PHENOMENOLOGICAL AND PHARMACOLOGICAL STUDY OF PROVOKED OBSESSIVE ANXIETY SYMPTOMS IN OBSSESIVE-COMPULSIVE DISORDER - A PRELIMINARY-STUDY/

Background: Inclusion. of obsessive-compulsive disorder (OCD) as an an xiety disorder in DSM-IV assumes that anxiety is the primary symptom o f OCD; however, persuasive empirical evidence in support of this view has not been presented yet. In the present study we hypothesized that provoked anxiety symptoms respond better to intravenous diazepam than would provoked obsessions, We, therefore, reasoned that anxiety sympto ms are secondary symptoms of OCD. Methods: To test the hypothesis we d esigned a double-blind, randomized, placebo-controlled crossover study , Patients underwent four experimental conditions in which the sequenc e of symptom provocation and IV injection of (placebo or diazepam) wer e alternated. Baseline and IV injection-induced symptom changes were a ssessed using visual analogs, Results: Obsessions and anxiety correlat ed strongly for all four experimental conditions in which the sequence of the symptom provocation and diazepam IV injections was alternated. IV diazepam injection before and after symptom provocation failed to preferentially modulate anxiety symptoms over obsessions. Unexpectedly , in the group in which IV diazepam injection preceded the symptom pro vocation, reduction of mean obsessions was even more pronounced. Concl usions: Strong correlations between anxiety and obsessions at baseline , during symptom provocation, and after IV diazepam infusion suggest t hat anxiety and obsessions are tightly coupled phenomena in OCD. (C) 1 997 Society of Biological Psychiatry.