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Despite the potential theoretical and clinical relevance of psychopathological dimensions in Obsessive-Compulsive Disorder (OCD), few studies to date have investigated their possible association with obsession subtypes.
We aimed to examine whether, in OCD patients, anger and other psychopathological dimensions are associated with specific obsession subtypes.
We consecutively recruited 57 first-visit DSM-V OCD patients (females = 66.7%; age range = 18–63 years) at the Psychiatric Outpatient Clinic of our University Hospital. These patients were affected by severe OCD, as shown by a median (1st quartile–3rd quartile) Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 27.0 (23.0–32.5). We used the point-biserial coefficient (rpbi) to measure the correlation between psychopathological dimensions, as assessed with the Scale for the Rapid Assessment of Psychopathology (SVARAD), and obsession subtypes, as evaluated with the Y-BOCS.
We found significant correlations (P-values < 0.05) between: anger/aggressiveness dimension and aggressive, contamination, and sexual obsessions; apprehension/fear dimension and contamination, religious, and somatic obsessions; sadness/demoralization dimension and contamination and somatic obsessions; obsessiveness/iterativity dimension and all obsession subtypes; impulsivity dimension and aggressive and sexual obsessions; somatic concern/somatization dimension and contamination and somatic obsessions. We also found, by using the Mann-Whitney U-test, that OCD patients with comorbid Obsessive-Compulsive Personality Disorder–but not Schizotypal or Histrionic ones–showed higher levels (P < 0.05) of obsessiveness/iterativity and anger/aggressiveness than OCD patients without the personality disorder.
Anger and other psychopathological dimensions seem to be linked with specific obsession subtypes in OCD patients, suggesting an association between these dimensions and OCD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Carlo Colosimo, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy,
Dorina Tiple, Dipartimento di Biologia Cellulare Neuroscienze, Istituto Superiore di Sanita, Roma, Italy,
Alfredo Berardelli, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
Primary blepharospasm is a common adult-onset focal dystonia, characterized by involuntary contractions of the periocular muscles that result in forceful eye closure and impaired opening and closing of the eyes (Marsden, 1976; Berardelli et al., 1985; Defazio et al., 2007). The severity of blepharospasm can vary from repeated frequent blinking, causing only minor discomfort, to persistent forceful closure of the eyelids leading to functional blindness (Fig. 8.1). Blepharospasm can be caused by tonic or phasic contractions of the orbicularis oculi muscles and may also be associated with levator palpebrae muscle inhibition (apraxia of eyelid opening) or involuntary movements in the lower face and masticatory muscles (Meige’s syndrome). In most cases, blepharospasm is considered primary and is only occasionally secondary to structural brain lesions or drug therapy (Jankovic, 2006).
Neurophysiological recordings of the blink reflex have given important insights into the pathophysiology of blepharospasm. In patients with blepharospasm, the recovery cycle of the R2 component of the blink reflex is enhanced, presumably owing to a lack of brainstem interneuronal inhibition (Berardelli et al., 1985, 1998). Blepharospasm is also associated with an abnormal responsiveness of the blink reflex to sensory stimuli. Studies using magnetic brain stimulation also suggest a loss of inhibition and increased plasticity in the central nervous system of patients with blepharospasm (Defazio et al., 2007; Quartarone et al., 2008).
Joint Hypermobility Syndrome/Ehlers Danlos Syndrome Hypermobility Type (JHS/EDS-HT) is a hereditary connective tissue disorder, mainly characterized by joint hypermobility and instability, widespread chronic pain, and other secondary features. To date, psychiatric disorders have been scarcely investigated in the context of JHS/EDS-HT. Previous studies reported a high rate of panic and other anxiety disorders. No data regarding personality disorders are currently available.
To determine the prevalence of psychiatric comorbidities among patients with JHS/EDS-HT
We conducted a single-centre case-control study, enrolling consecutive JHS/EDS-HT patients and healthy controls. The psychiatric evaluation was based on the Structured Clinical Interview for DSM-IV Axis I and II disorders. Symptom severity was assessed using the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Brief Psychiatric Rating Scale. The Global Assessment of Functioning Scale was used to assess the overall severity of psychological, social, and occupational functioning.
Forty-seven JHS/EDS-HT patients and 45 healthy controls were recruited. Cases had significantly higher mean scores for all the adopted measures, and a 4.3 higher risk of being affected by any psychiatric disorder when compared to controls. In particular, they had a 5.8 higher risk of having a personality disorders, and, specifically, a higher rate of OCPD (10.6%). Conversely, we did not observe a high prevalence of panic disorders, as previously reported.
