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Laurito LD, dos Santos-Ribeiro S, Moreira-de-Oliveira ME, Loureiro CP, Hühne V, Torres B, de Faro LFT, de Menezes GB, Fontenelle LF. Online group therapies for anxiety, obsessive-compulsive, and trauma-related disorders: a systematic review. Front Hum Neurosci 2024; 17:1286865. [PMID: 38273884 PMCID: PMC10809799 DOI: 10.3389/fnhum.2023.1286865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background This systematic review examined the existing literature to determine the evidence supporting the efficacy of online group treatments for anxiety-, obsessive-compulsive- and trauma-related disorders (AOTDs). Methods A systematic review using the PUBMED, PsycInfo, Web of Science, and ClinicalTrials databases with no language, date, or study design filters was performed. The inclusion criteria comprised studies that examined individuals who had received a formal diagnosis of AOTDs, were aged 18 years or older, and had baseline and endpoint assessments of symptom severity using formal tools. Results Five studies on social anxiety disorder (SAD), four on post-traumatic stress disorder (PTSD) and one on tic disorders (TDs) were found. The studies were open-label (n = 2) and randomized controlled trials (RCTs) (n = 8), with five of the RCTs being non-inferiority trials. Most studies were conducted in the US and investigated psychological CBT based interventions via internet-based therapies (IBT: n = 4), video teleconferencing (VTC: n = 5) or a combination of both (n = 1). In SAD, IBT studies associated with a clinician assisted web-based forum (here termed "forum-enhanced" studies) were superior to waiting lists and not inferior to similar versions that were also "forum enhanced" but self-guided, "telephone enhanced" by a contact with a non-specialist, and "email enhanced" by a contact with a clinician individually. Studies involving VTC have shown comparable effectiveness to in-person interventions across some online group CBT based treatments for PTSD. Two open trials also demonstrated symptoms reductions of social anxiety and tics through VTC. Conclusion There is evidence supporting the effectiveness of online group treatments for SAD and PTSD. Further studies from different research groups may be needed to replicate the use of these and other forms of online treatments in individuals with SAD, PTSD, and other clinical populations, such as OCD, panic disorder, agoraphobia and specific phobias. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023408491.
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Affiliation(s)
- Luana D. Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samara dos Santos-Ribeiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria E. Moreira-de-Oliveira
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carla P. Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Verônica Hühne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Torres
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Livi Ferreira Testoni de Faro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela B. de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Leonardo F. Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Nickson D, Singmann H, Meyer C, Toro C, Walasek L. Replicability and reproducibility of predictive models for diagnosis of depression among young adults using Electronic Health Records. Diagn Progn Res 2023; 7:25. [PMID: 38049919 PMCID: PMC10696659 DOI: 10.1186/s41512-023-00160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/10/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Recent advances in machine learning combined with the growing availability of digitized health records offer new opportunities for improving early diagnosis of depression. An emerging body of research shows that Electronic Health Records can be used to accurately predict cases of depression on the basis of individual's primary care records. The successes of these studies are undeniable, but there is a growing concern that their results may not be replicable, which could cast doubt on their clinical usefulness. METHODS To address this issue in the present paper, we set out to reproduce and replicate the work by Nichols et al. (2018), who trained predictive models of depression among young adults using Electronic Healthcare Records. Our contribution consists of three parts. First, we attempt to replicate the methodology used by the original authors, acquiring a more up-to-date set of primary health care records to the same specification and reproducing their data processing and analysis. Second, we test models presented in the original paper on our own data, thus providing out-of-sample prediction of the predictive models. Third, we extend past work by considering several novel machine-learning approaches in an attempt to improve the predictive accuracy achieved in the original work. RESULTS In summary, our results demonstrate that the work of Nichols et al. is largely reproducible and replicable. This was the case both for the replication of the original model and the out-of-sample replication applying NRCBM coefficients to our new EHRs data. Although alternative predictive models did not improve model performance over standard logistic regression, our results indicate that stepwise variable selection is not stable even in the case of large data sets. CONCLUSION We discuss the challenges associated with the research on mental health and Electronic Health Records, including the need to produce interpretable and robust models. We demonstrated some potential issues associated with the reliance on EHRs, including changes in the regulations and guidelines (such as the QOF guidelines in the UK) and reliance on visits to GP as a predictor of specific disorders.
