Raşit Tükel

The clinical impact of mood disorder comorbidity on obsessive-compulsive disorder

The present study examines the effect of concomitant major depressive or bipolar disorder on clinical symptoms of patients with obsessive–compulsive disorder (OCD). Forty–nine patients classified as OCD without a mood disorder, 26 classified as OCD with bipolar disorder (OCD–BD) and 42 classified as OCD with major depressive disorder (OCD–MDD) according to DSM–IV diagnostic criteria were included in the study. The groups were compared with respect to demographic variables and scores obtained on various scales. The OCD–BD group had more symmetry/exactness obsessions and ordering/arranging compulsions, and a more episodic course of illness and had better insight compared to the other two groups. Levels of anxiety, depression, disability and obsessive–compulsive symptom severity were significantly higher in the OCDMDD group. The rate of social phobia was higher in OCD–BD patients, whereas the rates of generalized anxiety disorder and simple phobias were higher in OCDMDD group. These findings suggest that comorbidity of major depressive disorder may increase the severity of OCD symptoms. On the other hand, bipolar disorder comorbidity may constitute a subgroup which is characterized by a higher rate of episodic course and better insight.

Impact of obsessive-compulsive disorder comorbidity on the sociodemographic and clinical features of patients with bipolar disorder

BACKGROUND In this study, our aim is to determine the prevalence rates of obsessive-compulsive disorder (OCD) comorbidity and to assess the impact of OCD comorbidity on the sociodemographic and clinical features of patients with bipolar disorder (BD). METHODS Using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-IV/Clinical Version on bipolar patients, 2 groups, BD with OCD comorbidity (BD-OCD) and BD without OCD comorbidity, were formed. These groups were compared for sociodemographic and clinical variables. RESULTS Of 214 patients with BD, 21.9% of them had obsession and/or compulsion symptoms and 16.3% had symptoms at the OCD level. Although there was no statistically significant difference between the frequency of comorbid OCD in BD-I (22/185, 11.9%) and BD-II (3/13, 23.1%) patients, but OCD was found to be significantly high in BD not otherwise specified (10/16, %62.5) patients than BD-I (P < .001) and BD-II (P = .03). Six patients (17.1%) of the BD-OCD group had chronic course (the presence of at least 1 mood disorder episode with a duration of longer than 2 years), whereas the BD without OCD group had none, which was statistically significant. There were no statistically significant differences between BD-OCD and BD without OCD groups in terms of age, sex, education, marital status, polarity, age of BD onset, presence of psychotic symptoms, presence of rapid cycling, history of suicide attempts, first episode type, and predominant episode type. LIMITATIONS Main limitation of our study was the assessment of some variables based on retrospective recall. CONCLUSIONS Our study confirms the high comorbidity rates for OCD in BD patients. Future studies that examine the relationship between OCD and BD using a longitudinal design may be helpful in improving our understanding of the mechanism of this association.

Evaluation of regional cerebral blood flow changes in panic disorder with Tc99m-HMPAO SPECT

OBJECTIVE To evaluate the differences in regional cerebral blood flow (rCBF) and rCBF asymmetry index values of panic disorder patients and a control group, using Tc99m-HMPAO SPECT. In addition, the influence of comorbid agoraphobia on the rCBF and rCBF asymmetry index values of the panic disorder patients was also investigated. METHOD The rCBF and rCBF asymmetry index values of 22 panic disorder patients, 9 with agoraphobia and 13 without agoraphobia, and 19 healthy controls were obtained using SPECT. Both (1) the panic disorder and control groups and (2) panic disorder groups with and without agoraphobia were compared in terms of the measured values. RESULTS A decrease in blood perfusion in the bilateral frontal region, a relative increase in blood perfusion in the right medial frontal and right superior frontal regions and a relative blood flow increase in the right medial frontal region according to rCBF asymmetry index values were determined in panic disorder patients. In the patients with agoraphobia, the decrease in blood perfusion in the right occipital region, and the relative increase in the right superior temporal region according to rCBF asymmetry index values were significantly higher than those in subjects without agoraphobia. CONCLUSION The decrease in the rCBF in the bilateral inferior frontal regions in panic patients may be related to the amygdala activation decreasing cerebral blood flow in the frontal region and/or the hyperactivation of the locus ceruleus. The explanations of the etiology of panic disorder are valid only if they are supported with clinical evidence from future studies.

