Obsessive-compulsive disorder

Therapeutic potential of Baicalin against experimental obsessive compulsive disorder: Evidence from CSF, blood plasma, and brain analysis

Obsessive-Compulsive Disorder (OCD) is a complex neuropsychiatric condition characterized by recurrent obsessions and compulsions, significantly impacting an individual's functionality and quality of life. This study aimed to explore the neuroprotective and therapeutic potential of baicalin, a flavonoid with known antioxidant, anti-inflammatory, and neurotropic properties, in an animal model of OCD induced by 8-OH-DPAT (8HPAT). The research utilized in silico docking studies and in vivo experiments to assess baicalin's interactions with key intracellular targets: SIRT-1, Nrf2, HO-1, and PPAR-gamma, and its effects on neurochemical, neurobehavioral, and histopathological parameters. In silico results indicated a strong binding affinity of baicalin for SIRT-1, Nrf2, HO-1, and PPAR-gamma, suggesting potential regulatory roles in antioxidant and anti-inflammatory pathways. In-vivo findings demonstrated that baicalin, administered at doses of 50 mg/kg and 100 mg/kg, significantly alleviated OCD-like behaviours, including excessive lever pressing, marble burying, and compulsive checking. Baicalin treatment normalized serotonin and dopamine levels and reduced glutamate levels in the brain, restoring neurotransmitter balance. Furthermore, baicalin decreased inflammatory cytokines (TNF-alpha and IL-1 beta), improved complete blood count profile, and gross morphological and histopathological alterations by restoring neuronal density and cellular integrity in affected brain regions. Combining baicalin with fluvoxamine (10 mg/kg) showed synergistic effects, further enhancing neuroprotective outcomes. These results suggest that baicalin holds promise as a potential therapeutic agent for OCD, warranting further clinical investigation to explore its efficacy and underlying mechanisms in human subjects. The findings underscore the importance of targeting intracellular pathways and neurotransmitter systems in developing effective treatments for OCD and related neuropsychiatric disorders.

Neurobiological differences in early-onset obsessive-compulsive disorder: A study of the glutamatergic system based on functional magnetic resonance spectroscopy

In this study, the combination of functional state magnetic resonance spectroscopy (fMRS) and cognitive tasks was used to conduct subgroup analyses on early-onset OCD (EO) and non-early-onset OCD (non-EO) and explore differences in the glutamatergic system and cognitive function among OCD subtypes. A total of 70 OCD and 30 healthy controls (HCs) underwent clinical evaluation and were subsequently divided into the EO or non-EO groups. Next, both resting and functional state MRS data were collected, with the anterior cingulate cortex (ACC) serving as the region of interest. Quantitative analysis of MRS data yielded precise neurometabolic concentrations, which were then statistically analyzed alongside inhibitory function, as measured by the Go-nogo task. The final analysis included 92 participants (22 EO-OCD, 41 non-EO OCD, and 29 HCs). EO-OCD patients had significantly higher Glx levels (p = 0.044) and lower GSH levels (p = 0.009) in the functional state compared to the non-EO group. Moreover, in the EO group, correlation analysis revealed a positive correlation between the functional state Glx levels and the average response time for errors in the nogo task (r = 0.526, p = 0.014). Additionally, resting-state GSH levels were positively correlated with total Y-BOCS scores (r = 0.854, p < 0.001). Overall, early-onset OCD may represent a distinct subtype that requires targeted interventions, as evidenced by the imbalance in the glutamatergic system observed in early-onset OCD patients. Additionally, in early-onset patients, Glx concentration during activation was related to cognitive impairment.

Clinical and neuroradiological differences in obsessive compulsive disorder with and without psychosis

Obsessive-compulsive disorder (OCD) and psychosis frequently co-occur, with several hypotheses proposed to explain the relationship between them, and there is limited information regarding the comorbidity of OCD and psychotic symptoms. Therefore, we aimed to detect the prevalence of psychotic symptoms in OCD patients and analyze the psychopathological and neuroimaging associations using Diffuse Tensor Imaging (DTI) between OCD with and without psychotic symptoms in a subset of these patients. Initially, 100 subjects with OCD were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) and a subset of 60 subjects underwent neuroimaging using DTI. Out of 100 subjects, 39 % were classified as OCD with psychotic features, who differed significantly from non-psychotic OCD on several Y-BOCS, BPRS and DTI (especially volume) domains. Our study suggests several clinical and neuroradiological (using DTI) differences between OCD with and without psychotic features. Clinically, the OCD group with psychotic symptoms had a shorter duration of illness, fewer previous episodes and a poorer level of insight, while on DTI, they had significant reduction in grey matter (GM) volume across several brain regions, and significant reduction in the right hippocampal tract on mean diffusivity (MD).

Efficacy and safety of transcranial direct current stimulation (tDCS) in patients with obsessive-compulsive disorder (OCD): A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Transcranial direct current stimulation (tDCS) is gaining traction for treating obsessive-compulsive disorder (OCD), but its effectiveness and safety remain uncertain. A systematic review of randomized controlled trials (RCTs) will assess its clinical benefits for symptom reduction.

METHODS

Six databases-Scopus, PubMed, Web of Science, Cochrane, PsycINFO, and Cochrane Central-were searched to identify relevant studies. The included studies were RCTs that assessed the effects of tDCS on OCD symptoms, as well as its impact on anxiety and depression, while also evaluating adverse events (AEs). The risk of bias (ROB) was analyzed using the ROB-2 tool. A meta-analysis was performed utilizing Stata-17 software.