Patients with JHS/EDS-HT show higher rates of mood and personality disorders (OCPD particularly), while we found low rate of anxiety disorders. The psychiatric evaluation of these patients is strongly recommended.
First-generation immigrants from developed countries appear to be particularly at risk of being diagnosed with a mental disorder after migration. Nevertheless, in Europe immigrated people appear less likely than their native counterparts to access community mental health care. Inequity in treatment may lead to enhanced severity of the disease and consequent emergency referrals.
The aim of this study was to explore demographic and clinical characteristics in immigrants patients compared to Italianborn patients admitted in a Psychiatric Intensive Care Unit (PICU) for an acute mental disorder.
One hundred first-generation immigrant patients were consecutively recruited and compared to 100 age-, genderand diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Medical history and demographic information were collected with a study-specific form and were abstracted from medical records.
The majority of patients were admitted to the PICU for an acute psychotic or manic episode. There were no differences in socio-demographic characteristics, in clinical severity scores and global functioning scores between immigrant and Italian-born patients. Despite no differences in age or diagnosis, immigrant patients were significantly more likely to be at the first psychiatric contact (32% vs 15%; p=0.007).
Our results suggest a role of migration in the development of acute psychotic or manic episodes. Moreover, limited access for immigrants to community mental health services may lead to longer duration of untreated illness, increased disease severity and consequent emergency referrals.
To investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features.
We studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness.
Of the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test.
Clinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores.
Primary blepharospasm is a common adult-onset focal dystonia, characterized by involuntary contractions of the periocular muscles resulting in forceful eye closure, and impairing normal opening and closing of the eyes (Marsden,1976; Berardelli et al., 1985). The severity of blepharospasm can vary from repeated frequent blinking, causing only minor discomfort, to persistent forceful closure of the eyelids leading to functional blindness (Figure 7.1). Blepharospasm can be caused by tonic or phasic contractions of the orbicularis oculi muscles and may also be associated with levator palpebrae muscle inhibition (apraxia of eyelid opening) or involuntary movements in the lower face or jaw muscles (Meige's syndrome). In most cases blepharospasm is considered primary and is only occasionally secondary to structural brain lesions or drug induced (Jankovic, 2006).
Neurophysiological recordings of the blink reflex have given important insight into the pathophysiology of blepharospasm. In patients with blepharospasm, the recovery cycle of the R2 component of the blink reflex is enhanced, presumably owing to a lack of brain stem interneuronal inhibition (Berardelli et al., 1985, 1998). Blepharospasm is also associated with an abnormal responsiveness of the blink reflex to sensory stimuli. Recent studies with the technique of magnetic brain stimulation also suggest a loss of inhibition and increased plasticity in the central nervous system of patients with blepharospasm.
Anatomy of the periocular muscles
Knowledge of the anatomy of the upper facial muscles is essential for treating patients with blepharospasm.
Clinical and experimental findings suggest that Obsessive-Compulsive Disorder (OCD) is due to an abnormality of the cortico-striato-thalamo-cortical circuit. Bradykinesia and mental slowness can be present in patients with basal ganglia disorders affecting the cortico-striato-thalamo-cortical circuit. Aim of this study is to investigate whether bradykinesia and mental slowness are present in patients with OCD.
Participants comprised 19 non-depressed anti-psychotic free patients with OCD.
Bradykinesia was assessed with the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). Mental slowness was investigated with the WAIS-R and the Y-BOCS. Psychiatric evaluation was performed with: SCID-I, Y-BOCS, HAMD, HAM-A, and MMPI. Cognitive functions were assessed with the WAIS-R.
Bradykinesia and mental slowness were present respectively in the 39% and 89% of the patients. Bradykinesia was positively correlated to Y-BOCS mental slowness score (rho=0.48, p< 0.05), and inversely related to the WAIS-R Performance IQ score (rho=-0.65, p< 0.01). Patients with bradykinesia scored significantly lower in the Similarities and Digit symbol coding WAIS-R subscales as compared to non-bradykinetic patients. in our sample pathological doubt was not associated with IQ measures nor with bradykinesia. Twelve out of 19 patients (63%) showed impairments in the nonverbal function scores.
