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OBJECTIVE Impulsivity impacts life domains and in a psychiatric context is often associated with disorders severity and stigmatization. Borderline personality disorder's (BPD), Schizophrenic disorder's (SZD), and obsessional compulsive disorder's (OCD) impulsivity issues relate to worse prognosis. This study aims to compare these disorders assessing their proneness to impulsivity and urgency. METHODS We recruited 90 patients among them OCD (n = 25), SZD (n = 23), and BPD (n = 50), and 24 healthy control participants (HC). We assessed the diagnosis according and measured the impulsivity level. RESULTS Our results showed that BPD was significantly more impulsive than HC, SZD, and OCD. HC, SZD, and OCD being equivalent on their global Urgency-Premeditation-Perseverance-Sensation seeking scores. For urgency, BPD was also superior to others, OCD was superior to HC, but SZD and HC were equivalent. The urgency was correlated to SZD's scale for SZD, no link appeared between borderline personality questionnaire and Yale-Brown Obsessive-Compulsive Scale's score. CONCLUSION These results question the existent literature relating impulsivity and SZD.

Background: Obsessive-compulsive and related disorders (OCRDs) and disorders due to addictive behaviors (DABs) are prevalent conditions that share behavioral and neurobiological similarities. The Research Domain Criteria (RDoC) lists a series of constructs whose dysfunctions may cut across OCRDs and DABs. Objective: To describe the research protocol of a scoping review of the literature on self-report scales that tap dysfunctional constructs though to underlie OCRDs and DABs. Methods: The review will select papers published in peer-reviewed journals and in grey literature. Inclusion and exclusion criteria were designed using the Population – Concept – Context framework, and two reviewers will independently screen titles, abstracts and full texts to determine eligibility of articles. The methodological framework including six stages steps (1. Identifying a research question; 2. Identifying relevant studies; 3. Study selection; 4. Charting the data; 5. Collating, summarizing and reporting the result) will be used and the findings will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Results: Information extracted will be collated, and quantitative results presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. Conclusions: This scoping review of the literature will inform researchers and provide new insights on self-report tools that assess OCRDs and DABs related constructs. Keywords: Scoping review, addiction, compulsive behavior, transdiagnostic, instruments.

COVID-19 presents an unprecedented time for both clinicians and clients alike. As clinicians we experience a shared trauma with our clients as we both adjust to new circumstances. I can relate to how my clients are coping with the pandemic, particularly for those clients who have compulsive or addictive behaviors. With many of our adaptive coping mechanisms diminished, it is easy to fall back into destructive habits. During this time, I have turned inward to reflect on how my own experiences can help serve my clients. Rather than preaching abstinence, I find that harm reduction strategies, which help reduce compulsions or allow clients to engage in them more safely, are the most effective form of treatment. More than ever before, my work as a therapist is based in the tool of acceptance. Acceptance allows my clients to interrupt the cycles of shame that help feed addiction. Ultimately, this provides the opportunity to change behaviors. As I fight parallel battles during the coronavirus pandemic, I find that shared trauma provides rare moments of intimacy and connection that serve to deepen my client relationships. And although they do not know it, my clients’ examples help me to accept and heal my own behaviors.

Impulsive and compulsive disorders are common in young people, present in many medical settings but frequently overlooked and left untreated. This article provides a primer on impulsivity and compulsivity, focusing on attention-deficit hyperactivity disorder (the archetypal impulsive disorder) and obsessive–compulsive disorder (the archetypal compulsive disorder). We focus on their presentations, epidemiology, pathogenesis and usual course, how to recognize them clinically (including brief screening tools) and management approaches. Finally, we highlight other types of impulsive and compulsive symptoms that are common but require more research to establish optimal assessment and treatment approaches.

