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Jacob C. Holzer

Bio: Jacob C. Holzer is an academic researcher from Harvard University. The author has contributed to research in topics: Epilepsy & Informed consent. The author has an hindex of 8, co-authored 14 publications receiving 512 citations. Previous affiliations of Jacob C. Holzer include Yale University & Tufts Medical Center.

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Journal ArticleDOI
TL;DR: Preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.
Abstract: The phenomenological features of 35 obsessive-compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.

209 citations

Journal ArticleDOI
TL;DR: The authors found that buspirone added to the treatment of 33 patients with obsessive-compulsive disorder who were refractory to the serotonin reuptake inhibitor fluvoxamine was no better than placebo in reducing obsessive-Compulsive, depressive, or anxiety symptoms.
Abstract: The authors found that buspirone added to the treatment of 33 patients with obsessive-compulsive disorder who were refractory to the serotonin reuptake inhibitor fluvoxamine was no better than placebo in reducing obsessive-compulsive, depressive, or anxiety symptoms. This finding suggests that addition of buspirone to ongoing fluvoxamine therapy is not an effective treatment strategy for most patients with obsessive-compulsive disorder.

119 citations

Journal ArticleDOI
TL;DR: Title Type frontal-subcortical circuits in psychiatric and neurological disorders PDF neurobiology of brain disorders biological basis of neurological and psychiatric disorders PDF pharmacological management of Neurology and Psychiatry disorders PDF neurological and Psychiatric disorders current clinical neurology PDF clinical neuropsychology interface with neurological andpsychiatric disorders PDF deep brain stimulation in neurological and psychiatry disorders current Clinical neurology
Abstract: Title Type frontal-subcortical circuits in psychiatric and neurological disorders PDF neurobiology of brain disorders biological basis of neurological and psychiatric disorders PDF pharmacological management of neurological and psychiatric disorders PDF neurological and psychiatric disorders current clinical neurology PDF clinical neuropsychology interface with neurological and psychiatric disorders PDF deep brain stimulation in neurological and psychiatric disorders current clinical neurology PDF literature neurology and neuroscience neurological and psychiatric disorders volume 206 progress in brain research PDF

59 citations

Journal Article
TL;DR: The results of this study support the association between the capacity to give informed consent in the hospital setting and measures of cognitive functioning, suggesting that utilization of cognitive function measures may strengthen the competency assessment process.
Abstract: Assessment of capacity to give informed consent in the general hospital setting usually rests on a clinical judgment made of a patient's understanding and appreciation of his or her illness, a process limited by its subjective nature, interexaminer variability, and relative deficiency of quantitative instruments available to provide collateral information. Inasmuch as identification of associated variables could strengthen this process, this study examines the association of cognitive functions to the capacity to give informed consent. Over a one-year period, 65 patients were evaluated independent of medical or psychiatric diagnoses. The study population consisted of medical and neurology inpatients seen for neuropsychiatric evaluation. All evaluations included assessment of capacity to give informed consent as it related to the reason for the admission to the hospital, followed by administration of the Hopkins Competency Assessment Test, the Mini-Mental Status Examination, the Trail-Making Test, Parts A and B, and the Executive Interview. Of 65 patients, 34 were excluded based on preset criteria. The remaining patients were assigned to either a "competent" or "noncompetent" group based on clinical evaluation. Number of patients, gender, and handedness distributions between groups were similar. The groups did not differ significantly in terms of age or education. Significant between-group differences were found on an empirical measure of competency, a general mental state measure, and on measures of attentional and executive cognitive functions. An analysis of classification rates indicated that a measure of executive cognitive functioning (Executive Interview) had the best sensitivity and specificity in correctly classifying competent and noncompetent patients. The results of this study support the association between the capacity to give informed consent in the hospital setting and measures of cognitive functioning, suggesting that utilization of cognitive function measures may strengthen the competency assessment process.

54 citations

Journal ArticleDOI
TL;DR: This work presents a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes and has important implications for all patients in the community who are marginalized or stereotyped during discussions of end- of-life treatment.
Abstract: End-of-life care is often influenced by the stereotyping of patients by age, diagnosis, or cultural identity. Two common stereotypes arise from the presumed incompetence of many patients to contribute to end-of-life decisions, and the fear that the discussions themselves will be de-stabilizing. We present a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes. The model, which draws on clinical research in competence and suicide risk assessment, has important implications for all patients in the community who are marginalized or stereotyped during discussions of end-of-life treatment.

