RESUMO
BACKGROUND: Recent studies have suggested that obsessive-compulsive disorder (OCD) is a heterogeneous disorder with some forms related to tics and Tourette's disorder. The present study was undertaken to investigate the sensory phenomena in patients with OCD and/or Tourette's disorder to determine if these phenotypic features represent valid clinical indices for differentiating tic-related OCD from non-tic-related OCD. METHOD: We evaluated 20 adult outpatients with OCD, 20 with OCD plus Tourette's disorder, and 21 with Tourette's disorder, using a semistructured interview designed to assess several definitions of sensory phenomena reported in the literature. DSM-III-R criteria were used for the OCD and Tourette's disorder diagnoses. RESULTS: Sensory phenomena including bodily sensations, mental urges, and a sense of inner tension were significantly more frequent in the 2 Tourette's disorder groups when compared with the OCD alone group. Feelings of incompleteness and a need for things to be "just right" were reported more frequently in the OCD plus Tourette's disorder group compared with the other 2 groups. CONCLUSION: Sensory phenomena may be an important phenotypic measure for grouping patients along the OCD-Tourette's disorder spectrum. Sensory phenomena include bodily and mental sensations. Bodily sensations include focal or generalized body sensations (usually tactile, muscular-skeletal/visceral, or both) occurring either before or during the patient's performance of the repetitive behaviors. These sensations are more frequently found in patients with OCD plus Tourette's disorder than in patients with OCD alone. Mental sensations include urge only, energy release (mental energy that builds up and needs to be discharged), incompleteness, and just-right perceptions. They are all more frequently found in patients with OCD plus Tourette's disorder than in patients with OCD alone.
Assuntos
Cognição , Transtorno Obsessivo-Compulsivo/diagnóstico , Sensação/fisiologia , Síndrome de Tourette/diagnóstico , Adulto , Análise de Variância , Conscientização/fisiologia , Cognição/fisiologia , Estudos de Coortes , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Imaginação/fisiologia , Masculino , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia , Prognóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores Sexuais , Tato/fisiologia , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/psicologia , Percepção Visual/fisiologiaRESUMO
BACKGROUND: Obsessive-compulsive disorder (OCD) is heterogeneous, with some forms related to Gilles de la Tourette's syndrome (GTS). This is a phenomenological study designed to investigate the nature of these possible OCD subtypes and the relationship between OCD and GTS. METHOD: We evaluated 20 adult outpatients with OCD, 21 with GTS, and 20 with OCD plus GTS using a semi-structured interview designed to assess cognitive, sensory and autonomic phenomena preceding repetitive behaviours. RESULTS: More cognitions and autonomic anxiety and fewer sensory phenomena were reported in OCD than in GTS. Like the GTS group, the OCD plus GTS group reported more sensory phenomena and fewer cognitions than the OCD group. CONCLUSIONS: The presence or absence of cognitions, sensory phenomena, and autonomic anxiety distinguishes repetitive behaviours in patients with OCD from those with OCD plus GTS, and GTS. These subjective experiences may be useful in subtyping OCD and may represent valid predictors of prognosis and treatment response.