Simple Summary Use of laser light pointers for feline play is popular with many cat guardians. It can be an enjoyable shared interaction and provide an easy way to encourage cats to exercise. Laser light play alone, however, does not allow cats to complete the hunting sequence; cats cannot ‘catch’ the prey. It has been suggested that this might trigger frustration and stress, both of which can contribute to compulsive behaviors. This study examined the potential relationship between the use of laser light pointers for play and the occurrence of excessive or abnormal repetitive behaviors (ARBs) often linked to diagnosis of feline compulsive disorders. Using an online, anonymous survey, we explored cat guardians’ use of laser light toys (e.g., reasons for and frequency of use) and reported ARBs. A total of 618 responses, primarily female participants from the United States, were analyzed. Nearly half (45.5%) of the respondents in our study reported using laser light toys to play with their cats, although frequency of use was low for many survey respondents. Although the statement “Laser pointers can make cats frustrated if they do not get to ‘catch’ something at the end of play” was familiar to over half of respondents (52.1%), only 35.6% of respondents reported following this advice. We found significant associations between the frequency of laser light play and the occurrence of all surveyed ARBs, apart from overgrooming. Overall, the more frequently LLP toys were used, the more likely guardians were to report ARBs in their cats. Provision of outdoor access and cat age were also significant predictors of reported ARBs: indoor-only cats, and young (1–2 years) cats were more likely to display ARBs. The strongest associations were seen for behaviors which may be connected to laser light play: chasing lights or shadows, staring “obsessively” at lights or reflections, and fixating on a specific toy. These results, although correlational, suggest that laser light toys may be associated with the development of compulsive behaviors in cats, warranting further research into their use and potential risks. Abstract Use of laser light pointers for feline play is popular with many companion cat guardians. It can be an enjoyable shared interaction and provide an opportunity for feline exercise. Laser light play alone, however, does not allow cats to complete the hunting sequence and it has been suggested that this may trigger frustration and stress, common contributors to compulsive behaviors. This study examined the potential relationship between the use of laser light pointers for play and excessive or abnormal repetitive behaviors (ARBs) often linked to diagnosis of feline compulsive disorders. Using an online, anonymous, cross-sectional survey, we explored cat guardians’ use of laser toys and reported ARBs in their cats. A total of 618 responses were analyzed, primarily female participants from the United States. We found significant associations between the frequency of laser light play and the occurrence of all surveyed ARBs, apart from overgrooming. Provision of outdoor access and cat age were also significant predictors of reported ARBs: indoor-only cats, and young (1–2 years) cats were more likely to display ARBs. The strongest patterns were seen for behaviors which may be connected to laser light play: chasing lights or shadows, staring “obsessively” at lights or reflections, and fixating on a specific toy. Although correlational, these results suggest that laser light toys may be associated with the development of compulsive behaviors in cats, warranting further research into their use and potential risks.

Lack of behavioral flexibility has been proposed as one underlying cause of compulsions, defined as repetitive behaviors performed through rigid rituals. However, experimental evidence has proven inconsistent across human and animal models of compulsive-like behavior. In the present study, applying a similarly-designed reversal learning task in two different species, which share a common symptom of compulsivity (human OCD patients and Sapap3 KO mice), we found no consistent link between compulsive behaviors and lack of behavioral flexibility. However, we showed that a distinct subgroup of compulsive individuals of both species exhibit a behavioral flexibility deficit in reversal learning. This deficit was not due to perseverative, rigid behaviors as commonly hypothesized, but rather due to an increase in response lability. These cross-species results highlight the necessity to consider the heterogeneity of cognitive deficits in compulsive disorders and call for reconsidering the role of behavioral flexibility in the aetiology of compulsive behaviors., Nabil Benzina et al. use a reversal learning task to examine behavioral flexibility in human and mouse models of obsessive compulsive disorder (OCD). They report that only subsets of human patients or OCD-like mice show deficits in behavioral flexibility, highlighting the diverse presentation of cognitive deficits in compulsive disorders.

International audience; Introduction: Low BMD is frequent in anorexia nervosa (AN), depression, and during SSRI treatment but relation between these elements in AN is not established. The aims of this study were to assess the relationships between depression and anxiety, SSRI prescription, and (1) low BMD during inpatient treatment and (2) BMD change 1 year after hospital discharge. Methods: From 2009 to 2011, 212 women with severe AN have been included in the EVHAN study (EValuation of Hospitalisation for AN). Depression, anxiety and obsessive–compulsive symptoms and comorbidity were evaluated using psychometric scales and CIDI-SF. BMD was measured by dual-energy X-ray absorptiometry. Results: According to the CIDI-SF, 56% of participants (n = 70) had a lifetime major depressive disorder, 27.2% (n = 34) had a lifetime obsessive–compulsive disorder, 32.8% (n = 41) had a lifetime generalized anxiety disorder and 25.6% (n = 32) had a lifetime social phobia disorder. Half of the sample (50.7%; n = 72) had a low BMD (Z score ≤ − 2). In multivariate analysis, lifetime lowest BMI was the only determinant significantly associated with low BMD (OR = 0.56, p = 0.0008) during hospitalization. A long duration of AN (OR = 1.40 (0.003–3.92), p = 0.03), the AN-R subtype (OR = 4.95 (1.11–26.82), p = 0.04), an increase of BMI between the admission and 1 year (OR = 1.69 (1.21–2.60), p = 0.005) and a gain of BMD 1 year after the discharge explained BMD change. Conclusion: We did not find any association between depression and anxiety or SSRI treatment and a low BMD or variation of BMD. Level of evidence: Level III, cohort study.