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Affiliation(s)
| | - Henrik Singmann
- Department of Experimental Psychology, University College London, London, UK
| | - Caroline Meyer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Carla Toro
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, UK
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Nickson D, Meyer C, Walasek L, Toro C. Prediction and diagnosis of depression using machine learning with electronic health records data: a systematic review. BMC Med Inform Decis Mak 2023; 23:271. [PMID: 38012655 PMCID: PMC10680172 DOI: 10.1186/s12911-023-02341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Depression is one of the most significant health conditions in personal, social, and economic impact. The aim of this review is to summarize existing literature in which machine learning methods have been used in combination with Electronic Health Records for prediction of depression. METHODS Systematic literature searches were conducted within arXiv, PubMed, PsycINFO, Science Direct, SCOPUS and Web of Science electronic databases. Searches were restricted to information published after 2010 (from 1st January 2011 onwards) and were updated prior to the final synthesis of data (27th January 2022). RESULTS Following the PRISMA process, the initial 744 studies were reduced to 19 eligible for detailed evaluation. Data extraction identified machine learning methods used, types of predictors used, the definition of depression, classification performance achieved, sample size, and benchmarks used. Area Under the Curve (AUC) values more than 0.9 were claimed, though the average was around 0.8. Regression methods proved as effective as more developed machine learning techniques. LIMITATIONS The categorization, definition, and identification of the numbers of predictors used within models was sometimes difficult to establish, Studies were largely Western Educated Industrialised, Rich, Democratic (WEIRD) in demography. CONCLUSION This review supports the potential use of machine learning techniques with Electronic Health Records for the prediction of depression. All the selected studies used clinically based, though sometimes broad, definitions of depression as their classification criteria. The reported performance of the studies was comparable to or even better than that found in primary care. There are concerns with generalizability and interpretability.
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Affiliation(s)
| | - Caroline Meyer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, UK
| | - Carla Toro
- Warwick Medical School, University of Warwick, Coventry, UK
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4
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Zemach S, Minkin Levy D, Zohar J. Neuroscience-based nomenclature as a teaching tool, introduction and pilot study. Int Clin Psychopharmacol 2023; 38:329-335. [PMID: 37159166 DOI: 10.1097/yic.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Neuroscience-based nomenclature (NbN) is a pharmacologically-driven nomenclature aiming to replace the current disease-based nomenclature of psychotropics, focusing on pharmacology and mode-of-action to encourage scientifically-minded prescribing. NbN might also be used as a teaching tool as it presents the depth and richness of the neuroscience of psychotropics. This study examines the effect of using NbN in student curriculum. Fifty-six medical students during clerkship in psychiatry, divided into a control group ( n = 20), taught standard psychopharmacology, and an intervention group ( n = 36) introduced with NbN. Both groups filled out identical questionnaires at the beginning and end of the clerkship, including questions of knowledge on psychopharmacology, views on current terminology and interest in psychiatric residency. Comparing the average change in scorings (delta post-pre) for each item in intervention vs. control questionnaires, the intervention group showed a significantly larger positive delta in 6 out of 10 items than the control group. Mean scores did not differ significantly between the two groups in the pre-questionnaires, while significantly higher scores were shown for the intervention group in within- and between-group comparisons. Introduction of NbN was associated with a better educational experience, a deeper understanding of psychotropics and increased interest in psychiatric residency.
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Affiliation(s)
- Sasson Zemach
- Women's Inpatient Unit, The Jerusalem Mental Health Center
| | | | - Joseph Zohar
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel
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5
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Oluyomi AO, Schneider SC, Christian C, Alvarez JM, Smárason O, Goodman WK, Storch EA. Geospatial Distribution of Obsessive-Compulsive Disorder Specialists: Understanding Access as a Function of Distance, Insurance Status, and Neighborhood Socioeconomic Status. J Obsessive Compuls Relat Disord 2023; 38:100829. [PMID: 37614722 PMCID: PMC10443932 DOI: 10.1016/j.jocrd.2023.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Obsessive-compulsive disorder is an impairing psychiatric condition affecting 1-2% of adults and youth. Cognitive-behavioral therapy with exposure and response prevention (CBT) is an efficacious intervention but requires specialty training and access is often limited. While certain factors are associated with treatment access, one key barrier that has not been explored is the geographic availability of OCD treatment providers. Using integrated geographically-referenced data, we examined the geographic distribution of OCD CBT specialty providers across the state of Texas, with particular attention to the relationship to neighborhood socioeconomic disadvantage, insurance status, and rural versus urban status. We found that specialist providers are almost exclusively located inside the highly urbanized parts of the state, primarily in more affluent areas, and often only accept self-pay. The characteristics of the areas located the furthest away from specialty OCD care include a high proportion of persons identifying as Hispanic; a high proportion of non-English speakers, households with income below poverty; households with no vehicles; and persons with no health insurance. Average household income decreased as distances from specialist providers increased. Broadly, findings confirm that OCD CBT specialty providers are clustered in large socially advantaged areas and that economic disadvantage remains a significant barrier to care. As inadequate or inappropriate treatment of OCD is likely to result in sustained and impairing symptoms, this is of great concern.