Assuntos
Transtorno Obsessivo-Compulsivo/psicologia , Síndrome de Tourette/psicologia , Adolescente , Adulto , Idoso , Ansiedade/etiologia , Doenças do Sistema Nervoso Autônomo/psicologia , Transtornos Cognitivos/psicologia , Comportamento Compulsivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Sensação/etiologiaRESUMO
Introduction: Obsessive-Compulsive Spectrum Disorders include Obsessive-Compulsive Disorder (OCD), Tourette's Disorder (TS), Body Dysmorphic Disorder (BDD) and Trichotillomania (TTM), which, supposedly, share common psychopathological, physiopathological and genetic aspects. To date, the relation of OCD and TS is the most established. Recent studies suggest that patients with OCD and TS have a better response to serotonin reuptake inhibitors (SRI) plus neuroleptics than to SRI alone. Thus, the detection of patients with OCD and tics is important, once it can point to a different psychopharmacological approach. Similarly, the recognition of other psychiatric disorders associated to OCD could indicate important factors in treatment response. This study compares psychiatric comorbidity in patients with OCD and OCD plus TS, with the following hypotheses: 1) The group with both TS and OCD would be at significant risk for greater severity and frequency of associated disorders; 2) TTM would be more frequent in the OCD plus TS group, whereas BDD would be more frequent in the OCD group. Method: Twenty outpatients with OCD and twenty with OCD plus TS (DSM-III-R) were evaluated by the Standar Clinical Interview for the DSM-III-R (SCID) and additional modules designed by the authors for the diagnosis of TS, Chronic Motor Tics, BDD, TTM and Attention Deficit Disorder. Results: 1) Within groups: In the OCD group, the most frequent diagnoses were:...
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Comorbidade , Transtorno Obsessivo-Compulsivo/epidemiologia , Síndrome de Tourette/epidemiologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/fisiopatologia , Síndrome de Tourette/diagnóstico , Síndrome de Tourette/fisiopatologiaRESUMO
Forty-three female inpatients with active systemic lupus erythematosus (SLE) were studied by a multidisciplinary team to answer the following research questions: 1) What are the features of the psychopathology in patients with active SLE? and 2) In these patients, what is the relationship between psychiatric disorders and symptoms and signs suggesting activity of SLE in the CNS? Our a priori hypothesis was that, in patients with active SLE, those with psychiatric manifestations would have more symptoms and signs of CNS activity than those without psychiatric manifestations. Psychiatric evaluation consisted of standardized psychiatric instruments and diagnostic criteria. The assessment of SLE systemic and central nervous system (CNS) activity consisted of rheumatologic, neurologic, and ophthalmologic evaluations; serum and cerebral spinal fluid (CSF) analysis; brain computerized tomography (CT); and electroencephalogram (EEG). Twenty-seven patients (63%) presented psychiatric symptoms (Psychiatric Group), and 16 (37%) patients presented no current psychiatric diagnosis (Nonpsychiatric Group). These groups were compared in terms of the above variables. Depressive syndrome was the most frequent diagnosis (44%) followed by delirium (7%) and dementia (5%). Psychiatric symptoms were associated with subjective cognitive impairment (85%) and neurologic abnormality (85%). Widened cortical sulci was the most frequent CT alteration and was equally common in both groups. No statistical difference was found between the 2 groups regarding their general clinical evaluation, serum and CSF exams, or EEG alterations. To determine whether the severity of psychiatric symptoms was related to CNS activity, we divided the 27 patients with psychiatric manifestations into 2 groups: the Major Group--18 patients with major psychopathology, and the Minor Group--9 patients with mild depressive syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Sistema Nervoso Central/fisiopatologia , Lúpus Eritematoso Sistêmico/psicologia , Adulto , Eletroencefalografia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/líquido cefalorraquidiano , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/fisiopatologia , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Treatment of non-streptococcal pharyngitis (NSP) varies among physicians. Recent data regarding difficult-to-culture bacterial pathogens have increased interest in antibiotic treatment of NSP. This study examined physician behavior regarding antibiotic treatment of NSP in preparation for a prospective clinical trial. The records of 358 patients with pharyngitis-related diagnoses from a large private family physician practice and an urban hospital's housestaff clinic were reviewed. No significant relationship between the presence of streptococcus and the prescribing of antibiotics was found. Physicians gave antibiotics to 50% of patients with clinical signs and symptoms of pharyngitis. Many of these tested negative for streptococcus. Physicians used antibiotics effective against Mycoplasma and Chlamydia less than one half of the time. Projected costs of drug treatment for patients with NSP was $1,200. Family medicine educators are encouraged to monitor their own and their residents' antibiotic prescribing behaviors when treating common upper respiratory infections.