February 2015

Vol. 27. No. 1


Diagnostic Tower of Babel: Need for diagnostic systems synchronization and comprehensible language

Diagnosis has again, as many times before, become the most important issue in modern psychiatry. This has been evident during
the passionate debate surrounding introduction of DSM-5 (which has calmed down, fortunately). We need a common, valid language to communicate about our patients’ disorders. The DSM system (from DSM-I to DSM-5) has been a solid, mostly good, and useful guide that has been providing such a language. Its use of detailed psychopathology in spelling out diagnostic criteria has been especially useful. The DSM system also has been a good teaching tool, not just for educating trainees about the, at times boring, diagnostic criteria, but also about the importance of paying attention to details of psychopathology.



Internet addiction is associated with social anxiety in young adults

Aviv Weinstein, PhD | Dikla Dorani, BA | Rotem Elhadif, BA | Yehely Bukovza, BA | Anastasya Yarmulnik, BA | Pinhas Dannon, MD

BACKGROUND: Problematic Internet use or excessive Internet use is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use, and Internet access that leads to impairment or distress. Cross-sectional studies on samples of patients reported high comorbidity of Internet addiction with psychiatric disorders, especially affective disorders (including depression), anxiety disorders (generalized anxiety disorder, social anxiety disorder), and attention-deficit/hyperactivity disorder.

METHODS: We have investigated the association between Internet addiction and social anxiety in 2 samples of 120 university students (60 males and 60 females in each sample).

RESULTS: We found a correlation between Internet addiction and social anxiety in the 2 samples (r = 0.411, P < .001; r = 0.342, P < .01) respectively. Secondly, we found no difference between males and females on the level of Internet addiction. Thirdly, we did not find a preference for social networks among participants with high levels of social anxiety.

CONCLUSIONS: The results of the study support previous evidence for cooccurrence of Internet addiction and social anxiety, but further studies need to clarify this association.


Getting the word out: Cognitive-behavioral therapy for trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder

Nancy J. Keuthen, PhD | Esther S. Tung, BA | Hannah E. Reese, PhD | Jennifer Raikes, BA | Leslie Lee, BA

BACKGROUND: To date, there has been no investigation of dissemination outcomes for cognitive-behavioral training programs for body-focused repetitive behaviors (BFRBs).

METHODS: Sixty-three past participants of the Trichotillomania Learning Center (TLC) intensive professional training institutes completed an online survey assessing referral sources, skills utilization, and treatment outcomes before and after training. The intensive training focused on the treatment of trichotillomania (hair-pulling) disorder and excoriation (skin-picking) disorder using in-person or videotaped didactics, role playing, and case presentations with supervision upon request.

RESULTS: Participants endorsed a greater number of referral sources and BFRB patients after attending training. Paired t tests indicated significant pre- to post-training increases in self-reported utilization of all individual cognitive-behavioral therapy (CBT) skills as well as overall mean skills usage (both P < .001). Changes after training in the reported percent of abstinent patients and mean reduction in symptom severity were also noted.

CONCLUSIONS: The TLC intensive professional training institutes may be useful for disseminating CBT skills for the treatment of BFRBs, but additional research is warranted.


Traumatic event exposure and gambling: Associations with clinical, neurocognitive, and personality variables

Eric W. Leppink, BA | Jon E. Grant, JD, MD, MPH

BACKGROUND: Epidemiological research has shown high comorbidity rates between at-risk/problem (ARP) gambling and trauma. However, few studies have assessed the neurocognitive implications of this comorbidity, and even fewer have been conducted with young adults. The present study sought to determine the neurocognitive, clinical, personality types associated with trauma in ARP gamblers.

METHODS: The present study analyzed young adult gamblers age 18 to 29 drawn from a study investigating impulsivity. Of the 230 gamblers, 52 (22.6%) reported experiencing a traumatic event during their life to which they responded with intense fear, helplessness, or horror. The remaining participants indicated no experience with trauma.

RESULTS: ARP gamblers who had experienced trauma showed significant neurocognitive deficits on tasks related to decision-making, risk adjustment, sustained attention, and spatial working memory. We did not detect significant differences in gambling severity. Trauma was associated with lower perceived quality of life and self-esteem, and higher rates of current comorbid diagnoses, suicidality, substance use disorders, and nicotine use.

CONCLUSIONS: This study suggests that trauma may not exacerbate the severity of gambling in ARP gamblers. However, significant differences in supplemental clinical and neurocognitive measures may indicate that trauma is an important consideration when assessing problems beyond those related directly to gambling severity.


Maintenance treatment for obsessive-compulsive disorder: Findings from a naturalistic setting

Eric D. Peselow, MD† | Demetria R. Pizano, MA | Waguih William IsHak, MD, FAPA

BACKGROUND: Although the utility of medication in the acute treatment of adult obsessive-compulsive disorder (OCD) is well-established, the role of maintenance therapy is not as well-studied. This study examines the efficacy of long-term treatment for, and predictors of, stability in medicated patients with adult OCD.

METHODS: Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), we retrospectively evaluated 84 OCD patients who responded to a 10- to 12-week, open-label, acute treatment in a naturalistic clinic setting. Patients were followed based on their medication response for 1 to 92 months (mean 34.3), or until they terminated therapy. We evaluated Y-BOCS scores every 6 months or sooner, if clinically indicated.

RESULTS: Of the 84 patients, 39 (46.4%) responded, having relapsed within a 5-year period. Predictors of longer duration of stability were adjunctive cognitive-behavioral therapy (CBT), lack of comorbid disorders, lower Y-BOCS score after treatment, and larger decrease in Y-BOCS score during treatment phase.

CONCLUSIONS: Our results show the importance of maintenance treatment of OCD, noting the benefits of long-term response to adjunctive CBT and of achieving maximal acute response. It is becoming crucial to develop larger maintenance studies with more uniform design to better assess the natural course of treated OCD and improve treatment strategies.