RESULTS

Immediately following treatment, the analysis revealed that tDCS significantly reduced the Y-BOCS score (SMD = -0.56 [-0.87, -0.26]), anxiety scores (SMD = -1.11 [-1.85, -0.37]), and depression scores (SMD = -1.57 [-2.64, -0.50]), while increasing CGI-S scores (SMD = 0.40 [0.08, 0.72]) in OCD patients compared to the sham group. During the follow-up period (1-2 months post-treatment), tDCS continued to decrease the Y-BOCS score (SMD = -0.69 [-1.22, -0.17]), anxiety scores (SMD = -1.13 [-3.05, -0.78]), and depression scores (SMD = -2.02 [-3.00, -1.04]), but showed no effect on CGI-S scores when compared to the sham group. Additionally, the analysis indicated no significant differences in AEs between active tDCS and the sham group (OR: 1.20 [0.86, 1.68]).

CONCLUSIONS

This review suggests that tDCS may effectively alleviate OCD symptoms, along with related depression and anxiety, both acute and at follow-up, while causing minimal AEs.

The RECAPACITA PROJECT: comparative study of the clinical, neuropsychological, and functional profile of people with severe mental disorder and partial and total capacity modification

BACKGROUND

Evaluating the decision-making capacity of individuals with Severe Mental Disorder (SMD) is essential for compliance with the 2006 Convention on the Rights of People with Disabilities. In Spain, capacity was historically determined through judicial procedures, resulting in partial or total capacity modification (CM). The abolition of this procedure in 2021 has left a gap in addressing the needs of this population, creating challenges under the new legal framework.

AIM

The RECAPACITA project studied the clinical, neuropsychological, and functional profiles of individuals with SMD and CM, focusing on differences between partial (pCM) and total (tCM) modifications.

METHODS

A cross-sectional study was conducted with 77 adult patients with SMD and CM (47 tCM, 30 pCM) from the Parc Sanitari Sant Joan de Déu mental health network (Spain). Sociodemographic, clinical, functional, and neuropsychological data were collected, along with an independent assessment of mental capacity.

RESULTS

Around 87% of sample had a schizophrenia spectrum disorder; pCM patients presented more substance-related and personality disorders as a secondary diagnosis. While no statistically significant differences were observed between groups, clinically, tCM group presents greater clinical alteration, lower insight, sustained attention, coding capacity, processing speed and resistance to interference compared to pCM group. tCM group had worse social functioning, and lower scores in reasoning and appreciation when assessing mental capacity.

CONCLUSIONS

Individuals with tCM show greater clinical impairment and higher support needs compared to those with pCM. With the practical and legal abolition of tCM, it is essential to ensure that these individuals' persistent challenges are adequately addressed, as their needs remain significant despite the disappearance of this legal category.

Abnormal intrinsic brain activity of the sensory-motor area as a predictor of the response to selective serotonin reuptake inhibitors in treatment-naïve obsessive-compulsive disorder

OBJECTIVES

Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic neuropsychiatric disorder. Selective serotonin reuptake inhibitors (SSRI) are first-line pharmacological agents for treating OCD. However, nearly half of patients show insufficient responses to SSRI. The aim of the study is to assess the relationship between the intrinsic brain activity and SSRI response by using the z-standardized fractional amplitude of low-frequency fluctuations (zfALFF).

METHODS

We exacted the zfALFF to probe the brain activity patterns from resting-state functional magnetic resonance imaging (fMRI) data in 63 treatment-naïve OCD patients (classified into 31 responders and 32 nonresponders based on the percentage of improvement in symptoms) and 33 healthy controls (HC). Then, the zfALFF values of large-scale networks and each brain region were compared among the three groups. The zfALFF values demonstrating significant intergroup differences were utilized to investigate characteristic neuroimaging changes in OCD, and factors predicting SSRI response.

RESULTS

In contrast to HC, OCD exhibited significantly lower zfALFF in sensory-motor area (SMA), and the brain regions within this network, including the bilateral postcentral gyrus (PoCG.L and POCG.R) and the left paracentral lobule (PCL.L). Although the alteration of zfALFF was not related to pre-treatment scores of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the lager zfALFF was found in SSRI responder group compared to the nonresponders, which could serve as a significant predictor of SSRI response.

CONCLUSIONS

The fALFF of SMA may reflect the neuropathological mechanisms underlying OCD and neuroimaging underpinning of SSRI treatment response, which could serve as a brain-based guidance of clinical practice.

Decoding goal-habit brain networks of OCD from the structural and functional connectivity

Obsessive-Compulsive Disorder (OCD) may involve an imbalance between goal-directed and habitual learning systems, and this study investigates the structural and functional brain networks underpinning these systems in OCD. Using predefined brain regions, structural and functional connectivity networks were constructed, and methods such as network-based statistics, average connectivity strength, structural-functional coupling, and partial least squares path modeling were employed to compare OCD patients and healthy controls. The results revealed that OCD patients showed increased structural connectivity within both the goal-directed and habitual learning networks, particularly in the subnetwork that connects these systems. However, functional connectivity strength was reduced in both the habitual learning network and the subnetwork connecting goal-directed and habitual learning systems. The symptoms of ordering and hoarding are, to some extent, correlated with the structural-functional coupling network and network characteristics. These findings suggest that alterations in both structural and functional brain networks underpin goal-directed and habitual learning in OCD, with increased structural connectivity potentially reflecting compensatory mechanisms, while reduced functional connectivity may contribute to the symptoms of OCD. Further research is required to better understand the complex interplay between these learning systems in OCD, considering symptom heterogeneity and disease's progression.

Complementary corticostriatal circuits orchestrate action repetition and switching

Action sequencing is fundamental to behavior. A critical decision for survival and reproduction is whether to repeat a current action or switch to a different one. However, the neural mechanisms governing action repetition and switching remain largely unknown. In mice trained to perform heterogeneous action sequences, we found that the M1-DLS circuit regulates action repetition, while the PrL-DMS pathway controls action switching. These distinct functions arise from preferential innervation of striatal D1-SPNs by M1 and D2-SPNs by PrL, respectively. In a Shank3 knockout mouse model of ASD, the D1/D2 innervation ratio in the PrL-DMS pathway was reversed, leading to impaired action switching and repetitive behaviors. Genetic restoration of Shank3 in the DMS rescued both physiological and behavioral deficits. These findings reveal how the brain orchestrates action sequencing in health and disease.

