The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report.

Objectives: To assess the rates of co-occurring putative 'behavioural addictions' in patients with obsessive-compulsive disorder (OCD).Methods: Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples.Results: Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a 'clinical diagnosis' to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder.Conclusions: Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive 'spectrum' disorders.

Treatments used for obsessive-compulsive disorder-An international perspective.

OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.

Prevalence of bullying in a pediatric sample of body dysmorphic disorder.

Little is known about etiological factors in Body dysmorphic disorder (BDD). Cognitive behavioral and diathesis-stress models have implicated teasing and bullying as significant early environmental stressful triggers. Due to these implications, this study aimed to assess the emergence of BDD in children during early development, and to see if bullying experiences played a role in its development. A total of 219 children ages 7 to 10 were screened for psychopathology. Children were separated into four groups including a BDD group, an OCD group, a clinical control group (consisting of depressive disorders, attention deficit hyperactivity disorder, oppositional defiant disorder, and anxiety disorders not otherwise specified), and a non-clinical control group. Children were given questionnaires to evaluate their bullying and victimization experiences. It was hypothesized that children with BDD would experience more instances of victimization than children with OCD, clinical controls, and non-clinical controls. Contrary to the hypothesis, results indicated that children with BDD symptoms were significantly more likely to be perpetrators of bullying than the other groups [F (3, 27.082) = 17.892, p < .001]. In addition to scoring high on the bullying questionnaires, children with BDD scored high on victim questionnaires as well, suggesting a link between these two peer interpersonal conflicts. The results of this study suggest that bullying behavior might be an unknown characteristic in young children with emerging BDD pathology.

Overvalued ideation in adolescents with obsessive-compulsive disorder.

In Obsessive Compulsive Disorder (OCD), overvalued ideas (OVI) are considered poor prognostic indicators in adults. To date, OVI has not been studied in an adolescent population with OCD, nor has it been examined in relation to obsessive-compulsive beliefs. To investigate the relationship between OVI and specific cognitions, fifty-five adolescents with OCD (35 male; 20 female; age range 13-17 years; M=14.05 years, SD=1.75 years) participated. It was predicted that OVI would be associated with symptom severity and would moderate obsessive-compulsive beliefs and functional disability. Results showed that OVI was associated with symptom severity, but did not moderate the relationship with any OC beliefs or functional domains. To evaluate the role of OVI in treatment outcome, thirteen adolescents completed a cognitive-behavioral treatment program. Severity of their OCD symptoms, OVI, degree of functional impairment and quality of life were assessed. It was expected that all variables would change in response to treatment. Further, it was expected that OVI would mediate treatment outcome for all measures of obsessive-compulsive symptom and belief assessments. Results indicated that there was clinically significant change in symptom severity and functional disability, as well as beliefs regarding responsibility/overestimation of threat. Treatment, assessment, and methodological recommendations for this population are offered.

Status of body dysmorphic disorder in Argentina.

Although body dysmorphic disorder (BDD) has received recent attention, it remains misunderstood and under-studied. The Argentine population seeks out plastic surgery at a disproportionate rate and exhibits high rates of preoccupation with bodily dissatisfaction, yet BDD is unrecognized and research is limited. The current study describes the prevalence, quality of life, and presentation style of BDD in depressed adolescents, as depression is the most common symptom for which adolescents seek treatment in Argentina. Twenty-five depressed adolescents and 85 non-depressed students were initially assessed for depression and BDD and subdivided depending on BDD status. Participants were assessed on various constructs including obsessions and compulsions, overvalued ideas, and overall level of impairment. A 2×2 factorial design was employed, and multivariate analysis of variance (MANOVA) was used to analyze the data. Significant main effects were observed for all dependent measures (BDI, OVIS, YBOCS, and Sheehan Disability Scale) for depressed vs. non-depressed participants and BDD status; significant interactions were observed between independent variables for all dependent measures. Depressed adolescents had significantly higher scores on the YBOCS-BDD, OVIS, BDI, and the Sheehan Disability Scale compared to non-depressed participants; furthermore, individuals reporting BDD symptoms reported significantly higher scores on the YBOCS-BDD, OVIS, BDI, and Sheehan Disability Scale. Significant interactions are discussed according to BDD status and depression on dependent measures. Patients with BDD have poor quality of life and present with anxiety and depression, yet it still remains underdiagnosed.

Regulation of m1 muscarinic receptors and nNOS mRNA levels by autoantibodies from schizophrenic patients.