The novel findings of this study is that bradykinesia can be present in patients with OCD, and it is correlated with mental slowness and nonverbal performance impairment. These preliminary data support the notion that dysfunction of basal ganglia is possibly present in OCD patients.
Antonio Currà, Department of Neurological Sciences and I.N.M. Neuromed IRCCS, University of Rome “La Sapienza”, Italy,
Rocco Agostino, Department of Neurological Sciences and I.N.M. Neuromed IRCCS, University of Rome “La Sapienza”, Italy,
Alfredo Berardelli, Department of Neurological Sciences and I.N.M. Neuromed IRCCS, University of Rome “La Sapienza”, Italy
Movement disorders are a disease group related to functional or structural abnormalities of the basal ganglia.
The term “basal ganglia” refers to the following structures: the striatum (caudate and putamen), globus pallidus (internal and external segments, GPi and GPe), subthalamic nucleus, and substantia nigra (SN) (SN pars compacta, SNpc, and SN pars reticulata, SNpr). The striatum receives connections from specific cortical areas and from the SNpc; the basal ganglia output nuclei, the GPi and SNpr, exert an inhibitory effect on the thalamus. Diminished phasic activity in the GPi/SNpr disinhibits the thalamus thus facilitating cortical motor areas, whereas increased phasic activity in the GPi/SNpr causes the opposite effect. The GPi–SNpr inhibition of the thalamus is modulated through two parallel pathways. According to the classical model of basal ganglia functioning (Albin et al., 1989; Alexander & Crutcher, 1990; Alexander et al., 1990; De Long, 1990; Parent & Hazarati, 1995; Wichmann & De Long, 1996) the first is an inhibitory “direct” pathway that originates in the striatum and projects directly onto the GPi/SNr; the second is an “indirect” inhibitory pathway that crosses the GPe and subthalamic nucleus to project indirectly onto the GPi/SNpr. Activation of the direct pathway tends to disinhibit the thalamus. Activation of the indirect pathway disinhibits the subthalamic nucleus thereby increasing GPi/SNpr excitation thus resulting in increased thalamic inhibition: the two parallel circuits have an opposing action on the GPi/SNr and hence on the thalamus.
Gerstmann-Sträussler-Scheinker disease is an autosomal dominant prion disease. The clinical features include ataxia, dementia, spastic paraparesis and extrapyramidal signs.
We report a new large Italian family affected by Gerstmann-Sträussler-Scheinker disease.
The four generation pedigree includes 11 patients. The mean age at onset ± SD was 41.4 ± 16.2 years. Mean disease duration to death in four patients was 5.5 ± 1.7 years. Two clinical patterns were evident: cognitive impairment with scarce neurological features or ataxia followed by cognitive impairment. Molecular analysis showed P102L mutation in PRNP gene.
Three Italian families have been reported to date. The variable phenotype has already been reported, and does not appear related to the codon 129 polymorphism.
Paolo M. Rossini, Department of Neurology, CRCCS AFaR Ospedale Fatebenefratelli, Rome, Italy,
Alfredo Berardelli, Departimento Scienze Neurologiche, Università La Sapienza, Rome, Italy,
Roberto Cantello, Clinica Neurologica, Università del Piemonte Orientale, Novara, Italy
Magnetoencephalography (MEG) is a non-invasive technique able to spatially identify the synchronous firing neurons in restricted cortical areas, either for spontaneous cerebral activity or in response to an external stimulus. MEG is unaffected by scalp and skull, and preferentially reflects the tangential component of dipoles in the depth of gyri and sulci.
The neuromagnetic technique consists of measurement of the magnetic field over the scalp, as generated by the bioelectrical currents in the brain. In order to achieve the sensitivity needed to measure these very weak magnetic fields (about 10 as compared to the earth magnetic field), the use of new superconducting magnetometers (superconducting quantum interferences devices or SQUID) and of devoted shielding is mandatory. Under the symmetry conditions, well approximated in the case of the head, it can be shown that the component of the magnetic field perpendicular to the skull is mostly sensitive to the tangential component of the primary current source, and negligibly to the field generated by the volume currents and to the distortions, smearing effects and filtering of frequency components, mainly in the faster rhythms caused by the intervening tissues (Romani & Rossini, 1988; Okada et al., 1999). This represents an advantage in respect to the purely electric measurement of neural activity, especially for the postsynaptic component at the level of the cortical mantle. The magnetic field is simultaneously measured over many scalp sites, with a rapid sampling in the time domain, and from these data the isofield contour maps are calculated and studied.