Effects of continuous theta burst stimulation on patients with obsessive‒compulsive disorder (OCD): A systematic review and meta-analysis of randomized sham controlled trials

Despite standard pharmacological and behavioral therapies, a significant proportion of patients with obsessive‒compulsive disorder (OCD) have a suboptimal or no response. Continuous theta burst stimulation (cTBS) is a novel variant of traditional transcranial magnetic stimulation (TMS) that has shown promising results in a wide array of behavioral disorders. To integrate the evidence of its role in OCD, we conducted a systematic review and meta-analysis of pertinent randomized controlled trials (RCTs). We conducted a comprehensive literature search from inception until June 2024 on PubMed, Google Scholar, PsycINFO, Embase, and clinical trial registries. Six RCTs were identified and included in our study. Data regarding obsessive‒compulsive symptoms, depression, and anxiety were extracted and analyzed via a random effects model. We found no significant differences between the active and sham groups regarding the change in obsessive‒compulsive symptoms, neither immediately posttreatment (p = 0.98) nor at follow-up (p = 0.83). Similarly, neither group was superior in alleviating concomitant anxiety and depression. Owing to the limited number of studies and their variability in terms of brain targets and the total number of pulses administered, we cannot definitively conclude the effectiveness of cTBS in patients with OCD. However, our research highlights it as a potentially safe treatment option with no serious side effects. Future investigators should aim to optimize intervention protocols and utilize neuronavigation techniques for accurate delivery of pulses to targeted brain loci. High-powered trials with sufficient sample sizes are needed to gain deeper insight into the effects of cTBS on primary and secondary clinical manifestations of OCD.

Gray and white matter alterations in Obsessive-Compulsive Personality Disorder: a data fusion machine learning approach

Introduction

Obsessive-Compulsive Personality Disorder (OCPD) is a complex mental condition marked by excessive perfectionism, orderliness, and rigidity, often starting in adolescence or early adulthood; it affects 1.9% to 7.8% of the population. The disorder differs from Obsessive-Compulsive Disorder (OCD) in an apparent compromise of personality, distorted self-representation, and altered perception of others. Although the two disorders present evident differences, unlike OCD, the neural bases of OCPD are understudied. The few studies conducted so far have identified gray matter alterations in brain regions such as the striatum and prefrontal cortex. However, a comprehensive model of its neurobiology and the eventual contribution of white matter abnormalities are still unclear. One intriguing hypothesis is that regions ascribed to the Default Mode Network are involved in OCPD, similar to what has been shown for OCD and other anxiety disorders.

Methods

To test this hypothesis, the gray and white matter images of 30 individuals diagnosed with OCPD (73% female, mean age=29.300), and 34 non-OCPD controls (82% female, mean age = 25.599) were analyzed for the first time with a data fusion unsupervised machine learning method known as Parallel Independent Component Analysis (pICA) to detect the joint contribution of these modalities to the OCPD diagnosis.

Results

Results indicated that two gray matter networks (GM-05 and GM-23) and one white matter network (WM-25) differed between the OCPD and the control group. GM-05 included brain regions belonging to the Default Mode Network and the Salience Network and was significantly correlated with anxiety; GM-23 included portions of the cerebellum, the precuneus, and the fusiform gyrus; WM-25 included white matter portions adjacent to Default Mode Network regions.

Discussion

These findings shed new light on the gray and white matter contributions to OCPD and may pave the way to developing objective markers of this disorder.

Memory Functions in Obsessive-Compulsive Disorder

Background/Objectives: Obsessive-compulsive disorder (OCD) is a complex psychiatric condition often associated with alterations in cognitive processes, including memory. Although memory dysfunction has been proposed as a contributing factor to the onset and maintenance of OCD symptoms, it remains debated whether these deficits reflect genuine cognitive impairments or maladaptive metacognitive processes, such as pathological doubt and memory distrust. This review aims to synthesize current findings on memory functioning in OCD, focusing on distinct memory systems and the role of metacognition. Methods: A comprehensive literature search was conducted across five databases (PubMed, Scopus, Embase, PsycINFO, and Google Scholar), covering studies up to April 2025. Search terms included "Obsessive-compulsive disorder"; "OCD"; "Memory dysfunction"; "Episodic memory"; "Working memory impairment"; "Prospective memory deficits"; "Checking compulsions"; "Memory confidence"; "Cognitive biases". Results: Short-term memory appears generally preserved in OCD. Working memory deficits are consistently reported, especially in the visuospatial domain, and they are associated with difficulties in updating and clearing irrelevant information. Episodic memory impairments are common and often linked to inefficient encoding strategies and heightened cognitive self-consciousness. Prospective memory is frequently compromised under neutral conditions. Individuals with checking symptoms tend to show intact objective memory performance, despite reporting low memory confidence, supporting the concept of memory distrust. Conclusions: Memory dysfunction in OCD is multifaceted, involving both cognitive and metacognitive alterations. The evidence supports a model in which executive dysfunctions and memory-related beliefs contribute to compulsive behaviors more than objective memory failure. These insights highlight the need for integrative assessment protocols and personalized interventions targeting both cognitive performance and metacognitive appraisals.

