Clozapine-related obsessive–compulsive symptoms and their impact on wellbeing: a naturalistic longitudinal study

Background Obsessive–compulsive symptoms (OCS) are commonly associated with clozapine treatment but are frequently overlooked by clinicians despite their potential impact on patients' quality of life. In this study, we explored whether OCS severity impacted subjective wellbeing and general functioning, independently of depressive and psychotic symptoms. Methods We used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine and assessed annually for OCS, wellbeing, general functioning, and psychopathology using standardised scales as part of routine clinical practice. We used statistical mixed linear model techniques to evaluate the longitudinal influence of OCS severity on wellbeing and general functioning. Results A total of 184 patients were included, with 527 face-to-face assessments and 64.7% evaluated three or more times. Different linear mixed models demonstrated that OCS in patients treated with clozapine were associated with significantly worse wellbeing scores, independently of depression and psychotic symptoms, but OCS did not impair general functioning. Obsessional thinking and hoarding behaviour, but not compulsions, were significantly associated with the impact on wellbeing, which may be attributable to the ego-syntonic nature of the compulsions. Conclusions Given the frequent occurrence of OCS and their negative impact on wellbeing, we encourage clinicians to routinely assess and treat OCS in patients who are taking clozapine.

Emotional intelligence and anger in adolescents with obsessive-compulsive symptoms

Poor perception, understanding and regulation of emotions often play a key role in the development and maintenance of psychopathological disorders. The aim of this study was to analyze differences in attention, compression, regulation of emotion and anger, taking into account some variables that may influence results (age, anxiety and depression). Participants were 315 adolescents (213 boys and 102 girls) aged between 12 and 18 years old (M= 14.92, SD= 1.98), high (≥ 90th percentile) and low (< percentile 21) ratings in obsessive-compulsive dimension in The Symptom Check List (SCL-90-R; Derogatis, 1975). Statistically significant differences between groups were observed in emotions and anger variables except internal expression of anger and physical expression of anger. Age, anxiety and depression influenced some variables. These findings are relevant for treatment.

Thought-action fusion and inflated responsibility in psychopathology

<p>The aim of the current research was to investigate the presence and roles of inflated responsibility and thought-action fusion in psychopathology. The three underlying research themes were to examine the relationship between thought-action fusion and inflated responsibility, the roles that they play in psychopathology, and the possible etiology of these types of beliefs. It is proposed that these responsibility beliefs are not specific to obsessive compulsive disorder, as commonly assumed, and that they play important roles in the maintenance of a range of psychological symptoms. This thesis presents the results of four studies. The first study was designed to investigate the presence of Thought-Action Fusion (TAF) and Inflated Responsibility (IR) alongside symptoms of depression, anxiety, and obsessive-compulsive disorder, with thought suppression playing an intermediary role. Study 2 examined the interaction between responsibility beliefs and locus of control on obsessive-compulsive symptoms with non-clinical and clinical participants. The third study focussed on the etiology of responsibility beliefs, taking Salkovskis, Shafran, Rachman, and Freeston’s (1999) theory of Pathways to Inflated Responsibility and empirically testing this with both clinical and non-clinical samples. Study 4 focussed on the relationship between responsibility beliefs and religiosity, using participants of Protestant Christian beliefs and Atheists. These studies collectively show that Thought-Action Fusion and Inflated Responsibility are both important and contributing factors in psychopathology, especially playing a part in the maintenance of symptoms and feelings of distress. Results indicated that while TAF tends to be specific to obsessive compulsive symptoms, IR is more of a general cognitive bias. Results also indicate that critical experiences in one’s life can lead to biases in responsibility beliefs. Additionally, results show that these biases are not always indicative of psychopathology when they are acceptable within a particular set of morals, for example religion. These findings are of both theoretical and clinical significance because they add to the growing understanding of TAF and IR in psychopathology. The current research was conducted with observational, self-report measures; further research using longitudinal studies is needed for more clarity on causality.</p>

Thought-action fusion and inflated responsibility in psychopathology

<p>The aim of the current research was to investigate the presence and roles of inflated responsibility and thought-action fusion in psychopathology. The three underlying research themes were to examine the relationship between thought-action fusion and inflated responsibility, the roles that they play in psychopathology, and the possible etiology of these types of beliefs. It is proposed that these responsibility beliefs are not specific to obsessive compulsive disorder, as commonly assumed, and that they play important roles in the maintenance of a range of psychological symptoms. This thesis presents the results of four studies. The first study was designed to investigate the presence of Thought-Action Fusion (TAF) and Inflated Responsibility (IR) alongside symptoms of depression, anxiety, and obsessive-compulsive disorder, with thought suppression playing an intermediary role. Study 2 examined the interaction between responsibility beliefs and locus of control on obsessive-compulsive symptoms with non-clinical and clinical participants. The third study focussed on the etiology of responsibility beliefs, taking Salkovskis, Shafran, Rachman, and Freeston’s (1999) theory of Pathways to Inflated Responsibility and empirically testing this with both clinical and non-clinical samples. Study 4 focussed on the relationship between responsibility beliefs and religiosity, using participants of Protestant Christian beliefs and Atheists. These studies collectively show that Thought-Action Fusion and Inflated Responsibility are both important and contributing factors in psychopathology, especially playing a part in the maintenance of symptoms and feelings of distress. Results indicated that while TAF tends to be specific to obsessive compulsive symptoms, IR is more of a general cognitive bias. Results also indicate that critical experiences in one’s life can lead to biases in responsibility beliefs. Additionally, results show that these biases are not always indicative of psychopathology when they are acceptable within a particular set of morals, for example religion. These findings are of both theoretical and clinical significance because they add to the growing understanding of TAF and IR in psychopathology. The current research was conducted with observational, self-report measures; further research using longitudinal studies is needed for more clarity on causality.</p>

Mediating Role of Rumination and Negative Affect in the Effect of Mind-Wandering on Symptoms in Patients With Obsessive-Compulsive Disorder

To explore the relationship between negative affect, mind-wandering, rumination and obsessive-compulsive symptoms, 100 patients with obsessive-compulsive disorder and 100 healthy controls were assessed using the Obsessive-Compulsive Inventory, the Beck Anxiety Inventory, the Beck Depression Inventory, the Mind Wandering Scale and the Ruminative Response Scale. The results show that (i) patients diagnosed with obsessive-compulsive disorder displayed higher obsessive-compulsive symptoms, negative affect, mind-wandering and rumination compared with healthy controls; (ii) negative affect, mind-wandering and rumination were positively correlated with the severity of obsessive-compulsive symptoms; (iii) mind-wandering predicted the severity of obsessive-compulsive symptoms (both directly and indirectly); (iv) rumination and negative affect mediated the relationship between mind-wandering and obsessive-compulsive symptoms. The results preliminarily reveal the relationship between mind-wandering and psychopathological obsessive-compulsive symptoms, providing a reference for exploring novel psychological treatments for obsessive-compulsive disorder.