22 citations


Cited by
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Journal ArticleDOI
TL;DR: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections.
Abstract: Objective: The purpose of this study was to describe the clinical characteristics of a novel group of patients with obsessive-compulsive disorder (OCD) and tic disorders, designated as pediatric autoimmune neuropsychiatric disorders associated with streptococcal (group A β-hemolytic streptococcal [GABHS]) infections (PANDAS). Method: The authors conducted a systematic clinical evaluation of 50 children who met all of the following five working diagnostic criteria: presence of OCD and/or a tic disorder, prepubertal symptom onset, episodic course of symptom severity, association with GABHS infections, and association with neurological abnormalities. Results: The children’s symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean=6.3 years, SD=2.7, for tics; mean=7.4 years, SD=2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children, there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure. Conclusions: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies. (Am J Psychiatry 1998; 155:264‐271)

1,286 citations

Journal ArticleDOI
TL;DR: The complex clinical presentation of OCD can be summarized with a few consistent, temporally stable symptom dimensions that can be understood as a spectrum of potentially overlapping syndromes that may coexist in any patient, be continuous with normal obsessive-compulsive phenomena, and extend beyond the traditional nosological boundaries of OCD.
Abstract: OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition. This heterogeneity can reduce the power and obscure the findings from natural history studies to genome scans, neuroimaging, and clinical trials. The authors review the evidence supporting a multidimensional model of OCD. METHOD: Computerized and manual literature searches were performed to identify factor-analytic studies of obsessive-compulsive symptoms before data from disciplines that bear on the potential usefulness of these dimensions were considered. Selection criteria included the novelty and importance of studies and their relevance to outcomes of interest to well-informed mental health professionals. RESULTS: Twelve factor-analytic studies involving more than 2,000 patients were identified that consistently extracted at least four symptom dimensions: symmetry/ordering, hoarding, contamination/cleaning, and obsessions/checking. These dimensions were associated with distinct patterns of comorbidity, genetic tra...

950 citations

Journal ArticleDOI
TL;DR: The state of the literature and opportunities for research related to "executive control function" (ECF), which has recently been separated from the specific cognitive domains traditionally used to assess patients, is reviewed.
Abstract: This report reviews the state of the literature and opportunities for research related to "executive control function" (ECF) ECF has recently been separated from the specific cognitive domains (memory, language, and praxis) traditionally used to assess patients ECF impairment has been associated with lesions to the frontal cortex and its basal ganglia-thalamic connections No single putative ECF measure can yet serve as a "gold standard" This and other obstacles to assessment of ECF are reviewed ECF impairment and related frontal system lesions and metabolic disturbances have been detected in many psychiatric and medical disorders and are strongly associated with functional outcomes, disability, and specific problem behaviors The prevalence and severity of ECF deficits in many disorders remain to be determined, and treatment has been attempted in only a few disorders Much more research in these areas is necessary

739 citations

Journal ArticleDOI
TL;DR: The four symptom dimensions identified in this study are largely congruent with those identified in earlier reports, and may be of value in future genetic, neurobiological, and treatment response studies.
Abstract: Objective Obsessive-compulsive disorder encompasses a broad range of symptoms that represent multiple psychological domains, including perception, cognition, emotion, social relatedness, and diverse motor behaviors. The purpose of these analyses was to evaluate the correlational relationships of the symptoms of obsessive-compulsive disorder. Method This study examined the 13 a priori categories used to group types of obsessions and compulsions in the Yale-Brown Obsessive Compulsive Scale symptom checklist in two independent groups of patients with obsessive-compulsive disorder (N = 208 and N = 98). A principal-components factor analysis with varimax rotation was performed, followed by a series of other exploratory analyses. Results The two data sets yielded nearly identical results. Four factors--obsessions and checking, symmetry and ordering, cleanliness and washing, and boarding--emerged in each data set, in total accounting for more than 60% of the variance. Conclusions Obsessive-compulsive disorder is a multidimensional and etiologically heterogeneous condition. The four symptom dimensions identified in this study are largely congruent with those identified in earlier reports. These factors may be of value in future genetic, neurobiological, and treatment response studies.

728 citations