Cortical thickness alternation in obsessive-compulsive disorder patients compared with healthy controls

Neuropathological changes, such as those found in obsessive-compulsive disorder (OCD), often include cortical morphological abnormalities. Neuroimaging research has indicated that individuals with OCD typically exhibit altered cortical thickness (CTh) through surface-based morphometry (SBM) analyses. Yet, the findings have been hit or miss, with inconsistent results across various studies. We are employing meta-analytic techniques on comprehensive brain imaging data to examine variations in CTh in patients with OCD. This approach could refine spatial precision in detection, thereby sharpening our diagnostic capabilities for OCD and paving the way for more targeted therapeutic interventions. The seed-based d mapping (SDM) method was utilized to perform a vertex-wise, coordinate-based meta-analysis (CBMA) examining CTh differences across whole-brain studies in OCD patients relative to healthy controls (HCs). This analytical approach systematically compared structural neuroimaging findings between clinical and control groups. A comprehensive review of existing research uncovered 9 relevant studies (containing 9 distinct datasets) examining CTh in OCD. The analysis incorporated data from 518 OCD patients and 449 HCs. The findings revealed significant cortical thinning in the left anterior cingulate and paracingulate gyri, along with the right insula among OCD patients. Conversely, increased CTh was observed in several left-hemisphere regions, including the lingual gyrus, orbital portion of the inferior frontal gyrus, and dorsolateral aspect of the superior frontal gyrus. Moreover, the meta-regression results indicated an inverse relationship between age and the thickness of the right insula cortex in those suffering from OCD. However, the analysis was constrained by the small pool of studies and samples, as well as incomplete data from certain participants, which hindered a thorough subgroup examination. Additionally, the results of the meta-regression should be viewed with caution, as they are based on a relatively limited number of studies. The analysis did show changes in CTh in certain brain areas for OCD patients, which adds to our knowledge of the intricate workings of OCD-related brain abnormalities. These insights could potentially serve as valuable landmarks for diagnosing and treating OCD. Clinical trial number: Not applicable.

Classifying Obsessive-Compulsive Disorder from Resting-State EEG using Convolutional Neural Networks: A Pilot Study

Objective: Classifying obsessive-compulsive disorder (OCD) using brain data remains challenging. Resting-state electroencephalography (EEG) offers an affordable and noninvasive approach, but traditional machine learning methods have limited its predictive capability. We explored whether convolutional neural networks (CNNs) applied to minimally processed EEG time-frequency representations could offer a solution, effectively distinguishing individuals with OCD from healthy controls. Method: We collected resting-state EEG data from 20 unmedicated participants (10 OCD, 10 healthy controls). Clean, 4-second EEG segments were transformed into time-frequency representations using Morlet wavelets. In a two-step evaluation, we first used a 2D CNN classifier using leave-one-subject-out cross-validation and compared it to a traditional support vector machine (SVM) trained on spectral band power features. Second, using multimodal fusion, we examined whether adding clinical and demographic information improved classification. Results: The CNN achieved strong classification accuracy (82.0%, AUC: 0.86), significantly outperforming the chance-level SVM baseline (49.0%, AUC: 0.45). Most clinical variables did not improve performance beyond the EEG data alone (subject-level accuracy: 80.0%). However, incorporating education level boosted performance notably (accuracy: 85.0%, AUC: 0.89). Conclusion: CNNs applied to resting-state EEG show promise for diagnosing OCD, outperforming traditional machine learning methods. Despite sample size limitations, these findings highlight deep learning's potential in psychiatric applications. Education level emerged as a potentially complementary feature, warranting further investigation in larger, more diverse samples.

Active information sampling in health and disease

Active information gathering is a fundamental cognitive process that enables organisms to navigate uncertainty and make adaptive decisions. Here we synthesise current knowledge on the behavioural, neural, and computational mechanisms underlying information sampling in healthy people and across several brain disorders. The role of cortical and subcortical regions spanning limbic, insular, fronto-parietal, and striatal systems is considered, along with the contributions of key neurotransmitters involving norepinephrine, dopamine, and serotonin. We also examine how various clinical conditions, including schizophrenia, obsessive-compulsive disorder, and Parkinson's disease have an impact on information gathering behaviours. To account for the findings, we outline a neuroeconomic perspective on how the brain may evaluate the costs and benefits of acquiring information to resolve uncertainty. This work highlights how active information gathering is a crucial brain process for adaptive behaviour in healthy individuals and how its breakdown is relevant to several psychiatric and neurological conditions. The findings have important implications for developing novel computational assays as well as targeted interventions in brain disorders.

Exploring genetic and epigenetic markers for predicting or monitoring response to cognitive-behavioral therapy in obsessive-compulsive disorder: A systematic review

Growing evidence has identified potential biomarkers of cognitive-behavioural therapy (CBT) efficacy in obsessive-compulsive disorder (OCD). Genetic and epigenetic mechanisms (e.g., polymorphisms, DNA methylation) contribute to OCD pathogenesis and CBT response variability, establishing them as a key research focus. To evaluate their associations with CBT outcomes in OCD, we conducted a systematic review of PubMed, Web of Science, CNKI, and Cochrane Library (from inception to January 2025), identifying eight studies that met rigorous inclusion criteria. The identified predictors included: (1) Genetic polymorphisms (BDNF); (2) Epigenetic modifications (DNA methylation of MAOA, SLC6A4, OXTR, PIWIL1, MIR886, PLEKHA1, KCNQ1, TRPM8, HEBP1, HTR7P1, MAPK8IP3, ENAH, RABGGTB (SNORD45C), MYEF2, GALK2, CEP192, and UIMC1). These markers may influence neural plasticity, neurotransmitter regulation, and related processes, providing molecular substrates for the observed treatment effects. Converging evidence suggests that distinct neurocognitive mechanisms may mediate CBT efficacy in OCD, particularly fear extinction learning and goal-directed behaviors (GDBs), which we analyze mechanistically. Future studies should integrate polygenic risk scores (PRS) with functional neuroimaging to dissect individual variability in CBT response, mainly through cortico-striato-thalamo-cortical (CSTC) circuit profiling. To our knowledge, this is the first systematic review synthesizing genetic and epigenetic predictors of CBT response in OCD; these findings provide compelling evidence for biomarkers for CBT personalization in OCD, advancing a novel precision psychiatry framework.

