Obsessive-compulsive disorder followed by psychotic episode in long-term ecstasy misuse

Aim. We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject. Findings. A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic. Conclusions. The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual. © 2009 Informa UK Ltd All rights reserved

The biological origins of rituals: An interdisciplinary perspective

Ritual behavior is ubiquitous, marking animal motor patterns, normal and psychopathological behavior in human individuals as well as every human culture. Moreover, formal features of rituals appear to be highly conserved along phylogeny and characterized by a circular and spatio-temporal structure typical of habitual behavior with internal repetition of non-functional acts and redirection of attention to the "script" of the performance. A continuity, based on highly conserved cortico-striatal loops, can be traced from animal rituals to human individual and collective rituals with psychopathological compulsions at the crossing point. The transition from "routinization" to "ritualization" may have been promoted to deal with environmental unpredictability in non-social contexts and, through motor synchronization, to enhance intra-group cohesion and communication in social contexts. Ultimately, ritual, following its biological constraints exerts a "homeostatic" function on the environment (social and non-social) under conditions of unpredictability

Mood-congruent and mood-incongruent psychotic symptoms in major depression: The role of severity and personality

Background: Whether psychotic symptoms in major depression (MD) are better explained by a severity model or by a vulnerability model, with personality as a predisposing factor, is still debated. The aim of the present study was to evaluate in MD the relationship between the content of psychotic features (mood congruent (MC) or mood incongruent (MI)) and severity of depression or personality traits. Methods: 62 inpatients affected by MD with psychotic features were divided into three groups on the basis of the content of psychotic symptoms: MC, MI, mixed MC-MI. All subjects completed the SCID-IV, the Structured Clinical Interview for DSM-IV Personality Disorders and the Hamilton Rating Scale for Depression. Personality was assessed after MD remission. Results: MI psychotic symptoms were positively associated with schizotypal traits, whereas MC symptoms were positively related to obsessive-compulsive traits and severity of depression. Patients with both MC and MI psychotic symptoms were characterized by a personality profile and depression severity standing in a middle position between the MC and MI groups. Limitations: The main limitations of the study are represented by the small sample size, the time of assessment of personality and the inclusion of only unipolar depression. Conclusions: Our findings suggest that both depression severity and personality profile, independently from each other, model the content of psychotic symptoms, confirming the validity of subgrouping psychotic depression into two distinct MC and MI types and supporting the inclusion of a third mixed MC-MI type because of its intermediate position in personality profile and severity between the MC or MI group. © 2012 Elsevier B.V

Comorbid bipolar disorder and obsessive-compulsive disorder: An old debate renewed

Abstract assent

The effect of severity and personality on the psychotic presentation of major depression

The aim of the present study was to evaluate whether symptom severity or personality traits are associated with psychotic symptoms in major depression (MD), since it is still debated whether psychotic depression represents the most severe form of depression or the effect of personality structure. The study included 163 patients affected by MD who were divided into four groups on the basis of the presence/absence of melancholic features and psychotic symptoms. All subjects completed the Structured Clinical Interview for DSM-IV Disorders (SCID-IV), the Structured Clinical Interview for DSM-IV Personality Disorders (SIDP-IV) and the Hamilton Rating Scale for Depression (Ham-D). Personality was assessed after MD remission (absence of DSM-IV criteria and Ham-D score lower than 7 for at least 2 months). Psychotic symptoms were positively associated with symptom severity (higher Ham-D total score) and with paranoid and schizotypal traits and negatively related to histrionic traits. Our data support the view that the effect of paranoid-schizotypal traits and symptom severity on the presence of psychotic symptoms in MD occurs separately and they are independent of each other. © 2011 Elsevier Ltd

The TAS-20 more likely measures negative affects rather than alexithymia itself in patients with major depression, panic disorder, eating disorders and substance use disorders

Background This study evaluates whether the difference in Toronto Alexithymia Scale-20 item (TAS-20) between patients with major depression (MD), panic disorder (PD), eating disorders (ED), and substance use disorders (SUD) and healthy controls persisted after controlling for the severity of anxiety and depression. Methods Thirty-eight patients with MD, 58 with PD, 52 with ED, and 30 with SUD and 78 healthy controls (C) completed the TAS-20, the Hamilton Rating Scale for Anxiety (Ham-A), the Hamilton Rating Scale for Depression (Ham-D). Results The differences in TAS-20 scores observed between patient groups, regardless of the type of their disorders, and controls disappeared after controlling for the effect of anxiety and depression severity. In contrast, the differences in severity of anxiety and depression between patients and controls were still present, after excluding the effect of alexithymic levels. Conclusions Our data suggest that alexithymic levels, as measured by the TAS-20, are modulated by the severity of symptoms, supporting the view that alexithymia can represent a state phenomenon in patients with MD, PD, ED and SUD, because the TAS-20 seems overly sensitive to a general distress syndrome, and it is more likely to measure negative affects rather than alexithymia itself. \ua9 2014 Elsevier Inc

Late-onset obsessive-compulsive disorder associated with left cerebellar lesion

The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology. An involvement of fronto-striatal circuits has been strongly suggested, whereas cerebellum remains so far scarcely explored. We present here the description of a "pure" late-onset OCD associated with a cerebellar lesion, neither comorbid with other mental disorders nor with neurological syndromes. To our knowledge, this condition was not previously described in literature. The patient is a 62-year-old woman who developed a late-onset OCD associated with a left cerebellar lesion due to an arachnoid cyst in the left posterior fossa. We debate the possible role of the cerebellar lesion in favoring a transition from a predisposing liability (namely an obsessive-compulsive personality disorder and a depressive status) to the onset of OCD in this woman. \ua9 2014 Springer Science+Business Media

The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis

Abstract Background: Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. Methods: A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. Results: 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). Limitations: Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. Conclusions: This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups

Obsessive-compulsive symptoms interact with disorganization in influencing social functioning in schizophrenia

Objective: Recent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptoms (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently. Method: Seventy-five patients affected by schizophrenia were administered the Structured Clinical Interview for DSM-IV Disorders, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale and the Social and Occupational Functioning Assessment.The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high OCS group). Results: In both groups, the effect of OCS on functioning was not mediated by their effect on positive, negative or disorganization symptoms. Conversely, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at high levels of disorganization. Conclusion: Data suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS

Obsessive–compulsive symptom severity in schizophrenia: a Janus Bifrons effect on functioning

The impact of obsessive–compulsive symptoms on functioning in schizophrenia is still debated. This study investigated the relationship between OC symptoms and functioning along a severity gradient of obsessive–compulsive dimension. Sixty patients affected by schizophrenia completed the SCID-IV, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive–Compulsive Scale and the Social and Occupational Functioning Assessment Scale. The relationship between functioning and obsessive–compulsive dimension was described by a reverse U-shaped curve; functioning was positively related to the presence of mild obsessive–compulsive symptoms and inversely related to moderate and severe symptoms, after controlling for the severity of positive, negative, disorganization and general psychopathological symptoms. The role of obsessive–compulsive symptoms on social functioning in schizophrenia occurs along a severity continuum with a gradual transition from a positive correlation (from absent to mild symptoms) to an inverse correlation (for symptoms ranging from moderate to severe) and independently from schizophrenia symptom dimensions