Links for Keyword: OCD - Obsessive Compulsive Disorder

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|By Ann Graybiel and Kyle Smith For children and adults who have conditions such as obsessive-compulsive disorder (OCD), Tourette syndrome or autism, repetitive thoughts and actions can occur even if the individuals do not want them to. In OCD a thought that repeats again and again—“my hands are dirty, my hands are dirty”—can recur in a habitual way. Such conditions occur in people from different countries and cultures, suggesting that they represent a core dysfunction related to an imbalance between behaviors. These problems appear to reflect disturbances in brain circuits that are different from, but allied with, the normal habit circuits. Researchers in our group and that of Susanne Ahmari at the University of Pittsburgh have tested whether these OCD circuits can be controlled. Our lab group stimulated the neocortex and striatum in mice that were genetically engineered to have OCD-like traits. These mice groom themselves excessively, especially around the face. In the lab we mimicked a problem that people with OCD often have because they react excessively and repetitively to some trigger stimulus in the environment. We conditioned the mice to learn that after a tone sounded a drop of water would fall on their noses about a second later. We also performed the same routine with normal (“control”) mice. The OCD-like mice started by just grooming when the water drop came, but then began to start grooming in response to the tone alone, and kept grooming all the way through when the drop fell. The control mice learned to suppress this early grooming, which after all was a wasted effort because the water drop came later. The OCD-like mice groomed compulsively every time the external cue sounded. Using optogenetics—a technique that controls the activity of brain cells by shining light on them—we then excited a pathway that connects a small region in the cortex with the striatum. The pathway has been implicated in suppressing behaviors. This treatment immediately blocked the compulsive early grooming in the mutant mice! Yet when the water drop came, they could groom normally. And the optogenetic stimulation did not affect other normal behaviors such as eating; it selectively blocked the compulsive aspect of behavior. © 2014 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 19646 - Posted: 05.23.2014

Kevin Loria Music was among the least of Mr. B's concerns. As a 59-year-old Dutch man living with extremely severe obsessive compulsive disorder for 46 years, he had other things on his mind. His OCD was so severe it led to moderate anxiety and mild depression. Not only was his condition extreme, but it was also resistant to traditional treatment. It got so bad that he opted to receive an implant to stimulate his brain constantly with electricity — a treatment, called deep brain stimulation (DBS), that has been shown to successfully treat OCD in the past. It worked, but had a very peculiar side effect. As researchers write in a study published in the journal Frontiers in Behavioral Neuroscience, it turned Mr. B. into a Johnny Cash fanatic, though he'd never really listened to The Man in Black before. Mr. B. had listened to the same music for decades, but was never a devout music lover. He was a Rolling Stones and Beatles fan (with a preference for the Stones), and listened to Dutch music as well. But just months after flying to Minneapolis and having two sets of electrodes tunneled into his brain for the shock therapy, he had a mind-blowing run-in with the song "Ring of Fire" playing on the radio. Something about Cash's deep bass-baritone voice resonated with him at that moment. His life had already changed. After the surgical implants and therapy, his OCD had gone from extremely severe to mild, and his depression and anxiety were at a level lower than mild. But when he heard Cash croon, another change began. Mr. B. bought all the Johnny Cash music he could find and stopped listening to anything else — no more Beatles, no more Stones, no more Nederpop. Instead, he played Cash all the time, and especially loved the songs from the '70s and '80s. "Folsom Prison Blues," "Ring Of Fire," and "Sunday Morning Come-Down" are his favorites. They make him feel like a hero, he told doctors. © 2014 Business Insider, Inc.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 18: Attention and Higher Cognition
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 14: Attention and Consciousness
Link ID: 19645 - Posted: 05.23.2014

