Quality of life in obsessive-compulsive disorder: the different impact of obsessions and compulsions.

BACKGROUND: Patients with obsessive-compulsive disorder (OCD) are troubled by repeated obsessions and/or compulsions, which seem senseless and frequently repugnant. OBJECTIVE: The study examines the differential impact of obsessions and compulsions on the quality of life (QoL) of patients with OCD. METHODS: Seventy-five patients (43 females, 32 males) between 21 and 62 years old with OCD (ICD 10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. The severity of OCD symptoms was assessed by the Yale Brown Obsessive-Compulsive Scale (a standardized, clinician-administered scale), and depressiveness was assessed with the Beck Depression Inventory (a self-report instrument). QoL was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by WHO. RESULTS: Compulsions reduced patients' QoL in the WHOQOL-BREF domains 'physical well-being', 'psychological well-being' and 'environment', whereas obsessions did not have any impact on QoL ratings. Depressive symptoms were a strong predictor of poor QoL in OCD patients. CONCLUSIONS: In order to judge the QoL of OCD patients, obsessions and compulsions have to be considered differently. Diagnosing and treating depressive symptoms is important for improving the QoL in OCD.

[Subjective quality of life of patients with obsessive-compulsive disorder compared to the general population]. / Subjektive Lebensqualität von Patienten mit Zwangserkrankungen im Vergleich mit der Allgemeinbevölkerung.

BACKGROUND: Patients with obsessive-compulsive disorder (OCD) not only suffer from obsessive-compulsive symptoms, but also the disorder is associated with impaired social functioning, which impact their everyday life negatively. OBJECTIVE: Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population. METHODS: 75 patients with OCD (ICD-10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. Patients showing psychiatric co-morbidity were excluded. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD and in a sample of the general population of Saxony/Germany. RESULTS: Compared with the general population, QoL in patients with obsessive-compulsive disorders was lower in all domains of the WHOQOL-BREF. CONCLUSION: OCD has a substantial adverse effect on patients' subjective QoL. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Quality of life of relatives of patients with obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) affects the lives of both patients and their relatives. Clinical observations suggest that family members of patients with OCD are involved in the patients' rituals, often impairing their own everyday life. OBJECTIVE: The objective of this study was to compare the quality of life (QoL) of relatives of patients with OCD with that of the general German population. METHODS: Seventy-four relatives (29 parents, 33 spouses, 8 children, and 4 siblings) of patients with OCD (International Statistical Classification of Diseases, 10th Revision F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders of the University of Leipzig Department of Psychiatry. The WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organization, assessed QoL. These findings were compared with the QoL of a representative sample of the general German population. RESULTS: Compared with that of the general population, the QoL of relatives of patients with OCD was significantly lower in the domains physical well-being, psychologic well-being, and social relationship. CONCLUSIONS: Obsessive-compulsive disorder has an adverse effect on the subjective QoL of relatives of patients with OCD. Therefore, these findings suggest that professionals working with relatives must focus not only on the care given to persons with an illness but also on their relatives' situation and personal QoL.

Subjective quality of life of patients with obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is the fourth most frequent diagnosis in psychiatry. Patients with OCD suffer from obsessive thinking and compulsive behavior, which impact their everyday life negatively. OBJECTIVE: Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population and to patients with schizophrenia. METHODS: Seventy-five patients, aged 21-72, with OCD (ICD 10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD in a representative sample of patients with schizophrenia and in a sample of the general population of Saxony/Germany. RESULTS: Compared with the general population, QoL in patients with OCDs was lower in all domains of the WHOQOL-BREF. Unexpectedly, QoL in patients with OCDs was lower in the domains "psychological well-being" and "social relationships" when compared with schizophrenia patients. CONCLUSIONS: OCD has a substantial adverse effect on patients' subjective QoL, which may be even greater than the adverse effect of schizophrenia. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Serotonin transporter imaging with [123I]beta-CIT SPECT before and after one year of citalopram treatment of obsessive-compulsive disorder.

BACKGROUND: Two thirds of patients with obsessive-compulsive disorder (OCD) respond to treatment with selective serotonin reuptake inhibitors (SSRIs). The neurobiological mechanisms of SSRI action and failure to respond to SSRI treatment remain to be elucidated. OBJECTIVES: The aim of this pilot study was to quantify changes in the availability of serotonin transporter (SERT) in the course of SSRI treatment and to relate these changes to improvements of clinical symptoms. METHODS: Ten patients with OCD were investigated at baseline and 5 of them after 1 year of SSRI treatment with citalopram 60 mg per day using brain single photon emission computed tomography and [123I]beta-CIT. Specific-to-nondisplaceable [123I]beta-CIT binding ratios (V3'') were calculated in SERT-rich brainstem, midbrain and thalamus using a magnetic resonance imaging-based region of interest (ROI) analysis. Symptom severity was evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS: V3'' differed significantly between pretreatment and follow-up scans in all three brain regions, thalamus, midbrain as well as in brainstem. In thalamic ROI, differ ences in SERT availability and Y-BOCS ratings correlated. In midbrain, a trend toward a significant association was found. In brainstem, no relationship was revealed. CONCLUSIONS: Higher occupancy of SERT by citalopram seems to be associated with better clinical response after 1 year of SSRI treatment of patients with OCD.

