Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-19T05:42:39.469Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of obsessive-compulsive spectrum disorders with SSRIs

Published online by Cambridge University Press:  06 August 2018

E. Hollander
E. Hollander*
Affiliation:
Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1230, New York, NY 10029, USA. Tel: +1 212 241 3623; Fax: +1 212 987 4031
Get access Rights & Permissions [Opens in a new window]

Abstract

Background Obsessive-compulsive spectrum disorders (OCSDs) are now recognised as distinct diagnostic entities related to obsessive-compulsive disorder (OCD). The features of OCSDs and OCD overlap in many respects including demographics, repetitive intrusive thoughts or behaviours, comorbidity, aetiology and preferential response to anti-obsessional drugs such as the selective serotonin reuptake inhibitors (SSRIs).

Method Literature was reviewed and preliminary data from various studies were re-examined to assess the relationship between compulsivity and impulsivity, and between OCD and OCSDs.

Results OCSDs include both compulsive and impulsive disorders and these can be viewed as lying at opposite ends of the dimension of risk avoidance. Compulsiveness is associated with increased frontal lobe activity and increased serotonergic activity, while impulsiveness is associated with reduced activity of these variables. Neural circuits affected by serotonergic pathways have been identified and pharmacological challenge of OCSD patients with serotonin receptor agonists have supported the involvement of serotonergic processes.

