Andreas Rabavilas

Obsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases.

Atypical antipsychotics (APs) are now widely in use in clinical practice. They exert a beneficial effect in patients with schizophrenic disorders, including cases resistant to traditional APs and negative symptoms. They have also enhanced the ratio of therapeutic efficacy to adverse effects. Atypical APs, mainly risperidone and olanzapine, have been used as adjunctive treatment in (selective) serotonin reuptake inhibitor [(S)SRI]-refractory cases with obsessive symptoms. However, de novo emergence or exacerbation of obsessive-compulsive (OC) symptoms during treatment with clozapine, risperidone, olanzapine and quetiapine has been described in the literature. The reported cases and the possible pathogenetic mechanisms involved in their occurrence are discussed and reviewed.

Reinforced Spatial Alternation as an Animal Model of Obsessive-Compulsive Disorder (OCD): Investigation of 5-HT2C and 5-HT1D Receptor Involvement in OCD Pathophysiology

BACKGROUND This study introduces a laboratory model of compulsive behavior based on persistence in the context of rewarded spatial alternation. METHODS Rats were screened for spontaneous persistence during T-maze reinforced alternation. Experiment 1: One high and one low spontaneous persistence group (n = 8) received 20 injections of fluoxetine, a matched pair saline, both followed by 4 days of meta-chlorophenylpiperazine (mCPP) challenge. Experiment 2: Five matched groups of rats (n = 9) received pretreatment (20 injections) with fluoxetine, mCPP, desipramine, diazepam or saline, followed by 4 days of mCPP challenge (fluoxetine in mCPP group). After washout, animals received 2 days of naratriptan, followed by another 2-day mCPP challenge. RESULTS In both experiments mCPP significantly increased persistence in saline controls. Fluoxetine also acutely increased persistence scores: after a gradual return to baseline, these scores showed tolerance to mCPP. Experiment 1: This pattern was significant in high but not low initial persistence groups. Experiment 2: Fluoxetine and mCPP showed cross-tolerance. Neither desipramine nor diazepam protected against mCPP challenge. Persistence scores returned to baseline during washout and naratriptan and were thereafter increased by another mCPP challenge in all but the fluoxetine and mCPP groups, suggesting 5-HT2C receptor mediation. CONCLUSIONS This model is based on spontaneous persistence behavior showing pharmacological responses concordant with those of compulsive symptomatology.

Olanzapine and obsessive-compulsive symptoms

Clozapine and risperidone have been implicated in the development of obsessive-compulsive symptoms. We present three cases in which olanzapine caused a significant exacerbation of obsessive-compulsive symptoms in schizophrenia (two cases) and obsessive-compulsive disorder (one case).

Glossodynia: personality characteristics and psychopathology.

BACKGROUND Glossodynia or burning mouth syndrome has been suggested to be a multifunctional disorder. Etiologic factors that have been reported include hematologic or vitamin deficiencies, denture factors, the climacteric, infections or endocrinological disorders. On the other hand psychological factors, such as anxiety, depression and phobias have been reported to play a significant role at the beginning of this nosological entity. It seems therefore that there are two main categories of glossodynia, one with a detectable organic etiology and another with a psychologic origin. The purpose of this study was to provide further information concerning the personality characteristics and the incidence of psychopathology in patients suffering from glossodynia without an organic etiology. METHODS Twenty-five patients suffering from glossodynia and 25 control subjects, matched for sex and age, participated in the study. Patients and controls were assessed concerning their psychosomatic morbidity. Both groups were given psychometric instruments (SRSD, STAI, EPQ, HDHQ, SSPS) for the assessment of personality characteristics and psychopathological symptoms. RESULTS Patients were significantly differentiated from controls with respect to all factors of HDHQ; they exhibited more hostility, either introverted or extroverted, than control subjects. The patients also had significantly higher values in the N (neuroticism) and the L (lie) factors of the EPQ. Concerning the other psychometric measurements there were no significant differences. Patients also had significantly higher rates of psychosomatic morbidity than controls. CONCLUSIONS Our findings indicate that hostility-especially introverted hostility-neuroticism and possibly depression are important components of the psychological profile of patients suffering from glossodynia.

