Ulrike Demal

Memory Deficits in Patients with DSM-IV Obsessive-Compulsive Disorder

Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers’ rituals. Another account of doubting implicates metacognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to metacognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.

Obsessive-Compulsive Disorder and Depression

In a retrospective study 62 patients, who fulfilled the ICD-8/9 criteria for obsessive-compulsive disorder (OCD), were followed up. Besides an assessment of the cross-sectional symptomatology of OCD and depression, the long-term course of OCD and its relationship to depression were investigated. Five courses of OCD could be differentiated: continuous and unchanging (27.4%); continuous with deterioration (9.7%); continuous with improvement (24.4%); episodic with partial remission (24.2%), and episodic with full remission (11.3%). There was no difference between primary or secondary depression on the prognosis of OCD, and there was also no difference between the continuous or episodic course with regard to primary or secondary depression. Our results may be biased by the fact that we selected a sample of OCD and not primarily major depressive patients.

Naturalistic course of obsessive compulsive disorder and comorbid depression. Longitudinal results of a prospective follow-up study of 74 actively treated patients.

Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25 % Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as ‘good prognosis course’. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.

Quality of life in depression and anxiety disorders: an exploratory follow-up study after intensive inpatient cognitive behaviour therapy.

Thirty-seven patients with depression and anxiety disorder, who participated in an intensive inpatient cognitive behaviour therapy program for 6 weeks, were interviewed before treatment and 6 weeks after the end of treatment; in addition to other measures, quality of life was assessed with the Berlin Quality of Life Profile. Substantial reduction in subjective quality of life, objective functioning and environmental assets was found at baseline. At follow-up, according to clinical global impression, 13.5% of the patients were very much improved, 45.9% much improved; in 26.3% only slight improvement and in 16.2% no improvement was reported. Quality of life changed for the better in areas like work and education, leisure, housing, social relations, psychological well-being and a global rating of satisfaction with life, but not in marital relations, health in general and in finances.

Obsessive compulsive disorder and depressionfirst results of a prospective study on 74 patients

1. Seventy-four patients who met DSM-III-R criteria for Obsessive Compulsive Disorder received a serotonin reuptake inhibitor and cognitive behavior therapy for 6 months (baseline to follow-up I). 2. In order to maximize therapeutic effects, different kinds of treatment were applied between follow-up I and follow-up II (12 months). 3. Patients were followed-up twice with respect to long-term outcome of obsessive compulsive disorder and depression. Forty % of the sample showed marked improvement at follow-up. No specific variant of treatment could be identified to be significantly more effective. 4. Cross-sectional investigations showed significant correlations between extent of depressive and obsessive compulsive symptomatology (admission, follow-up I and II).

Horten und Sammeln im Spektrum der Zwangsstörungen

Der Begriff „Messie-Syndrom“ hat in den letzten Jahren zunehmende Verbreitung erfahren. Der zwanghafte Charakter des „Messie-Syndroms“ hat dazu gefuhrt, dass das Syndrom schon fruh mit Zwangssymptomen in Verbindung gebracht wurde. An der Spezialambulanz fur Zwangsstorungen an der Universitatsklinik fur Psychiatrie und Psychotherapie der Medizinischen Universitat Wien haben sich in den letzten Jahren daher zunehmend Menschen mit Sammelzwangen vorgestellt, die unter einem „Messie-Syndrom“ leiden. Das „Messie-Syndrom“ ist aber sicher nicht zur Ganze als Zwangsstorung zu verstehen. Eine Reihe von psychiatrischen Erkrankungen konnen dem „Messie-Syndrom“ zugrunde liegen, die sich uber beinahe das gesamte Diagnosenspektrum des ICD-10 (WHO 1994) erstrecken (Tabelle 1). Fur den Therapeuten ist die Diagnostik der entsprechenden Grunderkrankung notwendig, um die geeigneten therapeutischen Schritte einleiten zu konnen. Der „Sammlertrieb“ kann als „Urtrieb“ der Jager und Sammler verstanden werden. Im Sammeln steckt ein Dominanzbedurfnis („Besitzen wollen“, „Beherrschen wollen“), aber auch ein Ausweichverhalten mit Ruckzug und Beschaftigung mit Gegenstanden. Sammeln kann eine Kompensation unerfullter sozialer Wunsche nach Anerkennung oder Bewunderung sein. Auch als „Ersatzbefriedigung“ zur Kompensation unerfullter sexueller Wunsche kann es dienen.

