Anne Katrin Kuelz

Neuropsychological performance in obsessive-compulsive disorder: a critical review

There is growing evidence for neuropsychological dysfunction in obsessive-compulsive disorder (OCD) related to an underlying frontal lobe and/or basal ganglia dysfunction. The following paper is a systematical review of the existing literature on cognitive impairment in OCD patients. Fifty studies were surveyed with regard to methodological aspects and cognitive impairments found in OCD patients. In addition, the impact of confounding variables such as psychotropic medication, co-morbidity or severity of symptoms on neuropsychological functioning as well as effects of treatment are discussed. OCD is often related to memory dysfunction that seems to be associated with impaired organization of information at the stage of encoding. Several other executive functions are also commonly disturbed, though results are inconsistent. The results of our study suggest that some cognitive deficits seem to be common in OCD, but future studies should focus more on possible confounding variables such as co-morbidity or psychotropic medication.

Neuropsychological Impairment in Obsessive-Compulsive Disorder—Improvement Over the Course of Cognitive Behavioral Treatment

A large body of studies demonstrates mild cognitive dysfunction in patients with Obsessive Compulsive Disorder (OCD). Few trials have investigated whether this dysfunction can be improved by treatment. Thirty unmedicated inpatients with OCD were administered a comprehensive neuropsychological test battery before and after 12 weeks of cognitive behavioral therapy (CBT). Thirty-nine carefully matched healthy controls were tested twice within the same interval. At baseline, patients exhibited significant impairments on several tests which normalized at follow-up. A significant group × time interaction was found for tests of nonverbal memory, set shifting and flexible, self guided behavior. Major responders improved significantly more than minor responders on the Rey-Osterrieth Figure immediate and delayed recall. Results suggest that cognitive dysfunction in OCD can improve in the course of treatment. We hypothesize that particularly cognitive behavioral treatment enables OCD patients to think and act in a more flexible way that helps them to develop more effective cognitive strategies.

Sleep in obsessive compulsive disorder

Several lines of evidence suggest that brain serotonergic systems may be disturbed in obsessive compulsive disorder (OCD). The serotonergic system strongly affects sleep and characteristic abnormalities of sleep are documented in depression. This study, therefore, aimed to investigate sleep structure of OCD patients in order to evaluate whether similar changes as in depression are present. Up to now, this issue has been addressed only in few studies with small numbers of patients. Sleep patterns of 62 unmedicated patients with primary OCD and 62 age- and sex-matched healthy controls were investigated by polysomnography. Additionally, the impact of tryptophan depletion on sleep was studied in a subgroup of 12 OCD patients and 12 controls. The OCD patients exhibited moderate, but significant disturbances of sleep continuity measures but no abnormalities of slow wave sleep or REM sleep, except a significant elevation of 1st REM density. Tryptophan depletion induced a worsening of sleep continuity, but no changes of REM sleep or slow wave sleep. Assuming that changes of sleep architecture indicate underlying neurobiological abnormalities, this study indicates that neurobiological disturbances are different in primary OCD as compared with primary depression.

Dream Recall and Dream Content in Obsessive-compulsive Patients: Is There a Change During Exposure Treatment?

Very little is known about dreams in patients with obsessive compulsive disorder, especially regarding changes over the course of treatment with stimulus exposure and response prevention. By use of dream content analysis, 40 dreams of 9 obsessive compulsive (OC) inpatients were compared with 84 dreams of 10 matched OC outpatients and 63 dreams of 11 healthy control participants. Dream protocols of inpatients were collected at the beginning of treatment and after the first exposure exercises. Controls filled in dream protocols in respective intervals. Before treatment, dreams of patients showed significantly less positive contents than dreams of healthy controls. Under treatment with exposure, a significant reduction of OC themes was observed. The findings support the continuity hypothesis of dreaming by showing a link between day-time symptoms and OC symptoms in dreams. Contrary to expectations, however, exposure treatment does not intensify dreams.