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Affiliation(s)
- Abiodun O Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Environmental Health Service, Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
- Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Catherine Christian
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Juan M Alvarez
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Orri Smárason
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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6
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Cooper DDJ, Perkes IE, Lam-Po-Tang J, Farrell LJ, Brakoulias V, Grisham JR. Finding help for OCD in Australia: development and evaluation of a clinician directory. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2023.2189003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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7
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Bai M, Huang E, Du H, Yang L, Zhang X, Yang Y, Yan Z, Wang W. Fluoxetine combined with risperidone in treatment of online gambling disorder-case report. Heliyon 2023; 9:e13772. [PMID: 36895358 PMCID: PMC9989641 DOI: 10.1016/j.heliyon.2023.e13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/11/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Pathological gambling leaves seriously negative impacts on individuals, families, and society. With the universal use of internet, online gambling disorder is also increasing worldwide. However, there is currently a lack of effective treatments, especially medical treatments, for online gambling disorder. This study shared 3 cases of online gambling disorder that was treated with combined fluoxetine and risperidone to provide an option for the treatment of online gambling.
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Affiliation(s)
- Mei Bai
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
| | - Erjia Huang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Surgery, The Second Xiangya Hospital Central South University, Changsha, China
| | - Huijie Du
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
| | - Lu Yang
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
| | - Xin Zhang
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
| | - Yang Yang
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
| | - Zhe Yan
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
| | - Wei Wang
- The First People's Hospital of Guiyang, Guiyang, Guizhou, 550001, China
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8
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Fontenelle LF, Nicolini H, Brakoulias V. Early intervention in obsessive-compulsive disorder: From theory to practice. Compr Psychiatry 2022; 119:152353. [PMID: 36341748 DOI: 10.1016/j.comppsych.2022.152353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/03/2022] [Accepted: 10/24/2022] [Indexed: 01/31/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is frequent and often disabling. Yet, correct diagnosis and appropriate treatment implementation are usually delayed, with undesirable consequences. In this paper we review the rationale for early intervention in OCD and provide recommendations for early intervention services. Two scenarios are discussed, i.e., subclinical (prodromal) obsessive-compulsive symptoms (OCS) and full-blown OCD. Although the typical patient with OCD reports a long history of subclinical OCS, longitudinal studies suggest most individuals with OCS in the community do not convert to full-blown OCD. Thus, research on "at risk" phenotypes for OCD and how they should incorporate different risk factors (e.g., polygenic risk scores) are badly needed. For this specific scenario, preventative treatments that are cheap, well tolerated and highly scalable (e.g., lifestyle interventions) are of major interest. On the other hand, increasing evidence suggests OCD to be a progressive disorder and the severity and duration of illness to be associated with both biological changes and increased clinical complexity, including greater number of physical and psychiatric comorbidities, increased family accommodation and worse treatment response. Therefore, prompt identification and early treatment implementation for full-blown OCD are also critical for ethical, clinical and therapeutic reasons. Based on the existing findings, we argue that, regardless of focusing on subclinical OCS or clinical OCD, early intervention services need to target a childhood age group. In addition to delivering well established treatments to people with full-blown OCD early on their illness, early intervention services also need to provide psychoeducation for patients, families and teachers.
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Affiliation(s)
- Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico; Clinical Research, Carracci Medical Group, Mexico City, Mexico
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District Mental Health Service, Sydney, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia
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9
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Deest M, Wieting J, Jakob MM, Deest-Gaubatz S, Groh A, Seifert J, Toto S, Bleich S, Frieling H, Eberlein CK. Aripiprazole treatment for temper outbursts in Prader-Willi syndrome. Orphanet J Rare Dis 2022; 17:324. [PMID: 36028863 PMCID: PMC9419314 DOI: 10.1186/s13023-022-02470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Prader–Willi syndrome (PWS) is a rare neurodevelopmental disorder based on a loss of paternally expressed genes in chromosome segment 15q11-13. Behavioral traits such as temper outbursts, stereotypic, and ritualistic behavior, as well as an increased risk of psychosis accompany the syndrome, representing a major issue in the treatment of adults with PWS. Up to now, no treatment guideline for these conditions in PWS exist. This study aimed to retrospectively analyze the effect and adverse effects of treatment with aripiprazole for temper outbursts in 10 adults with PWS.