David Adam The day the Brazilian racing driver Ayrton Senna died in a crash, I was stuck in the toilet of a Manchester swimming pool. The door was open, but my thoughts blocked the way out. It was May 1994. I was 22 and hungry. After swimming a few lengths of the pool, I had lifted myself from the water and headed for the locker rooms. Going down the steps, I had scraped the back of my heel on the sharp edge of the final step. It left a small graze through which blood bulged into a blob that hung from my broken skin. I transferred the drop to my finger and a second swelled to take its place. I pulled a paper towel from above the sink to press to my wet heel. The blood on my finger ran with the water as it dripped down my arm. My eyes followed the blood. And the anxiety, of course, rushed back, ahead even of the memory. My shoulders sagged. My stomach tightened. Four weeks earlier, I had pricked my finger on a screw that stuck out from a bus shelter's corrugated metal. It was a busy Saturday afternoon and there had been lots of people around. Any one of them, I thought, could easily have injured themselves in the way I had. What if one had been HIV positive? They could have left infected blood on the screw, which then pierced my skin. That would put the virus into my bloodstream. I knew the official line was that transmission was impossible this way – the virus couldn't survive outside the body – but I also knew that, when pressed for long enough, those in the know would weaken the odds to virtually impossible. They couldn't be absolutely sure. In fact, several had admitted to me there was a theoretical risk. © 2014 Guardian News and Media Limited

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 19447 - Posted: 04.05.2014

by Clare Wilson ARE people with obsessive compulsive disorder addicted to their repetitive behaviours? In a test designed to measure decision-making, individuals with OCD performed much like gambling addicts, suggesting their underlying brain problems may be similar. OCD makes people worry obsessively, compelling them to carry out rituals like repeated hand washing. It affects about one in 50 people and can take over their lives. Because sufferers get anxious if they can't complete their rituals, OCD is usually treated as an anxiety disorder with talking therapies to relieve distress or anti-anxiety drugs. These approaches reduce symptoms but only a minority of people are cured. In the new study, 80 people – half of whom had OCD – had to choose cards from four decks, winning or losing money in the process. Two decks were rigged to produce big wins but even bigger losses. The people without OCD learned to choose from the two safer decks but those with the disorder were consistently less likely to make good judgements and finished with a significantly lower final score. Drug and gambling addicts also perform poorly on the test. That doesn't prove OCD is an addiction but a growing body of work, including brain scans and other cognitive tests, suggest it should be recast in this way, says Naomi Fineberg of the University of Hertfordshire in Welwyn Garden City. Both addiction and OCD "share a lack of control of behaviour", she says. © Copyright Reed Business Information Ltd.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 19356 - Posted: 03.13.2014

by Ashley Yeager Humans aren’t the only ones to suffer from obsessive-compulsive disorder. Dogs can suffer from the disorder as well, with particular breeds compulsively chewing their feet, chasing their tails or sucking blankets. Now scientists say they have identified several of the genes that trigger the behavior in Doberman pinschers, bullterriers, sheepdogs and German shepherds. Four genes, CDH2, CTNNA2, ATXN1 and PGCP, involved in the communication between brain cells appear to play a role in dog OCD, researchers report February 16 in Genome Biology. The results could be used to better understand the disorder in people. © Society for Science & the Public 2000 - 2013.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 19255 - Posted: 02.17.2014

Stanley Rachman. “Will these hands ne'er be clean?” In Shakespeare's play Macbeth, Lady Macbeth helps to plot the brutal murder of King Duncan. Afterwards she feels tainted by Duncan's blood and insists that “all the perfumes of Arabia” could not sweeten her polluted hands. Baffled by her compulsive washing, her doctor is forced to admit: “This disease is beyond my practise.” In the 400 years since Macbeth was first performed, other doctors, psychiatrists, neuroscientists and clinical psychologists — myself included — have also found the problem beyond the reach of their own expertise. We see compulsive washing a lot, mostly as a symptom of obsessive–compulsive disorder (OCD), but also in people who have suffered a physical or emotional trauma, for example in women who have suffered sexual assault. The events trigger a deep-seated psychological, and ultimately biological, response. We know that the driving force of compulsive washing is a fear of contamination by dirt and germs. An obsessive fear of contact with sexual fluids, for example, can drive compulsive washing in OCD and force people to restrict sexual activity to a specific room in the house. Compulsive washing fails to relieve the anxiety. Most patients with OCD continue to feel contaminated despite vigorous attempts to clean themselves. Why does repeated washing fail? There is much debate at present about the direction that psychiatric medicine and research should take. We should not underestimate what we can continue to learn from the careful observation of patients. Such observations have led my colleagues and me to diagnose a new cause of OCD and other types of compulsive washing: mental contamination. © 2013 Nature Publishing Group

