Gyula Demeter

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different subtypes (for review see, Sookman, Abramowitz, Calamari, Wilhelm, & McKay, 2005; McKay & Neziroglu, 2008; Harsányi, Csigó, <strong>Demeter</strong>, Németh, & Racsmány, 2007). The symptom-based approaches were the most prominent ones and agree that the complains of OCD patients fall into one of several major categories: a) cleaning compulsions; b) checking rituals; c) obsessive thoughts alone; d) obsessional slowness; and e) mixed rituals (Jenike, Baer, & Minichiello,1998). Hodgson and Rachman (1977) in a seminal early work from this field found that 53% of their patients showed checking rituals, 48% cleaning rituals, 52% obsessional slowness and 60% doubting obsessions, demonstrating also that patients could have more than one type of major concern. Treuer, Németh, and Rózsa (2001) found the following pattern – symptom dimensions in a Hungarian population regarding frequency and coucurrence of major obsessions and compulsions: 1. obsessive fear of contamination (72%) with cleaning rituals (75%) 2. aggressive obsessive thoughts (63%) with checking rituals (72%) 3. obsessive thought related to sexual topic (27%) with repeating rituals (66%) 4. religious obsessive thoughts (43%) with praying rituals (15%) 5. obsessive thoughts related to ordering and symmetry (47%) with counting compulsions (35%). Other researchers agreed in the following symptom dimensions: washing compulsions, checking compulsions and obsessions without compulsions (van Oppen, Hoekstra, & Emmelkamp, 1995; Burns, Keortge, Formea, & Sternberger, 1996). Baer (1994) conducted a principal component analysis of the YBOC-SC (Yale Brown Obsessive Compulsive Scale Checklist) and found three major factors: symmetry and hoarding; contamination and cleaning; and pure obsessions. Calamari et al. (2004) using cluster analysis found support for taxonomy with seven subgroups: contamination, harming, hoarding, obsession, symmetry, certainty and contamination/harming. The second approach is represented by the neuroimaging studies, which try to found connections between the symptom dimensions and the functions, characteristics of specific brain areas. Rauch et al. (1998) found accentuated regional cerebral blood flow at the level of the striatum that was associated with checking rituals, while reduced activity was associated with dimension of symmetry and ordering symptoms. In case of washing and contamination dimension found increased activity bilaterally at the anterior cingular cortex respective at the left orbitofrontal cortex. Another researchgroup (Mataix-Cols, Wooderson, Lawrence, Brammer, & Speckens, 2004) in a functional MRI study focused on three main symptom dimensions and found that patients with cleaning symptoms showed increased activation 4
ilaterally at the ventromedial prefrontal cortex and at the right nucleus caudatus; patients with aggressive obsessive thoughts/checking compulsions at the putamen/globus palidus, thalamus and dorsal cortical areas while patients with hoarding symtoms at the left precentral gyrus and right orbitofrontal cortex. Gilbert et al. (2008) in a voxel based morphometrical study found connection between symptom dimensions, symptom severity and the reduced grey matter volume. In case of cleaning-washing dimension they described reduced grey matter at the level of Broadman 6 area in the right hemisphere, while found a tendency between reduced grey matter volume at the Broadman 6 area in the left hemisphere and hoarding dimension. The third approach is represented by studies describing different neuropsychological profiles across symptom-based OCD subtypes. This research has focused mainly on patients with checking rituals (Sher, Frost, & Otto, 1983; Tallis, Pratt, & Jamani, 1999; Zitterl et al., 2001), although less common subtypes, such as hoarding (Wincze, 2001) and obsessional slowness (Hymas, Lees, Bolton, Epps, & Head, 1991) have also been examined. It has been found that checkers exhibit greater deficits in general memory, memory for actions, and decreased vividness of memory (Sher et al., 1983; Sher, Frost, Kushner, Crews, & Alexander, 1989; Constans, Foa, Franklin, & Mathews, 1995). In another study the authors have found (Lawrence, Wooderson, Mataix-Cols, David, & Specker, 2006) that patients’ characterized with symmetry and ordering symptoms showed difficulties in shifting and the patients characterized dominantly with hoarding symptoms manifested difficulties in decision making. Hashimoto et al. (2011) in their study outlined that patients in the contamination/cleaning dimension performed better in the logical memory and shifting tests, while patients in the aggressive obsessive thoughts/checking compulsions dimension showed impaired performance on the shifting task and the patients from the symmetry dimension in the logical memory and shifting tasks. All these results are compelling evidence supporting a heterogeneous approach of OCD and it begins to be clear that different cortical areas and pathways are involved in the appearances of specific symptom dimensions. Based on all these findings and on the a factorial analysis of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores of huge number OCD patients (e.g., Leckman et al., 2007) most probably in the upcoming version of the DSM this heterogenic symptom based approach will be present containing 5 different subgroups: 1. aggressive obsessions with checking compulsions 2. sexual and religious obsessions 5