Results Aripiprazole was prescribed for temper outbursts (n = 10). Treatment outcome was assessed using the Clinical Global Impression-Severity (CGI-S) and -Improvement Scale (CGI-I). Treatment success (CGI-I < 3) was observed in 70% of cases, with adverse effects from mild to partly serious extent in 60% of cases. The major adverse effect observed was increased daytime sleepiness. In total, 50% of the individuals were treated successfully for temper outbursts. The BMI did not change significantly in the successfully treated group after 6 months of treatment. Conclusions Aripiprazole can be a treatment option for temper outbursts in people with PWS. Although a high rate of side effects was detected, their severity led to discontinuation in only 20% of the cases. Furthermore, the absence of weight gain makes aripiprazole interesting especially for the PWS population.
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Affiliation(s)
- Maximilian Deest
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Jelte Wieting
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Maximilian Michael Jakob
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stephanie Deest-Gaubatz
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian K Eberlein
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Cifter A, Erdogdu AB. Are the symptom dimensions a predictor of short-term response to pharmacotherapy in pediatric obsessive-compulsive disorder? A retrospective cohort study. Indian J Psychiatry 2022; 64:395-400. [PMID: 36060710 PMCID: PMC9435618 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_896_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/09/2021] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) symptom dimensions respond differently to behavioral and pharmacological interventions, and some dimensions are reported to be more resistant to treatment. AIM We aimed to investigate the responses of three symptom dimensions (harm/sexual, symmetry/hoarding, and contamination/cleaning) to serotonin reuptake inhibitor (SRI) therapy in pediatric OCD. METHODS Children who were between 6 and 17 years old, diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, followed up at our clinic for at least 3 months, and received SRI treatment were included in our study. Response to treatment was assessed using the Clinical Global Impressions scale. Predictors of treatment response were analyzed using regression models. RESULTS Of the 102 children with a mean age of 11.84 ± 2.87 years, 57.8% were male and the mean follow-up period was 12.39 ± 9.55 months. The overall response rate to pharmacotherapy was 66.7%. Patients with symmetry/hoarding symptoms [relative risk (RR) = 0.66, 95% confidence interval (CI) (0.12-0.79), P = 0.015] did not respond as well to SRIs. Besides, adolescent age (RR = 0.65, 95% CI (0.10-0.73), P = 0.01) was associated with a less favorable SRI response. CONCLUSION This study shows that symptom dimensions are one of the factors predicting response to pharmacotherapy in pediatric OCD. It is hypothesized that considering the dimensions is important to plan more appropriate treatment and provide more accurate prognostic information when assessing children with OCD.
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Affiliation(s)
- Anil Cifter
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum Rotenburg, 27356 Rotenburg, Germany
| | - Ayse Burcu Erdogdu
- Department of Child and Adolescent Psychiatry, School of Medicine, Marmara University, 34899 Istanbul, Turkey
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Wang P, Gu W, Gao J, Wang C, Fang J, Hu M, Xiang H, Li B, Liu N, Tang W, Wang X, Jia Y, Li Y, Cheng Y, Tang Z, Simpson HB, Stein DJ, Wang Z. Protocol for a Pragmatic Trial of Pharmacotherapy Options Following Unsatisfactory Initial Treatment in OCD (PROCEED). Front Psychiatry 2022; 13:822976. [PMID: 35651818 PMCID: PMC9150605 DOI: 10.3389/fpsyt.2022.822976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/04/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), but a large proportion of patients do not achieve remission after an adequate SSRI trial. To the best of our knowledge, there have been no well-powered randomized controlled trials (RCTs) of sequenced pharmacotherapy using pragmatic research designs. China provides a unique context for undertaking such a trial that will recruit the largest treatment-naïve participants and systematically compare the efficacy of different sequenced pharmacotherapy. METHODS A pragmatic research design will be adopted, with n = 1,600 treatment-naïve OCD patients initially treated for sertraline for 12 weeks, and with non-remitters then randomized to 5 different augmentation or switching pharmacotherapy options for another 12 weeks. The 5 arms will include: (1) treatment with higher than usual doses of sertraline, (2) switch to fluvoxamine, (3) switch to venlafaxine, (4) augmentation with memantine, and (5) augmentation with aripiprazole. DISCUSSION China is uniquely positioned to recruit sufficiently large sample sizes of treatment-naïve OCD patients to compare different pharmacotherapy options; data from the proposed trial promises to help inform current clinical practice guidelines by providing important information about optimal pharmacotherapy choice for those who demonstrate no response or response but no remission to first line pharmacotherapy. TRIAL REGISTRATION The trail was registered on 27 August 2020 in ClinicalTrials.gov (https://register.clinicaltrials.gov/) (NCT04539951).