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 17: Learning and Memory
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 18897 - Posted: 11.08.2013

By NICHOLAS BAKALAR Five antidepressant drugs are approved by the Food and Drug Administration for treating obsessive-compulsive disorder. But they are sometimes ineffective, and guidelines suggest adding an antipsychotic drug to the regimen. Now scientists have found that adding cognitive behavioral therapy, or C.B.T., may be more effective than an antipsychotic. Researchers studied 100 people with O.C.D. who were taking antidepressants without sufficient improvement. They randomized 40 to the antipsychotic risperidone (brand name Risperdal), 20 to a placebo pill, and 40 to exposure and ritual prevention, a special form of C.B.T. delivered twice a week over eight weeks. All continued their antidepressants as well. The study was published online in JAMA Psychiatry, and several of the authors have financial relationships with pharmaceutical companies. Using well-validated scales and questionnaires, the researchers found that 80 percent of the C.B.T. patients responded with reduced symptoms and improved functioning and quality of life. About 23 percent got better on risperidone, and 15 percent on the placebo. “It’s important to discontinue antipsychotics if there isn’t continued benefit after four weeks,” said the lead author, Dr. Helen Blair Simpson, a professor of psychiatry at Columbia. “O.C.D. patients who still have symptoms should first be offered the addition of C.B.T., and some will achieve minimal symptoms. “There’s a hopeful message here,” she added. “There are good treatments.” Copyright 2013 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18674 - Posted: 09.19.2013

By Carrie Arnold We all experience the occasional life-changing event—a new baby, a cross-country move, a serious injury. In rare cases, such events can precipitate a mental disorder. The problem is compounded because people often assume their suffering is par for the course after such upheaval. In reality, relief is probably a short treatment away, via therapy or medication. For a new mother, dealing with a newborn is fraught with anxieties. Did I fasten the car seat properly? Is the baby still breathing? In more than one in 10 new mothers, these normal worries can escalate into more serious obsessions that can interfere with her ability to care for herself and her baby. Most of the research on postpartum psychiatric problems has focused on depression and psychosis. Obstetricians such as Emily Miller of Northwestern University, however, were also noticing a range of anxiety-related disorders, including intrusive thoughts and repetitive behaviors. “It's good to check that your baby is strapped into the car seat,” Miller notes. “But these women aren't just doing it once. They're doing it over and over, and it's interfering with their lives.” With her colleagues, Miller followed 461 women after they gave birth. Eleven percent said they had obsessions and compulsions two weeks after delivery that the researchers found to be the equivalent of mild to moderate obsessive-compulsive disorder (OCD)—a sharp increase over the 2 to 3 percent rate of OCD in the general population. Half of these women's symptoms continued six months' postpartum, and an additional 5.4 percent developed new OCD symptoms in that time. The afflicted women indicated that their symptoms were distressing, taking up a significant amount of time and otherwise interfering with their daily life. © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 8: Hormones and Sex
Link ID: 18318 - Posted: 06.26.2013

By Scicurious People who suffer from obsessive compulsive disorder (OCD) can’t help some of their actions. They suffer from severely intrusive thoughts and anxiety, which they know are not right. And they feel a compulsion to do rituals to get rid of them. Maybe it’s repetitive hand washing. Maybe it’s checking that the stove is off exactly 7 times each night. Whatever it is, the symptoms can cause severely interfere with their daily lives. What causes these compulsive, repetitive behaviors? We’re not sure, but today’s paper suggests a role of the circuit between the striatum and the orbitofrontal cortex, areas associated with impulsivity and repetitive behaviors. And it could be that increasing activity within certain parts of this circuit might help shut down some repetitive behaviors, giving us important insight into how repetitive behaviors work. I should begin by noting that Ed also covered this paper over at Not Exactly Rocket Science, along with another paper about making compulsive behaviors. It’s a really cool look at the two papers and you should definitely check it out! Me, I’m interested in the circuit involved here, and why stimulating one part may end up inhibiting behavior. The authors of this study started with a model of obsessive behavior, the SAPAP3 knockout mouse, which I actually wrote a bit about recently. This mouse has a knockout of a special protein associated with synapses. Without it, mice display obsessive (well, repetitive, we can’t really ask the mouse if they are obsessing) grooming behavior, grooming their faces so much that they will cause lesions to form. The authors wanted to look at what caused this behavior, and what could potentially stop it. © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18285 - Posted: 06.18.2013

