Quality of life in obsessive compulsive disorder.

Obsessive-compulsive disorder (OCD) has a profound impact with a high disease burden. In order to truly understand the scope of the effect OCD has on the patient population, one must take into account not only the relentless symptoms beleaguering the patients but also examine their overall ability to enjoy their life. Quality of life (QOL) assessments/improvements are becoming an increasingly important component of healthcare, especially in the mental health field. This review examines QOL in OCD, as well as the influence of comorbidities, and the impact that OCD treatment has on QOL. We searched MEDLINE/PUBMED and PsycINFO databases from 1980-2011 using keywords "obsessive compulsive disorder" OR "OCD" AND "quality of life" OR "QOL." Fifty-eight studies meeting specific selection criteria were ultimately included in this review. The results show that QOL in OCD is significantly impaired when compared to QOL in the general population and in patients with other psychiatric and medical disorders. Likewise, QOL in OCD also appears to be largely affected by comorbid conditions, which should be taken into account when developing a treatment plan. Furthermore, QOL in OCD has been shown to improve with medications and with both individual and group psychotherapy, albeit not to the levels enjoyed by community norms. QOL assessment in both clinical and research settings is important to examine the disease burden, to monitor treatment effectiveness, and to determine full recovery from OCD. Treatment providers should strive to not only reach symptom abatement, but also to assure that patients have regained satisfaction and functioning in their daily lives.

Introducing Specialist Integrated Mental Health Care in Lebanon: The Psychosis Recovery Outreach Program.

The recognition of mental health needs in developing countries is growing in parallel with increased public awareness of and reduced stigma toward mental illness. With resources still limited in these countries, creating economically viable health care models is essential. These models are often adapted from already established and tested systems in industrialized nations. The Psychosis Recovery Outreach Program (PROP) at the American University of Beirut is an initiative that exemplifies the global transfer of knowledge, experience, and skills. Now in its second year, PROP provides specialist care to individuals with severe mental disorders in Lebanon by integrating psychiatry, psychology, nursing, and social work in a challenging social and cultural context.

Enhanced Striatal Dopamine Release to Expectation of Alcohol: A Potential Risk Factor for Alcohol Use Disorder.

BACKGROUND: We used positron emission tomography imaging with [11C]raclopride to examine the effects of consumption of alcohol or placebo beverage by participants with alcohol use disorder (AUD) compared with healthy participants with and without family history of AUD. We sought to assess dopamine release following alcohol exposure in relation to AUD risk. METHODS: Three groups were enrolled: participants with AUD (n = 15) and healthy participants with family history negative (n = 34) or positive (n = 16) for AUD. Participants consumed a placebo (n = 65) or alcohol (n = 63) beverage in counterbalanced order before positron emission tomography scanning (128 scans). Binding potential (BPND) in the two drink conditions and the percent change in BPND between conditions were evaluated across striatal subregions. Subjective effects of beverage consumption were rated. Effects of group, drink order, and sex were evaluated. RESULTS: Alcohol resulted in greater dopamine release than did placebo in the ventral striatum (p < .001). There were no main effects of group, drink order, or sex on ventral striatum BPND or percent change in BPND. However, there was a drink order-by-group interaction (p = .02) whereby family history-positive participants who received placebo first had both lower placebo BPND and less difference between placebo and alcohol BPND than all other groups, consistent with expectation of alcohol powerfully evoking dopamine release in this group. Subjective responses showed the same order-by-group interaction. CONCLUSIONS: Hyper-responsivity of the dopaminergic system in family history-positive participants to expectation of alcohol may contribute to the expression of familial risk for AUD.

Augmenting Buried in Treasures with in-home uncluttering practice: Pilot study in hoarding disorder.

Hoarding disorder is characterized by difficulty parting with possessions and by clutter that impairs the functionality of living spaces. Cognitive behavioral therapy conducted by a therapist (individual or in a group) for hoarding symptoms has shown promise. For those who cannot afford or access the services of a therapist, one alternative is an evidence-based, highly structured, short-term, skills-based group using CBT principles but led by non-professional facilitators (the Buried in Treasures [BIT] Workshop). BIT has achieved improvement rates similar to those of psychologist-led CBT. Regardless of modality, however, clinically relevant symptoms remain after treatment, and new approaches to augment existing treatments are needed. Based on two recent studies - one reporting that personalized care and accountability made treatments more acceptable to individuals with hoarding disorder and another reporting that greater number of home sessions were associated with better clinical outcomes, we tested the feasibility and effectiveness of adding personalized, in-home uncluttering sessions to the final weeks of BIT. Participants (n = 5) had 15 sessions of BIT and up to 20 hours of in-home uncluttering. Reductions in hoarding symptoms, clutter, and impairment of daily activities were observed. Treatment response rate was comparable to rates in other BIT studies, with continued improvement in clutter level after in-home uncluttering sessions. This small study suggests that adding in-home uncluttering sessions to BIT is feasible and effective.

Imaging dopamine transmission parameters in cannabis dependence.

Low striatal dopamine D2/3 receptor (D2/3) availability and low ventrostriatal dopamine release have been observed in alcoholism, cocaine and heroin dependence. Multiple studies to date have examined D2 availability in cannabis dependence and have consistently failed to demonstrate alterations. In addition, the response of the dopamine system to an amphetamine challenge and to a stress challenge has also been examined, and did not show alterations. We review these studies here and conclude that cannabis dependence is an exception among commonly abused drugs in that it is not associated with blunting of the dopamine system.

Health-related quality of life in childhood cancer.

OBJECTIVE: Health-related quality of life (HRQoL) has become an increasingly important measure of research and treatment outcomes across all medical specialties. However, to date, there has not been an in-depth review of research relevant specifically to HRQoL in the populations of children and adolescents with cancer. In this review, the authors examine the effects of cancer on HRQoL from diagnosis to remission/survivorship and the end of life. DESIGN: A literature search was conducted using Medline and PsycINFO for articles published from 2002 to 2011. Studies included patients from diagnosis to remission and also the terminally ill. Twenty-nine studies specifically addressing HRQoL were selected after reaching consensus and study quality check. RESULTS: Children who are newly diagnosed with cancer and are undergoing treatment or are terminally ill have impaired HRQoL. Survivors of childhood cancer have high HRQoL (with the exception of those who experienced medical comorbidity or PTSD). The authors found that demographic differences, cancer types, and treatment regimens, all significantly influence the negative impact of cancer on patients' HRQoL. CONCLUSIONS: There are specific and identifiable impacts of childhood cancer on patients' HRQoL that are significant and complex across the span of the illness. There is a need for continued research in many areas related to this population, especially related to those with terminal illness in order to improve patient care.