1,721,361 research outputs found
Clinical heterogeneity of obsessive-compulsive disorder in children and adolescents : temporal stability and treatment outcomes
Full text linkAntecedents i objectius: El Trastorn Obsessivocompulsiu (TOC) és un trastorn notablement heterogeni. Anàlisis de factors han agrupat de manera consistent els símptomes del TOC en diverses dimensions que, de manera diferencial, correlacionen amb diferents característiques biològiques i clíniques. Un cos creixent de dades científiques dóna suport a la idea de que aquesta heterogeneïtat clínica pot ser deguda a una heterogeneïtat etiològica. No obstant això, la major part d'aquest coneixement es basa en estudis fets en adults. Aquesta tesi va investigar 1) l'estabilitat temporal de les dimensions de símptomes del TOC en nens i 2) les característiques demogràfiques i clíniques i la resposta al tractament de nens i adolescents amb obsessions sexuals, una presentació comú i particularment pertorbadora de TOC. Mètodes: Tots els pacients inclosos complien criteris diagnòstics per al TOC i havien estat derivats a una clínica nacional i especialista en TOC en població pediàtrica de Londres, Regne Unit. Els participants van ser avaluats amb una sèrie de mesures aplicades pels clínics i també amb mesures autoadministrades. Estudi 1: La mostra la van conformar 74 participants avaluats en dues ocasions amb una diferència d'entre 1 i 11 anys entre les dues avaluacions (mitjana de 5 anys). Es van utilitzar anàlisis de la variància i models de regressió múltiple per examinar els canvis dins i entre les diferents categories de símptomes i dins i entre les principals dimensions de símptomes. Estudi 2: Tres-cents vuitanta-tres participants van ser avaluats en el moment de l'avaluació clínica inicial i, per aquells pacients tractats a la clínica, l'avaluació es va repetir un cop finalitzat el tractament. Els pacients amb i sense obsessions sexuals es van comparar respecte a les seves característiques sociodemogràfiques i clíniques. Anàlisis de models mixtos de la variància van comparar la resposta al tractament d'ambdós grups. Resultats: Estudi 1: Es van observar canvis dins de categories de símptomes individuals d'obsessions i compulsions en aproximadament el 15%-45% dels casos. El predictor més fort de la presència d'una dimensió de símptomes particular en el seguiment va ser la presència de la mateixa dimensió en la primera avaluació. Els canvis d'una dimensió a una altra van ser poc comuns. Estudi 2: Una quarta part dels pacients va presentar obsessions sexuals actuals. Els participants amb obsessions sexuals tenien símptomes més greus de TOC i estaven significativament més deprimits. Les obsessions agressives i religioses, el pensament màgic, la por de dir certes coses, els rituals de repetició, els jocs supersticiosos, els rituals mentals i la necessitat de comptar, preguntar o confessar van ser més freqüents en el grup amb obsessions sexuals. De manera important, no es van trobar diferències entre els grups en la resposta al tractament. Conclusions: Confirmant treballs similar en adults amb TOC, l'Estudi 1 va mostrar que el contingut dels símptomes del TOC en població pediàtrica és relativament estable en el temps. La majoria dels canvis van ser deguts a la millora clínica/remissió i es van produir dintre de cada dimensió i no entre les dimensions de símptomes. L'Estudi 2 va mostrar que les obsessions sexuals són comuns en el TOC pediàtric i, tot i que poden estar associades a característiques clíniques particulars, no interfereixen amb la resposta al tractament. Els resultats d'aquesta tesi se sumen al creixent cos d'investigació en el TOC pediàtric i contribueixen a una millor comprensió de l'heterogeneïtat del trastorn.Background & aims: Obsessive Compulsive Disorder (OCD) is a remarkably heterogeneous condition. Factor analyses have consistently grouped OCD symptoms into several dimensions, which differentially correlate with various biological and clinical characteristics. A growing body of scientific data supports the idea that this clinical heterogeneity may be due to etiological heterogeneity. However, the majority of this knowledge has been gathered from adult studies. This thesis investigated 1) the temporal stability of OCD symptom dimensions in children and 2) the demographic and clinical characteristics and treatment response of children and adolescents with sexual obsessions, a common and particularly disturbing presentation of OCD. Methods: All included participants met criteria for OCD and had been referred to a national and specialist OCD clinic for young people in London, United Kingdom. Participants were assessed with a series of clinician and self-administered measures. Study 1: The sample consisted of 74 participants assessed on two separate occasions ranging from 1 to 11 years apart (average 5 years). Analysis of variance and multiple regression models were used to examine changes within and between symptoms and the major symptom dimensions. Study 2: Three-hundred and eighty-three participants were assessed at the time of the initial clinical assessment and, for those treated at the clinic, again after