Kerri Smith Researchers have both created and relieved symptoms of obsessive-compulsive disorder (OCD) in genetically modified mice using a technique that turns brain cells on and off with light, known as optogenetics. The work, by two separate teams, confirms the neural circuits that contribute to the condition and points to treatment targets. It also provides insight into how quickly compulsive behaviours can develop — and how quickly they might be soothed. The results of the studies are published in Science1, 2. Brain scanning in humans with OCD has pointed to two areas — the orbitofrontal cortex, just behind the eyes, and the striatum, a hub in the middle of the brain — as being involved in the condition's characteristic repetitive and compulsive behaviours. But “in people we have no way of testing cause and effect”, says Susanne Ahmari, a psychiatrist and neuroscientist at Columbia University in New York who led one of the studies. It is not clear, for example, whether abnormal brain activity causes the compulsions, or whether the behaviour simply results from the brain trying to hold symptoms at bay by compensating. “There’s been a big debate in the field,” says Satinder Kaur Singh of Yale University in New Haven, Connecticut, who studies molecules involved in OCD-like disorders but was not involved in the new studies. “What the Ahmari paper shows is that it is causative.” © 2013 Nature Publishing Group

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 3: Neurophysiology: The Generation, Transmission, and Integration of Neural Signals
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 3: Neurophysiology: The Generation, Transmission, and Integration of Neural Signals
Link ID: 18248 - Posted: 06.08.2013

by Jennifer Viegas Dogs with obsessive compulsive disorder show nearly the same brain abnormalities of humans who have OCD, a new study finds. The discovery, published in Progress in Neuro-Psychopharmacology & Biological Psychiatry, adds another notch to the dog-human connection and holds promise for better treatments for OCD. “While the study sample was small and further research is needed, the results further validate that dogs with CCD (Canine Compulsive Disorder) can provide insight and understanding into anxiety disorders that affect people,” Nicholas Dodman, a professor of clinical sciences at the Cummings School of Veterinary Medicine at Tufts University who worked on the study, said in a press release. Dodman said that, in addition to having the same structural brain abnormalities as people with OCD, dogs also show similar behaviors, respond to the same medications and seem to have similar genetic roots to the disorder. Dogs with CCD engage in repetitious and destructive behaviors, such as flank and blanket-sucking, tail chasing and chewing. The main thing — and this is true for humans as well — is that the activity or thought is repetitive and persistent, such that it’s time consuming and interferes with normal daily routines. For dogs, Dobermans appear to be a breed that is most at risk, likely due to their genetics. © 2013 Discovery Communications, LLC

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 18241 - Posted: 06.06.2013

By Ferris Jabr If you had opened the front door of Lee Shuer's apartment in the early 2000s, you would have encountered a narrow hallway made even narrower by all kinds of random stuff: unnervingly tall stacks of books and papers, cardboard boxes full of assorted knickknacks, and two hot pink salon hair dryer chairs with glass domes suspended from their arched necks. Sidling down the hallway to the right, you would have reached Shuer's bedroom. The door would have opened just wide enough for you to squeeze inside, where you would have seen mounds of stuff three to four feet high on the floor, bed and every available surface. A typical heap might have contained clothes, a violin case, a big box of Magic Markers, record albums, a trumpet, a framed picture, a package of socks, three dictionaries, two thesauruses and a pillow. Traveling a little farther down the hallway would have brought you to the common space that Shuer shared with his two roommates—a space that they had come to call "the museum room." In addition to Shuer's extensive collection of vintage Atari video games and related paraphernalia—Pac-Man board games and action figures—the room contained numerous bobble heads and kitsch from 1970s and '80s; nine milk crates stuffed with hundreds of eight-track tapes; furniture that he planned to refurbish; pile of newspapers, magazines and his artwork; and an assemblage of curious salt and pepper shakers—a mouse and slice of cheese, a dog and fire hydrant. Like many people, Shuer collected things in his youth—baseball cards, coins, cool rocks—but his childhood collections never became unusually large or disorderly. After college he bounced from place to place with few possessions. But when he settled down in an apartment in Northampton, Mass., in 2000 he began collecting much more avidly than in the past. He spent his weekends and spare time visiting Goodwill, the Salvation Army and tag sales in search of his next acquisition—the more intriguing and unusual, the better. Sometimes he would visit a thrift shop on his lunch break rather than eat. © 2013 Scientific American