Neuropsychological function in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a chronic disease characterized by repetitive, unwanted intrusive thoughts and ritualistic behaviors. Studies of neuropsychological functions in OCD have documented deficits in several cognitive domains, particularly with regard to visuospatial abilities, executive functioning, and motor speed. The objective of the present study was to investigate systematically the cognitive functioning of OCD patients who were free of medication and comorbid psychiatric disorders. In the present study, 72 OCD patients were compared with 54 healthy controls on their performance in a comprehensive neuropsychological battery. The Yale-Brown Obsessive Compulsive Scale and the Hamilton Depression Rating Scale were administered to the patients, and a semistructured interview form was used to evaluate the demographic features of the patients and control subjects. Overall, widespread statistically significant differences were found in tests related to verbal memory, global attention and psychomotor speed, and visuospatial and executive functions indicating a poorer performance of the OCD group. A closer scrutiny of these results suggests that the OCD group has difficulty in using an effective learning strategy that might be partly explained by their insufficient mental flexibility and somewhat poor planning abilities.

Obsessive compulsive disorder and symptoms may have different effects on schizophrenia.

The aim of this study is to investigate the possible different effects of obsessive compulsive disorder (OCD) and obsessive compulsive symptoms (OCS) on schizophrenia illness in regard to clinical characteristics such as severity of symptomatology. We included 184 patients with schizophrenia on monotherapy with a stable dose of antipsychotics for at least three months. Severity of clinical symptoms was evaluated by Positive and Negative Syndrome Scale. OCS was examined by Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Checklist. We also assessed OCD by using Y-BOCS. Seventeen percent of the patients were diagnosed with current OCD, while 17.4% of the patients were found to have OCS without OCD. Age of onset for OCD group was earlier than non-OCS group (p=0.007). The rate of occupation was higher (p=0.001), prevalence of other comorbid psychiatric disorders was lower (p=0.05), number of hospitalization was lower (p=0.03), GAF score was higher (p=0.03) and duration of education was longer (p=0.02) in the OCS group than in the non-OCS group. The rate of occupation was higher (p=0.04) and that rate of comorbid psychiatric disorders was lower (p=0.01) in the OCS group than in the OCD group. We found more OCS in patients using atypical antipsychotics (p=0.03). Our findings suggest that OCD and OCS might have different effects on schizophrenia.

Comparison of clinical characteristics in trichotillomania and obsessive–compulsive disorder

Fifteen patients with trichotillomania (TM) and 25 patients with obsessive-compulsive disorder (OCD) were studied. All patients were evaluated using the structured clinical interview for DSM-III-R (SCID-P). TM and OCD patients were compared with respect to demographic variables and the scores obtained from the various scales. The TM group had a greater percentage of women and showed an earlier age at onset. There was no significant difference for depression and anxiety assessed with the STAI, HRSA, and HRSD between the groups. Compared to OCD patients, TM patients had significantly lower scores on the Y-BOCS. The two groups were similar on the measures of resistance to and control of the hair pulling/compulsive symptoms. We found significantly higher incidence of anxiety and depressive disorders, and Axis II personality disorders for OCD patients. These findings are discussed in the view of results from earlier reports.

