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Seventeen of 59 patients admitted to hospital for treatment of Obsessive-Compulsive Disorder (OCD) were found to have significant slowness, mainly due to difficulty in initiating goal-directed action and suppressing intrusive and perseverative behaviour. In this subgroup subtle neurological abnormalities were found more frequently than in healthy controls and included loss of motor fluency, hesitancy of initiation of limb movements, speech and gait abnormalities, cogwheel rigidity, complex repetitive movements and tics. Difficulties in cognitive set-shifting and complex spatial-and-shifting abilities were found on neuropsychological testing, but no correlation was found between these disturbances and either the degree of obsessionality or the severity of motor dysfunction. These results suggest that patients with obsessional slowness may have a dysfunction in the frontal-basal-ganglia loop system.

We report a 3.7 year follow-up study carried out on 42 patients with an original diagnosis of late paraphrenia who had had a CT scan and simple tests of cognition in addition to an assessment by means of the Geriatric Mental State Schedule. Mortality was found to be no different than in a control group. Patients showed improvement in target symptoms but exhibited a good deal of residual morbidity, particularly of motor and cognitive function. Cognitive performance, which was previously mildly impaired, showed some futher deterioration, usually falling short of clear-cut dementia. Ventricular size on the CT scan was not a predictor of outcome. The article highlights the organic substrate of late paraphrenia but suggests that the cerebral changes are relatively subtle and slowly progressive.K E Y wow-Paraphrenia, follow-up study.Requests for reprints: Section of Old Age Psychiatry,

Regional cerebral oxygen metabolism was measured before and after limbic leucotomy in a patient with Gilles de la Tourette syndrome, obsessive compulsive disorder, and obsessional slowness. The preoperative scan showed hypermetabolism in the caudate nuclei, which normalised after operation. It is proposed that the beneficial effects of this operation on both tics and obsessive compulsive behaviour are mediated by disruption of abnormal neural activity in basal ganglia-thalamocortical loops.