Bio Behavioral Institute

The case illustrates the effective assessment and treatment of misophonia in a 14-year-old adolescent female in which short-term cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) principles were utilized. Misophonia-related symptomology declined significantly during treatment, and partial gains were consolidated over time with the use of ongoing sporadic booster sessions to maintain reported improvements and to address the variable nature of the patient’s symptom expression. Significant tolerance of noise triggers occurred, both within and in between sessions, and the patient achieved concurrent behavioral changes and tolerated a marked reduction in relevant avoidance behaviors. Self-reported and observed psychological and physiological distress diminished when confronted with identified trigger noises, both during conducted in vivo exposures and, more broadly, in the patient’s home and school environments. The case serves as a contribution to the growing body of psychiatric literature recognizing misophonia as a distinct phenomenon, and offers anecdotal evidence regarding assessment treatment implications.

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This paper explores the relationship between primary anorexia nervosa (PAN) and obsessive-compulsive disorder (OCD) in both their concomitant and their sequential presentation. Their clinical descriptions demonstrate the presence of obsessionality and compulsiveness that seem to interface during their course and overlap in their symptomatologies has been noted for over sixty years. However, recent research in this regard is scant. Commonalities in pathophysiology indicate disturbances in neurotransmitters, notably serotonin. Biological challenges have failed to establish a definitive correlation with PAN and OCD, whether in combination or individually. We may postulate that, with limitations, they share some anatomical pathways. The areas affected are the amygdala, cingulum and orbito-frontal cortex. Few studies, however, have been devoted to the treatment of concomitant PAN and OCD.

The efficacy of medications, consisting of serotonin partial and specific reuptake blockers, and behavior therapy, consisting of exposure and response prevention in addition to social skills training, cognitive therapy, and habit reversal, in the treatment of obsessive-compulsive disorder are well documented. The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy. Ten children/adolescents who had not previously responded to behavior therapy were randomly assigned to two groups: fluvoxamine alone or fluvoxamine with behavior therapy. All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year. Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable, the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). According to the other measurements-National Institute of Mental Health-Global Obses-sive-Compulsive Scale, Clinical Global Impression-Improvement (assessing level of im-provement from week to week), and Clinical Global Impression-Severity of Illness Scale (as-sessing how ill the patient is from week to week)-improvement was not as evident. According to the CY-BOCS, those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication. At two-year follow-up, all patients continued to improve, with those in the combined approach improving more than those in the medication-alone group. Future studies should determine the specific effect of each treatment group, combined and singularly. Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed. The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy, according to the CY-BOCS.

This study focused in the treatment of two major Prader-Willi symptoms: hyperphagia and self-injurious behavior (SIB). Four patients participated in a four-year study with monthly follow-ups. Patients lived in a behaviorally structured environment, and were treated with selective serotonin reuptake blockers and phenothiazines. Psychopharmacological intervention improved SIB symptoms, but was ineffective to control appetite satiation.