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      Clinical correlates of tobacco smoking in OCD: A UK, case-controlled, exploratory analysis

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          Obsessive-compulsive disorder (OCD) is a biologically heterogeneous neuropsychiatric disorder. It is associated with impulsive as well as compulsive neurocognitive mechanisms. Cigarette smoking is common among most psychiatric patients; however, OCD patients are thought to show reduced rates. OCD smokers may thus represent a relatively uncommon OCD subtype, characterised by increased impulsivity. In this study, we aim to establish the prevalence of smoking in a large, well-defined OCD cohort. We investigate whether smokers with OCD differ from non-smokers with OCD on clinical measures of behavioural impulsivity and domains of personality and temperament, including reward-dependence and novelty-seeking.


          183 of 200 outpatients with DSM-IV OCD were interviewed to determine smoking status. A sub-sample of 10 smokers was compared with 10 non-smokers, pair wise matched for age and gender. Patients were assessed for DSM co-morbidity, symptom profile, OCD severity, behavioural impulsivity and personality dimensions.


          Only 10 individuals (5.46%; five males) were smokers. Compared to OCD non-smokers, OCD smokers scored significantly higher on the Barratt Impulsiveness Scale ( p < 0.001). They also scored significantly higher on TCI measures of novelty seeking ( p < 0.001) and reward dependence ( p < 0.001) and significantly lower on measures of harm avoidance ( p < 0.001).


          Tobacco smoking is rare in OCD. Significantly higher levels of behavioural impulsivity and temperamental factors associated with reward driven impulsivity are seen in OCD smokers compared to non-smokers. Tobacco smoking may indicate a possible source of neurocognitive heterogeneity in OCD.

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          Most cited references25

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          Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review.

          Failures in cortical control of fronto-striatal neural circuits may underpin impulsive and compulsive acts. In this narrative review, we explore these behaviors from the perspective of neural processes and consider how these behaviors and neural processes contribute to mental disorders such as obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder, and impulse-control disorders such as trichotillomania and pathological gambling. We present findings from a broad range of data, comprising translational and human endophenotypes research and clinical treatment trials, focussing on the parallel, functionally segregated, cortico-striatal neural projections, from orbitofrontal cortex (OFC) to medial striatum (caudate nucleus), proposed to drive compulsive activity, and from the anterior cingulate/ventromedial prefrontal cortex to the ventral striatum (nucleus accumbens shell), proposed to drive impulsive activity, and the interaction between them. We suggest that impulsivity and compulsivity each seem to be multidimensional. Impulsive or compulsive behaviors are mediated by overlapping as well as distinct neural substrates. Trichotillomania may stand apart as a disorder of motor-impulse control, whereas pathological gambling involves abnormal ventral reward circuitry that identifies it more closely with substance addiction. OCD shows motor impulsivity and compulsivity, probably mediated through disruption of OFC-caudate circuitry, as well as other frontal, cingulate, and parietal connections. Serotonin and dopamine interact across these circuits to modulate aspects of both impulsive and compulsive responding and as yet unidentified brain-based systems may also have important functions. Targeted application of neurocognitive tasks, receptor-specific neurochemical probes, and brain systems neuroimaging techniques have potential for future research in this field.
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            Prevalence of smoking among psychiatric outpatients.

            The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%). The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients. Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients. Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented.
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              Brain reward circuitry: insights from unsensed incentives.

              The natural incentives that shape behavior reach the central circuitry of motivation trans-synaptically, via the five senses, whereas the laboratory rewards of intracranial stimulation or drug injections activate reward circuitry directly, bypassing peripheral sensory pathways. The unsensed incentives of brain stimulation and intracranial drug injections thus give us tools to identify reward circuit elements within the associational portions of the CNS. Such studies have implicated the mesolimbic dopamine system and several of its afferents and efferents in motivational function. Comparisons of natural and laboratory incentives suggest hypotheses as to why some habits become compulsive and give insights into the roles of reinforcement and of prediction of reinforcement in habit formation.

                Author and article information

                Journal of Behavioral Addictions
                Akadémiai Kiadó, co-published with Springer Science+Business Media B.V., Formerly Kluwer Academic Publishers B.V.
                1 December 2012
                25 September 2012
                : 1
                : 4
                : 180-185
                [ 1 ] Mott House Specialist Rehab Unit, West London Mental Health NHS Trust, Southall, UB1 3EU, UK
                [ 2 ] National OCDs Service, Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, AL74HQ, UK
                [ 3 ] College Lane, University of Hertfordshire, Hatfield, Herts, UK
                [ 4 ] Addenbrookes Hospital, Cambridge University School of Clinical Medicine, Cambridge, UK
                [ 5 ] Mott House Specialist Rehab Unit, West London Mental Health NHS Trust, Uxbridge Road, Southall, UB1 3EU, UK
                Author notes
                © 2012 The Author(s)

                Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                : 29 May 2012
                : 12 August 2012
                : 18 August 2012
                Brief Reports

                Medicine,Psychology,Social & Behavioral Sciences,Clinical Psychology & Psychiatry
                harm avoidance,smoking,behavioural impulsivity,nicotine,OCD,tobacco


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