In this paper we demonstrate that, circulating antibodies from schizophrenic patients interacting with cerebral M1 muscarinic acetylcholine receptors (M1 mAChRs), can act as an inducer of m1 mAChR-mRNA, and neuronal nitric oxide synthase (nNOS) mRNA gene expression of rat frontal cortex. The different signaling pathways involved in the autoantibody's actions, were characterized. As previously reported serum autoantibodies from schizophrenic patients reacted against neural cells surface inhibiting the binding of the specific mAChR radioligand to rat cerebral frontal cortex membrane. Moreover, by ELISA using M1 synthetic peptide (with identical aminoacid sequence to human M1 mAChR) as coating antigen we demonstrated the reactivity against the second extracellular loop of human cerebral M1 mAChR. The corresponding affinity-purified anti M1 peptide IgG (anti M1 peptide IgG) from schizophrenic patients by stimulation of M1 mAChR exerted an increase in m1 mAChR-mRNA and nNOS-mRNA levels, that significantly correlated with the accumulation of phosphoinositides (IPs) and activation of NOS (alpha = 0.05). All these effects were blunted by pirenzepine and mimicked the action of the authentic agonist. Concurrent analysis of the effects of nNOS, phospholipase C (PLC) and calcium/calmodulin (CaM) inhibition on both, m1 mAChR-mRNA and nNOS-mRNA levels, showing that antibody up-regulation mRNA level is under the control of endogenous nitric oxide (NO) signaling system. On the basis of our results, the activation of M1 mAChR by schizophrenic autoantibody appears to induce nNOS-mRNA expression and reciprocally, the activation of NOS up-regulates m1 mAChR gene expression. These results gave support to the participation of an autoimmune process in a particular group of chronic schizophrenic patients.

Antibodies against astrocyte M1 and M2 muscarinic cholinoceptor from schizophrenic patients' sera.

We demonstrated the presence of circulating antibodies from schizophrenic patients able to interact with cultured astrocytes activating muscarinic acetylcholine receptors (mAChRs). Sera and purified IgG from 15 paranoid schizophrenic and 15 age-matched normal subjects were studied by indirect immunofluorescence (IFI), flow cytometry, dot blot, enzyme immunoassay (ELISA), and radioligand competition assays. Astrocyte membranes and/or a synthetic peptide, with identical amino acid sequence of human M(1) and M(2) mAChR, were used as antigens. By IFI and flow cytometry procedures, we proved that serum purified IgG fraction from schizophrenic patients, reacted to astrocyte cell surface. The same antibodies were able to inhibit the binding of the specific mAChR radioligand (3)H-QNB. Using synthetic peptide for dot blot and ELISA, we demonstrated that these antibodies reacted against the second extracellular loop of human cerebral M(1) and M(2) mAChR. Also, the corresponding affinity-purified antipeptide antibody displayed an agonistic-like activity associated to specific M(1) and M(2) mAChR activation, increasing inositol phosphates accumulation and decreasing cyclic AMP production, respectively. This article gives support to the participation of an autoimmune process in schizophrenia disease.

Tratamiento del trastorno obsesivo-compulsivo / Treatment of obsessive-compulsive disorder

El trastorno obsesivo-compulsivo (TOC) es una delas patologías más subdiagnosticadas y tratadasde forma equivocada en las últimas décadas.Como resultado hoy nos encontramos con unimportante número de pacientes que tienen altaresistencia a los tratamientos convencionales,presentándose un cuadro particular al quese denomina trastorno obsesivo-compulsivoresistente. En este trabajo queremos transmitir nuestra forma de pensar y abordar el tratamiento del TOC.

he Obsessive-CompulsiveDisorder is one of themost subdiagnosed and inadequately treateddisease of the last decades; therefore, nowadaysthere is an important number of patients thatoffer resistance to conventional treatments,arranging a particular clinical status namedObsessive-Compulsive Resistant Disorder. Inthis paper we wanted to share our way to think and treat the OCD.

Antibodies against cerebral M1 cholinergic muscarinic receptor from schizophrenic patients: molecular interaction.

We demonstrated the presence of circulating Abs from schizophrenic patients able to interact with cerebral frontal cortex-activating muscarinic acetylcholine receptors (mAChR). Sera and purified IgG from 21 paranoid schizophrenic and 25 age-matched normal subjects were studied by indirect immunofluorescence, flow cytometry, immunoblotting, dot blot, ELISA, and radioligand competition assays. Rat cerebral frontal cortex membranes and/or a synthetic peptide, with an amino acid sequence identical with that of human M(1) mAChR, were used as Ags. By indirect immunofluorescence and flow cytometry procedures, we proved that serum-purified IgG fraction from schizophrenic patients reacted to neural cell surfaces from rat cerebral frontal cortex. The same Abs were able to inhibit the binding of the specific M(1) mAChR radioligand [(3)H]pirenzepine. Immunoblotting experiments showed that IgG from schizophrenic patients revealed a band with a molecular mass coincident to that labeled by an anti-M(1) mAChR Ab. Using synthetic peptide for dot blot and ELISA, we demonstrated that these Abs reacted against the second extracellular loop of human cerebral M(1) mAChR. Also, the corresponding affinity-purified antipeptide Ab displayed an agonistic-like activity associated to specific receptor activation, increasing cyclic GMP production and inositol phosphate accumulation, and protein kinase C translocation. This paper gave support to the participation of an autoimmune process in schizophrenia.