Obsessive‐compulsive neurosis, anacastic symptomatology and ABO blood types

Determination of ABO blood types was carried out in 38 patients with obsessive‐compulsive neurosis, 48 schizophrenics with anancastic symptomatology, 31 depressives with anancastic symptomatology, 260 schizophrenics free of anancastic symptomatology and 65 depressives free of anancastic symptomatology. Results were compared with a representative sample of the general population.

Epidemic Faintness: A Psychophysiological Investigation

A psychophysiological assessment was carried out in 16 telephone operators, who fainted during an epidemic, and in 16 control subjects. Heart rate, skin conductance level, number of spontaneous fluctuations and pulse volume were measured at rest and during periods of auditory and visual stimulation. All subjects completed rating scales on anxiety, depression, anxiety experienced during experimental procedure and personality inventories. Analysis of data support the notion that the fainting episodes represent a form of transitory anxiety attacks in response to environmental stress and are not related either to hysteria or to anxiety state.

Clinical significance of the electrodermal habituation rate in anxiety disorders.

The electrodermal response habituation rate (EDR-HR) is examined in relation to clinical, personality and electrodermal measures in patients with generalized anxiety, phobic, obsessive-compulsive, dysthymic and conversion disorders by means of a stepwise regression analysis procedure. The results in the entire sample suggest that EDR-HR depends on the phasic component (amplitude and spontaneous activity) of the electrodermal response as well as on state anxiety, extraversion and depersonalization. When tested separately, most of the diagnostic groups demonstrated main trends similar to those found in total patients. A noteworthy correspondence between the importance of the contribution of certain clinical symptoms to the EDR-HR variance and some long-standing views of psychopathology was also found during the separate analysis of the groups. Although these findings question the diagnostic specificity of EDR-HR, the importance of this index as an objective measure of change following a therapeutic intervention as well as its potential usefulness in high-risk studies of anxiety disorders is put forward.

Relation of Obsessional Traits to Anxiety in Patients with Ulcerative Colitis

The obsessional personality traits and the ‘state’ and ‘trait’ anxiety, measured by means of self-rating inventories, were correlated in a group of patients with ulcerative colitis and a group of anxi

Obsessional Personality Traits and ABO Blood Types

The relation of ABO blood types to obsessional personality traits, as measured by the Leyton Obsessional Inventory (LOI), was studied in a sample of 600 normal individuals. High scorers of the LOI trait portion demonstrated a significantly lower incidence of phenotype O and a significantly higher incidence of phenotypes AB, A and B, taken together, compared to those of a general population sample and the entire study group. Findings of the present study, in conjunction with previous findings concerning a lower incidence of phenotype O and a higher incidence of phenotype A in obsessive compulsive patients, could be interpreted as indicating that phenotype O may be associated with personality traits hindering the development of obsessive-compulsive symptomatology.

Neuroses and ABO Blood Types

Determination of ABO blood types was carried out in 72 (35 female and 37 male) patients with obsessive-compulsive neurosis, 73 (35 female and 38 male) patients with phobic neurosis, 75 (54 female and 21 male) patients with hysteria and a random sample of 600 individuals (268 female and 332 male) drawn from the general population. Results provide evidence of: (1) a positive association between obsessive-compulsive neurosis and blood type A and a corresponding negative association between the former and blood type O; (2) a positive association between phobic neurosis and blood type O and a corresponding negative association between the former and blood type A, and (3) a positive association between hysteria and blood type A and a corresponding negative association between the former and blood type O. Moreover, sex does not appear to modify the ABO blood type distribution in our patients with obsessive-compulsive neurosis, phobic neurosis or hysteria. These findings might be considered as supporting the view that hereditary factors in the neurotic individual may influence the clinical form of his neurosis.