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 17851 - Posted: 02.26.2013

by Andy Coghlan Deep brain stimulation helps some people with obsessive-compulsive disorder (OCD), but no one was quite sure why it is effective. A new study offers an explanation: the stimulation has surprisingly pervasive effects, fixing abnormal signalling between different parts of the brain. A small number of people with difficult-to-treat OCD have had electrodes permanently implanted deep within their brain. Stimulating these electrodes reduces their symptoms. To work out why stimulation has this effect, Damiaan Denys and Martijn Figee at the Academic Medical Center in Amsterdam, the Netherlands, and colleagues recorded neural activity in people with electrodes implanted into a part of the brain called the nucleus accumbens. This region is vital for conveying motivational and emotional information to the frontal cortex to guide decisions on what actions to take next. In some people with OCD, feedback loops between the two get jammed, leading them to do the same task repeatedly to reduce anxiety. Surplus signalling The researchers took fMRI scans as participants rested. In 13 people with OCD and implanted electrodes, there was continuous and excessive exchange of signals between the nucleus accumbens and the frontal cortex that was not seen in 11 control subjects. When the electrodes were activated, though, the neural activity of both brain regions in the people with OCD became virtually identical to that in the controls. © Copyright Reed Business Information Ltd

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 17842 - Posted: 02.25.2013

By Neil Swidey IMAGINE THAT ONE NIGHT you put your bright, athletic, well-adjusted 8-year-old son to bed, a kid who loves playing baseball and cracking jokes and scarfing down chocolate chip cookies. The next morning, he wakes up as someone entirely different, and in subsequent days turns into someone unrecognizable. He’s manic, spending hours doing sit-ups or running laps on the driveway — unwilling to sit down even for a minute. He alternates between tears of soul-crushing sadness and tantrums of rage directed at you and your spouse. He’s obsessed with the unhealthiness of food, refusing to eat or drink much of anything. More than anything, though, all the comforting touchstones of his life — home, school, even sleep — have suddenly been transformed into dangers. He seems trapped in a horror movie, his fear unmistakable in the way his pupils have overtaken the irises of both his eyes. As this bizarre behavior continues, you find yourself staring at your formerly normal, healthy son and you can’t help but wonder, Where did my boy go? You ask yourself: Is this what children of Alzheimer’s patients mean when they talk about looking at a loved one who’s no longer there? You take your son to your pediatrician, a sympathetic and smart woman who is nonetheless flummoxed. Because some of your son’s symptoms appear to be compulsions, she refers you to a psychologist. Actually, because the need for pediatric mental health treatment dwarfs the supply of mental health professionals, your pediatrician turns to a state referral service called MCPAP, or Massachusetts Child Psychiatry Access Project. © 2012 NY Times Co.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 13: Memory, Learning, and Development
Link ID: 17433 - Posted: 10.29.2012

By Katherine Harmon Jill, a 60-year-old woman in Milwaukee, has overcome extreme poverty. So, now that she has enough money to put food in the fridge, she fills it. She also fills her freezer, her cupboard and every other corner of her home. “I use duct tape to close the freezer door sometimes when I’ve got too many things in there,” she told A&E’s Hoarders. Film footage of her kitchen shows a cat scrambling over a rotten grapefruit; her counters—and most surfaces in her home—seemed to be covered with several inches of clutter and spoiled food. “I was horrified,” her younger sister said after visiting Jill. And the landlord threatened eviction because the living conditions became unsafe. Jill joins many others who have been outed on reality TV as a “hoarder.” We might have once called people with these tendencies “collectors” or “eccentrics.” But in recent years, psychiatrists had suggested they have a specific type of obsessive-compulsive disorder (OCD). A movement is underfoot, however, for the new edition of the psychiatric field’s diagnostic bible (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5), to move hoarding disorder to its own class of illness. And findings from a new brain scan study, published online August 6 in Archives of General Psychiatry, support this new categorization. Hoarding disorder is categorized as “the excessive acquisition of and inability to discard objects, resulting in debilitating clutter,” wrote the researchers behind the new study, led by Yale University School of Medicine’s David Tolin. © 2012 Scientific American,

