The seeds of addiction are typically sown years prior to the onset of addictive substance use or engagement in addictive behaviors, due to the priming of the reward pathway (RewP) by alterations in the mechanism of stress-signaling from the hypothalamic-pituitary-adrenal axis (HPA) and related pathways. Excessive stress from a single-event and/or cumulative life experiences during childhood, such as those documented in the Adverse Childhood Experiences Study, is translated into neurobiological toxicity that alters the set-point of the HPA axis and limbic system homeostasis [suggested new term: regulation pathway (RegP)]. The resultant alteration of the RegP not only increases the risk for psychiatric and physical illness, but also that for early onset and chronic addictions by dysregulating the RewP. This paper reviews the interface of these symbiotic pathways that result in the phenotypic pathology of emotional dysregulation, cognitive impairment, and compulsive behaviors, as well as morbidity and shorter life expectancy when dysregulated by chronic stress.
Behavior, Addictive ; Cognition Disorders ; Compulsive Behavior ; Homeostasis ; Life Change Events ; Life Expectancy ; Limbic System ; Pathology ; Reward

No abstract available.
Obsessive Behavior* ; Obsessive-Compulsive Disorder*

Diagnosing and managing dementia, presenting with compulsions is challenging. Presented are three cases, a possible representative subset of the Donepezil responders. Selective degeneration of dorsolateral prefrontal cortex networking striatum leading to compulsions would be amenable to cholinergic modulation.
Compulsive Behavior* ; Dementia* ; Prefrontal Cortex ; Psychotic Disorders

BACKGROUND: Smoking is a very dangerous behavior and people know that it will lead to fatal health problems. But, many people continue to smoke. We studied psychiatric aspect of smoking. METHODS: We distributed self-questionnaire to people who visited Dong-San Medical Hospital for periodical examination and checkups between the months of April and June, 1996. It consisted of inquiries on their smoking status and symptom check list for minor psychiatric disorders(SCL-MPD). Among the total of 147 men 58 were current smokers, 63 non-smokers, 26 ex-smokers. We compared minor psychiatric differences between each groups by Student t-test. RESULTS: The mean age of current smokers, ex-smokers and non-smokers were 44.9 +/-8.9, 44.8+/-8.4 and 46.6+/-9.6, respectively. Among 10 dimensions of SCL-MPD, the smokers (includes current smokers and ex-smokers) had significantly higher scores on anger-hostility, interpersonal sensitivity and obsessive-compulsive dimensions than those of non-smokers(p<0.05). When comparing with current smokers and non-smokers, current smokers had significantly higher scores on anger-hostility and obsessive-compulsive dimensions(p<0.05). Between ex-smokers and non-smokers, ex-smokers had significantly higher scores on anger-hostility and obsessive-compulsive dimensions(.p<0.05). But, no significant differences were observed between current smokers and ex-smokers. CONCLUSIONS: Smokers(current smokers and ex-smokers) were highly associated with anger-hostility, interpersonal sensitivity and obsessive-compulsive disorders compared to non-smokers. But, no minor psychiatric differences were observed between current smokers and ex-smokers.
Dangerous Behavior ; Humans ; Male ; Obsessive-Compulsive Disorder ; Smoke* ; Smoking*

OBJECTIVE: There has been no study in the literature evaluating total blood count in obsessive-compulsive disorder (OCD). Therefore, we performed the present study to spesifically measure serum total blood count particularly white blood cells to see whether or not its eventual alterations might have an etiopathogenetic significance in patients with OCD. METHODS: Total blood count was measured in thirty patients and same number of healthy controls. Additionally, all patients were assessed by Yale-Brown Obsession Compulsion Scale (Y-BOCS). RESULTS: Except for neutrophil count, there were no significant differences between the groups regarding any haematological parameter. The mean neutrophil count of the patient group was lower compared to that of the control subjects. CONCLUSION: In conclusion, the present study suggests that neutrophil count is reduced in pure OCD patients and this finding may contribute to the role of immunological factors in the pathogenesis of OCD.
Humans ; Immunologic Factors ; Leukocytes ; Neutrophils ; Obsessive Behavior ; Obsessive-Compulsive Disorder