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Affiliation(s)
- Pei Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Gu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changhong Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Jianqun Fang
- Mental Health Center, General Hospital of Ningxia Medical University, Ningxia, China
| | - Maorong Hu
- Psychiatry Department, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Hui Xiang
- Guizhou Provincial People's Hospital, Guizhou, China
| | - Bin Li
- Mental Health Center, West China Hospital, The Sichuan University, Sichuan, China
| | - Na Liu
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenxin Tang
- Hangzhou Seventh People's Hospital, Mental Health Center Zhejiang University School of Medicine, Zhejiang, China
| | - Xijin Wang
- The First Psychiatric Hospital of Harbin, Heilongjiang, China
| | - Yanbin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yi Li
- Wuhan Mental Health Center, Hubei, China
| | - Yuqi Cheng
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhen Tang
- Suzhou Guangji Hospital, Jiangsu, China
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Dan J Stein
- Department of Psychiatry and South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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Matsumoto Y, Nakamae T, Abe Y, Watanabe A, Narumoto J. Duration of untreated illness of patients with obsessive-compulsive disorder in Japan. Early Interv Psychiatry 2021; 15:1644-1649. [PMID: 33372398 PMCID: PMC9290628 DOI: 10.1111/eip.13105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/20/2020] [Accepted: 12/13/2020] [Indexed: 12/15/2022]
Abstract
AIM Obsessive-compulsive disorder (OCD) is a common and severe disease; however, the duration of untreated illness (DUI) of OCD is approximately 7 years, which is longer than that of other psychiatric disorders. Differences in medical environments have been reported to affect the DUI. Therefore, we surveyed the DUI of OCD in Japan and the reason for delayed treatment. METHODS The study participants were outpatients who visited the OCD specialty outpatient clinic for the first time between June 1, 2017 and May 31, 2019. Obsessive-compulsive disorder was diagnosed using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and semistructured clinical interviews, which included asking the reason for the delay in seeking treatment and treatment drop-out history. RESULTS Seventy-one patients met the inclusion criteria for the study. The mean period between OCD and the first visit to the hospital was 2.8 years and the mean DUI of OCD was 4.7 years. There was a significant difference in the history of tic disorders and treatment drop out between patients with a DUI of >2 years and those with a DUI of ≤2 years. The most common reason for delaying treatment was that the patient did not consider the symptoms of OCD to be those of an illness, and the most common reason for dropping out of treatment was lack of improvement. CONCLUSIONS This was the first study on the DUI of OCD in Japan. The DUI was relatively shorter than that found by studies in other countries. Stopping treatment lengthened the duration of the illness. Preventing the patient from dropping out of treatment could further shorten the duration of the illness.
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Affiliation(s)
- Yoshihiro Matsumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Nakamae
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinari Abe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Anri Watanabe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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13
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Pozza A, Dèttore D, Marazziti D, Doron G, Barcaccia B, Pallini S. Facets of adult attachment style in patients with obsessive-compulsive disorder. J Psychiatr Res 2021; 144:14-25. [PMID: 34592507 DOI: 10.1016/j.jpsychires.2021.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
Literature data did not show univocal evidence in discriminating which form of attachment insecurity is involved in obsessive-compulsive disorder (OCD): both anxiety and avoidance was related to OCD symptomatology. No study used the Attachment Style Questionnaire (ASQ) that allows for investigation of differentiated facets of attachment anxiety and of avoidance. We investigated: (1) whether individuals with OCD differed from controls in the facets of attachment security (anxiety and avoidance), (2) which attachment facets predicted a diagnosis of OCD, controlling for socio-demographics and obsessive beliefs, (3) which attachment facets predicted specific OCD symptoms, controlling for socio-demographics and obsessive beliefs. Two hundred seventy participants (135 OCD patients and 135 matched controls) completed the Obsessive-Compulsive Inventory-Revised, Obsessive Beliefs Questionnaire-46 and ASQ. OCD patients reported respectively lower and higher levels on confidence and attachment anxiety than controls. Higher need of approval was the most important predictor of OCD diagnosis beyond the other attachment facets, and even of the obsessive beliefs. Using multivariate generalised linear models, the two facets of attachment anxiety, the need for approval (that predicted higher levels of obsessing and ordering symptoms), and preoccupation with relationships (that predicted higher hoarding symptoms) seemed to explain variance over and above OCD-related beliefs and socio-demographics. Discomfort with closeness contributed to the predictions of ordering symptoms. In conclusion, the interpersonal dynamics related to attachment in OCD patients should be carefully considered during assessment and treatment of OCD patients in clinical practice.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Pisa, Italy; Unicamillus University, Rome, Italy; Brain Research Foundation, Lucca, Italy
| | - Guy Doron