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 2: Functional Neuroanatomy: The Nervous System and Behavior
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 2: Cells and Structures: The Anatomy of the Nervous System
Link ID: 17137 - Posted: 08.07.2012

Criteria for a broadened syndrome of acute onset obsessive compulsive disorder (OCD) have been proposed by a National Institutes of Health scientist and her colleagues. The syndrome, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), includes children and teens that suddenly develop on-again/off-again OCD symptoms or abnormal eating behaviors, along with other psychiatric symptoms — without any known cause. PANS expands on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS), which is limited to a subset of cases traceable to an autoimmune process triggered by a strep infection. A clinical trial testing an immune-based treatment for PANDAS is currently underway at NIH and Yale University (see below). "Parents will describe children with PANS as overcome by a 'ferocious' onset of obsessive thoughts, compulsive rituals and overwhelming fears," said Susan Swedo, M.D., of the NIH’s National Institute of Mental Health (NIMH), who first characterized PANDAS two decades ago. “Clinicians should consider PANS when children or adolescents present with such acute-onset of OCD or eating restrictions in the absence of a clear link to strep.” The PANS criteria grew out of a PANDAS workshop convened at NIH in July 2010, by the NIMH Pediatric and Developmental Neuroscience Branch, which Swedo heads. It brought together a broad range of researchers, clinicians and advocates. The participants considered all cases of acute-onset OCD, regardless of potential cause.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 16570 - Posted: 03.24.2012

By JoNel Aleccia For Kelly Wooldridge of St. Louis, the change in her son’s behavior was so abrupt, it was like someone flipped a switch. Overnight, Brendan, now 10, went from being an easy-going, “huggy-kissy” kid to a rageful child plagued with tics, compulsions and obsessions, she said. “He would walk up and choke kids at school, or pick up a chair and throw it at them,” recalled Wooldridge, 37. Brendan developed facial tics, constant throat clearing, some humming. "He was just miserable in his own skin," his mother said. The shift first occurred when Brendan was 3, just after several recurring bouts of strep throat. The disturbing behaviors lingered, seeming to wax and wane for the next few years with no clear cause or explanation. It wasn’t until last year that Wooldridge -- like a growing number of parents, pediatricians and researchers -- finally connected the dots between the common childhood infection and the sudden onset of some forms of mental illness. “Last spring, we learned about PANDAS,” said Wooldridge. “I thought it sounded a little crazy, but it totally fit.” PANDAS -- or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections -- is the unusual diagnosis given to a group of children who abruptly develop Obsessive Compulsive Disorder or tic disorders such as Tourette’s Syndrome – but only after contracting infections such as scarlet fever or strep throat caused by Group A streptococcus bacteria. © 2012 msnbc.com

