Yoko Iwasaki

Clinical characteristics in patients with anorexia nervosa and obsessive–compulsive disorder

BACKGROUND The purpose of this study was to assess clinical characteristics, including co-morbid personality disorders in patients with both anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) in comparison with age- and sex-matched patients with OCD. METHODS Fifty-three female patients with AN were divided into two groups based on the presence or absence of a current diagnosis of OCD, as assessed by the Structured Clinical Interview for DSM-III-R Patient version (SCID-P). Twenty-one women (40 %) who met the DSM-III-R criteria for both AN and OCD were compared with 23 female patients with OCD, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the SCID Axis II disorders. RESULTS There were no significant differences on the mean Y-BOCS severity scores between these groups. However, AN patients with OCD were significantly more likely than OCD patients to have obsessions with need for symmetry or exactness and ordering/arranging compulsions, whereas both aggressive obsessions and checking compulsions tended to be more frequently identified in OCD patients compared with AN patients with OCD. AN patients with OCD were significantly more likely than OCD patients to meet the criteria for obsessive-compulsive personality disorder (OCPD). CONCLUSIONS These results suggest that there are some differential characteristics of the OCD symptomatology between these disorders, although many patients with AN manifest significant impairment from primary OCD symptoms with similar magnitude in severity to that found in OCD patients.

Personality disorders in patients with obsessive‐compulsive disorder in Japan

A total of 75 patients with obsessive‐compulsive disorder (OCD) were studied in order to investigate the characteristics of OCD symptoms and the comorbidity of personality disorders (PD). Contamination obsessions and checking compulsions were most commonly found in patients, of whom 53% met the criteria for at least one PD. Among comorbid PD, the anxious‐fearful (cluster C) PDs, such as avoidant, obsessive‐compulsive and dependent PD, were most prevalent, followed by the odd‐eccentric (cluster A) PDs, such as paranoid and schizotypal PD. The patients with PD had more severe social maladaptation and concurrent depressive and anxious symptoms than the patients without any PD, despite the similar severity of OCD symptoms. These results are consistent with those reported in the Western world, and are considered to be relatively stable cross‐culturally.

Event‐related potentials in patients with obsessive–compulsive disorder

Twenty‐three unmedicated patients with obsessive–compulsive disorder (OCD) were compared with 12 unmedicated patients with social phobia (SP) and 18 age‐matched normal controls (C) using a two‐tone auditory oddball event‐related potentials (ERP) paradigm. The OCD group showed significantly shorter P300 latencies and shorter N200 latencies for target stimuli than the SP and the C groups. The OCD patients also tended to have greater N200 negativity compared with normal controls. However, there were no significant relationships between these ERP abnormalities in OCD patients and the type or severity of their OCD symptoms. In the mean ERP waveforms, increased N200 negativity for target stimuli, as well as the provocation in the later part of N200 for non‐target stimuli, were more commonly observed in the OCD and the SP groups compared with the C group. These results raise the possibility that the shorter N200 and P300 latencies in OCD patients may be an OCD‐specific phenomenon that is more closely related to the biological basis for OCD, rather than the characteristics of their OCD symptoms. On the other hand, increased negativity in the N200 region, even for non‐target stimuli, may represent the common abnormalities among anxiety disorders.

Prevalence and symptomatology of comorbid obsessive–compulsive disorder among bulimic patients

This study sought to assess the prevalence and symptomatology of comorbid obsessive– compulsive disorder (OCD) among Japanese subjects who met the DSM‐III‐R criteria for bulimia nervosa (BN). The Structured Clinical Interview for DSM‐III‐R Patient Version was used to distinguish 26 BN patients with concurrent OCD from 52 BN patients without OCD. Obsessive–compulsive symptoms in BN subjects with concurrent OCD were evaluated using the Japanese version of the Yale‐Brown Obsessive–Compulsive Scale. There were no differences in the prevalence of concurrent OCD between BN subjects with and without a lifetime history of anorexia nervosa. Among BN subjects with concurrent OCD, symptoms related to symmetry and order were most frequently identified, followed by contamination and aggressive obsessions, and checking and cleaning/washing compulsions. Bulimia nervosa subjects with concurrent OCD were more likely than subjects without OCD to have more severe mood and core eating disorder psychopathology. Comorbid OCD is a common phenomenon in Japanese bulimics (33%) similar to that suggested in BN subjects in the Western countries. Obsessive– compulsive symptoms related to symmetry and order were most frequently observed in BN subjects with concurrent OCD, which was a similar finding to that reported among restricting anorexic subjects.

A comparison of clinical features among Japanese eating-disordered women with obsessive-compulsive disorder.

Clinical features, such as obsessive-compulsive disorder (OCD) symptoms, were investigated in Japanese women with DSM-III-R eating disorders (EDs) and concurrent OCD in comparison to age-matched women with OCD. Sixteen women with restricting anorexia nervosa (AN), 16 with bulimia nervosa (BN), and 16 with both AN and BN (BAN) showed commonality in a more elevated prevalence of OCD symptoms of symmetry and order compared with 18 OCD women. Among the personality disorders (PDs), likewise, obsessive-compulsive PD (OCPD) was more prevalent in each ED group compared with the OCD group. However, aggressive obsessions were more common in both BN and BAN subjects compared with AN subjects. Subjects with bulimic symptoms were also distinguished from AN subjects by impulsive features in behavior and personality. Thus, an elevated prevalence of aggressive obsessions along with an admixture of impulsive and compulsive features specifically characterized the clinical features of bulimic subjects with OCD.

A comparative study of clinical features between pure checkers and pure washers categorized using a lifetime symptom rating method.

The current study assessed lifetime obsessive-compulsive disorder (OCD) symptoms in 156 Japanese patients with OCD in order to investigate clinical differences between pure lifetime checkers and pure lifetime washers. Fifty subjects (32%), who had no lifetime history of washing or checking compulsions, or who had a principal symptom other than washing or checking compulsions, were initially excluded. The remaining 106 subjects were divided into three groups: 43 pure lifetime washers (W), 33 pure lifetime checkers (C) and 30 subjects who had experienced both checking and washing compulsions over their lifetime (WC). No differences in clinical characteristics were observed between the W and C groups, suggesting that the lifetime washer-checker distinction may not be useful in subtyping OCD. However, subjects in the WC group differed from other subjects in a number of respects including poorer level of insight, more severe psychopathology and global dysfunction. Thus, they can be generally distinguished by more pervasive and severe psychopathological features, and may constitute a valid subgroup of OCD. Further work from a multidimensional perspective is required to verify the clinical significance of a typology based on lifetime symptoms.

Clinical features in two cases with musical obsessions who successfully responded to clomipramine

Abstract Clinical features in two cases with musical obsessions are presented to discuss phenomenological and psychopharmacological differences from those in patients with musical hallucinations. The present patients commonly experienced music as an internally generated cognitive product accompanied by full insight into the senselessness of the symptoms. They also attempted to suppress the musical symptoms or to neutralize them with other thoughts. Thus, despite no covert or systematic compulsive behaviors, the musical symptoms of the present cases are consistent with the phenomenological nature of obsessive–compulsive disorder defined in DSM‐IV. In addition, in contrast to previous case reports of musical hallucinations, the present patients failed to respond to neuroleptics, but showed significant response to an adequate trial of clomipramine. Thus, their symptoms appear to be phenomenologically and biologically distinct from musical hallucinations, especially those characteristic of schizophrenia.