This chapter aims to familiarise the reader with a diverse and fast-growing literature concerning the role that habits play in obsessive-compulsive disorder (OCD). Core concepts will be introduced, including how the balance between habits and a more deliberate form of action selection (goal-directed control) has traditionally been measured and how cross-species translation, neuroscience tools, and computational modelling have been used to build on these basic principles and reveal core mechanisms under study today. Next, the application of these methods to the study of OCD and related disorders will be detailed, converging on a theory that enhanced habit expression, and indeed compulsions in OCD, might arise from deficits in goal-directed control systems. These basic findings will be contextualised in terms of major tide changes in the field, including the shift from categorical disease frameworks to dimensional ones. Mechanistically, recent research concerning how goal-directed deficits arise, perhaps through failures in the construction of a mental model, are discussed along with studies critically evaluating our ability to measure habits in humans, in a laboratory setting. The chapter ends with a nod to the future, focusing on the need for clinically oriented, longitudinal, and intervention-based research that aim to translate what is now a wealth of cross-sectional mechanistic insights to the clinic.

Optogenetic tools allow for the selective activation, inhibition or modulation of genetically-defined neural circuits with incredible temporal precision. Over the past decade, application of these tools in preclinical models of psychiatric disease has advanced our understanding the neural circuit basis of maladaptive behaviors in these disorders. Despite their power as an investigational tool, optogenetics cannot yet be applied in the clinical for the treatment of neurological and psychiatric disorders. To date, deep brain stimulation (DBS) is the only clinical treatment that can be used to achieve circuit-specific neuromodulation in the context of psychiatric. Despite its increasing clinical indications, the mechanisms underlying the therapeutic effects of DBS for psychiatric disorders are poorly understood, which makes optimization difficult. We discuss the variety of optogenetic tools available for preclinical research, and how these tools have been leveraged to reverse-engineer the mechanisms underlying DBS for movement and compulsive disorders. We review studies that have used optogenetics to induce plasticity within defined basal ganglia circuits, to alter neural circuit function and evaluate the corresponding effects on motor and compulsive behaviors. While not immediately applicable to patient populations, the translational power of optogenetics is in inspiring novel DBS protocols by providing a rationale for targeting defined neural circuits to ameliorate specific behavioral symptoms, and by establishing optimal stimulation paradigms that could selectively compensate for pathological synaptic plasticity within these defined neural circuits.

BACKGROUND Dopaminergic medications in Parkinson's disease (PD) are usually associated with the development of both levodopa-induced dyskinesias (LID) and impulse control and repetitive behavior disorders (ICRB). OBJECTIVE To assess the prevalence and the severity of ICRB in a cohort of moderate and advanced PD patients and to investigate the potential interplay between ICRB, LID and dopaminergic therapies. METHODS 117 PD patients were consecutively recruited. LID were assessed by using the Rush Dyskinesia Rating Scale (RDRS). ICRB were tested by means of Questionnaire for Impulsive Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS). RESULTS 55 patients were affected by LID. Among them, 37 were treated only by oral therapy, OT (LID/OT), while 18 were on treatment with jejunal levodopa infusion, JLI (LID/JLI). 62 patients were not affected by LID (NLID) and all of them were on therapy only with oral drugs. The overall prevalence of clinically significant ICRB was 34% (95% CI = 26% to 43%) and the mean value (±SD) of QUIP-RS total score was 5.4±8.5. Prevalence of clinically significant ICRB, as well as severity of ICRB, was higher in patients with LID compared to NLID patients (p = 0.016 and p

