽

Cited By ~ 36

Author(s):

Albina Rodrigues Torres ◽

Ana Teresa de Abreu Ramos-Cerqueira ◽

Ricardo Cezar Torresan ◽

Mariana de Souza Domingues ◽

Ana Carolina R. Hercos ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicidal Ideation ◽

Obsessive Compulsive Disorder ◽

Beck Depression Inventory ◽

Alcohol Problems ◽

Worth Living ◽

Obsessive Compulsive ◽

Suicidal Thoughts ◽

Compulsive Disorder ◽

Suicidal Plans

ABSTRACTIntroductionPatients with obsessive-compulsive disorder (OCD) have historically been considered at low risk for suicide, but recent studies are controversial.ObjectiveTo study the prevalence of suicidal thoughts and attempts in OCD patients and to compare those with and without suicidality according to demographic and clinical variables.MethodsFifty outpatients with primary OCD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) from a Brazilian public university were evaluated. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess OCD severity, the Beck Depression Inventory to evaluate depressive symptoms and the Alcohol Use Disorders Identification Test to assess alcohol problems.ResultsAll patients had obsessions and compulsions, 64% a chronic fluctuating course and 62% a minimum Y-BOCS score of 16. Half of the patients presented relevant depressive symptoms, but only three had a history of alcohol problems. Seventy percent reported having already thought that life was not worth living, 56% had wished to be dead, 46% had suicidal ideation, 20% had made suicidal plans, and 10% had already attempted suicide. Current suicidal ideation occurred in 14% of the sample and was significantly associated with a Y-BOCS score ≥16. Previous suicidal thoughts were associated with a Beck Depression Inventory score ≥19.ConclusionSuicidality has been underestimated in OCD and should be investigated in every patient, so that appropriate preventive measures can be taken.

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Effectiveness of group-based cognitive–behavioural therapy in patients with obsessive–compulsive disorder

The Psychiatrist ◽

10.1192/pb.bp.106.011510 ◽

2010 ◽

Vol 34 (1) ◽

pp. 6-9 ◽

Cited By ~ 1

Author(s):

Colette Kearns ◽

Yvonne Tone ◽

Gavin Rush ◽

James V. Lucey

Keyword(s):

Obsessive Compulsive Disorder ◽

Cognitive Behavioural Therapy ◽

Rating Scales ◽

Behavioural Therapy ◽

Post Treatment ◽

Group Setting ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Cognitive Behavioural ◽

The Mean

Aims and methodTo establish whether cognitive-behavioural therapy (CBT) with response and exposure prevention (ERP) is effective in individuals with obsessive–compulsive disorder (OCD). Twenty-four patients with OCD, divided into four groups, participated in ten sessions of group CBT. All patients completed the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Maudsley Obsessive–Compulsive Inventory (MOCI), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) pre- and post-treatment.ResultsThe mean (s.d.) YBOC score post-treatment was 17.1 (5.8). This was significantly lower than the mean (s.d.) YBOC pre-treatment (24.7 (6.1); t = 8.4, d.f. = 23, P < 0.005). A significant reduction was also observed in relation to all other rating scales.Clinical implicationsCognitive–behavioural therapy for OCD delivered in a group setting is a clinically effective and acceptable treatment for patients. The use of group-based CBT is an effective means to improve access to psychotherapy.

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Group Versus Individual Cognitive Treatment for Obsessive-Compulsive Disorder: Changes in Severity at Post-Treatment and One-Year Follow-up

Behavioural and Cognitive Psychotherapy ◽

10.1017/s135246580999066x ◽

2009 ◽

Vol 38 (2) ◽

pp. 227-232 ◽

Cited By ~ 11

Author(s):

Elena Cabedo ◽

Amparo Belloch ◽

Carmen Carrió ◽

Christina Larsson ◽

Héctor Fernández-Alvarez ◽

...

Keyword(s):

Obsessive Compulsive Disorder ◽

Post Treatment ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Cognitive Behaviour ◽

One Year ◽

The One ◽

The Individual ◽

Group Cbt

Background: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. Aims: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. Method: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. Results: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. Conclusions: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

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