Hippocampal and amygdala subfield volumes in obsessive-compulsive disorder by medication status

BACKGROUND

Although it has been suggested that the hippocampus and amygdala (HA) are involved in the neurobiology of obsessive-compulsive disorder (OCD), volumetric findings have been inconsistent, and little work has been undertaken on the volumetry of the heterogeneous anatomic units of HA, with their specific functions and cytoarchitecture, in OCD. We sought to explore potential sources of heterogeneity in brain volumes by performing a separate analysis for people with and without psychotropic medication use, as well as the association of subfield volumes with OCD symptom severity.

METHODS

We segmented T 1-weighted images from people with OCD and healthy controls in the OCD Brain Imaging Consortium to produce 12 hippocampal subfields and 9 amygdala subfields using Free-Surfer 6.0. We assessed between-group differences in subfield volume using a mixed-effects model adjusted for age and quadratic effects of age, sex, site, and whole HA volume. We also performed subgroup analyses to examine subfield volume in relation to comorbid anxiety and depression, medication status, and symptom severity. We corrected all analyses for multiple comparisons using the false discovery rate (FDR).

RESULTS

We included images from 381 people with OCD and 338 healthy controls. These groups did not significantly differ in HA subfield volumes. However, medicated people with OCD had significantly smaller volumes in the hippocampal dentate gyrus (p FDR = 0.04, d = -0.26) and molecular layer (p FDR = 0.04, d = -0.29), and larger volumes in the lateral (p FDR = 0.049, d = 0.23) and basal (p FDR = 0.049, d = 0.25) amygdala subfields, than healthy controls. Unmedicated people with OCD had significantly smaller volumes in the hippocampal cornu ammonis sector 1 (p FDR = 0.02, d = -0.28) than controls. We did not detect associations between any subfield volume and OCD severity.

LIMITATIONS

We used cross-sectional data, which limits the interpretation of our analysis.

CONCLUSION

Differences in HA subfields between people with OCD and healthy controls are dependent on medication status, in line with previous work on other brain volumetric alterations in OCD. This emphasizes the importance of considering psychotropic medication in neuroimaging studies of OCD.

Astrocyte Dysfunctions in Obsessive Compulsive Disorder: Rethinking Neurobiology and Therapeutic Targets

Obsessive-compulsive disorder (OCD) has long been conceptualized as a neuron-centric disorder of cortico-striato-thalamo-cortical (CSTC) circuit dysregulation. However, a growing body of evidence is now reframing this narrative, placing astrocytes-once relegated to passive support roles-at the center of OCD pathophysiology. Astrocytes are critical regulators of glutamate and GABA homeostasis, calcium signaling, and synaptic plasticity, all of which are disrupted in OCD. Recent high-resolution molecular and proteomic studies reveal that specific astrocyte subpopulations, including Crym-positive astrocytes, directly shape excitatory/inhibitory balance and control perseverative behaviors by modulating presynaptic inputs from the orbitofrontal cortex. Disruptions in astrocytic neurotransmitter clearance and dopamine metabolism amplify CSTC circuit hyperactivity and reinforce compulsions. This review reframes OCD as a disorder of neuro-glial dysfunctions, proposing that targeting astrocytic signaling, metabolism, and structural plasticity may unlock transformative therapeutic strategies. By integrating human and animal data, we advocate for a glial-centric model of OCD that not only enhances mechanistic understanding but also opens new frontiers for precision treatment.

The CogLearn Toolkit for Unity: Validating a virtual reality paradigm for human avoidance learning

Avoidance learning encompasses the acquisition of behaviours that enable individuals to evade or withdraw from potentially harmful stimuli, prior to their occurrence. Maladaptive avoidance is a crucial feature of anxiety and trauma-related disorders. In biological and clinical settings, avoidance behaviours usually involve uninstructed, idiosyncratic and complex motor actions. However, there is a lack of laboratory paradigms that allow investigating how such actions are acquired. To fill this gap, we developed a wireless virtual reality platform to investigate avoidance learning in naturalistic settings, with an uncomfortable sound as unconditioned stimulus (US), a physically plausible avoidance action, and allowing for unconstrained movements. This platform, the CogLearn Toolkit for Unity, is publicly available and allows conducting various types of learning experiments with simple text files as input. We validated this platform in an exploration-confirmation approach with five independent experiments. Overall, participants showed successful acquisition of avoidance behaviour in all experiments. In three exploration experiments, we refined the paradigm and identified mean distance from US location during conditioned stimulus (CS) presentation (before US occurs) as a sensitive measure of avoidance. Two confirmation experiments revealed stronger avoidance for CS+ than CS- during avoidance learning, whether or not this phase was preceded by Pavlovian acquisition. Furthermore, we demonstrated reduced avoidance during extinction with instruction to approach CS, but persistent residual avoidance during this phase. We found evidence of reinstatement in one of two confirmation experiments. Overall, our study provides robust evidence supporting the efficacy of our paradigm in studying avoidance learning in conditions of high ecological relevance.