Bidirectionally aberrant medial orbitofrontal cortical (mOFC) activity has been consistently linked with compulsion and compulsive disorders. Although rodent studies have established a causal link between mOFC excitation and compulsive-like actions, no such link has been made with mOFC inhibition. Here we use excitotoxic lesions of mOFC to investigate its role in sensitivity to punishment; a core characteristic of many compulsive disorders. In our first experiment, we demonstrated that mOFC lesions prevented instrumental conditioned punishment learning in a manner that could not be attributed to differences in Pavlovian conditioned fear. We then showed that increasing the frequency of punishing outcomes allowed mOFC-lesioned animals to overcome their initial deficit. Our second experiment demonstrated that the retrieval of instrumental punishment is also mOFC-dependent, as mOFC lesions prevented the extended retrieval of punishment contingencies relative to shams. In contrast, mOFC lesions did not prevent the re-acquisition of conditioned punishment that was learned prior to lesions being administered. Together, these results reveal that the mOFC does indeed regulate punishment learning and retrieval in a manner that is disassociated from any role in Pavlovian fear learning. These results imply that aberrant mOFC activity may contribute to the punishment insensitivity that is observed across multiple compulsive disorders.

Preface, Carnes, Adams. Part I: The Early Stages. The Sexual Addiction Assessment Process, Carnes, Wilson. Intervention and the Sexually Addicted Patient, James, Fearing. Breaking Through Defenses, Canning. Strategies for Assessment and Early Treatment with Sexually Addicted Families, Matheny. Part II: Treatment and Therapy. Shame Reduction, Affect Regulation, and Sexual Boundary Development: Essential Building Blocks in Sexual Addiction Treatment, Adams, Robinson. Manifestations of Damaged Development of the Human Affectional Systems and Developmentally Based Psychotherapies, Schwartz, Southern.Clinical Boundary Issues with Sexually Addicted Clients, Tays, Garrett, Earle. The Integration of Psychotherapy and 12-step Programs in Sexual Addiction Treatment, Parker, Guest. Recovery for Couples, Laaser. Disclosure of Extramarital Sexual Activities by Persons with Addictive or Compulsive Disorders: Results of a Study and Implications for Therapists, Schneider, Corely. Art Therapy: Treating the Invisible Sex Addict, Wilson. The Value of Group Psychotherapy for Sexual Addicts, Nerenberg.Psycho-pharmacologic Intervention in Addictive Sexual Behavior, Sealy. Dual and Triple Diagnosis: Addictions, Mental Illiness, and HIV Infection Guidelines for Outpatient Therapists, Sealy. Part III: Special Populations. Sex on the Superhighway: Understanding and Treating Cybersex Addiction, Delmonico. Females: the Forgotten Sexual Addicts, Ferree. Sexual Acting-out in Borderline Women: Impulsive Self-destructiveness or Sexual Addiction/Compulsivity? Rickards, Lasser. Pastors and Sexual Addiction, Lasser, Adams. Sexually Addicted Healthcare Professionals, Irons. Clinical Case Management and the Homeless Sex Addict, McGill. Treatment Concerns for Gay Male Sex Addicts, Weiss. Adolescent Sex and Love Addicts, Griffin-Shelley. Classifying Problematic Sexual Behavior: A Working Model Revisited, Delmonico, Griffin. Part IV: Clinical Practive and Resources. How to Build a Sex Addiction Practice, Turner. Resources.

Purpose of review Parkinson’s disease (PD) has a wide spectrum of symptoms including the presence of psychiatric disease. At present, most treatment plans, comprised of dopaminergic drugs, are chronic and complex. Though dopaminergic agents are quite efficient in managing the motor aspects of the disease, chronic pharmacotherapy specifically with dopamine receptor agonists has been highly linked to the occurrence of Impulse Compulsive disorder (ICD), which can be problematic for individual patients. Recent findings Much of what is known today about PD-related ICD stems from brain imaging studies, however, evidence is not quite conclusive. Research in the field has been focused on identifying the underlying mechanisms of PD-related ICD and understanding the functions of the structures involved in the reward network. Summary This article presents an update of recent findings from key neuroimaging studies in PD-related ICD, discusses results from controversial studies, and identifies areas for future research in the field.

