ABSTRACT
Treatment of obsessive-compulsive disorder has focused almost exclusively on symptom reduction; however, deficits in social functioning and quality of life of individuals with this disorder may contribute more to their "burden," suffering, and disability. To gauge the significance of social dysfunction and quality of life of persons with obsessive-compulsive disorder (OCD), we made comparisons with a group of persons with schizophrenia matched for age and gender. Thirty-one patients with OCD participating in a partial hospital treatment program were compared with 68 schizophrenic outpatients participating in a day rehabilitation program. The Independent Living Skills Survey (ILSS) and Lehman Quality of Life Scale (QOL) were administered before and after treatment for both cohorts. QOL scores were significantly lower for the OCD patients both before and after treatment, but improved significantly during treatment. OCD and schizophrenic patients had similar scores on almost every domain of the ILSS at pretreatment. The OCD patients improved significantly on many of the domains of social and independent living skills as a result of treatment and acquired significantly greater skills by post-treatment than did their counterparts with schizophrenia; however, the performance of social and independent living skills by OCD patients remained less than satisfactory even in domains where they improved. In the areas of job and leisure skills, there were significant group-by-time interactions. We concluded that patients with severe OCD and patients with schizophrenia are equally socially impaired. However, OCD patients experience greater significant functional improvement with multimodal treatment.
Subject(s)
Obsessive-Compulsive Disorder/psychology , Quality of Life , Schizophrenic Psychology , Social Adjustment , Activities of Daily Living/psychology , Adult , Cohort Studies , Day Care, Medical , Female , Humans , Leisure Activities , Male , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/rehabilitation , Outcome Assessment, Health Care , Rehabilitation, Vocational , Schizophrenia/diagnosis , Schizophrenia/rehabilitationABSTRACT
BACKGROUND: Although body dysmorphic disorder (BDD) has many features in common with obsessive-compulsive disorder (OCD) and is frequently comorbid with OCD, few studies have directly compared the 2 disorders. Although BDD and OCD respond to similar medications and cognitive-behavioral therapy (CBT), their response to treatment has never been directly compared. METHOD: We studied 107 consecutive patients with DSM-III-R OCD (N = 96) or BDD (N = 11) treated openly for 6 weeks with intensive CBT, medication, and psychosocial rehabilitation, in a specialized partial hospitalization program for severely ill OCD patients. All patients were assessed, before and after treatment, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). Retrospectively, we compared the clinical characteristics, symptom severity, and response to treatment of BDD patients with those of OCD patients. RESULTS: BDD patients and OCD patients had similar sex ratio, age, treatment duration, prevalence of comorbid major depression, and pretreatment Y-BOCS and GAS scores. BDD patients had significantly higher pretreatment HAM-D and HAM-A scores. The proportions of patients treated with serotonin reuptake inhibitors and antipsychotics did not differ between groups. Both groups improved with treatment, with significant (p < .001) changes in Y-BOCS, HAM-D, HAM-A, and GAS scores. Change in Y-BOCS did not differ between groups, but changes in HAM-D and HAM-A were significantly greater in BDD patients than in OCD patients. CONCLUSION: While BDD may be associated with greater severity of depressive and anxiety symptoms than OCD, this study suggests that BDD may respond to intensive, multimodal treatment.
Subject(s)
Cognitive Behavioral Therapy , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/therapy , Psychotropic Drugs/therapeutic use , Somatoform Disorders/diagnosis , Somatoform Disorders/therapy , Adult , Anxiety Disorders/epidemiology , Anxiety Disorders/therapy , Combined Modality Therapy , Comorbidity , Depressive Disorder/epidemiology , Depressive Disorder/therapy , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Length of Stay , Male , Obsessive-Compulsive Disorder/epidemiology , Patient Education as Topic , Psychiatric Status Rating Scales/statistics & numerical data , Retrospective Studies , Severity of Illness Index , Somatoform Disorders/epidemiology , Treatment OutcomeSubject(s)
Imagery, Psychotherapy , Panic Disorder/diagnosis , Panic Disorder/psychology , Adaptation, Physiological/physiology , Adolescent , Adult , Analysis of Variance , Biofeedback, Psychology , Blood Pressure/physiology , Clinical Laboratory Techniques/psychology , Galvanic Skin Response/physiology , Heart Rate/physiology , Humans , Middle Aged , Relaxation , Respiration , Self-Assessment , Surveys and Questionnaires , Valsalva ManeuverABSTRACT
The objectives of this study were to compare continuous subjective and physiological responses of panic disorder patients and normal controls during 5% CO2 inhalation. Psychophysiological responses of panic disorder patients (n = 42) and controls (n = 25) were monitored during baseline (20 min), 5% CO2 inhalation (20 min), and recovery (20 min). The data were compared at baseline and over periods of the experiment using analysis of variance. A subgroup of patients who experienced panic attacks during the CO2 inhalation (n = 12) were significantly different from the other subjects on baseline heart rate and on variability of systolic and diastolic blood pressure, skin conductance, and breathing variability (length and number of breathing pauses and length of breathing cycle variability). Inspection of the data showed that elevation in blood pressure and breathholding were present during some of the panic attacks, suggesting that some attacks may represent a complex psychophysiological response with elements of a "freezing" reaction, well described in animal experiments, which can quickly shift to a "fight/flight" reaction that is usually characterized by an increase in heart and breathing rate. However, some patients had only minimal changes in breathing and others had minimal psychophysiological changes during the time they indicated that they had a panic attack. Panic attacks are not homogeneous and may be characterized by a variety of physiological and cognitive responses. This may indicate that biological mechanisms of panic include abnormality in many functionally connected areas of the brain responsible for complex psychophysiological reactions to multiple threatening situations.