Page 1 and 2: Budapest University of Technology a
Page 3 and 4: 6.3. Study 3: Over-monitoring secon
Page 5 and 6: Glossary of abbreviations ACC Anter
Page 7 and 8: WCST-LS Wisconsin Card Sorting Task
Page 9 and 10: Kivonat Az obszesszív-kompulzív z
Page 11 and 12: Introduction In our daily life we r
Page 13: Chapter 1. Overview of Obsessive co
Page 17 and 18: Chapter 2. The study of executive f
Page 19 and 20: 2.2. Theories and measurement of ex
Page 21 and 22: outcomes etc.) which in many labora
Page 23 and 24: As far as we know no executive task
Page 25 and 26: The tasks that are most commonly us
Page 27 and 28: 2002) and on the Intra-Dimensional/
Page 29 and 30: Inhibition In the Miyake et al. (20
Page 31 and 32: Table 1. Summary of OCD patients re
Page 33 and 34: Authors Samples Medication Performa
Page 35 and 36: Chapter 3. The study of memory func
Page 37 and 38: 3.2. Prospective memory Prospective
Page 39 and 40: 3.2.1. Theories of prospective memo
Page 41 and 42: According to Guynn (2008) retrieval
Page 43 and 44: intention or the initiation and exe
Page 45 and 46: 3.2.3. Studying PM in OCD While at
Page 47 and 48: 3.2.4. A possible PM model of OCD O
Page 49 and 50: 3.3. The role of inhibition in sele
Page 51 and 52: Further two recent results will be
Page 53 and 54: it, (3) the neuropsychological impa
Page 55 and 56: 4.3. Current neurobiological model
Page 57 and 58: The role of amygdale in the express
Page 59 and 60: 5.1. Main goals 1. To assess the le
Page 61 and 62: Chapter 6. Studies 6.1. Study 1: Im
Page 63 and 64: impairment in this task 15 and othe
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Procedure All OCD patients received
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series of equal length, and we cons
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called error inhibition index (SEII
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Reaction Time Colour Naming Conditi
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which might be impaired in OCD. 9 I
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REFERENCES 1. American Psychiatric
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20. van der Wee NJ., Ramsey NF, Jan
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39. Goodman WK, Price LH, Rasmussen
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6.2. Study 2: Impaired prospective
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Table 1 Sample demographics and bas
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Written instructions were read to t
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Table 2 Hit rate in the two experim
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Comparison of patient and healthy a
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can be concluded that OCD patients
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6.5. Study 5: No retrieval induced
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Experimental design and materials T
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Procedure “In the study phase, pa
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RIF effect in the control group, t(
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Chapter 7. Discussion, conclusions
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and retrospective memory processes
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Bjork, & Bjork, 1994), which was of
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of the dACC contributes to the pers
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of patients’ cognitive abilities
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Anderson, M. C., & Spellman, B. A.
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Bajo, M. T., Gómez-Ariza, C. J., F
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Burgess, P. W. (1997). Theory and m
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Cambridge Cognition Limited (2006).
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Cuttler, C., & Graf, P. (2007). Sub
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Duncan, J. (1986). Disorganziation
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Gilbert, S.J. & Shallice, T. (2002)
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Harsányi, A., Csigó, K., Demeter,
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Kearns, N. P., Cruickshank, C. A.,
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Levy, B. J., & Anderson, M. C. (200
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McDaniel, M. A., Guynn, M. J., Eins
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neuropsychological and psychoanalyt
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(Eds.), Prospective memory: Cogniti
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Rogers, R. D., & Monsell, S. (1995)
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Smith, G. V., Della Salla, S., Logi
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Thordarson, D. S., Radomsky, A. S.,
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Wincze, J. (2001). The role of unde
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