Background and objectives Excessive maladaptive avoidance has been claimed to be one of the mechanisms through which intolerance of uncertainty (IU) may play its causal role in the development and maintenance of several anxiety and compulsive disorders. Consistently, Flores et al. (2018) found that individuals with higher Prospective IU (P-IU), a specific IU subfactor, display excessive avoidance response repetitions in a free-operant discriminative task to avoid an aversive noise. In the present study we tested the hypothesis that P-IU not only predicts the amount of avoidance responses but also how well the temporal distribution of such responses fits the temporal distribution of threats. Methods Further correlation and hierarchical regression analysis of Flores et al.‘s (2018) data served to test this hypothesis. We evaluated two aspects of the temporal distribution of responses: a) for how long participants were performing the responses; b) the behavioral discrimination between threatening and safe time periods. Results The results showed that scoring high in P-IU was positively associated with longer periods of time dedicated to avoiding and with worse behavioral discrimination between threatening and safe time periods. Hierarchical regression analyses indicated that later addition of inhibitory intolerance of uncertainty and trait anxiety did not significantly improved the explained variance. Limitations Our results are exclusively based on the use of a low-cost avoidance response, and the present study does not clarify the precise mechanisms that lead high P-IU people to engage in non-optimal avoidance response distribution through time. Conclusions These results suggest that excessive avoidance is also driven by uncertainty of threat timing and highlight the relevance of P-IU as a vulnerability factor for excessive and outspread avoidance behaviors.

It has been suggested that some individuals may experience an addictive-like response to certain foods in a manner similar to addictive drugs. Indeed, research suggests that there is some overlap in neurobiological mechanisms, brain activation patterns, and behavioral outcomes in individuals reporting an addictive-like response to certain foods and persons with substance-misuse disorders. This chapter reviews existing literature on the effects of addictive drugs and palatable, high-calorie foods on the brain's reward circuitry and discusses neural systems and neural vulnerability factors similarly implicated in drug addiction and problematic eating behavior. We will also review differentiating factors of addictive-like eating and offer essential next steps in neuroimaging research for food addiction.

Kaolin eating is an ancestral and worldwide tradition, particularly in women in order to relieve nauseas and abdominal troubles. Nevertheless, damaging effects such as anemia and intestinal troubles are well documented. However, compulsive disorders associated with kaolin intake are less known. We reported in this paper a severe craving observed in a young woman consuming kaolin for several years, associated with a microcytic iron-deficiency non-regenerative anemia. This paper allows to draw attention among physicians who are rarely informed of this practice imported from abroad and have consequently a limited role in informing patients of the potential deleterious side effects of geophagia.

Objective Parkinson’s disease (PD) management is usually successfully reached with proper pharmacological treatment. However, PD patients can manifest neuropsychiatric symptoms secondary to medical therapy, including impulse control disorders (ICD), presenting as pathological gambling, hypersexuality, compulsive buying, drinking or eating disorders. We translated and validated the Portuguese version of the gold-standard questionnaire Parkinson’s Disease Impulsive-Compulsive Disorders Questionnaire, or (QUIP) for identifying ICDs in PD patients. Methods Translation, back translation and submission to instrument developer was performed, that approved its new version comparing it to his original, validated version, with no loss of it’s original properties. Then, the Portuguese version was administered to 30 PD patients. They also were asked to rate from 1 to 5 the level of comprehensibility of the questions. Results The average level of comprehension was 4.06 ± 0.69 DP, considering 3 or more as acceptable. No patient has answered 1 or 2. Conclusion Our results on Portuguese version of QUIP-CS show that QUIP-CS translated and corrected version was easily understood and easily self-applied. RESUMO Objetivo O manejo da doença de Parkinson (DP) é usualmente alcançado com sucesso com o tratamento farmacológico apropriado. Entretanto, os pacientes com DP podem manifestar sintomas neuropsiquiátricos secundários à terapêutica, como a síndrome de descontrole dos impulsos (SDI), que se apresenta como o jogar patológico, a hipersexualidade, o comprar, beber ou comer compulsivos. Traduzimos e validamos a versão em português do questionário padrão-ouro para identificação de transtornos impulsivo-compulsivos na DP (QUIP-CS) para identificar nesses pacientes a presença de SDI. Métodos Foram realizadas a tradução, a retrotradução e a submissão do instrumento ao desenvolvedor deste, que aprovou a nova versão comparando esta à sua, que já está validada, sem a perda das suas propriedades originais. Após, a versão em português foi administrada a 30 pacientes com o diagnóstico de DP. Eles também foram solicitados a classificar o nível de compreensibilidade das questões, graduando-as de 1 a 5. Resultados O nível médio de compreensão foi 4,06 ± 0,69 DP, considerando-se 3 ou mais como aceitável. Nenhum paciente respondeu 1 ou 2. Conclusão Os nossos resultados para a versão em português da QUIP-CS mostraram que essa versão, traduzida e corrigida, foi facilmente compreendida e aplicada pelos próprios pacientes.

