Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed wi...Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals' abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient's purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.展开更多
Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that a...Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients＇ age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery. Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables. Results There was a significant difference in the relapse rate for funnel chest in the different age groups （X2=11.883, P=-O.008）. There was a higher relapse rate in patients of 〈10 or 〉-19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups （F=12.538, P=-0.0001）, the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E （introversion/extraversion） in the different age groups （F=10.06, P=0.0001）. There was also a significance in the funnel chest index before surgery in the different psychological scales （P〈0.01）, with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated （correlation indices were 0.402, 0.623, -0.505, and 0.473, respectively, P〈0.01）. Conclusions There are higher complication rates after surgery and relapse rates when funne{ chest patients are too young or too old. There is more obvious psychological trauma in patients with a high funnel chest index. Our results indicate that the best age for surgery for funnel chest is 14-16 years.展开更多
One of the major social-biological characteristics in the genus Rhinopithecus is that the animals live in large groups of tens to hundreds of individuals. Study of the distribution pattern of various age-sex classes i...One of the major social-biological characteristics in the genus Rhinopithecus is that the animals live in large groups of tens to hundreds of individuals. Study of the distribution pattern of various age-sex classes in the foraging Sichuan golden monkey troop has revealed that the spatial pattern of the Sichuan golden monkey group is an ellipse with its vertical axes longer than the horizontal axes. Most members are concentrated in the center and the center-back.Adult males gather in the front, the center and the back of the troop; adult females and the young assemble in the center and near-center; sub-adult males are mainly distributed in the center-back and back, but some are also seen in the front, front-center and center; sub-adult females are more or less uniformly dispersed. The spatial distribution of various age-sex classes seems well correspondent with their status and role in the group. This result indicates that the spatial distribution strategy adopted by Sichuan golden monkeys is展开更多
Objective To explore the regulatory effect of Galectin-3 on the pathogenesis mechanism of brain-derived neurtrophic factor/tyrosine kinase receptor B (BDNF/TrkB) pathway in the model of schizophrenia rats.Methods Twen...Objective To explore the regulatory effect of Galectin-3 on the pathogenesis mechanism of brain-derived neurtrophic factor/tyrosine kinase receptor B (BDNF/TrkB) pathway in the model of schizophrenia rats.Methods Twenty-four rats were randomly divided into model (M) group (n=12) and control (C) group (n=12). Schizophrenia model was established by using MK-801 in rats in group M and rats in group C were given saline.展开更多
Objective To investigate the efficacy of cognitivebehavioraltherapy for insomnia (CBT-i) or combinationwith tapered hypnotic agents. Methods Seventy-five patientswere randomized into either CBT-i group (n = 37)or comb...Objective To investigate the efficacy of cognitivebehavioraltherapy for insomnia (CBT-i) or combinationwith tapered hypnotic agents. Methods Seventy-five patientswere randomized into either CBT-i group (n = 37)or combination group ( n = 38). The duration of treatmentlasted for 8 weeks. The efficacy was evaluated byPittsburgh sleep quality index (PSQI),Beck depressionindex (BDI),Beck anxiety inventory (BAI) and sleepdiary variables at baseline,in the process and end oftreatment. Results ( 1 ) Compared with the results atbaseline,the total scores of PSQI,BDI and BAI in bothgroups significantly decreased at the end of treatment:CBT-i group,PSQI (4. 7 ± 2. 5) vs. (12. 9 ± 3. 5);BDI (3. 2 ± 4. 4) vs. (9. 7 ± 6. 4);BAI (4. 2 ± 5. 6)vs. ( 10. 7 ± 8. 1 );and combination group, PSQI(5. 8 ± 2. 8) vs. (13. 9 ± 3. 1);BDI (4. 5 ± 4. 8) vs.(13. 8 ± 8. 7);BAI (4. 4 ± 4. 0) vs. (14. 1 ± 6. 3) (allP < 0. 01). (2) Compared with the results at baseline,subjective sleep quality ( SQ ), sleep onset latency(SOL),sleep efficiency (SE),sleep disturbance (SD)and used sleep medication (USM) in PSQI in combinationgroup significantly decreased at week 4 and 8 ( allP < 0. 05). The total sleep time (TST) and daytime dysfunction(DF) in PSQI significantly decreased at week 8( both P < 0. 05 ). ( 3 ) Compared with combinationgroup,improvement of SOL and SE in CBT-i group wassuperior (both P = 0. 01). Conclusion CBT-i for chronicinsomnia is effective in both CBT-i alone and combinationwith tapered hypnotic agents. CBT-i group is superiorin improving SOL and SE. Combination regimen in ourstudy can significantly reduce the doses of medication.展开更多
