Exploring yale-brown obsessive-compulsive scale symptom structure in Iranian OCD patients using item-based factor analysis

Agency in the process of change: Investigating the experience of patients with obsessive-compulsive disorder and their counsellors

OBJECTIVES

The aim of this study was to explore how client's agency appears in the narratives of patients with obsessive compulsive disorder.

METHODS

A qualitative descriptive design was used as a study design and a thematic analysis was employed to collect and analyse the data. Semi-structured interviews were conducted with 37 participants (26 patients with obsessive compulsive disorder and 11 counselors). All patients had received tele-counseling.

RESULTS

Three main themes were extracted from the data including agency prior to the therapy, agency via awareness, and enhancers of client's agency.

CONCLUSIONS

Findings demonstrated that when the participants became aware of having OCD and underwent therapy with self-involvement, they achieved a higher level of agency in the therapy process and achieve better treatment results. Culture may also influence on how the disorder is experienced, and the level of agency in starting and following the required treatments.

PRACTICE IMPLICATIONS

The results could be used by counsellors to enhance their clients' agency.

Response to Fluvoxamine in the Obsessive-Compulsive Disorder Patients: Bayesian Ordinal Quantile Regression

Background:

Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or mental behaviors to relieve discomfort. 40-60% of patients do not respond to Serotonin Reuptake Inhibitors, including fluvoxamine therapy.

Introduction:

The aim of the study is to identify the predictors of fluvoxamine therapy in OCD patients by Bayesian Ordinal Quantile Regression Model.

Methods:

This study was performed on 109 patients with OCD. Three methods, including Bayesian ordinal quantile, probit, and logistic regression models, were applied to identify predictors of response to fluvoxamine. The accuracy and weighted kappa were used to evaluate these models.

Results:

Our result showed that rs3780413 (mean=-0.69, sd=0.39) and cleaning dimension (mean=-0.61, sd=0.20) had reverse effects on response to fluvoxamine therapy in Bayesian ordinal probit and logistic regression models. In the 75^th quantile regression model, marital status (mean=1.62, sd=0.47) and family history (mean=1.33, sd=0.61) had a direct effect, and cleaning (mean=-1.10, sd=0.37) and somatic (mean=-0.58, sd=0.27) dimensions had reverse effects on response to fluvoxamine therapy.

Conclusion:

Response to fluvoxamine is a multifactorial problem and can be different in the levels of socio-demographic, genetic, and clinical predictors. Marital status, familial history, cleaning, and somatic dimensions are associated with response to fluvoxamine therapy.

Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates

Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.

A comparison of cluster and factor analytic techniques for identifying symptom-based dimensions of obsessive-compulsive disorder

A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.

Obsessions Across Two Cultures: A Comparison of Belgian and Turkish Non-clinical Samples

There is a growing interest in the role of culture in Obsessive-Compulsive Disorder, yet cultural studies to date have suffered from methodological limitations and lack a clear theoretical framework. In the current study, we adopted a rigorous methodological approach, and a clear cultural psychological framework. We compared the structure and frequency of obsessions in non-clinical samples (N = 706) from Belgium, a Western culture, and Turkey, a non-Western cultural context. Obsessions were measured by a newly compiled instrument that included a broad range of obsessions. Cross-cultural equivalence of the structure of obsessions was assessed both in the pooled data, and in each culture separately. At an abstract level, we found a two-factor structure that was cross-culturally invariant, and that fit both cultures equally well. These two types of obsessions each corresponded with a different model of agency. Compared to the Turkish sample, the Belgian sample reported more obsessions that can be understood from a disjoint (independent) model of agency as frequently found in Western cultures, whereas the Turkish sample, compared to their Belgian counterparts, reported more obsessions that can be tied to a conjoint (shared) model of agency as frequently found in non-Western cultural contexts. Differences in the prevalent types of obsessions were systematic and interpretable, therefore. In addition to the cross-culturally equivalent two-factor structure, we found culture-specific factor solutions; these solutions point to cultural differences in the experience of obsessions that have yet to be fully understood. In the Discussion, we outline future directions of the research on culture and obsessions.

Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist

Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.