Traumatisierung und Dissoziationsneigung bei Zwangserkrankten: Ein Überblick

Hintergrund: Traumatisierung und eine erhöhte Dissoziationsneigung bei Zwangserkrankten erweisen sich ätiologisch, symptomatisch und therapeutisch als relevant. Die vorliegende Arbeit stellt bisherige Ergebnisse hierzu im Überblick dar. Methode: Vorgestellt werden alle in MEDLINE und PSYCINFO verfügbaren Studien, die Traumatisierung und/oder Dissoziationsneigung bei Zwangserkrankten anhand repräsentativer Stichproben systematisch untersuchten. Ergebnisse: Die Ergebnisse zu Traumatisierungen bei Zwangserkrankten zeigen ein heterogenes Bild. Einige Studien berichten eine klare Häufung von Traumata, andere können dieses Ergebnis nicht bestätigen. Gehäuft treten vor allem leichte Traumatisierungen auf. Die Dissoziationsneigung bei Zwangserkrankten ist höher als in der Allgemeinbevölkerung und ist vergleichbar mit anderen klinischen Stichproben. Sowohl Traumatisierungen als auch Dissoziationsneigung sind häufiger mit den Symptomdimensionen «Kontrollzwänge» und «Symmetrie-/Ordnungszwänge» assoziiert. Schlussfolgerung: Bisherige Ergebnisse lassen keine eindeutigen Schlüsse auf eine Interaktion von Traumatisierung, Dissoziationsneigung und Zwangserkrankung zu. Die Datenlage spricht tendenziell für häufigere Typ-II-Traumatisierungen bei Zwangserkrankten, ohne Hinweise auf häufigere Typ-I-Traumata in der Vorgeschichte. Aktuelle Publikationen legen interessante Hypothesen bezüglich eines spezifischen Zusammenhangs zu einzelnen Symptomdimensionen nahe.

Marty Seligman: «Das pathologische Krankheitsmodell hat uns bei ganz normalen Leuten nicht weitergeholfen»

Prof. Dr. Martin E.P. Seligman ist Professor für Klinische Psychologie und Leiter des Instituts für Positive Psychologie an der University of Pennsylvania, PA. Neben seinen bahnbrechenden Arbeiten zur erlernten Hilflosigkeit, hat Prof. Seligman das Feld der Positiven Psychologie begründet, über 170 wissenschaftliche Arbeiten in hochrangigen Journals veröffentlicht und ist Autor von über 20 Bestsellern («Learned Optimism», «What You Can Change and What You Can’t», «The Optimistic Child», «Abnormal Psychology»). Prof. Seligman war Präsident der Abteilung für Klinische Psychologie der Amerikanischen Gesellschaft für Psychologie und hat zahlreiche internationale Auszeichnungen erhalten (u.a.: «Distinguished Scientific Contribution Award» der American Psychological Association, «William James Fellow Award» für Beiträge zur Grundlagenforschung und «James McKeen Cattell Fellow Award» für die Anwendung psychologischen Wissens). Das Gespräch mit ihm fand im Rahmen eines regelmäßigen Treffens des Steering Commitees der Forschergruppe zu Positive Health am Institut für Positive Psychologie der University of Pennsylvania statt. Das Interview führte Dr. Yvonne Nestoriuc, Beraterin im Projekt «Super Healthy» der Positive-Health-Forschergruppe und akademische Rätin am Lehrstuhl für Klinische Psychologie und Psychotherapie der Philipps-Universität Marburg.

Contents Vol. 19, 2009

4 237 Body Dysmorphic Symptoms Inventory: A Screening Instrument Buhlmann, U. (Berlin); Wilhelm, S. (Boston, MA); Glaesmer, H.; Brähler, E. (Leipzig); Rief, W. (Marburg) 4 243 Compulsive Hoarding Inventory – Evaluation of the German Version of the Saving Inventory-Revised Mueller, A. (Erlangen, Fargo, ND); Crosby, R.D. (Fargo, ND); Frost, R.O. (Northampton, MA); Bleich, S. (Erlangen, Hannover); Glaesmer, H. (Leipzig); Osen, B. (Bad Bramstedt); de Zwaan, M. (Erlangen)