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Barbara Barcaccia
- Department of Education, Roma Tre University, Rome, Italy; Associazione di Psicologia Cognitiva APC and Scuola di Psicoterapia Cognitiva srl SPC, Rome, Italy
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14
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Moritz S, Xie J, Lion D, Penney D, Jelinek L. Impaired test performance yet spared neurocognitive functioning in individuals with obsessive-compulsive disorder: the role of performance mediators. Cogn Neuropsychiatry 2021; 26:394-407. [PMID: 34431448 DOI: 10.1080/13546805.2021.1967733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although most studies report neurocognitive deficits in patients with obsessive-compulsive disorder (OCD), important exceptions exist, highlighting the possible role of mediators (e.g., poor motivation). This study investigated neurocognitive functioning and potential influences affecting performance in OCD. METHODS Forty-three participants (13 OCD patients, 30 healthy controls) were assessed using a battery of neurocognitive tests. During the assessment, the examiner completed the Impact on Performance Scale (IPS) which measures variables that may impact neurocognitive performance. RESULTS Pooled neurocognitive performance was lower in OCD patients versus healthy controls at a moderate effect size. Patients performed more poorly on the IPS, particularly the Well-Being During Assessment subscale. Performance differences across the two groups were attenuated to a non-significant small-to-medium effect when the IPS was entered as a covariate. A total of 34% of patients showed scores greater than one standard deviation below the mean compared to 9.63% in healthy individuals. Yet, when a conservative impairment criterion (≥2 standard deviations below the mean) was applied, less than 10% of patients displayed deficits. CONCLUSIONS Neurocognitive impairment in OCD is likely exaggerated. In addition to considering important mediators researchers should report the percentage of participants displaying performance deficits rather than mean group differences alone; the latter obscures the high percentage of patients without impairment and thus may unduly foster stigma in this population.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jingyuan Xie
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Despina Lion
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Danielle Penney
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l'Île-de-Montréal, Douglas Mental Health University Institute, Montréal, Canada
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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Parental rearing and personality traits as predictors for adolescents with obsessive-compulsive disorder (OCD). Dev Psychopathol 2021; 34:387-394. [PMID: 33432895 DOI: 10.1017/s095457942000108x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We aim to determine the correlation between parental rearing, personality traits, and obsessive-compulsive disorder (OCD) in different quantiles. In particular, we created an intermediary effect model in which parental rearing affects OCD through personality traits. All predictors were measured at the time of the survey, comprising parental rearing (paternal rearing and maternal rearing), demographics (grade and gender), and personality traits (neuroticism, extroversion, and psychoticism). These results suggest that (a) paternal emotional warmth was negatively correlated with OCD at the 0.40-0.80 quantile, while maternal emotional warmth was positively correlated with the OCD at the 0.45-0.69 quantile. (b) The correlation between negative parental rearing and OCD ranged from the 0.67 to 0.95 quantile for paternal punishment, 0.14-0.82 quantile for paternal overprotection, 0.05-0.36 and >0.50 quantile for maternal over-intervention and overprotection, and 0.08-0.88 quantile for maternal rejection. (c) Extroversion, neuroticism, and psychoticism were not only associated with OCD in a particular quantile but also mediated between parental rearing (namely parental emotional warmth, paternal punishment, paternal overprotection, maternal rejection, maternal over-intervention, and overprotection) and OCD. These findings provide targets for early interventions of OCD to improve the form of family education and personality traits and warrant validation.
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17
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Sexual Arousal in Obsessive-Compulsive Disorder With and Without Contamination/Washing Symptoms: A Moderating Role of Disgust Sensitivity. J Nerv Ment Dis 2020; 208:694-700. [PMID: 32366750 DOI: 10.1097/nmd.0000000000001184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Different findings would indicate that obsessive-compulsive disorder (OCD), a common psychiatric condition, might significantly impair intimate relationships and sexual well-being. The aim of the present study was to ascertain whether OCD outpatients with contamination/washing symptoms experience a lower sexual arousal than those experiencing other symptoms. In addition, we explored whether a higher disgust propensity/sensitivity might moderate the relation between contamination/washing symptoms and impaired sexual arousal. A total of 72 outpatients (27 with contamination/washing symptoms and 45 with other obsessive-compulsive symptoms) were selected for this study and assessed by a battery of specific rating scales. The results highlighted how OCD patients with contamination/washing symptoms and higher disgust sensitivity showed an increased propensity to inhibition due to threat of sexual performance failure and consequences. It may be speculated that the disgust sensitivity may be a mechanism involved in the impairment of this well-being domain. In conclusion, these findings suggest that the sexual wellbeing should be evaluated during routine clinical evaluation of OCD patients.