Subject(s)
Autonomic Nervous System/physiopathology , Carbon Dioxide/administration & dosage , Carbon Dioxide/adverse effects , Panic Disorder/physiopathology , Panic Disorder/psychology , Administration, Inhalation , Adult , Analysis of Variance , Blood Pressure , Case-Control Studies , Confounding Factors, Epidemiologic , Electromyography , Female , Galvanic Skin Response , Heart Rate , Humans , Male , Panic Disorder/chemically induced , Psychiatric Status Rating Scales , Respiratory Function TestsABSTRACT
Ten patients meeting DSM-IV criteria for non-comorbid panic disorder or panic disorder with agoraphobia were treated in a 12-week open-label, flexible dosage trial of nefazodone. Dosages ranged from 50 to 400 mg per day. Clinical assessment utilized several recently developed scales of panic disorder severity, as well as the clinical global impression scale. At the conclusion of the study, 9 out of 10 patients were rated much improved with 7 of the patients rated as panic free and in full remission. Significantly improved scores were reflected by all of the scales. Low sample size and absence of placebo control indicate the need for a large placebo-controlled trial. The results of this pilot study suggest that nefazodone may be promising in the treatment of panic and justify further research.
Subject(s)
Antidepressive Agents, Second-Generation/therapeutic use , Panic Disorder/drug therapy , Adult , Female , Humans , Male , Middle Aged , Pilot Projects , Piperazines , Psychiatric Status Rating Scales , Remission Induction , Treatment Outcome , Triazoles/therapeutic useSubject(s)
Electroencephalography , Panic Disorder/diagnosis , Adult , Alpha Rhythm/statistics & numerical data , Brain/physiopathology , Electroencephalography/methods , Electroencephalography/statistics & numerical data , Female , Humans , Male , Middle Aged , Panic Disorder/physiopathology , Temporal Lobe/physiopathologyABSTRACT
Thirty treatment-resistant patients with a primary DSA-IV diagnosis of obsessive-compulsive disorder were assessed at admission to and discharge from a partial hospitalization program to determine whether improvement in symptoms of the disorder was associated with improvements in patients' quality of life. Symptom severity was measured using the Yale-Brown Obsessive Compulsive Scale (YBOCS). Quality of life was measured using Lehman's Quality of Life (QOL) scale, which includes several objective and subjective indexes. YBOCS scores significantly improved with treatment, as did scores on the majority of the QOL subjective indexes and on the objective social, health, and activity indexes. No significant association between changes in YBOCS scores and QOL scores was found.
Subject(s)
Day Care, Medical , Obsessive-Compulsive Disorder/therapy , Outcome Assessment, Health Care , Quality of Life , Adult , Analysis of Variance , Female , Humans , Los Angeles , Male , Middle Aged , Obsessive-Compulsive Disorder/psychology , Statistics, NonparametricABSTRACT
OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.
Subject(s)
Day Care, Medical/standards , Obsessive-Compulsive Disorder/therapy , Adolescent , Adult , Behavior Therapy , California , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/diagnosis , Psychotropic Drugs/therapeutic use , Socioenvironmental Therapy , Treatment OutcomeSubject(s)
Anxiety Disorders/diagnosis , Depressive Disorder/diagnosis , Personality Inventory/statistics & numerical data , Adolescent , Adult , Aged , Agoraphobia/classification , Agoraphobia/diagnosis , Agoraphobia/psychology , Anxiety Disorders/classification , Anxiety Disorders/psychology , Depressive Disorder/classification , Depressive Disorder/psychology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Panic Disorder/classification , Panic Disorder/diagnosis , Panic Disorder/psychology , Phobic Disorders/classification , Phobic Disorders/diagnosis , Phobic Disorders/psychology , Psychometrics , Reproducibility of ResultsABSTRACT
Ten patients with panic disorder and 10 matched control subjects were compared as to their blood pressure and heart rate during regular daily activity. Physiological responses were monitored by ambulatory recorder, and subjective reports of mood were collected. Data were analyzed controlling for activity and stress level of the subjects. Diastolic blood pressure emerged as a possible discriminatory factor between the groups. A trend for higher heart rate occurred in the panic group. In behavioral terms, panic patients tended to avoid anxiety-provoking situations, resulting in anxiety ratings comparable to those of the control group. Thus, recorded physiological differences between the groups may reflect heightened baseline autonomic activity in panic patients.