Gastro-intestinal conditions in patients with obsessive compulsive disorder

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Obsessive-compulsive disorder (OCD) is a serious mental illness and frequently leads to psychiatric disability. In addition, individuals struggling with OCD often have other comorbid anxiety-related disorders (Camuri et al., 2014). The treatment of OCD requires experienced mental health professionals with extensive training. There is no empirical evidence that the successful treatment of OCD has ever occurred within integrated health-care settings that typically restrict the number of sessions and session time with patients. One potentially poor outcome of trying to treat OCD within these limitations is that a compromised treatment occurs with marginal symptom reduction that effectively inoculates patients from an empirically supported treatment in the future when relapse occurs. Anecdotally, as a clinician, it is worrisome that this would leave patients discouraged about the treatment and less likely to engage in therapy in the future, especially in more severe presentations in which treatment adherence is less likely to begin with (Mancebo, Pinto, Rasmussen, & Eisen, 2008). One of the primary reasons that briefer treatments of OCD is contraindicated is that OCD is maintained by covert surreptitious safety cognitions that can continue to persist and evolve for years, often requiring years of treatment to extinguish (Jakubovski et al., 2013). It is strongly recommended that integrated health-care settings refer patients with OCD to an experienced mental health professional for treatment.
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In half of Obsessive Compulsive Disorder (OCD) patients the disorder runs a chronic course despite treatment. The factors determining this unfavourable outcome remain unknown. The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study is a multicentre naturalistic cohort study of the biological, psychological and social determinants of chronicity in a clinical sample. Recruitment of OCD patients took place in mental health organizations. Its design is a six-year longitudinal cohort study among a representative clinical sample of 419 OCD patients. All five measurements within this six-year period involved validated semi-structured interviews and self-report questionnaires which gathered information on the severity of OCD and its co-morbidity as well as information on general wellbeing, quality of life, daily activities, medical consumption and key psychological and social factors. The baseline measurements also include DNA and blood sampling and data on demographic and personality variables. The current paper presents the design and rationale of the study, as well as data on baseline sample characteristics. Demographic characteristics and co-morbidity ratings in the NOCDA sample closely resemble other OCD study samples. Lifetime co-morbid Axis I disorders are present in the majority of OCD patients, with high current and lifetime co-morbidity ratings for affective disorders (23.4% and 63.7%, respectively) and anxiety disorders other than OCD (36% current and 46.5% lifetime). Copyright © 2012 John Wiley & Sons, Ltd.
The irritable bowel syndrome (IBS) is a common problem encountered in primary medical clinics. Psychiatric comorbidity has been reportedly high in those settings. We investigated the prevalence of the IBS in generalized anxious and major depressive patients in an ambulatory psychiatric clinic. IBS was significantly more common in anxious and/or depressive patients than matched controls. Measures of psychiatric and gastrointestinal symptoms severities were closely related to one another suggesting that IBS is not solely specific to a single psychiatric condition, but rather a generic expression of global psychopathology. Early recognition of this relationship should contribute to less patient morbidity and greater heal care cost containment.
In clinical studies there is a strong relationship between gastrointestinal symptoms, anxiety and depression. The results may be biased, however, since anxiety and depression will influence the decision to consult a doctor. The aim of this study was to investigate the relationship between these symptoms in the population. In the Health Study of Nord-Trøndelag County of Norway (HUNT) a questionnaire concerning physical and mental health, demographic and life-style factors was sent to all inhabitants aged 20 years and above (a total of 94,197 persons). Valid questionnaires were returned by 62,651 persons (66.5%). Presence of nausea, heartburn, diarrhoea and constipation during the last year was self-reported. Anxiety disorders and depression were based on self-ratings of the Hospital Anxiety and Depression Scale (HADS). 48% of the population reported one or more of the four gastrointestinal symptoms. Based on the HADS ratings, 15.3% of the population had an anxiety disorder and 10.4% a depression. Anxiety disorder was most strongly associated with nausea (OR 3.42). Anxiety was also associated with heartburn, diarrhoea and constipation, but weaker than with nausea. Depression was less strongly associated with the four gastrointestinal symptoms. Demographic factors, life-style factors and extra-gastrointestinal complaints could not explain the effect of anxiety disorders and depression on these gastrointestinal symptoms. In this population study there was a strong relationship between gastrointestinal symptoms, anxiety disorders and depression. These findings suggest that mental disorders in patients with gastrointestinal symptoms are not merely a consequence of selection bias in patient materials but connected to the symptoms themselves.
Functional disorders of the digestive system, such as irritable bowel syndrome, are often associated with affective disorders, such as depression, anxiety, panic, and posttraumatic stress disorder (PTSD). Some of these associations are observed not only in clinical populations, but also in population-based samples, suggesting a relationship with pathophysiologic mechanisms underlying both gastrointestinal (GI) dysfunction and certain affective disorders. Sustained and acute life-threatening stressors play an important role in the onset and modulation of GI symptoms as well as in the development of affective disorders and PTSD. A neurobiological model is proposed that attempts to explain the development of visceral hypersensitivity, the neuroendocrine and autonomic dysfunction characteristic of functional GI disorders, as well as the overlap with affective disorders.
van Balkom n , Department of Psychiatry and EMGO þ Institute
  • A Ellemijn
  • Neeltje M Kuiper
  • Patricia Batelaan
  • Anton J L M Van Oppen
  • A J Ggzingeest
Ellemijn A. Kuiper, Neeltje M. Batelaan, Patricia van Oppen, Anton J.L.M. van Balkom n, Department of Psychiatry and EMGO þ Institute, VU University Medical Center, GGZinGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, the Netherlands E-mail address: (A.J. van Balkom)
Overwaal " , Institute for Integrated Mental Health Care " Pro Persona
  • Gert-Jan Hendriks Center
  • Anxiety Disorders
Gert-Jan Hendriks Center for Anxiety Disorders " Overwaal ", Institute for Integrated Mental Health Care " Pro Persona ", Radboud University Behavioural Science Institute, Nijmegen, the Netherlands