OBJECTIVE: Although several self-report versions of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been developed and used widely, few psychometric studies have established the construct validity of this measure. Therefore, we developed Korean self-report version of the Y-BOCS and evaluated its factor structure, reliability, and validity. METHODS: A non-clinical student sample (n=206) and a clinical OCD sample (n=199) completed the Korean self-report version and other measures of obsessive-compulsive disorder (OCD), depression, and anxiety. RESULTS: Consistent with the originally proposed structure, confirmatory factor analyses supported a factor structure comprised of Obsessions and Compulsions factors in the Korean self-report version. Two subscale scores and the total score of the Korean self-report version showed good internal consistency and convergent validity, but relatively poor discriminant validity. Applying a cutoff score of 16, 84% of OCD patients and 93% of the non-clinical sample were classified correctly. CONCLUSION: Korean self-report version of the Y-BOCS is a psychometrically sound and valid measure for assessing OCD symptoms as compared with the clinician-administered version. The originally proposed division of OCD severity into obsessions and compulsions appears accurate in the Korean self-report version. The cutoff score for the Korean self-report version needs adjustment based on further researches.
Depression ; Humans ; Obsessive Behavior ; Obsessive-Compulsive Disorder ; Psychometrics

Obsessive-compulsive disorder(OCD) is characterized by recurrent obsessions or compulsions causing marked distress. The lifetime prevalence of OCD in general population is estimated about 2~3%. OCD can usually be distinguished from psychosis by the facts that the patients recognize the irrational nature of the symptoms. OCD is also different from obsessive-compulsive personality in that the patients suffer from obsessions and compulsions which accompany marked distress. The etiology of OCD is not know yet. However, numerous studies suggest that OCD may be associated with several psychological and neurobiological factors such as functional abnormalities of cortico-striatal circuit and serotonin. Selective serotonin reuptake inhibitors(SSRI) are the first-line drugs for the treatmemt of OCD. Approximately 50~80% of OCD patients improved with these anti-obsessional drugs with average reduction in symptoms between 30~70%. Benefits may not appear for 2 or more weeks. Continuing a medication for more than 10 weeks is required to determine the anti-obsessional efficacy. Maintenance treatment is usually required for more than several months. Cognitive-behavioral therapy also proved to be effective, particularly for patients with prominent compulsions. Therefore, it is a logical choice to combine pharmacotherapy and cognitive-behavioral therapy. For extreme cases electroconvulsive therapy(ECT) or stereotaxic neurosurgery may be considered. However, at present, neurosurgery is recommended only for a few patients who remained severely disabled even after years of sufficient treatments.
Compulsive Personality Disorder ; Drug Therapy ; Humans ; Logic ; Neurosurgery ; Obsessive Behavior ; Obsessive-Compulsive Disorder* ; Prevalence ; Psychotic Disorders ; Serotonin

OBJECTIVES: The Symmetry, Ordering and Arranging Questionnaire (SOAQ) has been reported as a valid tool for the assessment of symmetry, ordering and arranging compulsive behaviors of patients with obsessive compulsive disorder. It was introduced by Radomsky and Rachman in 2004. The aim of this study was to assess the reliability, validity and psychometric properties of the Korean-version of the SOAQ (K-SOAQ). METHODS: Two hundreds twenty eight under-graduate college students were enrolled in this study. They were assessed with K-SOAQ, Obsessive-Compulsive Inventory-Revised (OCI-R), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Statistical analysis was done using calculation of Cronbach's alpha, Spearman Correlation Coefficient and Principal Components Analysis. RESULTS: There were no significant differences in sex, education, and total scores of BDI and BAI. The Cronbach's alpha coefficient of K-SOAQ was high, Cronbach's alpha=0.96. There was strong evidence for a one-factor solution, accounting for 60.3% of the variance. Convergent validity was examined through correlations between the SOAQ and the OCI-R (r=0.61). Divergent validity was examined through correlations between the SOAQ and two self report measures; BDI (r=0.12) and BAI (r=0.19). CONCLUSION: The K-SOAQ showed good reliability and validity for the assessment of severity of compulsive characteristics regarding symmetry, ordering and arranging. The K-SOAQ is a useful instrument for assessing compulsive symptoms related with symmetry, ordering and arranging in Korea.
Accounting ; Anxiety ; Compulsive Behavior ; Depression ; Humans ; Korea ; Obsessive-Compulsive Disorder ; Psychometrics ; Surveys and Questionnaires ; Reproducibility of Results ; Self Report