Serotonin and dopamine transporter imaging in patients with obsessive-compulsive disorder.

In obsessive-compulsive disorder (OCD), the success of pharmacological treatment with serotonin re-uptake inhibitors and atypical antipsychotic drugs suggests that both the central serotonergic and dopaminergic systems are involved in the pathophysiology of the disorder. We applied [123I]-2beta-carbomethoxy-3beta-(4-idiophenyl)tropane (beta-CIT) and a brain-dedicated high-resolution single photon emission computed tomography (SPECT) system to quantify dopamine transporter (DAT) and serotonin transporter (SERT) availability. By comparing 15 drug-naïve patients with OCD and 10 controls, we found a significantly reduced availability (corrected for age) of striatal DAT and of thalamic/hypothalamic, midbrain and brainstem SERT in OCD patients. Severity of OCD symptoms showed a significant negative correlation with thalamic/hypothalamic SERT availability, corrected for age and duration of symptoms. Our data provide evidence for imbalanced monoaminergic neurotransmitter modulation in OCD. Further studies with more selective DAT and SERT radiotracers are needed.

[Employment of professional help by patients with obsessive-compulsive disorders]. / Inanspruchnahme von professioneller Hilfe durch Patienten mit Zwangserkrankungen.

BACKGROUND: Several studies have investigated the pathway to psychiatric care. There are no results available for OCD. METHODS: Therefore, 23 patients with OCD were recruited among individuals seeking treatment at our university hospital outpatient clinic for anxiety and obsessive-compulsive disorders. All patients underwent a semistructured interview aimed at investigating their individual pathways to psychiatric care, to their experiences in the health system and to the first appearances of the psychiatric disorder. RESULTS: Those affected often trivialize and normalize the first symptoms of OCD. Also, in many cases, family members of OCD-patients do not understand the first symptoms of OCD. Contrary to patients with depression and anxiety disorder, OCD-patients often choose psychiatrists as their first professional contact. DISCUSSION: The first symptoms of the disorder must be diagnosed at an early stage in order to provide the patients with the acknowledged therapy for OCD.

Coping strategies used by the relatives of people with obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a destructive mental illness that alters the lives of both patients and their relatives. Many investigations have described the coping strategies of relatives of patients with schizophrenia, depression and other psychiatric disorders, but there have been no studies reported about coping strategies and OCD. AIM: The aim of this paper is to report an investigation into experiences of burden in relatives of patients with OCD, and the coping strategies they had developed. METHOD: Narrative interviews with 22 family members of patients with OCD were analysed using a grounded theory approach. FINDINGS: Relatives described different burdens and developed different strategies to cope with these. While parents tried to educate their ill children, spouses focused on the patient's resources. The attempts of family members to cope with patients with OCD included assisting in rituals, opposing the symptoms and supporting patients in dealing with the illness. CONCLUSION: Implications for clinical practice to support these relatives are discussed.

Reduced serotonin transporter-availability in obsessive-compulsive disorder (OCD).

We investigated the availability of brain serotonin transporters in 10 drug-free patients with obsessive-compulsive disorder (OCD) and age-matched healthy controls in vivo using single-photon emission computed tomography (SPECT) and the radioligand [(123)I]-2beta-carbomethoxy-3beta-(4-idiophenyl)-tropane ([(123)I]beta-CIT). For quantification of regional serotonin transporter a ratio of specific to non-specific [(123)I]beta-CIT-binding was used. The availability of serotonin transporter was calculated using regions of interests (ROI) for thalamus/hypothalamus, midbrain, brainstem (highest density of serotonin transporter) and cerebellum as a reference. The mean specific to non-specific [(123)I]beta-CIT binding ratios in the thalamic/hypothalamic ROI were 4.95 +/- 0.57 (OCD patients), and 5.48 +/- 0.87 (control group). The mean ratios in the midbrain ROI were 3.51 +/- 0.45 (OCD patients) and 4.89 +/- 1.23 (controls) and in the brainstem ROI the ratios were 2.38 +/- 0.76 (OCD patients) and 3.53 +/- 1.01 (controls). This in vivo finding of significant reduced serotonin transporter availability in midbrain/brainstem using [(123)I] beta-CIT SPECT further supports the serotonin deficit hypothesis of OCD.

