scholarly journals Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome

2019 ◽  
Vol 17 (8) ◽  
pp. 703-709 ◽  
Author(s):  
Aribert Rothenberger ◽  
Veit Roessner
Keyword(s):  
Drug Treatment ◽  
Tourette Syndrome ◽  
Clinical Symptoms ◽  
Behavioral Therapy ◽  
Stress Sensitivity ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Hair Pulling Disorder ◽  
Skin Picking Disorder

: While Behavioral Therapy (BT) should be recommended as the first step in the treatment of OCD as well as TS, medication can be added for augmentation and in certain situations (e.g. family preference, BT not available or feasible) the priority may even reverse. This narrative review is given on the complexity of drug treatment in patients comorbid with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occurring combination of the two generally delimitable, but in detail, also overlapping disorders which wax and wane with time but have different courses as well as necessities and options of treatment. Distinct subtypes like “tic-related OCD” are questionable. Obsessive-compulsive symptoms (OCS) and tics are frequently associated (OCS in TS up to 90%, tics in OCD up to 37%). Sensory-motor phenomena like urges and just-right feelings reflect some behavioral overlap. The main additional psychopathologies are attention-deficit hyperactivity disorder (ADHD), mood problems and anxiety. Also, hair pulling disorder and skin picking disorder are related to OCD with TS. Hence, the assessment and drug treatment of its many psychopathological problems need high clinical experience, careful planning, and ongoing evaluation/adaptation. Drugs are able to reduce clinical symptoms but cannot cure the disorders, which should be treated in parallel in their own right; i.e. for OCD serotonin reuptake inhibitors (SSRI) and for TS (tics), certain antipsychotics can be successfully prescribed. In cases of OCD with tics, when OCS responds only partially, an augmentation with antipsychotics (recommended: risperidone and aripiprazole) may improve OCS as well as tics. Also, the benzamide sulpiride, an atypical antipsychotics, may be beneficial in treating the combination of OCS, tics and anxious-depressive problems. : Probably, any additional psychopathologies of OCD might attenuate the effectiveness of SSRI on OCS; on the other hand, in cases of OCD with tics, SSRI may reduce not only OCS but also stress sensitivity and emotional problems and thus leading to better selfregulatory abilities, useful to improve tic suppression. : In sum, some clinical guidance can be given, but there remain many uncertainties because of a scarce database for psychopharmacotherapy in OCD with TS.

scholarly journals Suppression of Obsessive-Compulsive Symptoms after Head Trauma

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Seyed Hamzeh Hosseini ◽  
Paria Azari ◽  
Roohollah Abdi ◽  
Reza Alizadeh-Navaei
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Head Trauma ◽  
Clinical Symptoms ◽  
Brain Lesions ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Compulsive Symptom ◽  
Obsessive Compulsive Symptom ◽  
Unwanted Thoughts

Obsessive-Compulsive Disorder (OCD) encompasses a spectrum of clinical symptoms characterized by unwanted thoughts coupled with an intense compulsion to act and to repeat behavior fragments in a ritualistic and stereotyped sequence. Obsessive-compulsive symptom due to brain lesions is not rare, but suppression of these symptoms after head trauma is very rare and we found only 3 cases in review of literatures from 1966 to 2001. The case of a patient suffering with severe OCD is described of note; her symptoms disappeared following right temporo-parietofrontal lesion.

Efficacy of Drug Treatment in Obsessive–Compulsive Disorder: a Meta-Analytic Review

1995 ◽  
Vol 166 (4) ◽  
pp. 424-443 ◽  
Author(s):  
Marco Piccinelli ◽  
Stefano Pini ◽  
Cesario Bellantuono ◽  
Greg Wilkinson
Keyword(s):  
Drug Treatment ◽  
Obsessive Compulsive Disorder ◽  
Therapeutic Efficacy ◽  
Antidepressant Drugs ◽  
Physical Symptoms ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Improvement Rate ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder

BackgroundA review of the efficacy of antidepressant drug treatment in patients with obsessive–compulsive disorder (OCD), using a meta-analytic approach.MethodRandomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica – Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive–compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.ResultsClomipramine was superior to placebo in reducing both obsessive–compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive–compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y–BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.ConclusionAntidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive–compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive–compulsive symptoms.