treatment. Patients with and without sexual obsessions were compared on socio-demographic and clinical characteristics. Mixed model analyses of variance compared treatment outcomes in both groups. Results: Study 1: Changes within individual symptom categories of obsessions and compulsions were observed in approximately 15%-45% of the cases. The strongest predictor of the presence of a particular symptom dimension at follow-up was the presence of the same dimension at baseline. Shifts from one dimension to another were rare. Study 2: A quarter of patients had current sexual obsessions. Participants with sexual obsessions had more severe OCD symptoms and were significantly more depressed. Aggressive and religious obsessions, magical thinking, fear of saying certain things, repeating rituals, superstitious games, mental rituals, and the need to tell, ask, or confess were more frequent in the sexual obsessions group. Importantly, no differences in treatment outcome were found between the groups. Conclusions: Confirming similar work in adults with OCD, Study 1 showed that the content of OCD symptoms in young people is relatively stable across time. Most changes were attributable to clinical improvement/remission and occurred within rather than between symptom dimensions. Study 2 showed that sexual obsessions are common in pediatric OCD and, although they may be associated to particular clinical features, they do not interfere with treatment response. The results of this thesis add to the growing body of research in pediatric OCD and contribute to a better understanding of the heterogeneity of the disorder
New insights into prediction of OCD treatment response, DBS for treatment resistant schizophrenia and bipolar disorder, consensus for the practical management of depression and pain, and coping behaviours in times of crisis
No full textReliability and validity of the work and social adjustment scale in phobic disorders
No full textThe Work and Social Adjustment Scale (WSAS) is a simple widely used 5-item measure of disability whose psychometric properties need more analysis in phobic disorders. The reliability, factor structure, validity, and sensitivity to change of the WSAS were studied in 205 phobic patients (73 agoraphobia, 62 social phobia, and 70 specific phobia) who participated in various open and randomized trials of self-exposure therapy. Internal consistency of the WSAS was excellent in all phobics pooled and in agoraphobics and social phobics separately. Principal components analysis extracted a single general factor of disability. Specific phobics gave less consistent ratings across WSAS items, suggesting that some items were less relevant to their problem. Internal consistency was marginally higher for self-ratings than clinician ratings of the WSAS. Self-ratings and clinician ratings correlated highly though patients tended to rate themselves as more disabled than clinicians did. WSAS total scores reflected differences in phobic severity and improvement with treatment. The WSAS is a valid, reliable, and change-sensitive measure of work/social and other adjustment in phobic disorders, especially in agoraphobia and social phobi
Voxel-wise meta-analysis of grey matter changes in obsessive-compulsive disorder
No full textBackground Specific cortico-striato-thalamic circuits are hypothesised to mediate the symptoms of obsessive-compulsive disorder (OCD), but structural neuroimaging studies have been inconsistent. Aims To conduct a meta-analysis of published and unpublished voxel-based morphometry studies in OCD. Method Twelve data-sets comprising 401 people with OCD and 376 healthy controls met inclusion criteria. A new improved voxel-based meta-analytic method, signed differential mapping (SDM), was developed to examine regions of increased and decreased grey matter volume in the OCD group v. control group. Results No between-group differences were found in global grey matter volumes. People with OCD had increased regional grey matter volumes in bilateral lenticular nuclei, extending to the caudate nuclei, as well as decreased volumes in bilateral dorsal medial frontal/anterior cingulate gyri. A descriptive analysis of quartiles, a sensitivity analysis as well as analyses of subgroups further confirmed these findings. meta-regression analyses showed that studies that included individuals with more severe OCD were significantly more likely to report increased grey matter volumes in the basal ganglia. No effect of current antidepressant treatment was observed. Conclusions The results support a dorsal prefrontal-striatal model of the disorder and raise the question of whether functional alterations in other brain regions commonly associated with OCD, such as the orbitofrontal cortex, may reflect secondary compensatory strategies. Whether the reported differences between participants with OCD and controls precede the onset of the symptoms and whether they are specific to OCD remains to be established
The profile of executive function in OCD hoarders and hoarding disorder
No full textAbstractHoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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