Abnormal repetitive behaviors (ARBs) represent a diverse group of behaviors whose underlying mechanism is poorly understood. Their neurobiology likely involves several different neurotransmitter systems. These behaviors have been referred to as compulsive disorders, obsessive compulsive disorders and stereotypies. Underlying medical conditions and pain can often cause changes in behavior that are mistaken for ARBs. A complete medical work-up is always indicated prior to reaching a presumptive diagnosis. The frequency of ARBs can be reduced but not always eliminated with the use of selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) in conjunction with behavior modification and environmental enrichment.

In 2014, a team of psychiatrists from Mainland China jointly published the “Guideline of Compulsive Disorders Diagnosis and Treatment” (1). Shortly thereafter, the “Guide to the Prevention and Treatment of Obsessive-Compulsive Disorder in China” was published. It recommends cognitive behavioral therapy (CBT) as the first line treatment for obsessive-compulsive disorder (OCD). Although therapists and psychiatrists have been trying to treat OCD with CBT ever since CBT was introduced in China in the 1980s, these position papers—which are consistent with recommendations in the United States and Europe (2)—drew greater attention to the need to promote access to this intervention.

Sertraline HCl, (1S-cis)-4-(3, 4-dichloro-phenyl)-1, 2, 3, 4-tetrahydro-N-methyl-l-naphthalenamine hydro- chloride, is a potent and selective serotonin reuptake inhibitor which is used in the treatment of depression and obsessive- compulsive disorders. The purpose of the present study was to evaluate the bioequivalence of two sertraline HCl tablets, Traline tablet (Myungin Pharm. Co. Ltd.) and Zoloft ® tablet (Pfizer Inc.), according to the guidelines of the Korea Food and Drug Administration (KFDA). The in vitro release of sertraline from the two sertraline HCl formulations was tested using KP VIII Apparatus II method with various dissolution media. Twenty four healthy Korean male volunteers, 23.50± 1.74 years in age and 64.09±7.10 kg in body weight, were divided into two groups and a randomized 2 × 2 crossover study was employed. After a single tablet containing 50 mg as sertraline HCl was orally administered, blood samples were taken at predetermined time intervals and the concentrations of sertraline in serum were determined using an online column- switching HPLC method with UV/Vis detection. The dissolution profiles of two formulations were similar in all tested dis- solution media. The pharmacokinetic parameters such as AUCt, Cmax and Tmax were calculated, and computer programs (Equiv Test and K-BE Test) were utilized for the statistical analysis of the parameters using logarithmically transformed AUCt, Cmax and un-transformed Tmax. The results showed that the differences between two formulations based on the ref- erence drug, Zoloft ® tablet, were 0.04, 3.26 and -1.29% for AUCt, Cmax, and Tmax, respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log0.8 to log1.25. Thus, the criteria of the KFDA bioequivalence guideline were sat- isfied, indicating Traline tablet was bioequivalent to Zoloft ® tablet.

Objective—To evaluate efficacy of fluoxetine hydrochloride for treatment of compulsive disorders in dogs. Design—Randomized, controlled clinical trial. Animals—63 dogs with compulsive disorders. Procedures—The diagnosis was confirmed on the basis of analysis of videotapes of the dogs' behavior by 3 veterinary behaviorists, results of physical examination and clinicopathologic testing, and, when necessary, telephone interviews with owners. Dogs were randomly assigned to treatment with fluoxetine (1 to 2 mg/kg [0.45 to 0.9 mg/lb], PO, q 24 h) or a placebo. Owners did not receive any advice regarding behavioral or environmental modifications. Severity of episodes was measured through telephone interviews every 2 weeks and on the basis of a daily diary kept by each owner. Results—42 days after the initiation of treatment, the proportion of dogs with a decrease in severity of the compulsive disorder, as reported by the owners, was significantly higher for dogs treated with fluoxetine than for control dogs, and dogs treated with fluoxetine were significantly more likely (odds ratio, 8.7) to have a decrease in severity of the compulsive disorder. However, mean number and duration of compulsive episodes, as determined from daily diary entries, did not differ significantly between groups. The most common adverse effects were decreased appetite and mild lethargy. Conclusions and Clinical Relevance—Results suggested that fluoxetine may be efficacious in the treatment of compulsive disorders in dogs, although results were equivocal. The present study did not examine whether fluoxetine was more efficacious than or synergistic with behavioral and environment modifications.

