Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers’ rituals. Another account of doubting implicates metacognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to metacognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.

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Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25 % Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as ‘good prognosis course’. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.

Numerous findings indicate alterations in brain serotonin systems in obsessive-compulsive disorder (OCD). We investigated the in vivo availability of thalamus-hypothalamus serotonin transporters (SERT) in patients with DSM-IV OCD who displayed prominent behavioral checking compulsions (OC-checkers). Four hours after injection of [ 123 I]-2b-carbomethoxy-3b-(4-iodophenyl)tropane ([ 123 I]-b-CIT), single photon emission computed tomography (SPECT) scans were performed in 24 medication-free non-depressed OC-checkers and 24 age-and gender-matched healthy controls. For quantification of brain serotonin transporter availability, a ratio of specific to non-displaceable [ 123 I]-b-CIT brain binding was used (V 00 3 ¼ (thalamus and hypothalamusÀcerebellum)/cerebellum). Drug-free nondepressed OC-checkers showed an 18% reduced brain serotonin transporter availability in the thalamus and hypothalamus, as compared with healthy control subjects (1.3870.19 vs 1.6970.21; po0.001). There was a strong negative correlation between severity of OC symptomatology (Y-BOCS scores) and SERT availability (r ¼ À0.80; po0.001). Moreover, we found a significant positive correlation between illness duration and serotonin transporter availability (r ¼ 0.43; po0.05). This first report of significantly reduced [ 123 I]-b-CIT binding in the thalamus-hypothalamus region in OC-checkers suggests reduced brain serotonin transporter availability, which is more pronounced with increased severity of OC symptomatology and short duration of illness. The results provide direct evidence for an involvement of the serotonergic system in the pathophysiology of OCD.

Thirty-seven patients with depression and anxiety disorder, who participated in an intensive inpatient cognitive behaviour therapy program for 6 weeks, were interviewed before treatment and 6 weeks after the end of treatment; in addition to other measures, quality of life was assessed with the Berlin Quality of Life Profile. Substantial reduction in subjective quality of life, objective functioning and environmental assets was found at baseline. At follow-up, according to clinical global impression, 13.5% of the patients were very much improved, 45.9% much improved; in 26.3% only slight improvement and in 16.2% no improvement was reported. Quality of life changed for the better in areas like work and education, leisure, housing, social relations, psychological well-being and a global rating of satisfaction with life, but not in marital relations, health in general and in finances.