Yiannis Kasvikis

Predictors of improvement in obsessive-compulsive disorder☆

Abstract Forty-nine obsessive-compulsive ritualizers had clomipramine and live exposure therapy in a randomized controlled design. 29 pretreatment demographic, clinical, and psychophysiologic variables were examined as predictors of outcome using multiple regression analysis. Severity of rituals, social disability, male sex, checking rituals, bizarre and fixed obsessions, and severe and uncontrollable obsessions predicted poorer outcome. Patients who had been initially more severely ill habituated less to ritual-evoking stimuli in the laboratory and showed less improvement at all assessment points. Plasma desmethylclomipramine predicted improvement only during the active phase of treatment.

Postwithdrawal Exposure Treatment to Prevent Relapse in Opiate Addicts: A Pilot Study

A major problem in treating opiate addiction is relapse within a few months after withdrawal. Learning models of relapse offer some promise toward understanding this problem. The present pilot study examines whether cue-exposure treatment to drug-related cues, in hospital and real life, might reduce relapse. Fourteen opiate addicts were withdrawn on clonidine over 6 days, and 10 of those were exposed to drug-related cues in hospital for 1 week and in real life for another. There were then followed as outpatients up to 6 months. Craving was elicited in half of the 10 patients exposed to drug cues who showed within- and between-session habituation. Four cases were opiate-free at 6 months follow up and 1 at 3 months. Half of the cases had relapsed to heroin at various times up to 6 months. Habituation to craving responses was not obviously related to outcome whereas vocational factors were. The operational use of craving in research is discussed.

Clonidine versus long- and short-term methadone-aided withdrawal from opiates. An uncontrolled comparison.

Twelve heroin addicts and one methadone addicts began withdrawal from street opiates, under clonidine cover, in a general psychiatric ward. Ten (80%) of them completed it within 6 days. Clonidine doses used were lower than in similar studies and all patients were alert and mobile throughout withdrawal. Two other groups of opiate addicts, of similar age and sex, were withdrawn on standard methadone regimens. Clonidine and methadone withdrawal had similar acceptability and attrition rates. Self-reports of subjective discomfort were higher in the clonidine group without affecting compliance with treatment. Withdrawal under clonidine cover deserves further study, in view of the need for postwithdrawal treatment to prevent relapse to opiate use.

Clomipramine, self-exposure, and therapist-accompanied exposure in obsessive-compulsive ritualizers: Two-year follow-up

Abstract Forty-nine obsessive-compulsive ritualizers took part in a double blind controlled study of clomipramine and exposure therapy. Thirty-nine of those (80%) were followed up to two years and were examined on the same clinical ratings scales as those used in the study. At two years there were no between group differences; patients had maintained their gains of one year and were significantly improved on all outcome measures compared to pretreatment. Improvement in rituals and in mood emerged as distinct components in a principal component analysis, suggesting that the two variables were relatively independent despite their high intercorrelations.

Urinary cortisol during exposure in obsessive-compulsive ritualizers

Nineteen obsessive-compulsive (OC) ritualizers were exposed to both brief and prolonged neutral and aversive stimuli (the latter evoked a significant urge to ritualize). Urinary cortisol and subjective anxiety were measured over 3 1/2 hours throughout the experiment, and cortisol secretion was compared to a control session the previous day. Both groups showed higher cortisol secretion after exposure compared to the control session. Only the group that received prolonged aversive stimuli, in addition to brief aversive and neutral stimuli, showed significantly higher urinary cortisol levels after the session. Cortisol response correlated with subjective anxiety reports during prolonged aversive stimulation only.