Conclusions SSRIs such as fluvoxamine have established efficacy in OCD and preliminary studies indicate that they are also effective in OCSDs. The features of three specimen OCSDs –body dysmorphic disorder, pathological gambling and autism – and their treatment with SSRIs are reviewed.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S35: New perspectives in research and treatment of obsessive-compulsive disorder , August 1998 , pp. 7 - 12
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
Baxter, L. R., Phelps, M. E., Mazziotta, J. C., et al (1987) Local cerebral glucose metabolic rates in obsessive-compulsive disorder: a comparison with rates in unipolar depression and in normal controls. Archives of General Psychiatry, 44, 211–218.CrossRefGoogle ScholarPubMed
Birtchnell, S. A. (1988) Dysmorphophobia – a centenary discussion. British Journal of Psychiatry, 153 (suppl. 2), 41–43.CrossRefGoogle Scholar
Brown, R. I. F. (1985) The effectiveness of Gamblers Anonymous. In The Gambling Studies: Proceedings of the Sixth National Conference on Gambling and Risk Taking, Reno, Nevada, USA (ed. W. R. Eadington). Las Vegas, NV: University of Nevada Bureau of Business and Economic Research.Google Scholar
Carlton, O. L. & Goldstein, L. (1987) Physiological determinants of pathological gambling. In Handbook of Pathological Gambling (ed. Galski, T.), pp. 657–663. Springfield, IL: Charles C. Thomas.Google Scholar
Commission on the Review of the National Policy Toward Gambling. (1976) Gambling in America. Washington, DC: Government Printing Office.Google Scholar
DeCaria, C. M. & Hollander, E. (1993) Pathological gambling. In Obsessive-Compulsive Related Disorders (ed. Hollander, E.), pp. 155–178. Washington, DC: American Psychiatric Press.Google Scholar
DeCaria, C. M. & Hollander, E., Grossman, R., et al. (1996) Diagnosis, neurobiology and treatment of pathological gambling. Journal of Clinical Psychiatry, 57 (suppl. 8), 80–84.Google ScholarPubMed
Foa, E. B., Kozak, M. J., Goodman, W. K., et al (1995) DSM–IV field trial: obsessive-compulsive disorder. American Journal of Psychiatry, 152, 90–96; correction 152, 654.Google Scholar
Freeman, C., Trimble, M., Deakin, J. F., et al (1994) Fluvoxamine versus clomipramine in the treatment of obsessive-compulsive disorder: a multicenter, randomized, double-blind, parallel group comparison. Journal of Clinical Psychiatry, 55, 301–305.Google Scholar
Fukuda, O. (1977) Statistical analysis of dysmorphophobia in out-patient clinic. Japanese Journal of Plastic and Reconstructive Surgery, 20, 569–577.Google Scholar
Goodman, W. K., Price, L. H., Delgado, P. L., et al (1990) Specificity of serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder. Archives of General Psychiatry, 47, 577–585.CrossRefGoogle ScholarPubMed
Gordon, C. T., State, R. C., Nelson, J. E., et al (1993) A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder. Archives of General Psychiatry, 50, 441–447.CrossRefGoogle ScholarPubMed
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. Revised DHEW Pub. (ADM). Rockville, MD: National Institute for Mental Health.Google Scholar
Hollander, E. (1993) Obsessive-compulsive spectrum disorders: an overview. Psychiatric Annals, 23, 355–358.CrossRefGoogle Scholar
Hollander, E., DeCaria, C. & Liebowitz, M. (1989a) Biological aspects of obsessive compulsive disorder. Psychiatric Annals, 19, 80–87.Google Scholar
Hollander, E., Liebowitz, M. R., Winchel, R., et al (1989b) Treatment of body dysmorphic disorder with serotonin reuptake blockers. American Journal of Psychiatry, 146, 768–770.Google ScholarPubMed
Hollander, E., Liebowitz, M. R. & Rosen, W. T. (1991) Neuropsychiatric and neuropsychological studies in obsessive-compulsive disorder. In Psychobiology of Obsessive Compulsive Disorder (eds Zohar, J., Insel, T. R. & Rasmussen, S.), pp. 126–145. New York: Springer.Google Scholar
Hollander, E., DeCaria, C. M., Nitescu, A., et al (1992a) Serotonergic function in obsessive-compulsive disorder: behavioural and neuroendocrine responses to oral m-chlorophenylpiperazine and fenfluramine in patients and healthy volunteers. Archives of General Psychiatry, 49, 21–28.CrossRefGoogle ScholarPubMed
Hollander, E., Frenkel, M., DeCaria, C., et al (1992b) Treatment of pathological gambling with clomipramine (letter). American Journal of Psychiatry, 149, 710–711.Google Scholar
Hollander, E., Cohen, L. J. & Simeon, D. (1993) Body dysmorphic disorder. Psychiatric Annals, 23, 359–364.CrossRefGoogle Scholar
Hollander, E., Cohen, L. J. & Simeon, D., et al (1994) Fluvoxamine treatment of body dysmorphic disorder. Journal of Clinical Psychopharmacology, 14, 75–77.Google Scholar
