Subtyping obsessive compulsive patients by depressive symptoms: a retrospective pilot study.

Depression is a frequent comorbid condition in obsessive compulsive disorder (OCD) patients and may impact upon treatment prognosis. Identification of OCD "subtypes" might ultimately aid in treatment decision-making as it has in other psychiatric disorders. A retrospective pilot study was performed examining depressive and OCD symptomatology by analyzing the relation between factor scores on the Beck Depression Inventory (BDI) and the Maudsley Inventory (MOCI) in 41 OCD patients. Total BDI score was significantly correlated with total MOCI score (r = .36, p < .02). Checking was correlated with Retarded depression (r = .30, p < .05). Doubting correlated with both Guilty depression (r = .48, p < .002) and Retarded depression (r = .37, p < .02). None of the canonical correlations were significant. At p < .08, the first canonical correlation approached significance. The data were interpreted cautiously as suggesting that some OCD patients may exhibit symptoms of Doubting together with Guilty depression and Retarded depression symptoms. These data need replication in a larger, prospective study design.

Irritable bowel syndrome: overview of diagnosis and treatment.

Irritable bowel syndrome (IBS) is common in primary care practice and in gastroenterology clinics and is occasionally seen in psychiatric clinics. The symptoms include abdominal cramping, bloating, and pain, as well as diarrhea, constipation, or both. Treatment includes patient education and reassurance, dietary modification, medications if necessary, and consideration of psychological interventions. The etiology of IBS is poorly understood. Research suggests a role for bowel dysmotility, altered pain perception, history of physical and sexual abuse, and psychiatric disturbance, though none of these factors alone has been proven to cause IBS.

Risk of HIV infection in the homeless and chronically mentally ill.

Recent data suggest that the homeless and those with chronic mental illness may be at increased risk for HIV infection. A review of the recent literature reveals insufficient rigorously collected data to identify with confidence any particular subgroup of chronically mentally ill patients at increased risk. Nonetheless, it seems reasonable to suspect that those with acute psychosis, a history of substance abuse, or a history of sexual abuse may be at higher risk. Conversely, some data currently support the conclusion that homeless persons are at increased risk for infection due to human immunodeficiency virus (HIV). Clinicians of all disciplines should be aware of these findings and be particularly vigilant when patients are members of both aforementioned groups. Future research should focus upon improving service delivery to the homeless and mentally ill, particularly with regard to sex education and substance abuse intervention. Also, continued research into causal influences of homelessness will ultimately lead to more definitive intervention.

Behavioral aspects of trichotillomania.

Trichotillomania is characterized by an inability to resist urges to pull out hair. It is estimated to occur in at least 1 out of 200 persons by college age. The disorder usually begins in childhood or adolescence with a chronic course more likely in patients with a later onset. Some investigators hypothesize a relationship between trichotillomania and obsessive compulsive disorder, but this proposal has not yet been substantiated. Little rigorous treatment research has been done, but the current treatments of choice are clomipramine and behavior therapy (habit reversal training).

A psychoeducational and support group for obsessive-compulsive disorder patients and their significant others.

This report details the contents of a 10-week psychoeducational and support group for obsessive-compulsive disorder (OCD) patients and their significant others. As growing numbers of OCD patients seek behavioral and psychopharmacologic treatments for their disorder, the need for such a group has increased. Little is written about this type of group, despite the need. Successful research and evaluation of this treatment entity will rely on a clearly defined group protocol such as the one reported here. In the present study, the group averaged 21 members in attendance. The 17 members present at the final session rated the group an average of 3.8 on a 0 (poor) to 4 (excellent) scale across several content areas. These uncontrolled data suggest that the format has clinical utility as a tool for the delivery of information and support to OCD patients and their significant others.

Perceived mistreatment and attitude change by graduating medical students: a retrospective study.

The goal of this study was to assess types and sources of perceived mistreatment, perceived attitude change, and academic performance of graduating medical students. A total of 87 of 143 (61%) students anonymously completed a mistreatment questionnaire, an attitude questionnaire, and questions about academic performance. The percentage of mistreatment was widespread (98.9%) with psychological mistreatment (shouting and humiliating) by residents/interns being most frequent. Over half of the students perceived sexual harassment, with women reporting greater harassment than men. There was a high incidence of disparaging remarks about doctors and medicine as a profession from a variety of sources. Increased mistreatment was positively associated with a perceived increase in cynicism. The potentially adverse effects of mistreatment on the individual student, the teacher-student relationship, and the doctor-patient relationship are discussed with recommendations for improving medical education.

Obsessive compulsive patients: familial frustration and criticism.

Familial factors such as attitudes toward illness, knowledge of disease process, and criticism of patients often play an important role in patient compliance and outcome in general medical practice as well as in psychiatric settings. As part of the initial assessment in a psychoeducational group for obsessive compulsive disorder patients and their significant others, nonpatients completed the Relative's Reactions Questionnaire and the Control of Symptoms Schedule. The patients completed the Perceived Criticism Measure. Results suggest that significant others experience frustration with the symptomatic behavior of their friend or family member with obsessive compulsive disorder and may respond too frequently with verbal criticism. The patients themselves reported a moderately high level of criticism from significant others at home. Further research is needed on a larger sample size and with nonpsychiatric and nonobsessive compulsive disorder psychiatric controls.

Fluvoxamine in the treatment of tricyclic-resistant depression.

Following an initial double-blind, randomized, parallel treatment group comparison of fluvoxamine, desipramine, and placebo in 89 outpatients with major depression at two centers, double-blind crossover to fluvoxamine was offered to 13 of 22 desipramine-treated completers of the initial phase who were considered failures on desipramine. Twelve elected to cross over to blinded fluvoxamine, and eleven continued on fluvoxamine for at least eight weeks. Nine of these eleven improved, and overall there was a statistically significant decrease in average Hamilton Depression Scores, from 24 to 13, for these fluvoxamine-treated desipramine-resistant patients.

Toward a new nosology of obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is receiving increasing attention in the clinical research literature. This review briefly summarizes data concerning diagnosis, phenomenology, and epidemiology of OCD and examines other disorders that closely resemble OCD. In addition, the nosological and treatment implications of these data are discussed. We find that OCD is characterized by a focal anxiety point(s) reflected in obsessions and by behavioral or cognitive compulsions. The appearance of these characteristics in other disorders suggests some relation between them and, consequently, the treatment of these disorders may be enhanced by conceptualizing them as OCD "variants".