Objective To find the common neurocognitive deficits in patients with obsessive-compulsive disorder (OCD) and their unaffected first-degree relatives (UFDR) and to identify neurocognitive endophenotypes for OCD. Metho...Objective To find the common neurocognitive deficits in patients with obsessive-compulsive disorder (OCD) and their unaffected first-degree relatives (UFDR) and to identify neurocognitive endophenotypes for OCD. Methods Forty patients with OCD,forty UFDR of OCD probands and forty展开更多
Objective To evaluate the effectiveness of cognitive behavior therapy for insomnia(CBT-i)in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters.Methods Patients who met t...Objective To evaluate the effectiveness of cognitive behavior therapy for insomnia(CBT-i)in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters.Methods Patients who met the diagnostic criteria of chronic insomnia,were divided into primary group or comorbid group.Both groups received standard CBT-i interventions.Psychological scales and sleep diaries were used to evaluate participants'severity of insomnia and psychological conditions related to insomnia at four time points:before intervention(base-line),immediate after intervention,4 weeks and 16 weeks after intervention.Results Both groups achieved significant improvements after intervention on psychologi-cal measurements and sleep diary parameters.Such improvements were maintained at 4-week and 16-week follow-ups.The sleep diary data indicated that by the end of the intervention,there were significant differences on sleep onset latency(51.72 min to 10.53 min in primary group,P<0.01;59.26 min to 15.67 min in comorbid group,P<0.01)and sleep efficiency(71% to 95% in primary group,P<0.01;68% to 90% in comorbid group,P<0.01).There were differences on sleep onset latency(10.00 min vs.13.93 min,P<0.05),total sleep time(355.71 min vs.327.85 min,P<0.05)and sleep efficiency(95% vs.91%,P<0.01)in primary group and comorbid group respectively.No differences were found on wake-up after sleep onset in the two groups.Conclusion Chronic insomnia patients with or without comorbidities both have improvements after CBT-i.Sleep diary parameters rather than psychological measurements are different in the two groups.Thus,CBT-i is an effective non-pharmaceutical therapy in patients with chronic insomnia.展开更多
Objective To explore the relation of clinical characteristics and drug therapeutic effect in patients with obsessive-compulsive disorder(OCD).Methods Totally 87 patients meeting the DSM-Ⅳ criteria for OCD were recrui...Objective To explore the relation of clinical characteristics and drug therapeutic effect in patients with obsessive-compulsive disorder(OCD).Methods Totally 87 patients meeting the DSM-Ⅳ criteria for OCD were recruited.They were assessed with the Y-BOCS and Obsessive-Compulsive Inventory-Revised(OCI-R)to evaluate the degree of obsessive-compulsive symptoms and distress,and Beck Depression Inventor-Ⅱ and Beck Anxiety Inventory to evaluate the degree of depression and anxiety,Childhood Trauma Questionnaire was used to measure the childhood trauma,and the patients were arranged to complete the follow-up of 16 weeks,the reductive rate of Y-BOCS was used to assess efficacy.Pearson correlation and binary logistic stepwise regression were used to analyze the relationship between clinical characteristics and therapeutic effect.Results The total effective rate of treatment was 65.3%(47/27).Compared with early-onset OCD patients(n=40),late-onset OCD patients(n=47)showed higher checking scores of OCI-R(3.7±3.3 vs 6.3±3.7;t=-2.50,P<0.05).Higher-trau-ma OCD patients(n=52)scored higher than lower-trauma OCD patients(n=23)in obsession and Beck Depression Inventor-Ⅱ scores(6.8±3.3 vs.4.5±3.5,t=-2.14,P=0.038;23.8±12.1 vs.15.6±5.8,t=-3.08,P=0.003).The age at onset of OCD was positively correlated with the reductive rate of Y-BOCS(r=0.25,P<0.05).Logistic regression analysis reported that age of onset entered the regression model(OR=1.15,P<0.05).Conclusion It suggests that OCD patients with more childhood trauma experience may exhibit more severe obsession,and those with earlier age of onset may exhibit the worse therapeutic effect.展开更多
