Phenomenological and pharmacological study of provoked obsessive/anxiety symptoms in obsessive-compulsive disorder: a preliminary study.
BACKGROUND
Inclusion of obsessive-compulsive disorder (OCD) as an anxiety disorder in DSM-i.v. assumes that anxiety is the primary symptom of OCD; however, persuasive empirical evidence in support of this view has not been presented yet. In the present study we hypothesized that provoked anxiety symptoms respond better to intravenous diazepam than would provoked obsessions. We, therefore, reasoned that anxiety symptoms are secondary symptoms of OCD.


METHODS
To test the hypothesis we designed a double-blind, randomized, placebo-controlled crossover study. Patients underwent four experimental conditions in which the sequence of symptom provocation and i.v. injection of (placebo or diazepam) were alternated. Baseline and i.v. injection-induced symptom changes were assessed using visual analogs.


RESULTS
Obsessions and anxiety correlated strongly for all four experimental conditions in which the sequence of the symptom provocation and diazepam i.v. injections was alternated. i.v. diazepam injection before and after symptom provocation failed to preferentially modulate anxiety symptoms over obsessions. Unexpectedly, in the group in which i.v. diazepam injection preceded the symptom provocation, reduction of mean obsessions was even more pronounced.


CONCLUSIONS
Strong correlations between anxiety and obsessions at baseline, during symptom provocation, and after i.v. diazepam infusion suggest that anxiety and obsessions are tightly coupled phenomena in OCD.
Kim
S W
SW
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, USA.
Dysken
M W
MW
Kushner
M G
MG
Kuskowski
M A
MA
Hoover
K M
KM
Klein
K W
KW
Faris
P L
PL
Hartman
B K
BK
D000328:Adult; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D001794:Blood Pressure / Q000502:physiology; D003975:Diazepam / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009770:Obsessive Behavior / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D015656:Respiratory Mechanics / Q000502:physiology
D014151:Anti-Anxiety Agents; D003975:Diazepam