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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Drug addiction is a chronic relapsing brain disorder characterized by neurobiological changes that lead to a compulsion to take a drug with loss of control over drug intake. The hypothesis outlined here is that knowledge of the neurochemical systems involved in the transition from drug use to the compulsive use of addiction will provide the rational basis for development of pharmacotherapies for drug addiction. Much evidence has been obtained in identifying the midbrain-basal forebrain neural elements involved in the positive reinforcing effects of drugs of abuse and more recently in the neural elements involved in the negative reinforcement associated with drug addiction. Key elements for the acute reinforcing effects of drugs of abuse include a macrostructure in the basal forebrain called the extended amygdala that contains parts of the nucleus accumbens and amgydala and involves key neurotransmitters such as dopamine, opioid peptides, serotonin, GABA, and glutamate. Withdrawal from drugs of abuse is associated with subjective symptoms of negative affect, such as dysphoria, depression, irritability and anxiety, and dysregulation of brain reward systems involving some of the same neurochemical systems implicated in the acute reinforcing effects of drugs of abuse. In addition, acute withdrawal is accompanied by recruitment of the brain stress neurotransmitter system, corticotropin-releasing factor. Animal models of craving involve not only conditioning models but also models of excessive drug intake during prolonged abstinence, post-acute withdrawal, that may reflect continued dysregulation of drug reinforcement that could lead to vulnerability to relapse and represent an important focus for pharmacotherapy. Such changes have been hypothesized to involve a change in set point for drug reward that may represent an allostatic state contributing to vulnerability to relapse and re-entry into the addiction cycle. Elucidation of the specific neuropharmacological changes contributing to this prolonged functional dysregulation will be the challenge of future research on the neurobiology of drug addiction.
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PMID:Neurobiology of addiction. Toward the development of new therapies. 1091 30

Gilles de la Tourette Syndrome (GTS) and obsessive-compulsive disorder (OCD) share obsessive-compulsive phenomena. The aims of this study were to compare the OC symptom distribution between GTS and OCD and to investigate whether a subdivision of these phenomena into obsessions, compulsions and 'impulsions' is useful in distinguishing GTS and OCD patients. Thirty-two GTS, 31 OCD (10 with tics, 21 without tics) and 29 control subjects were studied using the Leiden repetitive behaviors semi-structured interview to assess GTS as well as OCD-related behaviors. Each reported repetitive thought or action was evaluated on the presence of anxiety and on goal-directedness. This information was used to define whether the behavior was an obsession, compulsion, or 'impulsion'. Both the GTS and OCD study groups showed higher scores than control subjects on rating scales measuring depression, OC behavior and anxiety. In GTS, Y-BOCS severity scores and trait anxiety were lower than in the OCD groups. Furthermore, GTS patients differed from OCD patients in the distribution of symptoms. Aggressive repetitive thoughts, contamination worries and washing behaviors were reported more frequently by tic-free OCD, while mental play, echophenomena, touching and (self)-injurious behaviors were reported more frequently by GTS. OCD individuals with tics were intermediate, but closer to tic-free OCD. GTS individuals reported significantly more 'impulsions' and fewer obsessions and compulsions than OCD individuals with and without tics. Factor analysis revealed three factors accounting for 44% of the variance, resulting in an 'impulsive' factor related to GTS, a 'compulsive' factor related to OCD and an 'obsessive' factor related to tic-free OCD. In conclusion, OCD individuals reported more anxiety and goal-directedness associated with their behaviors than did GTS subjects. The distinction between obsessions, compulsions and impulsions is of importance in identifying Tourette-related vs. non-Tourette-related repetitions.
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PMID:Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences? 1128 20

The objective of this study was to evaluate the psychological side effects of a transvaginal natural progesterone gel in hormone replacement therapy (HRT). This 3-month preliminary study was part of a multicenter study previously performed in our center. We enrolled 49 women (ages 18-45 years) with hypothalamic amenorrhea (HA) (n = 40) and premature ovarian failure (POF) (n = 9). Estrogenized patients applied vaginal progesterone gel (4% or 8%) every other day for six doses per month. The Hopkins Symptom Checklist (HSCL), a psychometric profile test, was administered at baseline, day 13 of cycle 2, day 24 of cycle 2, and day 24 of cycle 3. Application of the progesterone gel caused no significant change in HSCL total scores or individual symptom scores for somatization, obsession-compulsion, interpersonal sensitivity, depression, and anxiety. Natural vaginal progesterone gel can be an effective alternative to oral progesterone for women on HRT.
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PMID:Natural vaginal progesterone is associated with minimal psychological side effects: a preliminary study. 1178 9

A review of the literature on adolescent pregnancy and child abuse, both of which are showing alarming increases in the US, suggests a strong link between these two fields as well as potential for integrated research. Numerous studies have identified a significant incidence of childhood sexual abuse in teenage mothers who neglect or abuse their own children. The experience of child abuse has been associated with psychiatric sequelae such as somatization, anxiety, depression, interpersonal sensitivity, obsessive-compulsive behavior, dissociation, and suicidality. Another study found that dissociation and depression were significant mediators between a child abuse history and negative life outcomes such as victimization and interpersonal difficulties. Also recorded has been a tendency for abuse survivors to use rapidly initiated sexual activity with multiple partners as a means of coping with feelings of depression, abandonment, and emptiness. A positive correlation has been noted between the severity of childhood abuse and the intensity of subsequent psychopathology. Also found has been considerable overlap between the Minnesota Multiphasic Personality Inventory scores of pregnant/parenting teens and abuse victims. If further research continues to substantiate the association between these two social problems, treatment of childhood trauma in high-risk teens may emerge as an important pregnancy prevention strategy.
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PMID:Integration of teen pregnancy and child abuse research: identifying mediator variables for pregnancy outcome. 1229 Sep 75