OBJECTIVES: The pharmacologic treatment of obsessive-compulsive disorder(OCD) with serotonergic antidepressant agents is well established in clinical psychiatry on the basis of serotonin hypothesis. Studies on predictive factors of treatment response to OCD are relatively scarce. The author compared the demographic factors, age of onset, length of illness, family history of mental illness, previous drug history for OCD, severity and type of symptoms between the drug responders and non-responders to find out the predicitive factors that may be related to treatment response. METHODS: The subjects were 31, both inpatients and outpatients who met the diagnostic criteria for OCD by DSM-IV and scored 20 or higher on the Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) completed 12-week trial of sertraline. Y-BOCS, National Institute of Mental Health Obsessive-Compulsive Scale(NIMHOCS), Clinical Global Impression Scale(CGI) were scored to measure the changes of obsessive-compulsive symptoms, and Hamilton Anxiety Scale(HAM-A) was measured at each visit. RESULTS: 1) The responders, defined as achieving at least a 40% decrease in the Y-BOCS total score and more than a 2 point decrease in CGI score, were 17(54.8%), and non-responders were 14(45.2%). Responders tended to show later onset(p<0.1), and shorter duration of illness(p<0.05), and less previous drug therapy for OCD(p<0.05) than non-responders. There were no significant differences in family history of mental illness between the two groups. 2) The baseline Y-BOCS compulsive score was significantly lower in responders(p<0.05), although there was no significant difference in the baseline severity of other measures. 3) The obsession of contamination and washing behaviors were more frequent, but compulsive counting was not shown, in responders(p<0.05). The pathological doubt tended to be more common in nonresponders(p<0.1). CONCLUSIONS: In summary, the patients with shorter duration of illness, less prior drug therapy for OCD, and less severe compulsive behaviors, and the obsession of contamination and washing behaviors are expected to be better outcome with sertraline, whereas compulsive counting are the predictor of poor response.
Age of Onset ; Anxiety ; Compulsive Behavior ; Demography ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy ; Humans ; Inpatients ; National Institute of Mental Health (U.S.) ; Obsessive Behavior ; Obsessive-Compulsive Disorder* ; Outpatients ; Serotonin ; Sertraline*

OBJECTIVE: Although obsessive-compulsive disorder (OCD) has long been a unitary diagnosis, there is much recent interest in its potential heterogeneity, as manifested by symptom subgroups. Although the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used instrument to assess obsessive-compulsive symptomatology, the variables reflecting the pathogenesis of OCD and Y-BOCS subscores usually were not significantly associated. The aims of this study are to clarify identification of dimensional structure of the symptoms from YBOCS checklist and to explore the factor structure of the Y-BOCS. METHODS: Ninety five OCD patients participated in this study and performed the Y-BOCS and Y-BOCS checklist. The 13 main symptom categories from Y-BOCS checklist and 10 items from Y-BOCS were factor analyzed by using principal components analysis, respectively. RESULTS: Using principal component analysis, we derived 4 factors from 13 main contents of YBOCS checklist. Four factors-hoarding/repeating, contamination/cleaning, aggressive/sexual, and religious/somatic- accounted for more than 60% of the variance. And we derived 3 factors from 10 items of Y-BOCS and these 3 factors-severity of obsession, severity of compulsion, and resistance to symptoms-accounted for more than 70% of variance. CONCLUSIONS: The four symptom dimensions from Y-BOCS checklist and three symptom dimensions from Y-BOCS were identified as significant factors accounting for the variance. These factors may be of value in future genetic, neurobiological, and treatment response studies.
Checklist* ; Diagnosis ; Humans ; Obsessive Behavior ; Obsessive-Compulsive Disorder ; Population Characteristics ; Principal Component Analysis