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18
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Görmezoğlu M, Bouwens van der Vlis T, Schruers K, Ackermans L, Polosan M, Leentjens AF. Effectiveness, Timing and Procedural Aspects of Cognitive Behavioral Therapy after Deep Brain Stimulation for Therapy-Resistant Obsessive Compulsive Disorder: A Systematic Review. J Clin Med 2020; 9:jcm9082383. [PMID: 32722565 PMCID: PMC7464329 DOI: 10.3390/jcm9082383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background and aim: Deep brain stimulation (DBS) is an effective treatment for patients with severe therapy-resistant obsessive-compulsive disorder (OCD). After initiating DBS many patients still require medication and/or behavioral therapy to deal with persisting symptoms and habitual behaviors. The clinical practice of administering postoperative cognitive behavioral therapy (CBT) varies widely, and there are no clinical guidelines for this add-on therapy. The aim of this review is to assess the efficacy, timing and procedural aspects of postoperative CBT in OCD patients treated with DBS. Method: Systematic review of literature. Results: The search yielded 5 original studies, one case series and three reviews. Only two clinical trials have explicitly focused on the effectiveness of CBT added to DBS in patients with therapy-resistant OCD. These two studies both showed effectiveness of CBT. However, they had a distinctly different design, very small sample sizes and different ways of administering the therapy. Therefore, no firm conclusions can be drawn or recommendations made for administering CBT after DBS for therapy-resistant OCD. Conclusion: The effectiveness, timing and procedural aspects of CBT added to DBS in therapy-resistant OCD have hardly been studied. Preliminary evidence indicates that CBT has an added effect in OCD patients being treated with DBS. Since the overall treatment effect is the combined result of DBS, medication and CBT, future trials should be designed in such a way that they allow quantification of the effects of these add-on therapies in OCD patients treated with DBS. Only in this way information can be gathered that contributes to the development of an algorithm and clinical guidelines for concomittant therapies to optimize treatment effects in OCD patients being treated with DBS.
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Affiliation(s)
- Meltem Görmezoğlu
- Department of Psychiatry, Ondokuz Mayıs University, 55270 Samsun, Turkey;
- Department of Neurosurgery, Maastricht University Medical Centre, 6229 Maastricht, The Netherlands; (T.B.v.d.V.); (L.A.)
| | - Tim Bouwens van der Vlis
- Department of Neurosurgery, Maastricht University Medical Centre, 6229 Maastricht, The Netherlands; (T.B.v.d.V.); (L.A.)
| | - Koen Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, 6229 Maastricht, The Netherlands;
- School of Mental Health and Neuroscience, Maastricht University, 6229 Maastricht, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Centre, 6229 Maastricht, The Netherlands; (T.B.v.d.V.); (L.A.)
- School of Mental Health and Neuroscience, Maastricht University, 6229 Maastricht, The Netherlands
| | - Mircea Polosan
- Grenoble Institute of Neurosciences, University of Grenoble Alpes, 38058 Grenoble, France;
| | - Albert F.G. Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, 6229 Maastricht, The Netherlands;
- School of Mental Health and Neuroscience, Maastricht University, 6229 Maastricht, The Netherlands
- Correspondence:
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19
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Raviv N, Staudt MD, Rock AK, MacDonell J, Slyer J, Pilitsis JG. A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. Neurosurgery 2020; 87:1098-1110. [PMID: 32615588 DOI: 10.1093/neuros/nyaa249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated. OBJECTIVE To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature. METHODS A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates. CONCLUSION The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.