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 16434 - Posted: 02.25.2012

By BENEDICT CAREY In recent years, many psychiatrists have come to believe that the last, best chance for some people with severe and intractable mental problems is psychosurgery, an experimental procedure in which doctors operate directly on the brain. Hundreds of people have undergone brain surgery for psychiatric problems, most in experimental trials, with some encouraging results. In 2009, the government approved one surgical technique for certain severe cases of obsessive-compulsive disorder, or O.C.D. For the first time since frontal lobotomy fell into disrepute in the 1950s, surgery for behavior problems seemed back on the road to the medical mainstream. But now some of the field’s most prominent scientists are saying, “Not so fast.” In a paper in the current issue of the journal Health Affairs, these experts say approving the surgery for O.C.D. was a mistake — and a potentially costly one. They argue that the surgery has not been sufficiently tested, that neither its long-term effectiveness nor its side effects are well known and that even calling it “therapy” raises people’s hopes well beyond what is scientifically supportable. “We’re not against the operation, we just want to see it tested adequately before it’s called a therapy,” said the paper’s lead author, Dr. Joseph J. Fins, chief of medical ethics at NewYork-Presbyterian/Weill Cornell hospital. “With the legacy of psychosurgery, it’s important that we don’t misrepresent things as therapy when they’re not.” Doctors who run programs offering the operation strongly object. “These patients are very capable of making informed decisions based on our experience with the surgery,” said Dr. Wayne K. Goodman, chairman of psychiatry at the Mount Sinai School of Medicine, “and I would not want to deprive them of the option, any more than I would deny someone with AIDS access to a promising therapy that has not been established yet. Their life has been so destroyed by O.C.D. that they might contemplate suicide” if the surgery were not available. © 2011 The New York Times Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders
Link ID: 15005 - Posted: 02.15.2011

by Linda Geddes Sammy Maloney was a healthy, outgoing 12-year-old, who played in the school band, and liked nothing better than to dump his backpack after school and hang out with his friends in Kennebunkport, Maine. Then, in 2002, Sammy's personality began to change. "The first thing I noticed was that he was walking around the backyard with his eyes closed," says Sammy's mother, Beth Maloney. "I asked him what he was doing, and he said he was memorising." The next day, Sammy was again walking with his eyes closed and would only use the back door. Then he progressed to holding his breath while doing it, only wearing certain coloured clothes, and refusing to allow the windows to be opened, or the lights to be switched off. "Every single day was a new behaviour," says Beth. "We went from baseline to completely dysfunctional within a period of four to six weeks." Sammy was diagnosed with obsessive compulsive disorder, and then Tourette's syndrome. When he continued to deteriorate, a friend suggested testing Sammy for streptococcus - a common childhood bacterial infection that usually causes no more than a sore throat. "By this point he was totally emaciated and he was covered with scabs from scratching himself," says Beth. Sammy hadn't shown any signs of streptococcal infection, but it turned out he was infected. When doctors prescribed antibiotics, his symptoms began to improve. Within a few weeks he was playing board games with his brothers. "After six months of treatment, I knew that he would recover," says Beth. © Copyright Reed Business Information Ltd.

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 14882 - Posted: 01.18.2011

By Dana Scarton Following a protocol demonstrated moments earlier, the Colorado youth pressed his bare hands against the rim of a urinal, licked each palm, then reached out to accept a Tic Tac. Before popping the mint into his mouth, Christian added a move of his own: He dropped it onto the tile floor and stomped on it. The ad lib elicited gasps, congratulatory pats on the back, and applause from onlookers crammed into the men's room on a lower level of the Hyatt Regency Crystal City. As the others took their turn at the bizarre ritual, Christian leaned on a wall outside, seeming pleased if perhaps a bit queasy. "I wanted to challenge myself," he said. Christian later told his father, Kern Low, that he would no longer struggle with paralyzing fears of contamination associated with public restrooms, a problem that had interfered with family outings for the past three years. Facing fears was the evening's objective for Christian and about 150 other people dealing with obsessive-compulsive disorder (OCD). Led by psychologist Jonathan Grayson, they were going "Virtual Camping" -- a two-hour after-dark excursion and germfest that was part of the 2010 International OCD Foundation Conference held at the Hyatt Regency last month. "What can you do in one night?" Grayson had asked as the evening began. "You can take a step toward learning how to deal with uncertainty." Then he led the participants into the steamy streets of Crystal City, where, among other things, they would be encouraged to shake the hand of a homeless man (to fight more contamination fears), to chant "Crash and burn" to passing motorists (to show that thoughts would not cause actual harm) and to touch ripe garbage with their bare hands (contamination, again). © 1996-2010 The Washington Post Company

Related chapters from BP7e: Chapter 16: Psychopathology: Biological Basis of Behavior Disorders; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 12: Psychopathology: Biological Basis of Behavioral Disorders; Chapter 11: Emotions, Aggression, and Stress
Link ID: 14320 - Posted: 08.03.2010