Experience of stigmatization by relatives of patients with obsessive compulsive disorder.

Patients with mental illness and their relatives experience discrimination and stigmatization in their everyday lives. The stigma of mental illness has been investigated in numerous studies. However, the subjective experiences of patients with OCD and their relatives have not been reported up until now. Narrative interviews with 22 family members of patients with obsessive-compulsive disorder were performed as part of a study on the burden and distress among the families of those with mental illness. Stigma experiences were analyzed using a grounded theory approach. Different areas of life could be described, where stigmatization is anticipated or concretely experienced by relatives of patients with OCD. Concealing is an important coping strategy for the family members interviewed. Stigmatization can be reduced by handling the illness and the co-operation of patients, their relatives, and the professionals in an unbiased manner.

[Shame, embarrassment and trouble...relatives of patients with OCD describe stigma experiences in every-day life]. / Scham, Peinlichkeit und Arger...Angehörige von Patienten mit Zwangserkrankungen beschreiben Stigmatisierungserfahrungen im Alltag.

BACKGROUND: There are numerous studies on the stigma of mental illness. However, the subjective stigma experiences of patients with obsessive-compulsive disorder and their relatives have, so far not been investigated. METHOD: Narrative interviews with 22 family members of patients with OCD were carried out as part of a study on the burden of mental illness on the family. Experience of stigma was analysed as an aspect of subjective burden using a grounded theory approach. RESULTS: Different areas of life could be described, in which stigmatization is anticipated or experienced by family members of patients with OCD. Concealing is a relevant strategy for the members in dealing with the illness. DISCUSSION: Stigmatization can be minimized by impartially handling the illness and cooperation of patients, their relevant others and professionals.

[Between assistance and opposition: relatives' coping strategies with obsessive-compulsive patients]. / Zwischen Einbezogensein und Widerstand: Angehörige im Umgang mit Zwangserkrankten.

OBJECTIVE AND METHOD: The aim of this study was to investigate the coping strategies of relatives of patients with obsessive-compulsive disorder. 22 narrative interviews were analysed by a Grounded Theory approach. RESULTS: While parents in our investigation often try to educate their ill children, spouses focus on resources of the patient. Children seem to take a parent-role in interaction with the ill father or mother. DISCUSSION: Family members try to support patients in dealing with the illness. Therefore, different strategies to cope with OCD are developed, ranging between assisting in rituals and opposition to the symptoms.

[Compulsive-obsessive disorder after severe head trauma: diagnosis and treatment]. / Zwangsstörung nach Schädel-Hirn-Trauma: Diagnostik und Therapie.

An 18-year-old man suffered a severe head trauma from a car accident. Eight months later the patient had a good general state of health. But at this time he was referred to our psychiatric hospital and he reported increased checking compulsions and aggressive obsessions. In addition there was increased impulsivity. The patient was treated with an selective-serotonin-reuptake-inhibitor (SSRI) and showed a clinical response. Obsessive-compulsive disorder (OCD) has rarely been described after traumatic brain injury. Clinical symptoms, neuropsychological dysfunctions, brain imaging and therapy are illustrated. The represented connections of the frontal brain lesions and OCD-symptoms with interventions in the serotonin system support the neurobiological hypotheses of the obsessive-compulsive disorder.

[Behavioral Group Therapy for Patients with OCD and Family Members]. / Ambulante Gruppentherapie für Patienten mit Zwangserkrankungen und deren Angehörige - Erste Erfahrungen mit einem neuen Konzept -

PROBLEM: Behavioral group therapy program is presented of patients with OCD and the involvement of their significant others. First experiences of evaluation are reported. METHOD: 20 patients (10 women, 10 men) diagnosed with OCD were treated in a 16-session behavioral group therapy which included the involvement of 17 family members in selected sessions. The behavioral group therapy program involved cognitive restructuring, behavior exposure to anxiety-evoking stimuli and the discussion about the family system. Y-BOCS and a self-rating scale for the assessment of treatment benefit were used as outcome measures. RESULTS: In this study, Y-BOCS scores reduced from a mean of 24 before therapy to 19,8 after therapy. Patients and their significant others agreed on the general benefit from the group therapy and the level of understanding of individual problems. Family members in particular appreciated that they had learned more about coping strategies regarding OCD-symptoms.The majority of patients and their significant others would recommend behavioral group therapy to other affected people. CONCLUSIONS: Behavioral group therapy can be effective in reducing OCD-symptoms. Inclusion of family members in behavioral group therapy may be advantageous, because they can assist the patients during their treatment. This form of treatment may become an attractive and cost-effective alternative to conventional group settings.