Anticuerpos antimuscarínicos en pacientes esquizofrénicos / Anti-muscarinic antibodies in schizophrenic patients

La esquizofrenia es una enfermedad neuropsiquiátrica que cursa con múltiples síntomas y signos del área del pensamiento, percepción, emoción, movimientos y conducta. Su etiología está aún en discusión, existiendo hipótesis genéticas, neuroanatómicas, neuroquímicas e inmunológicas. En este trabajo estudiamos la interacción del sistema nervioso autónomo colinérgico y del sistema inmune como base biológica de algunos de los síntomas negativos de esta enfermedad. Tres ítems merecen subrayarse:a)la presencia de anticuerpos en el suero de los pacientes capaces de interactuar con la membrana de corteza frontal; b) dichos anticuerpos son capaces, además, de interactuar con los receptores muscarínicos (mACH) del subtipo M1; c) posible correlación entre los eventos biológicos y el déficit cognitivo de estos pacientes. Concluímos que la presencia de anticuerpos dirigidos contra los receptores mACh del subtipo M1 de la corteza frontal en los pacientes esquizofrénicos, podría ser un marcador biológico del déficit atencional de esta enfermedad

Anticuerpos antimuscarínicos en pacientes esquizofrénicos / Anti-muscarinic antibodies in schizophrenic patients

La esquizofrenia es una enfermedad neuropsiquiátrica que cursa con múltiples síntomas y signos del área del pensamiento, percepción, emoción, movimientos y conducta. Su etiología está aún en discusión, existiendo hipótesis genéticas, neuroanatómicas, neuroquímicas e inmunológicas. En este trabajo estudiamos la interacción del sistema nervioso autónomo colinérgico y del sistema inmune como base biológica de algunos de los síntomas negativos de esta enfermedad. Tres ítems merecen subrayarse:a)la presencia de anticuerpos en el suero de los pacientes capaces de interactuar con la membrana de corteza frontal; b) dichos anticuerpos son capaces, además, de interactuar con los receptores muscarínicos (mACH) del subtipo M1; c) posible correlación entre los eventos biológicos y el déficit cognitivo de estos pacientes. Concluímos que la presencia de anticuerpos dirigidos contra los receptores mACh del subtipo M1 de la corteza frontal en los pacientes esquizofrénicos, podría ser un marcador biológico del déficit atencional de esta enfermedad

Multireceptor interactions of haloperidol on rat cerebral frontal cortex "in vitro"

As severall side effects of neuroleptics would be related to their interactions with several neurotransmitter receptors (R) haloperidol action on muscarinic cholinergic (mACh) R on frontal cerebral cortex preparations was analyzed. Here we shown that haloperidol was able to inhibit in a concentration dependent manner the binding of specific mAChR radiollabeled antagonist on cerebral cortex membranes. This effect would be related to its interaction on mAChR of the M1 subtype as haloperidol blocked the stimulation of phosphoiinositides (Pis) turnover induced by low concentrations of carbachol similarly as the M1 antagonist pirenzepine. However at high carbachol concentrations haloperidol triggered a potentiating stimulation of Pis hydrolysis that was only blocked by the alpha1 adrenergic antagonist prazosin indicating and alpha1 agonistic action of haloperidol on these Rs. These multireceptor actions of haloperidol found "in vitro"would strengthen its assocation with "in vivo"neuroleptic-induced side effects.

Multireceptor interactions of haloperidol on rat cerebral frontal cortex "in vitro"

As severall side effects of neuroleptics would be related to their interactions with several neurotransmitter receptors (R) haloperidol action on muscarinic cholinergic (mACh) R on frontal cerebral cortex preparations was analyzed. Here we shown that haloperidol was able to inhibit in a concentration dependent manner the binding of specific mAChR radiollabeled antagonist on cerebral cortex membranes. This effect would be related to its interaction on mAChR of the M1 subtype as haloperidol blocked the stimulation of phosphoiinositides (Pis) turnover induced by low concentrations of carbachol similarly as the M1 antagonist pirenzepine. However at high carbachol concentrations haloperidol triggered a potentiating stimulation of Pis hydrolysis that was only blocked by the alpha1 adrenergic antagonist prazosin indicating and alpha1 agonistic action of haloperidol on these Rs. These multireceptor actions of haloperidol found "in vitro"would strengthen its assocation with "in vivo"neuroleptic-induced side effects. (AU)