Monitoring- und Feedback-Systeme in der Psychotherapie

SummarySeveral electronically assisted monitoring and feedback systems have been developed in the context of psychotherapy research. The purpose of this paper is to present three methods that differ mainly in their ways of observing the progress of therapy at closely-spaced time intervals, in their scope of functionalities and in their theoretical background: the handheld-based Outcome Questionnaire-45 (OQ-45) completed weekly is presented first. Of all the available monitoring and feedback systems, this is the one whose effectiveness has been studied and published most comprehensively. The most important results of these studies are explained and discussed with regard to their positive effects on the outcome of the psychotherapy and on the duration of therapy. Next the Internet-based Synergetic Navigation System (SNS) is examined, taking as an example a Therapy Process Questionnaire (TPQ) which is based on the theory of synergetics, the self-organization of non-linear systems, and evaluates the progress of therapy daily via the patients self-assessment. The extensive time series analyses available through the use of the SNS are presented. In conclusion, information is given about those points that currently still stand in the way of implementing monitoring and feedback systems in routine psychotherapeutic care, and future research strategies are also indicated.ZusammenfassungIm Rahmen der Psychotherapieforschung wurden mehrere elektronisch gestützte Monitoring- und Feedback-Systeme entwickelt. In der vorliegenden Arbeit sollen zwei Methoden vorgestellt werden, die sich vor allem durch eine unterschiedliche engmaschige Betrachtung des Therapieverlaufes, im Umfang der Funktionalitäten und im theoretischen Hintergrund unterscheiden: Zuerst wird das wöchentlich auszufüllende Hand-heldbasierte Outcome Questionnaire-45 (OQ-45) vorgestellt, dessen Effektivität von allen verfügbaren Monitoring- und Feedback-Systemen am umfangreichsten untersucht und publiziert wurde. Die wichtigsten Ergebnisse dieser Studien werden im Hinblick auf die positiven Auswirkungen auf das Ergebnis der Psychotherapie und der Therapiedauer dargelegt und diskutiert. Des Weiteren wird das internet-basierte Synergetic Navigation System (SNS) am Beispiel eines Therapieprozessbogens (TPB) erörtert, welcher auf der Theorie der Synergetik, der Selbstorganisation nichtlinearer Systeme, beruht und den Therapieverlauf täglich durch eine Selbsteinschätzung des Patienten evaluiert. Die mittels des SNS verfügbaren umfangreichen Zeitreihenanalysen werden vorgestellt. Abschließend werden sowohl Hinweise auf diejenigen Punkte gegeben, die einer Implementierung von Monitoring- und Feedback-Systemen in der psychotherapeutischen Routineversorgung gegenwärtig noch entgegenstehen als auch zukünftige Forschungsansätze aufgezeigt.

Beeinflussung des Behandlungsergebnisses einer stationären Psychotherapie von Zwangsstörungen durch den Ausprägungsgrad der Instabilität im Therapieverlauf

SummaryBackgroundThe present study evaluates a central hypothesis of synergetic psychotherapy research according to which a marked instability in the psychotherapeutic process is associated with high response rates.Methods14 patients with obsessive-compulsive disorder (OCD) completed an eight-week in-patient course of multimodal behavior therapy with exposure exercises. The instability during the course of the therapy was recorded by daily selfassessment by the patient using the Synergetic Navigation System (SNS), an Internet-based real-time monitoring procedure.ResultsThere was a negative correlation between the degree of the instability and the percentage reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (r = −0.395; P = 0.199), the “Global Severity Index” (GSI) of the symptom check-list (SCL-90-R) (r = −0.718; P = 0.013), the scale value for obsessive-compulsiveness in the SCL-90-R (r = −0.782; P = 0.004) and the remaining sub-scales of this data-gathering instrument.ConclusionsAn unstable progress of the psychotherapy causes a smaller reduction in symptoms than a stable one. The contradiction relative to the study hypothesis is possibly based on the special features of OCD, with a high level of patient insecurity when anticipating new, non-obsessive-compulsive ways of thought and behavior. The relationships between instability and reduction in symptoms appear to be diagnosisspecific.ZusammenfassungGrundlagenDie vorliegende Studie evaluiert eine zentrale Hypothese der synergetischen Psychotherapieforschung, nach der eine ausgeprägte Instabilität im psychotherapeutischen Prozess mit hohen Ansprech-Raten assoziiert ist.Methodik14 Patienten mit einer Zwangsstörung absolvierten eine achtwöchige stationäre multimodale Verhaltenstherapie mit Expositionsübungen. Die Instabilität im Therapieverlauf wurde durch eine tägliche Selbsteinschätzung der Patienten mittels eines internetbasierten Real-Time-Monitoring-Verfahrens, des Synergetic Navigation System (SNS), erfasst.ErgebnisseDer Ausprägungsgrad der Instabilität korrelierte negativ mit der prozentualen Reduktion der Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) und allen Subskalen der Symptom-Check-Liste (SCL-90-R).SchlussfolgerungenEin instabiler Psychotherapieverlauf bedingt eine geringere Symptomreduktion als ein stabiler. Der Widerspruch zur Studienhypothese beruht möglicherweise auf den Besonderheiten der Zwangsstörung mit starker Verunsicherung beim Antizipieren neuer, nicht-zwanghafter Denkund Verhaltensweisen. Die Zusammenhänge zwischen Instabilität und Symptomreduktion scheinen diagnosespezifisch zu sein.

Deutsche Gesellschaft Zwangserkrankungen

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