Hollander, E., Prohovnik, I. & Stein, D. (1995) Increased cerebral blood flow during m-CPP exacerbation of obsessive-compulsive disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 7, 485–490.Google ScholarPubMed
Hollander, E. & Wong, C. M. (1995a) Obsessive-compulsive spectrum disorders. Journal of Clinical Psychiatry, 56 (Suppl 4), 3–6.Google ScholarPubMed
Hollander, E. & Wong, C. M. (1995b) Body dysmorphic disorder, pathological gambling, and sexual compulsions. Journal of Clinical Psychiatry, 56 (suppl. 4), 7–12.Google Scholar
Hollander, E. & Wong, C. M. (1995c) Developments in the treatment of obsessive-compulsive disorder. Primary Psychiatry, 2, 28–33.Google Scholar
Hollander, E., Kwon, J. H., Stein, D. J., et al (1996) Obsessive-compulsive and spectrum disorders: overview and quality of life issues. Journal of Clinical Psychiatry, 57 (suppl. 8), 3–6.Google ScholarPubMed
Hollander, E., Begaz, T. & DeCaria, C. (1998) Pharmacological approaches in the treatment of pathological gambling. CNS spectrums. International Journal of Neuropsychiatric Medicine, 3, 72–78.Google Scholar
Karno, M., Golding, J. M., Sorenson, S. B., et al (1988) The epidemiology of obsessive-compulsive disorder in five US communities. Archives of General Psychiatry, AS, 1004–1099.Google Scholar
Ladouceur, R. & Mireault, C. (1988) Gambling behaviour among high school students in the Quebec area. Journal of Gambling behaviour, 4, 3–12.Google Scholar
Lesieur, H. R. & Klein, R. (1987) Pathological gambling among high school students. Addictive Behavior, 12, 129–135.Google Scholar
Marcus, P. (1984) Some preliminary psychological observations on narcissism, the cosmetic rhinoplasty patient and the plastic surgeon. Australia and New Zealand Journal of Surgery, 54, 543–547.CrossRefGoogle ScholarPubMed
McDougle, C. J., Naylor, S. T., Cohen, D. J., et al (1996) A double-blind placebo-controlled study of fluvoxamine in adults with autistic disorder. Archives of General Psychiatry, 53, 1001–1008.Google Scholar
McElroy, S. L., Phillips, K. A., Keck, P. E., et al (1993) Body dysmorphic disorder: does it have a psychotic subtype. Journal of Clinical Psychiatry, 54, 389–395.Google ScholarPubMed
McElroy, S. L., Keck, P. E. Jr. & Phillips, K. A. (1995) Kleptomania, compulsive buying, and binge-eating disorder. Journal of Clinical Psychiatry, 56 (suppl. 4), 14–26.Google Scholar
Moskowitz, J. A. (1980) Lithium and lady luck: use of lithium carbonate in compulsive gambling. New York State Journal of Medicine, 80, 785–788.Google Scholar
Philippopoulos, G. S. (1979) The analysis of a case of dysmorphopbobia. Canadian Journal of Psychiatry, 24, 397–401.Google Scholar
Phillips, K. A. (1991) Body dysmorphic disorder: the distress of imagined ugliness. American Journal of Psychiatry, 148, 1138–1149.Google ScholarPubMed
Phillips, K. A. (1995) Body dysmorphic disorder. Clinical features and drug treatment. CNS Drugs, 3, 30–40.CrossRefGoogle Scholar
Phillips, K. A., McElroy, S. L., Keck, P. E. Jr, et al (1994) A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacology Bulletin, 30, 179–186.Google Scholar
Phillips, K. A., McElroy, S. L., Hudson, J. I., et al (1995) Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both? Journal of Clinical Psychiatry, 56 (suppl. 4), 41–51.Google Scholar
Rasmussen, S., Eisen, J. & Pato, M. (1993) Current issues in the pharmacologic management of obsessive-compulsive disorder. Journal of Clinical Psychiatry, 54 (suppl.), 4–9.Google ScholarPubMed
Roy, A., De-Jong, J. & Linnoila, M. (1989) Extraversion in pathological gamblers: Correlates with indexes of noradrenergic function. Archives of General Psychiatry, 46, 679–681.Google Scholar
Russo, A. M., Taber, J. I., McCormick, R. A., et al (1984) An outcome study of an inpatient treatment program for pathological gamblers. Hospital and Community Psychiatry, 35, 823–827.Google Scholar
Sommers, I. (1988) Pathological gambling: estimating prevalence and group characteristics. International Journal of Addiction, 23, 477–490.CrossRefGoogle ScholarPubMed
Stekei, W. & Gutheil, E. A. (1949) Compulsion and Doubt. New York: Livewright Publishing.Google Scholar
Stewart, R. M. & Brown, R. I. F. (1988) An outcome study of Gamblers Anonymous. British Journal of Psychiatry, 152, 284–288.CrossRefGoogle ScholarPubMed
Vitiello, B. & De Leon, J. (1990) Dysmorphobia misdiagnosed as obsessive-compulsive disorder. Psychosomatics, 31, 220–222.CrossRefGoogle Scholar
Westphal, J. R. & Rush, J. (1996) Pathological gambling in Louisiana: an epidemiological perspective. Journal of the Louisiana State Medical Society, 148, 353–358.Google Scholar
Zohar, J., Kaplan, Z. & Benjamin, J. (1994) Compulsive exhibitionism successfully treated with fluvoxamine: a controlled case study. Journal of Clinical Psychiatry, 55, 86–88.Google ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.