Medication plays an important role in the treatment of canine compulsive disorders (CCD). Not all cases can be managed with the current medications, and new pharmacological options are needed. This case series assesses the efficacy of the NMDA receptor blocker memantine as a possible new treatment option for CCD. Thirteen dogs with different manifestations of CCD were enrolled in the study, and data from 11 dogs were available for analysis. A behavioral and clinical history was obtained for each dog. Further medical tests were performed if deemed necessary. The main presenting complaints in the included cases were light/shadow chasing, spinning/circling, and tail chasing. All dogs were either treated with memantine alone or memantine was added to ongoing fluoxetine treatment. All owners of dogs included in the study were provided with a specific behavior modification plan in addition to the pharmacological treatment. Memantine was administered orally twice a day at a starting dose of 0.3-0.5 mg/kg. The dose was increased over time if necessary, and side effects permitting, to a dose not higher than 1 mg/kg. The owners were asked to use a clinical global impression scale (CGI) on a daily basis to assess the severity of their dog's compulsive behaviors. This score was obtained daily for up to 4 consecutive weeks, and average weekly scores were calculated. Seven (64%) of the dogs included in the study showed a reduction in the severity of CCD, with CGI scores reduced by the second week of treatment. Only 1 out of 11 dogs showed a side effect (increased frequency of urination) that was potentially related to the medication. The results suggest that memantine may be an effective, well-tolerated option for the treatment of CCD either as a sole treatment or as an add-on to fluoxetine. Further studies are needed to investigate the efficacy of memantine in the treatment of CCD.

This article addresses possibilities for more empathic interpretations in the clinical situation. Using both clinical case material and mythical allegories, the author, a psychotherapist and philosopher, considers the interrelated themes of human capability, fallibility, luck, and compassion within the context of clinical circumstances, especially in relation to intractable compulsive disorders. While addressing the implications of deterministic and indeterministic assumptions regarding human nature, the author attempts to show how human capability is subject to fallibility and how both are dependent on the workings of luck. Clinical material is then used to elucidate and illustrate more empathic ways of relating both to patients in particular and our fellow human beings in general. A new interpretive framework is also introduced to facilitate and to suggest ways to more compassionately understand, interpret, and respond to patients' own struggles for well being.

The nature and content of intrusive images in obsessional compulsive disorders (OCD) are described. They are primarily visual, usually vivid, effortless, fully formed, of brief duration, and remarkably stable. The persistence and changes of the images are described and some therapeutic possibilities considered.

Yalcin E., H. Batmaz: Signalment Factors, Comorbidity in Behavior Diagnoses in Dogs in Bursa Region, Turkey (2000 - 2004). Acta Vet. Brno 2007, 76: 445-450. The aim of this study was to classify the behaviour problems of dogs reported by owners in the Bursa region. A survey was conducted with the owners of 80 dogs with behaviour problems in 2000 - 2004. The questionnaire consisted of questions related to the demographics of the problems the owners observed in their dogs. Sixty eight dogs were selected from animals referred to the Clinic of the Internal Medicine Department of the Uludag University, Faculty of Veterinary Medicine and 12 dogs were selected at a private kennel. The 68 dogs diagnosed at the clinic as having behaviour problems represented 6.2% of the 1086 patient dogs older than 6 months seen in the same period. Twelve dogs with behaviour problems were selected from a total of 150 dogs at a private kennel. A total of 110 behavioural problems were detected. Some dogs showed more than one behavioural disorder. The classifi cation of the problems was as follows: 65 dogs (59%) with aggression, 13 dogs (12%) with separation anxiety, 12 dogs (10.5%) with phobia of veterinary clinics and high-volume noises such as thunders and fi reworks, 12 dogs (10.5%) with compulsive disorders (9 dogs with tail chasing, 2 dogs with lick dermatitis, 1 dog with self mutilation), 4 dogs (4%) with inappropriate elimination, 2 dogs (2%) with coprophagia, and 1 dog (1%) with puppy killing, 1 dog (1%) with false pregnancy. The breeds most often presented in our study were: German shepherd (19%), Terrier (18%), mixed breed (15%), Anatolian sheepdog (10%). The results of the study showed that behavioural problems are common among dogs in Bursa and aggression ranks fi rst, followed by separation anxiety, phobia and tail chasing. Dog, behavioural problems, aggression, separation anxiety, phobia, compulsive disorder