Excitatory Amino Acid Transporters as Therapeutic Targets in the Treatment of Neurological Disorders: Their Roles and Therapeutic Prospects

Excitatory amino acid transporters (EAATs) are pivotal regulators of glutamate homeostasis in the central nervous system and orchestrate synaptic glutamate clearance through transmembrane transport and the glutamine‒glutamate cycle. The five EAAT subtypes (GLAST/EAAT1, GLT-1/EAAT2, EAAC1/EAAT3, EAAT4, and EAAT5) exhibit spatiotemporal-specific expression patterns in neurons and glial cells, and their dysfunction is implicated in diverse neurological pathologies, including epilepsy, amyotrophic lateral sclerosis (ALS), schizophrenia, depression, and retinal degeneration. Mechanistic studies revealed that astrocytic GLT-1 deficiency disrupts glutamate clearance in ALS motor neurons, whereas GLAST genetic variants are linked to both epilepsy susceptibility and glaucomatous retinal ganglion cell degeneration. Three major challenges persist in ongoing research: ① subtype-specific regulatory mechanisms remain unclear; ② compensatory functions of transporters vary significantly across disease models; and ③ clinical translation lacks standardized evaluation criteria. The interaction mechanisms and dynamic roles of EAATs in neurological disorders were systematically investigated in this study, and an integrated approach combining single-cell profiling, stem cell-based disease modeling, and drug screening platforms was proposed. These findings lay the groundwork for novel therapeutic strategies targeting glutamate homeostasis.

Self-Inflicted Head Injury in Behavioral Variant Frontotemporal Dementia with Compulsive Behaviors: A Case Report

Here we present the case of a 56-year-old right-handed White male who developed osteomyelitis and empyema after repetitive compulsive excoriation rituals. His recent history included profound personality changes, apathy, loss of empathy, limited insight, behavioral agitation, and episodic memory loss. In addition to these progressive behavioral deficits, he had significant difficulties with executive functioning, leading to the loss of his job and inability to independently perform instrumental activities of daily living. Brain MRI showed asymmetric enlargement of the right lateral ventricle and mild asymmetric parenchymal volume loss in the right hippocampus. 18F-FDG PET imaging revealed severe hypometabolism in the right hemisphere. Based on this individual's clinical presentation, reported history, and neuroimaging findings, we concluded that his condition was most consistent with a diagnosis of behavioral variant frontotemporal dementia (bvFTD), rather than another psychiatric diagnosis. This case illustrates the importance of differentiating between bvFTD and other psychiatric disorders, as well as the need for further studies to improve clinicians' ability to do so at earlier stages.

Event-related potential in juvenile obsessive-compulsive disorder: a systematic review and meta-analysis of error- and correct-related negativity

The error-related negativity (ERN) is a negative wave observed in electroencephalography (EEG) following errors in certain neurocognitive tasks, such as the Flanker task. This wave has been found to be heightened in individuals suffering from obsessive-compulsive disorder (OCD) in several adult studies and meta-analyses. Therefore, the ERN may serve as a relevant neurobiological marker for OCD. However, the ERN exhibits some developmental aspects. Considering this, we conducted a meta-analysis of studies examining the ERN in children and adolescents with OCD. We identified nine studies that compared ERN amplitude during a Flanker task between youth with OCD and matched controls. Our meta-analysis revealed that ERN amplitude was elevated in juvenile OCD patients compared to controls. We did not find that age, task accuracy, or sex moderated the difference between patients and controls. In conclusion, our meta-analysis confirmed that the ERN observed during the Flanker task may be a relevant biological marker for OCD in children and adolescents.

Obsessive-compulsive disorder and temporal lobe porencephaly: a case report

BACKGROUND

The functional and structural abnormalities of cortico-striato-thalamo-cortex have been reported to be associated with the neurobiological basis of obsessive-compulsive disorder (OCD). OCD can also occur in the striatum damaging after brain infarction, which is called OCD caused by physical diseases. The relationship and mechanism between temporal lobe abnormalities and OCD are still unclear.

CASE PRESENTATION

A young male with temporal lobe porencephaly presented with obsessive-compulsive symptoms. The cognition of this OCD participant was not significantly impaired, and his social function was well maintained. After treatment with sertraline, aripiprazole, and fluvoxamine, he was improved but relapsed several times after drug withdrawal. However, the therapeutic effect was sustained upon reinitiation of the medication.

CONCLUSION

This is the first reported case of OCD in an individual with left temporal lobe porencephaly. The possible relationship between obsessive-compulsive symptoms and temporal lobe structural abnormalities needs to be further studied. The maintenance treatment and prognosis of organic obsessive-compulsive disorder also deserve further study.

Remission of OCD and ulcerative colitis with a ketogenic diet: Case Report

Background

There is little research describing the clinical use of a ketogenic diet in obsessive-compulsive disorder (OCD) or inflammatory bowel disease. We describe the first clinical application of a ketogenic diet in adult OCD with ulcerative colitis (UC) resulting in complete remission of OCD, clinical remission of UC, and improved metabolic health.

Methods

A 37-year-old obese woman with longstanding OCD and ulcerative colitis was treated for 12 weeks with a personalized whole-food ketogenic diet (KMT 1:5:1 ratio) in a specialized metabolic psychiatry clinic. Adherence was assessed by capillary beta-hydroxybutyrate (BHB) and photojournaling of food intake. Remission of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Florida Obsessive Compulsive Inventory scale (FOCI), and Clinical Global Impression-Improvement/Severity scale (CGI-S/I). Patient Health Questionnaire-9 (PHQ-9) and Yale Food Addictions Scale 2.0 (YFAS 2.0) assessed depression and food addiction. Remission of UC was assessed by the Partial Mayo Score (PMS) and the Ulcerative Colitis Patient-Reported Outcome (UC-PRO). Metabolic health was assessed by laboratories and bioimpedance. Quality of life was assessed using validated scales for flourishing, resilience, self-compassion, and subjective narrative.

Results

Clinical remission of UC occurred within 3 weeks (PMS 0, UC-PRO 0). Progressive improvement in OCD was inversely related to oscillating BHB, with FOCI 0 at 9 weeks, and complete remission at 12 weeks (Y-BOCS 0, CGI-S 1). Body weight decreased 12.2%, with significant decreases in the percentage of body fat and visceral fat. Flourishing, resilience, and self-compassion improved 2- to 20-fold.