Stress, Trauma, and Obsessive-Compulsive and Related Disorders

2021 ◽  
pp. 173-200
Author(s):  
Jennifer Forte ◽  
Christal L. Badour ◽  
C. Alex Brake ◽  
Jordyn M. Tipsword ◽  
Thomas G. Adams Jr.
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Environmental Factors ◽  
Body Dysmorphic Disorder ◽  
The Other ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Skin Picking Disorder ◽  
Traumatic Stressors ◽  
Homeostatic State

Obsessive-compulsive and related disorders (OCRDs) represent a newly defined category of disorders that include obsessive-compulsive disorder (OCD), hoarding disorder, body dysmorphic disorder, trichotillomania, and skin-picking disorder. Many environmental factors can influence the etiology and expression of obsessive-compulsive symptoms and OCD, such as exposure to environmental stressors, including traumatic and other life stressors. Stressors include incidents and experiences that disrupt a person’s homeostatic state and can range from mild acute stressors to traumatic stressors. Although all stressors are inherently stressful, most of them are not traumatic in nature. Although multiple researchers have reviewed the contributions of stress and trauma on OCD, currently no reviews exist that consider the associations among stress, trauma, and the other putative OCRDs. This chapter reviews the extant literature on the associations among OCRDs and stress, trauma, and posttraumatic stress disorder and discusses how these factors may influence the incidence, etiology, expression, and treatment of OCRDs.

Pharmacological, experimental therapeutic, and transcranial magnetic stimulation treatments for compulsivity and impulsivity

CNS Spectrums ◽  
2013 ◽  
Vol 19 (1) ◽  
pp. 50-61 ◽  
Author(s):  
Stefano Pallanti ◽  
Eric Hollander
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Behavioral Therapy ◽  
Hair Pulling ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Diagnostic And Statistical Manual ◽  
Hair Pulling Disorder

Obsessive-compulsive disorder (OCD) has been recently drawn apart from anxiety disorder by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and clustered together with related disorders (eg, hoarding, hair pulling disorder, skin picking), which with it seems to share clinical and neurophysiological similarities. Recent literature has mainly explored brain circuitries (eg, orbitofrontal cortex, striatum), molecular pathways, and genes (eg, Hoxb8, Slitrk5, Sapap3) that represent the new target of the treatments; they also lead the development of new probes and compounds. In the therapeutic field, monotherapy with cognitive behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs) is recommendable, but combination or augmentation with a dopaminergic or glutamatergic agent is often adopted. A promising therapy for OCD is represented by repetitive transcranial magnetic stimulation (rTMS), which is suitable to treat compulsivity and impulsivity depending on the protocol of stimulation and the brain circuitries targeted.

Symptoms in Obsessive-Compulsive Disorder and Tourette Syndrome: A Spectrum?

CNS Spectrums ◽  
1999 ◽  
Vol 4 (3) ◽  
pp. 21-33 ◽  
Author(s):  
Neal R. Swerdlow ◽  
Sam Zinner ◽  
Robert H. Farber ◽  
Cassie Seacrist ◽  
Heidi Hartston
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Tourette Syndrome ◽  
Clinical Symptoms ◽  
Age Of Onset ◽  
Distribution Patterns ◽  
Obsessive Compulsive ◽  
Clinical Interviews ◽  
Compulsive Disorder ◽  
Clinical Impairment ◽  
The Many

ABSTRACTThere is clear overlap in the clinical symptoms of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). As a result, OCD (with or without tics) and TS (with or without obsessive-compulsive symptoms [OCS]) have been conceptualized to form a disorder spectrum—an overlapping set of phenotypes reflecting presumed commonality at the level of the underlying genetics and neuropathology. We identified the characteristics of a research sample of patients with OCD or TS, based on information obtained in semistructured clinical interviews, to examine the similarities and differences in the clinical symptoms across this spectrum. This sample conformed to known age-of-onset and sex distribution patterns for OCD and TS. Previously reported patterns of predominant aggressive and sexual obsessions and touching compulsions were observed in subjects with tic-related OCD, compared with non—tic-related OCD (ie, OCD alone). The majority of patients with tic-related OCD experienced horrifically violent obsessions that were less common in OCD alone and much less common in TS. Nonetheless, symptomatic and functional impairment in TS subjects was clearly related to the intensity of their OCS. The specific obsessions and compulsions associated with clinical impairment in TS differed from those associated with impairment in OCD. These results suggest that, despite the many overlapping dimensions of these disorders, the symptoms and associated impairment in “pure” OCD, tic-related OCD, and TS do not form a simple continuous spectrum.