Objective To compare and explore the characteristics of striatum functional connectivity in major depression and schizophrenic.Methods Thirty-six patients with major depressive disorder (MDD),schizophrenia,and health ...Objective To compare and explore the characteristics of striatum functional connectivity in major depression and schizophrenic.Methods Thirty-six patients with major depressive disorder (MDD),schizophrenia,and health controls were recruited in this study.All subjects underwent rest-stating functional magnetic resonance imaging (rsfMRI).展开更多
Objective To explore the effect of the acute treatment outcome on the trajectory of residual symptoms for major depressive disorder (MDD).Method This is a multicenter,prospective,non-intervention study.The MDD patient...Objective To explore the effect of the acute treatment outcome on the trajectory of residual symptoms for major depressive disorder (MDD).Method This is a multicenter,prospective,non-intervention study.The MDD patients who self-reported an improvement after receiving an 8-12weeks antidepressant treatment were included.展开更多
Objective To explore the neurobiological mechanisms underlying cognitive-behavior therapy(CBT)for major depressive disorder(MDD)by detecting the neural changes of patients following CBT.Methods Thirteen first-episode ...Objective To explore the neurobiological mechanisms underlying cognitive-behavior therapy(CBT)for major depressive disorder(MDD)by detecting the neural changes of patients following CBT.Methods Thirteen first-episode treatment-naive patients with MDD and 13 matched healthy volunteers underwent fM RI scan.All the patients were treated with 6-week CBT only and scanned again after treatment.A gender recognition展开更多
Objective To explore the effect of group cognitive behavior therapy (GCBT) on symptom relief and cognitive function improvement of patients with obsessive-compulsive disorder (OCD). Methods Forty-eight OCD patients wh...Objective To explore the effect of group cognitive behavior therapy (GCBT) on symptom relief and cognitive function improvement of patients with obsessive-compulsive disorder (OCD). Methods Forty-eight OCD patients who met the DSM-Ⅳ-TR diagnostic criteria were introduced into this study.展开更多
Objective To explore the influence of demographic characteristics,psychiatric symptoms and medication on the adherence of long-acting injectable paliperidone palmitate(PP)treatment in schizophrenia patients.Methods In...Objective To explore the influence of demographic characteristics,psychiatric symptoms and medication on the adherence of long-acting injectable paliperidone palmitate(PP)treatment in schizophrenia patients.Methods In this one year,naturalistic longitudinal study,156 consecutive patients with schizophrenia were initi-展开更多
Objective To compare the effect between the group of 5-selective serotonin reuptake inhibitor(SSRIs)treatment and the group of SSRIs combining cognitive behavioral therapy(CBT).Methods Eighty patients meeting the Diag...Objective To compare the effect between the group of 5-selective serotonin reuptake inhibitor(SSRIs)treatment and the group of SSRIs combining cognitive behavioral therapy(CBT).Methods Eighty patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fourth edition criteria for obsessive-compulsive dis-展开更多
文摘Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals' abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient's purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.
文摘Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients＇ age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery. Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables. Results There was a significant difference in the relapse rate for funnel chest in the different age groups （X2=11.883, P=-O.008）. There was a higher relapse rate in patients of 〈10 or 〉-19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups （F=12.538, P=-0.0001）, the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E （introversion/extraversion） in the different age groups （F=10.06, P=0.0001）. There was also a significance in the funnel chest index before surgery in the different psychological scales （P〈0.01）, with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated （correlation indices were 0.402, 0.623, -0.505, and 0.473, respectively, P〈0.01）. Conclusions There are higher complication rates after surgery and relapse rates when funne{ chest patients are too young or too old. There is more obvious psychological trauma in patients with a high funnel chest index. Our results indicate that the best age for surgery for funnel chest is 14-16 years.