Conclusion

Complete remission of OCD, clinical remission of UC, and marked improvement in metabolic health occurred within 12 weeks using a well-formulated personalized ketogenic diet (KMT ratio 1:5:1) with a meaningful positive impact on quality of life and significant improvements in flourishing, resilience, and self-compassion.

Precision Psychiatry for Obsessive-Compulsive Disorder: Clinical Applications of Deep Learning Architectures

Obsessive-compulsive disorder (OCD) is a complex psychiatric condition characterized by significant heterogeneity in symptomatology and treatment response. Advances in neuroimaging, EEG, and other multimodal datasets have created opportunities to identify biomarkers and predict outcomes, yet traditional statistical methods often fall short in analyzing such high-dimensional data. Deep learning (DL) offers powerful tools for addressing these challenges by leveraging architectures capable of classification, prediction, and data generation. This brief review provides an overview of five key DL architectures-feedforward neural networks, convolutional neural networks, recurrent neural networks, generative adversarial networks, and transformers-and their applications in OCD research and clinical practice. We highlight how these models have been used to identify the neural predictors of treatment response, diagnose and classify OCD, and advance precision psychiatry. We conclude by discussing the clinical implementation of DL, summarizing its advances and promises in OCD, and underscoring key challenges for the field.

Computationally derived parent-child interaction patterns and oxytocin in children with and without OCD

BACKGROUND

Parent-child interactive processes are important factors in pediatric OCD. Understanding biological mechanisms of parent-child interactive behaviors could help improve treatment of pediatric OCD. Oxytocin has been suggested as a biological mechanism in parent-child interactions. However, no studies in pediatric OCD exist. We used machine learning to discover latent patterns in parent-child interactive behaviors and explored associations with oxytocin in children with and without OCD.

METHODS

We used parent and child salivary oxytocin levels measured with enzyme-linked immunosorbent assay (ELISA) and investigator-rated parent-child behaviors during a frustration task. Children with or without OCD and their parents - 107 mother-child and 62 father-child pairs were included. We used two machine learning techniques, principal component analysis and archetypal analysis, to generate data-driven, theory-agnostic behavioral variables, and regression to estimate their associations with oxytocin.

RESULTS

Principal component and archetype analyses identified behavioral patterns describing the mother-child and father-child interactions. We found a positive association between child and mother oxytocin and the interaction patterns "overinvolved interaction" and "emotional interaction" and a negative association with "distant interaction". Additionally, mother oxytocin was positively associated with "supportive interaction" and "varied-coping interaction", and negatively associated with "conflictual interaction" and "negative-low support interaction". Father oxytocin was associated with "supportive interactions" only in the presence of child OCD.

CONCLUSION

Child and mother oxytocin appear related with mother-child interactive patterns. Fathers' oxytocin was related with interaction patterns only in children with OCD. Our exploratory findings can be used to generate hypothesis for future research regarding the relationship between oxytocin and maladaptive family engagement in OCD and differences between mothers and fathers' behaviors when the child has OCD.

Exploring immunological and molecular mechanisms involved in obsessive-compulsive disorder with comorbid neurodevelopmental disorders

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a psychiatric disease with a prevalence of 2%-3%. Despite the effectiveness of antidepressants, such as serotonin reuptake inhibitors, for treating OCD, its pathogenesis remains unclear. Recent research has implicated immunological mechanisms, particularly in OCD patients with comorbid neurodevelopmental disorders (NDD), such as autism spectrum disorder, attention deficit/hyperactive disorder, and Tourette's disorder. To examine these mechanisms, we investigated immunological factors involved in OCD patients with any NDD comorbidity (OCD + NDD group), compared with those without comorbid NDD (OCD group).

MATERIALS AND METHODS

Twenty-eight OCD patients treated at Hyogo Medical University Hospital were recruited for this study. Of them, 14 patients with NDD comorbidity (OCD + NDD) were compared with 14 patients without comorbid NDD (OCD). RNA was extracted from blood samples and analyzed using RNA sequencing and Ingenuity Pathway Analysis (IPA). Plasma levels of IL11 and IL17A were measured with ELISA.

RESULTS

RNA sequencing identified 716 significantly differentially expressed genes, with 47 related to immune functions, in the OCD + NDD group compared with the OCD group. IL11 and IL17A were central, with IL11 linked to neutrophil production and IL17A to T cell migration and cytokine secretion. Pathway analysis indicated complex interactions among these genes.

DISCUSSION

This study highlights significant immunological changes in OCD patients with any NDD. Decreased anti-inflammatory IL11 and increased proinflammatory IL17A suggest a shift towards inflammation, which may contribute to neurodevelopmental issues.

CONCLUSION

Immunological dysregulation in OCD with comorbid NDD may offer potential therapeutic targets. Immune gene interactions should be further investigated in effort to improve treatment strategies for treatment-refractory OCD patients, especially those with neurodevelopmental comorbidities.

Transcranial Magnetic Stimulation-Induced Plasticity Improving Cognitive Control in Obsessive-Compulsive Disorder, Part I: Clinical and Neuroimaging Outcomes From a Randomized Trial

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for obsessive-compulsive disorder (OCD). The neurobiological mechanisms of rTMS in OCD have been incompletely characterized. We compared clinical outcomes and changes in task-based brain activation following 3 different rTMS protocols, all combined with exposure and response prevention.

METHODS

In this 3-arm proof-of-concept randomized trial, 61 treatment-refractory adult patients with OCD received 16 sessions of rTMS immediately before exposure and response prevention over 8 weeks, with task-based functional magnetic resonance imaging scans and clinical assessments before and after treatment. Patients received high-frequency rTMS to the left dorsolateral prefrontal cortex (n = 19 [13 women/6 men]), high-frequency rTMS to the left presupplementary motor area (preSMA) (n = 23 [13 women/10 men]), or control rTMS to the vertex (n = 19 [13 women/6 men]). Changes in task-based functional magnetic resonance imaging activation before/after treatment were compared using both a Bayesian region of interest and a general linear model whole-brain approach.