Clinical characteristics in obsessive-compulsive disorder with schizophrenia

The objective of this study was to compare two groups of patients with obsessive-compulsive disorder (OCD) with and without comorbid schizophrenia in terms of demographic and clinical features. A total of 65 patients diagnosed with OCD were divided into two groups: one comprising 20 patients with schizophrenia and the other comprising 45 patients without schizophrenia. The groups were then compared with respect to demographic variables and scores obtained on various scales. The two groups were similar for the frequency and severity of obsessive-compulsive symptoms. Insight into obsessive-compulsive symptoms was significantly better in the group with schizophrenia. Our findings suggest that the characteristics of obsessive-compulsive symptoms in schizophrenic OCD patients are similar to those in nonschizophrenic OCD patients.

Audiovestibular functioning in patients with panic disorder

OBJECTIVE The objective of this study was to investigate audiovestibular function in patients with panic disorder and healthy subjects by using vestibular and audiologic tests. METHODS Thirty-four panic disorder patients and 20 healthy control subjects were assessed by using clinical otoneurological examination, pure tone audiometry, tympanometry, and electronystagmography (ENG). All patients were evaluated with the Panic and Agoraphobia Scale (PAS), the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the State-Trait Anxiety Inventory (STAI). RESULTS On vestibular testing, abnormal responses were more prevalent in panic disorder patients compared to healthy controls. The presence of agoraphobia in panic disorder patients did not make a significant difference on vestibular test results. The only variable that may be a predictor of vestibular abnormalities in panic disorder patients was found to be dizziness between attacks. CONCLUSION The results show that dizziness between panic attacks may warrant audiovestibular testing among other medical investigations.

Brain-derived neurotrophic factor gene Val66Met polymorphism and cognitive function in obsessive–compulsive disorder†‡

In the present study, we have tested the hypothesis that brain‐derived neurotrophic factor (BDNF) gene Val66Met polymorphism is associated with obsessive–compulsive disorder (OCD) and also investigated the association between the BDNF Val66Met polymorphism and the performance on tests measuring executive functions in a sample of patients with OCD. A total of 100 patients diagnosed with OCD according to DSM‐IV criteria and 110 control subjects were included in this study. Single nucleotide polymorphism (G/A) leading to Val to Met substitution at codon 66 in BDNF was screened in the DNA samples of all participants. The genotype frequencies of BDNF Val66Met polymorphism were compared in OCD patients and healthy controls. The four subgroups of OCD and healthy control subjects, determined according to being Val homozygous or carrying a Met allele, were also compared according to their performance in a battery of neuropsychological tests of executive functions and verbal memory. There was no significant difference for the allele and genotype distributions of BDNF Val66Met polymorphism between the OCD and healthy control groups. Compared to the other three subgroups, OCD‐Met carriers were slower on Trail‐Making Test part A (TMT A), part B (TMT B) score and its speed‐corrected score (TMT B‐A). OCD‐Met carriers had also poor performance on verbal fluency tasks and several CVLT measures compared only to the healthy control‐Met carriers. These results demonstrate that the BDNF Val66Met polymorphism does not appear to be a risk factor for OCD. However, the presence of a BDNF Met allele, which is a known attenuator of BDNF activity, may be associated with a poorer executive functioning in OCD.

Decreased IFN-γ and IL-12 levels in panic disorder

OBJECTIVE The aim of this study is to assess the measures of proinflammatory cytokines in patients with panic disorder in comparison with the healthy subjects. METHODS Twenty three patients with panic disorder with or without agoraphobia and twenty three controls were recruited for the study. Plasma samples of all subjects were analyzed for TNF-α, IFN-γ, IL-1β, IL-2, IL-6, and IL-12 concentrations and NK-cell activity is measured in the peripheral blood samples of the subjects. RESULTS We found significant differences on the mean values of IL-12 (p=0.01) and IFN-γ (p=0.02) between the panic disorder and control groups. In a logistic regression analysis, IFN-γ values were significant statistical predictors of the presence of panic disorder (B=-0.07, SE=0.03, p=0.04). CONCLUSION The most important implication of our results is to suggest a relation between panic disorder and low levels of IFN-γ, compatible with the results of the animal studies showing that IFN-γ plays a role by acting to regulate the development of anxiety-like behaviors.