文摘One of the major social-biological characteristics in the genus Rhinopithecus is that the animals live in large groups of tens to hundreds of individuals. Study of the distribution pattern of various age-sex classes in the foraging Sichuan golden monkey troop has revealed that the spatial pattern of the Sichuan golden monkey group is an ellipse with its vertical axes longer than the horizontal axes. Most members are concentrated in the center and the center-back.Adult males gather in the front, the center and the back of the troop; adult females and the young assemble in the center and near-center; sub-adult males are mainly distributed in the center-back and back, but some are also seen in the front, front-center and center; sub-adult females are more or less uniformly dispersed. The spatial distribution of various age-sex classes seems well correspondent with their status and role in the group. This result indicates that the spatial distribution strategy adopted by Sichuan golden monkeys is
文摘Objective To explore the regulatory effect of Galectin-3 on the pathogenesis mechanism of brain-derived neurtrophic factor/tyrosine kinase receptor B (BDNF/TrkB) pathway in the model of schizophrenia rats.Methods Twenty-four rats were randomly divided into model (M) group (n=12) and control (C) group (n=12). Schizophrenia model was established by using MK-801 in rats in group M and rats in group C were given saline.
文摘Objective To investigate the efficacy of cognitivebehavioraltherapy for insomnia (CBT-i) or combinationwith tapered hypnotic agents. Methods Seventy-five patientswere randomized into either CBT-i group (n = 37)or combination group ( n = 38). The duration of treatmentlasted for 8 weeks. The efficacy was evaluated byPittsburgh sleep quality index (PSQI),Beck depressionindex (BDI),Beck anxiety inventory (BAI) and sleepdiary variables at baseline,in the process and end oftreatment. Results ( 1 ) Compared with the results atbaseline,the total scores of PSQI,BDI and BAI in bothgroups significantly decreased at the end of treatment:CBT-i group,PSQI (4. 7 ± 2. 5) vs. (12. 9 ± 3. 5);BDI (3. 2 ± 4. 4) vs. (9. 7 ± 6. 4);BAI (4. 2 ± 5. 6)vs. ( 10. 7 ± 8. 1 );and combination group, PSQI(5. 8 ± 2. 8) vs. (13. 9 ± 3. 1);BDI (4. 5 ± 4. 8) vs.(13. 8 ± 8. 7);BAI (4. 4 ± 4. 0) vs. (14. 1 ± 6. 3) (allP < 0. 01). (2) Compared with the results at baseline,subjective sleep quality ( SQ ), sleep onset latency(SOL),sleep efficiency (SE),sleep disturbance (SD)and used sleep medication (USM) in PSQI in combinationgroup significantly decreased at week 4 and 8 ( allP < 0. 05). The total sleep time (TST) and daytime dysfunction(DF) in PSQI significantly decreased at week 8( both P < 0. 05 ). ( 3 ) Compared with combinationgroup,improvement of SOL and SE in CBT-i group wassuperior (both P = 0. 01). Conclusion CBT-i for chronicinsomnia is effective in both CBT-i alone and combinationwith tapered hypnotic agents. CBT-i group is superiorin improving SOL and SE. Combination regimen in ourstudy can significantly reduce the doses of medication.
文摘Objective To find the common neurocognitive deficits in patients with obsessive-compulsive disorder (OCD) and their unaffected first-degree relatives (UFDR) and to identify neurocognitive endophenotypes for OCD. Methods Forty patients with OCD,forty UFDR of OCD probands and forty
文摘Objective To evaluate the effectiveness of cognitive behavior therapy for insomnia(CBT-i)in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters.Methods Patients who met the diagnostic criteria of chronic insomnia,were divided into primary group or comorbid group.Both groups received standard CBT-i interventions.Psychological scales and sleep diaries were used to evaluate participants'severity of insomnia and psychological conditions related to insomnia at four time points:before intervention(base-line),immediate after intervention,4 weeks and 16 weeks after intervention.Results Both groups achieved significant improvements after intervention on psychologi-cal measurements and sleep diary parameters.Such improvements were maintained at 4-week and 16-week follow-ups.The sleep diary data indicated that by the end of the intervention,there were significant differences on sleep onset latency(51.72 min to 10.53 min in primary group,P<0.01;59.26 min to 15.67 min in comorbid group,P<0.01)and sleep efficiency(71% to 95% in primary group,P<0.01;68% to 90% in comorbid group,P<0.01).There were differences on sleep onset latency(10.00 min vs.13.93 min,P<0.05),total sleep time(355.71 min vs.327.85 min,P<0.05)and sleep efficiency(95% vs.91%,P<0.01)in primary group and comorbid group respectively.No differences were found on wake-up after sleep onset in the two groups.Conclusion Chronic insomnia patients with or without comorbidities both have improvements after CBT-i.Sleep diary parameters rather than psychological measurements are different in the two groups.Thus,CBT-i is an effective non-pharmaceutical therapy in patients with chronic insomnia.