Differentiating Body Dysmorphic Disorder from Normal Appearance Concerns and Other Mental Disorders

2017 ◽  
Author(s):  
Katharine A. Phillips
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Psychotic Disorders ◽  
Body Dysmorphic Disorder ◽  
Obsessive Compulsive ◽  
Normal Appearance ◽  
Compulsive Disorder ◽  
Illness Anxiety ◽  
Hair Pulling Disorder ◽  
Skin Picking Disorder

This chapter discusses differentiation of body dysmorphic disorder (BDD) from disorders that may be misdiagnosed as BDD or that present differential diagnosis challenges: eating disorders, major depressive disorder, obsessive-compulsive disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, illness anxiety disorder, social anxiety disorder, agoraphobia, panic disorder, generalized anxiety disorder, schizophrenia and other psychotic disorders, gender dysphoria, avoidant personality disorder, olfactory reference syndrome, and several other constructs. This chapter also discusses how to differentiate BDD from normal appearance concerns and from problematic preoccupation with obvious physical defects.BDD is commonly misdiagnosed as another mental disorder. Sometimes misdiagnosis occurs because patients are too embarrassed and ashamed to reveal their appearance concerns; in such cases, BDD symptoms that are more readily observable (such as social anxiety) may be assigned an incorrect diagnosis while BDD goes undetected. In other cases, BDD symptoms are recognized but are misdiagnosed as another disorder. BDD must be differentiated from other conditions so appropriate treatment can be instituted.

scholarly journals Psychological Treatment of Obsessive-Compulsive Disorder in Children and Adolescents: a Meta-Analysis

2015 ◽  
Vol 18 ◽  
Author(s):  
Ana I. Rosa-Alcázar ◽  
Julio Sánchez-Meca ◽  
Ángel Rosa-Alcázar ◽  
Marina Iniesta-Sepúlveda ◽  
José Olivares-Rodríguez ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Outcome Measures ◽  
Psychological Treatment ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Cognitive Strategies ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Treatment Techniques

AbstractAlthough several meta-analyses have investigated the efficacy of psychological treatments for pediatric obsessive-compulsive disorder (OCD), there is not yet a consensus on the most efficacious treatment components. A meta-analysis was carried out to examine the efficacy of the different treatment techniques used in the psychological interventions of pediatric OCD. An exhaustive literature search from 1983 to February 2014 enabled us to locate 46 published articles that applied some kind of cognitive-behavioral therapy (CBT). For each group the effect size was the standardized pretest-posttest mean change, and it was calculated for obsessive-compulsive symptoms and for other outcome measures. The results clearly showed large effect sizes for CBT in reducing obsessive-compulsive symptoms and, to a lesser extent, other outcome measures (d+ = 1.860; 95% CI: 1.639; 2.081). The most promising treatments are those based on multicomponent programs comprising ERP, cognitive strategies, and relapse prevention. The analysis of other potential moderator variables and the implications for clinical practice are discussed.

scholarly journals Recent Advances in Understanding and Managing Tourette Syndrome

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 152 ◽  
Author(s):  
Mary Ann Thenganatt ◽  
Joseph Jankovic
Keyword(s):  
Tourette Syndrome ◽  
Work Performance ◽  
Behavioral Therapy ◽  
Management Strategies ◽  
Behavioral Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Oral Medications ◽  
Recent Developments ◽  
Hyperkinetic Movement Disorder

Tourette syndrome (TS) is a neurologic and behavioral disorder consisting of motor and phonic tics with onset in childhood or adolescence. The severity of tics can range from barely perceptible to severely impairing due to social embarrassment, discomfort, self-injury, and interference with daily functioning and school or work performance. In addition to tics, most patients with TS have a variety of behavioral comorbidities, including attention deficit hyperactivity disorder and obsessive-compulsive disorder. Studies evaluating the pathophysiology of tics have pointed towards dysfunction of the cortico-striato-thalamo-cortical circuit, but the mechanism of this hyperkinetic movement disorder is not well understood. Treatment of TS is multidisciplinary, typically involving behavioral therapy, oral medications, and botulinum toxin injections. Deep brain stimulation may be considered for “malignant” TS that is refractory to conventional therapy. In this review, we will highlight recent developments in the understanding and management strategies of TS.

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