Some meta-analyses have suggested that the selective serotonin reuptake inhibitors (SSRIs) are less effective than clomipramine in the treatment of obsessive-compulsive disorder (OCD). The aim of this double-blind, randomised, multicentre study was to directly compare the efficacy and safety of fluvoxamine and clomipramine in patients with OCD. A total of 227 patients were randomised to flexible doses of fluvoxamine or clomipramine (both 150-300 mg/day) for 10 weeks. Fluvoxamine and clomipramine were both clinically effective and there were no statistically significant differences between the two treatment groups, at any visit, on the National Institute of Mental Health Obsessive-Compulsive global rating scale, the Yale-Brown Obsessive-Compulsive scale (total score and obsession and compulsion subscores), the Clinical Global Impression severity of illness and global improvement subscales, the Clinical Anxiety Scale and the 17-item Hamilton Depression Rating Scale. However, there were differences in safety between the two treatments. Compared with fluvoxamine-treated patients, those treated with clomipramine had more anticholinergic side effects (dry mouth, constipation and tremor) and premature withdrawals due to adverse events (18 versus 9). The results from this controlled study indicate that fluvoxamine is as effective as clomipramine in the treatment of OCD but has a better tolerability profile. Copyright 2001 John Wiley & Sons, Ltd.
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PMID:Fluvoxamine in obsessive-compulsive disorder: similar efficacy but superior tolerability in comparison with clomipramine. 1240 54

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.
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PMID:Psychological characteristics of elderly insomniacs. 1250 Jul 82

Some psychometric properties of an adaptation of the Yale-Brown Obsessive Compulsive Scale for use in the Netherlands (Y-BOCS-NL) were examined in 65 psychiatric inpatients. The factorial invariance of two-dimensional systems were determined, namely Severity and Disturbance versus Obsessions and Compulsions, with the latter performing substantially better than the former in different respects. All further analyses were therefore focused on the Obsessions and Compulsions prototype. Inter-rater agreement was established in four inpatients by 39 raters at different institutions and found to be excellent. Internal consistency was also excellent. Concurrent and divergent validity were examined and established by correlating the Y-BOCS-NL with the Padua Inventory, the Burns Perfectionism Scale and state and/or trait measures of, among others, hostility, anxiety, depression, irrational fears and assertiveness. The Obsessions and Compulsions dimensions were lowly intercorrelated and showed evidence of clearly different patterns of correlations with external measures (divergent validity).
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PMID:Cross-cultural validity of the Yale-Brown Obsessive Compulsive Scale. 1262 34

Psychogenic excoriation (PE), characterized by excessive scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV disorder. It is a chronic disorder with a high rate of psychiatric comorbidity. The purpose of this study was to compare patients diagnosed with PE and patients with another dermatological disease in terms of comorbid psychiatric disorders. Thirty-one consecutive subjects were recruited from an outpatient dermatology clinic. The control group was composed of 31 patients with chronic urticaria. All subjects were interviewed using the Structured Clinical Interview for DSM-III-R (SCID-I), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HARS), and Yale-Brown Obsession and Compulsion Scale (Y-BOCS) and also completed a semistructured questionnaire. Current major depressive syndrome was the most common psychiatric disorder in the PE group. There was a statistically significant difference between the two groups in terms of current major depressive syndrome (PE group 58.1%, control group 6.5%, P<.01). In the PE group, 45.2% of subjects were diagnosed with obsessive compulsive disorder (OCD), while the rate of OCD was only 3.7% in the control group (P <.01). The PE group scored significantly higher on the BDI, HARS, and Y-BOCS. The results of this study point to the close relationship of PE to depression and OCD.
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PMID:The relation of psychogenic excoriation with psychiatric disorders: a comparative study. 1276 14

An 82-year-old man with treatment-resistant depression and early Alzheimer's disease was started on methylphenidate. Significant obsessive-compulsive behavior ensued but diminished over several weeks when methylphenidate was replaced by fluvoxamine. The patient had no prior psychiatric history, but he had a sister with obsessive-compulsive disorder. It appears that methylphenidate precipitated the patient's pathological behavior.
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PMID:Methylphenidate-induced obsessive-compulsive symptoms in an elderly man. 1290 24

Tic disorders (TD), obsessive-compulsive disorders (OCD) and attention-deficit/hyperactivity disorder (ADHD) are often associated with deficits of impulse control and aggressive behavior. Tic disorders and OCD are closely related on epidemiological, psychopathological and neurobiological levels, whereas ADHD and OCD phenomena seem to be at opposite poles. Research evidence on the clinical significance of associated obsessive-compulsive behavior is reviewed and linked to our own new data. Thus the analyses of a worldwide database on Tourette's Syndrome (TS) (N = 4,833) showed that that the associated symptomatology of the OCD spectrum has to emphasized. In further investigations, premonitory sensorimotor phenomena reminiscent of OCD were more frequent in children with tic disorders as they grew older. Obsessive-compulsive behavior concomitant with TS was particularly associated with impulsive and aggressive behavior, as well as with depression and anxiety. The data suggest a reduced serotonergic transmission. Self-reports by children with ADHD, as opposed to those by their parents, mentioned a significantly higher quantitative degree of OC phenomena than those by children with TS. These findings suggest that OC symptoms in children with ADHD have so far been neglected in assessments by others. In summary, a complex psychopathological pattern of tic, OC behavior, impulsivity and internalizing symptomatology emerges that requires discriminating assessment and treatment.
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PMID:[Compulsive phenomena in children with tic disorder and attention deficit-hyperactive disorder]. 1294 92


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