文摘Objective To explore the relation of clinical characteristics and drug therapeutic effect in patients with obsessive-compulsive disorder(OCD).Methods Totally 87 patients meeting the DSM-Ⅳ criteria for OCD were recruited.They were assessed with the Y-BOCS and Obsessive-Compulsive Inventory-Revised(OCI-R)to evaluate the degree of obsessive-compulsive symptoms and distress,and Beck Depression Inventor-Ⅱ and Beck Anxiety Inventory to evaluate the degree of depression and anxiety,Childhood Trauma Questionnaire was used to measure the childhood trauma,and the patients were arranged to complete the follow-up of 16 weeks,the reductive rate of Y-BOCS was used to assess efficacy.Pearson correlation and binary logistic stepwise regression were used to analyze the relationship between clinical characteristics and therapeutic effect.Results The total effective rate of treatment was 65.3%(47/27).Compared with early-onset OCD patients(n=40),late-onset OCD patients(n=47)showed higher checking scores of OCI-R(3.7±3.3 vs 6.3±3.7;t=-2.50,P<0.05).Higher-trau-ma OCD patients(n=52)scored higher than lower-trauma OCD patients(n=23)in obsession and Beck Depression Inventor-Ⅱ scores(6.8±3.3 vs.4.5±3.5,t=-2.14,P=0.038;23.8±12.1 vs.15.6±5.8,t=-3.08,P=0.003).The age at onset of OCD was positively correlated with the reductive rate of Y-BOCS(r=0.25,P<0.05).Logistic regression analysis reported that age of onset entered the regression model(OR=1.15,P<0.05).Conclusion It suggests that OCD patients with more childhood trauma experience may exhibit more severe obsession,and those with earlier age of onset may exhibit the worse therapeutic effect.
文摘Objective To compare and explore the characteristics of striatum functional connectivity in major depression and schizophrenic.Methods Thirty-six patients with major depressive disorder (MDD),schizophrenia,and health controls were recruited in this study.All subjects underwent rest-stating functional magnetic resonance imaging (rsfMRI).
文摘Objective To explore the effect of the acute treatment outcome on the trajectory of residual symptoms for major depressive disorder (MDD).Method This is a multicenter,prospective,non-intervention study.The MDD patients who self-reported an improvement after receiving an 8-12weeks antidepressant treatment were included.
文摘Objective To explore the neurobiological mechanisms underlying cognitive-behavior therapy(CBT)for major depressive disorder(MDD)by detecting the neural changes of patients following CBT.Methods Thirteen first-episode treatment-naive patients with MDD and 13 matched healthy volunteers underwent fM RI scan.All the patients were treated with 6-week CBT only and scanned again after treatment.A gender recognition
文摘Objective To explore the effect of group cognitive behavior therapy (GCBT) on symptom relief and cognitive function improvement of patients with obsessive-compulsive disorder (OCD). Methods Forty-eight OCD patients who met the DSM-Ⅳ-TR diagnostic criteria were introduced into this study.
文摘Objective To explore the influence of demographic characteristics,psychiatric symptoms and medication on the adherence of long-acting injectable paliperidone palmitate(PP)treatment in schizophrenia patients.Methods In this one year,naturalistic longitudinal study,156 consecutive patients with schizophrenia were initi-
文摘Objective To compare the effect between the group of 5-selective serotonin reuptake inhibitor(SSRIs)treatment and the group of SSRIs combining cognitive behavioral therapy(CBT).Methods Eighty patients meeting the Diagnostic and Statistical Manual of Mental Disorders,Fourth edition criteria for obsessive-compulsive dis-