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Affiliation(s)
- Nataly Raviv
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Andrew K Rock
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Jacquelyn MacDonell
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Julia Slyer
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
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20
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Fatori D, Costa DL, Asbahr FR, Ferrão YA, Rosário MC, Miguel EC, Shavitt RG, Batistuzzo MC. Is it time to change the gold standard of obsessive-compulsive disorder severity assessment? Factor structure of the Yale-Brown Obsessive-Compulsive Scale. Aust N Z J Psychiatry 2020; 54:732-742. [PMID: 32475123 DOI: 10.1177/0004867420924113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The Yale-Brown Obsessive-Compulsive Scale has been considered the gold standard scale to assess obsessive-compulsive disorder severity. Previous studies using exploratory factor analysis and confirmatory factor analysis with this scale showed mixed findings in terms of factor structure and fit of models. Therefore, we used confirmatory factor analysis to compare different Yale-Brown Obsessive-Compulsive Scale models in a large sample aiming to identify the best model fit. METHODS We assessed adult obsessive-compulsive disorder patients (n = 955) using three measures: Yale-Brown Obsessive-Compulsive Scale severity ratings, the Dimensional Yale-Brown Obsessive-Compulsive Scale and the clinical global impression scale. We tested all factor structures reported by previous studies to investigate which model best fitted the data: one-factor, two-factor, three-factor and their equivalent high-order solutions. We also investigated Yale-Brown Obsessive-Compulsive Scale items correlations with scores from the other measures of obsessive-compulsive disorder severity. RESULTS Confirmatory factor analysis models presented mediocre to fair goodness-of-fit indexes. Severity items related to resistance to obsessions and compulsions presented low factor loadings. The model with the best fit indexes was a high-order model without obsessive-compulsive disorder resistance items. These items also presented small correlations with other obsessive-compulsive disorder severity measures. CONCLUSION The obsessive-compulsive disorder field needs to discuss further improvements in the Yale-Brown Obsessive-Compulsive Scale and/or continue to search for better measures of obsessive-compulsive disorder severity.
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Affiliation(s)
- Daniel Fatori
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Daniel Lc Costa
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Fernando R Asbahr
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Maria Conceição Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Euripedes C Miguel
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Roseli G Shavitt
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Marcelo C Batistuzzo
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil.,Department of Methods and Techniques, Psychology Course, Pontifical Catholic University of São Paulo, São Paulo, Brazil
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21
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Marazziti D, Pozza A, Avella MT, Mucci F. What is the impact of pharmacotherapy on psychotherapy for obsessive-compulsive disorder? Expert Opin Pharmacother 2020; 21:1651-1654. [PMID: 32543242 DOI: 10.1080/14656566.2020.1775814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa , Pisa, Italy.,UniCamillus - Saint Camillus International University of Health Sciences , Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa , Pisa, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena , Siena, Italy
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22
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Talaei A, Hosseini FF, Aghili Z, Akhondzadeh S, Asadpour E, Mehramiz NJ, Forouzanfar F. A comparative, single-blind, randomized study on quetiapine and aripiperazole augmentation in treatment of selective serotonin reuptake inhibitor refractory obsessive-compulsive disorder. Can J Physiol Pharmacol 2020; 98:236-242. [PMID: 32228235 DOI: 10.1139/cjpp-2019-0381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder, of unknown etiology, that affects 2.5% of the population. An appropriate therapeutic response to conventional treatment is seen. Some studies use augmentative treatment by antipsychotics, glutamatergic, lithium, buspirone, and others agents to improve the therapeutic response. In this study, we aimed to evaluate the efficacy and tolerability of aripiprazole and quetiapine as augmentative treatments in patients with selective serotonin reuptake inhibitor (SSRI) refractory OCD. The OCD patients were initially treated for 12 weeks with a SSRI. If after 12 weeks their Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score was more than 16, they were randomly assigned to either the aripiprazole or the quetiapine augmentation group for an additional 12 weeks. There were no significant differences in age, sex, education, marital status, or score of Y-BOCS and Clinical Global Impression-Severity Scale (CGI-S) between groups (p > 0.05) at the outset of the study. Significant differences were noted after 1 month when compared with results at 2, 3, and 4 months in both groups (p < 0.001). Both quetiapine and aripiprazole may be effective and well-tolerated augmentative agents in the treatment of SSRI-refractory OCD. Because of positive results, aripiprazole may be considered more effective and may have a more rapid onset in terms of therapeutic response.
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Affiliation(s)
- Ali Talaei
- Psychiatry and Behavioral Sciences Research Center and Department of Psychiatry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Farid Hosseini
- Psychiatry and Behavioral Sciences Research Center and Department of Psychiatry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Aghili
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Asadpour
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fatemeh Forouzanfar
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Neuroscience, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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23
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Shafti SS, Kaviani H. Adjunctive quetiapine may help fluvoxamine-resistant obsessive-compulsive disorder among female in-patients: A randomized-controlled study. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1597584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Saeed Shoja Shafti
- Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Razi Psychiatric Hospital, Tehran, Iran
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