Association of HTR1A gene polymorphisms with obsessive-compulsive disorder and its treatment response: the influence of sex and clinical characteristics

OBJECTIVE

There have been controversial results in the literature on the association between HTR1A polymorphisms (rs10042486, C-1019G, and Gly272Asp) and obsessive-compulsive disorder (OCD). Here, the plausibility for such genetic and pharmacogenetic association was investigated by assessing a sample of Iranian OCD patients.

METHOD

OCD patients had fulfilled the criteria for DSM-IV-TR with Y-BOCS scores higher than 9. A total of 207 controls and 205 patients' blood samples were genotyped by means of PCR-RFLP.

RESULTS

The results showed that there was no association between these three SNPs and the treatment response. The distribution of rs10042486 genotypes was significantly different in the patients compared to the controls. The association analyses of the C-1019G showed significant differences in the genotypic frequency of the patients with or without a positive family history of psychiatric disorders. Similar differences in female patients were also observed. We found that the age of onset also associates with the C-1019G polymorphism but only in the female patients. No association of Gly272Asp polymorphism and OCD was observed in this study.

CONCLUSION

We concluded that among the HTR1A polymorphisms, only the association of rs10042486 CT genotype and OCD was statistically significant. The association of C-1019G with OCD by considering the age of onset and family history was just significant in the female patients. No significant association between the studied HTR1A SNPs with treatment response was observed. Acquiring both positive and negative pharmacogenetic outcomes in each population helps to select the appropriate medication for a particular patient with fewer side effects.

Association of the functional serotonin transporter haplotype with familial form of obsessive compulsive disorder in Iranian patients

OBJECTIVE

Several polymorphisms have been reported in the 5-HTTLPR of the serotonin transporter gene (SLC6A4). Family-based evidences for the association of 5-HTTLPR polymorphisms with OCD were previously reported but results were controversial. The present study investigated the possible correlation of SLC6A4 polymorphisms (5-HTTLPR, rs25532, rs25531) in Iranian OCD patients considering gender, age of onset, family history of psychiatric disorders, obsessive and compulsive subtypes and severities.

METHODS

The included OCD patients fulfilled the criteria for DSM-IV-TR whom Y-BOCS score was more than 9. Blood samples (184 cases and 192 controls) were genotyped by means of PCR-RFLP.

RESULTS

Mean of Y-BOCS scores of included patients was 20.1 ± 0.69. Rs25532 CC genotype showed significant association with OCD in men and were detected more in the patients reported positive family history of psychiatric disorders but the other single loci (5-HTTLPR and rs25531) did not associate with OCD. Haplotype analysis showed significant association of 14-A variant with OCD and revealed the association of 14-A/14-A genotype with familial form of OCD.

CONCLUSIONS

The findings of this study showed the association of SLC6A4 variants with familial form of OCD and proposed stratified analyses in the genetic studies facilitate identification of genetic risk factors for this heterogeneous disorder.

A critical appraisal of heterogeneity in Obsessive-Compulsive Disorder using symptom-based clustering analysis

Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms and is commonly considered a heterogeneous condition. Attempts were made to define discrete OCD subtypes using a range of symptom-based methods including factor and cluster analyses. The present study aims to find the most appropriate clustering model based on Yale-Brown obsessive-compulsive scale (YBOCS) checklist explaining OCD heterogeneity. Five different clustering algorithms (FCM, K-means, Ward, Ward+K-means and Complete) applied on YBOCS symptoms of 216 patients with OCD. Data studied as four different sets including item-level raw data, item-based factor scores, category-level raw data and category-based factor scores and clustering results for 2 to 6 cluster solutions evaluated by four clustering indices (Davies-Bouldin, Calinski-Harabasz, Silhouettes and Dunn indices). Two-cluster solution was detected as the most appropriate model for item and category-based clustering analyses of YBOCS checklist symptoms. Patients in each cluster were characterized based on their clinical and demographic properties and results showed that they had similar patterns of symptoms but in different severities. Heterogenity of OCD based on the YBOCS-symptoms has been challenged as OCD patients were classified based on their symptom severity not their symptom patterns. More investigations need to find appropriate measures explaining OCD heterogeneity with clinical importance.