To assess problematic sexually explicit media (SEM) consumption, and to identify clinically meaningful cut-off points, we examined clinical correlates using the new Compulsive Pornography Consumption (CPC) scale among 1165 participating MSM. Building on scale practices in measuring compulsive sexual behavior, two cut-off points were identified. While most (76-80%) MSM do not report compulsive symptoms, about 16-20% report levels of problematic SEM consumption, including 7% with extreme scores consistent with DSM criteria for compulsive disorders. Demographic, sexual, and HIV risk differences were identified between the three groups. Researchers and clinicians are encouraged to consider using the CPC scale for comprehensive assessment of compulsive sexual behavior.

This article discusses the presenting signs, diagnosis, and differential diagnosis of compulsive disorder. Problems with the diagnosis and heterogeneity of the condition are discussed. Likely causes, development, and pathophysiology of the condition form the basis for the clinical approach to the treatment of the condition. Treatment includes environmental and management changes, behavioral modification, and drugs.

Zusammenfassung: Fragestellung: Die Übersicht widmet sich der Frage, inwieweit der medikamentöse Zugang durch empirische Studien zur Therapie von Zwängen mit Beginn im Kindes- und Jugendalter begründet ist. Methode: Die Literaturübersicht beruht auf der Auswertung der aktuellen Literatur. Dabei wurden auch Studien bei Erwachsenen berücksichtigt, soweit sie für die pharmakologische Behandlung von Kindern und Jugendlichen ergänzende Hinweise liefern konnten. Ergebnisse: Es liegen nur relativ wenige, dafür jedoch methodisch gute empirische Studien vor. Diese Studien haben eine gute Wirksamkeit von Clomipramin und von Serotonin-Wiederaufnahmehemmern bei der Behandlung von Zwängen im Kindes- und Jugendalter aufgezeigt. Bei der pharmakologischen Behandlung ist auf der Grundlage der bisher vorliegenden Untersuchungen die Frage der Dosierung nur orientierend zu beantworten. Für Clomipramin liegt sie wahrscheinlich zwischen 75 mg und 150 mg, für Fluoxetin zwischen 20 mg und 60 mg und für Fluvoxamin zwischen 100 mg bis 250 mg pro Tag. Dabei ist zu beachten, dass im Einzelfall erst nach etwa 8 bis 10 Wochen medikamentöser Behandlung mit einer Besserung gerechnet werden kann. Schlussfolgerung: Clomipramin und Serotonin-Wiederaufnahmehemmer sind wirksam in der Behandlung von Zwangsstörungen bei Kindern und Jugendlichen. Es besteht ein dringender Bedarf für Therapiestudien bei Zwangsstörungen im Kindes- und Jugendalter. Notwendig sind Untersuchungen zur Evaluation pharmakologischer Behandlungen unter Placebokontrolle, kontrollierte verhaltenstherapeutische Behandlungsstudien sowie Vergleichsstudien von medikamentösen und psychotherapeutischen Behandlungsansätzen.

The compulsive nature of weight loss behaviours central to Anorexia Nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as Obsessive-Compulsive Disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behaviour, and consider evidence of aberrances in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behaviour in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.

Despite relatively high prevalence rates and significant morbidity and mortality associated with pathological gambling (PG), our understanding of the neurobiological basis of PG lags in comparison to that for other psychiatric illnesses of comparable magnitude. An improved understanding of the neurobiology of PG would facilitate targeted investigations into more effective treatments. Emerging data suggest shared neurobiological features determine in part pathological gambling and substance use disorders. These findings both challenge current conceptualizations of addictions and provide a substantial basis of knowledge on which to design investigations into the understanding and treatment of pathological gambling. The findings that substance use disorders and the behavioral "addiction" of PG share common causative features raise the question as to what extent other compulsive disorders (eg, compulsive shopping, compulsive sexual behaviors, compulsive computer use) might be biologically related.