RESULTS

Mean OCD symptom severity decreased significantly in all treatment groups (Δ = -10.836, p < .001, 95% CI -12.504 to -9.168), with no differences between groups. Response rate in the entire sample was 57.4%. The dorsolateral prefrontal cortex rTMS group showed decreased planning-related activation after treatment that was associated with greater symptom improvement. No group-level activation changes were observed for the preSMA and vertex rTMS groups. Participants in the preSMA group with greater symptom improvement showed decreased error-related activation, and symptom improvement in the vertex group was associated with increased inhibition-related activation.

CONCLUSIONS

rTMS to preSMA and dorsolateral prefrontal cortex combined with exposure and response prevention led to activation decreases in targeted task networks in individuals showing greater symptom improvement, although we observed no differences in symptom reduction between groups.

Local effective connectivity changes after transcranial direct current stimulation in obsessive-compulsive disorder patients

AIM

This study investigates the effects of transcranial direct current stimulation (tDCS) on brain network connectivity in individuals with obsessive-compulsive disorder (OCD).

METHODS

In a randomized, double-blind, sham-controlled experimental design anodal tDCS (vs. sham) was applied in a total of 43 right-handed patients with OCD, targeting the right pre-supplementary motor area (pre-SMA). Cathodal reference electrode was put on the left pre-SMA. The current was set as 2 mA, with a stimulation duration of either 30 s (sham) or 1200 s. Concurrent resting-state functional MRI data were collected following tDCS (or sham) stimulation. We employed regression dynamic causal modelling (rDCM) to extract whole brain effective connectivity (EC) matrices subsequently analyzing these matrices through graph theory approaches to examine changes in brain activity across different network scales.

RESULTS

We found that tDCS compared to sham caused significant changes in local effective connectivity. Increased recruitment level was detectable in the sensorimotor network (SMN), indicating enhanced intra-network connectivity after active tDCS. Clustering coefficient and local efficiency were also found to be increased in the same area. No significant changes were detectable with regard to global network connectivity.

CONCLUSIONS

Current findings indicate that single-session tDCS can effectively alter local effective connectivities within the SMN in OCD patients. Given the relevance of the SMN and connected regions for the pathophysiology of OCD we believe that tDCS targeting these areas might constitute an effective intervention to normalize altered network connectivity in the disorder of OCD.

LIMITATION

We used a single tDCS session, which may not reflect long-term effects.

Transcranial Magnetic Stimulation-Induced Plasticity Improving Cognitive Control in Obsessive-Compulsive Disorder, Part II: Task-Based Neural Predictors of Treatment Response

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) has the potential to increase the clinical effect of exposure with response prevention psychotherapy for obsessive-compulsive disorder (OCD). We investigated the use of task-based functional magnetic resonance imaging for predicting clinical outcomes to different rTMS protocols combined with exposure with response prevention in OCD.

METHODS

Sixty-one adults with OCD underwent rTMS and exposure with response prevention and were randomized to different high-frequency rTMS conditions: left dorsolateral prefrontal cortex (n = 19), left presupplementary motor area (n = 23), and control stimulation at the vertex at low intensity (n = 19). The Tower of London task and stop signal task were used to assess pretreatment activation during planning and inhibitory control, respectively. We adopted a Bayesian region-based approach to test whether clinical improvement can be predicted by task-based functional magnetic resonance imaging-derived measures of task-related brain activation or functional connectivity between task-relevant regions and the bilateral amygdala.

RESULTS

For the vertex group, but not the dorsolateral prefrontal cortex/presupplementary motor area rTMS conditions, higher activation in several task-relevant regions during planning and response inhibition and lower error-related activation corresponded with better short-term clinical improvement. Lower precuneus activation with increased planning taskload was correlated with symptom reduction in the dorsolateral prefrontal cortex group. In the presupplementary motor area group, higher error-related activation and lower inhibition-related insular-amygdalar connectivity were associated with symptom reduction.

CONCLUSIONS

Pretreatment task-based functional magnetic resonance imaging-derived measures of activation and connectivity during planning and inhibition-related processes are associated with clinical response for specific rTMS conditions in OCD. Future placebo-controlled trials with larger sample sizes should combine clinical information and neural correlates to improve prediction of clinical outcome.

Emotion regulation difficulties in children and adolescents with obsessive-compulsive disorder: A multi-informant and multi-method study

Pediatric obsessive-compulsive disorder (OCD) is associated with emotion regulation (ER) difficulties. Most studies are based on self-reports, while few have examined how these difficulties are expressed across modalities, which may hold important diagnostic and therapeutic information. We applied a multi-informant and multi-method approach to examine ER difficulties in 211 children aged 8-17 years: 121 with OCD and 90 non-clinical controls. Child ER difficulties were assessed with The Difficulties in Emotion Regulation Scale (self-report and parent-report) and a Tangram frustration task with investigator-rated behavior, self-rated frustration, and heart rate variability (HRV). Children with OCD differed significantly from non-clinical controls in showing: (i) elevated child ER difficulties on self-report (partial eta squared =.068-.165) and parent-report (partial eta squared =.207-.369); (ii) more investigator-rated ER difficulties during the task (Cohen's d = -.33); (iii) increased levels of self-rated frustration before and after the task (partial eta squared =.089); notably, the magnitude of this increase did not differ between children with and without OCD. Finally, (iv) all children, regardless of group, demonstrated significant HRV changes during the frustration task, with no discernible group differences in the magnitude of these changes. Results suggest the OCD-related experience of ER difficulties may not impact autonomic functioning.

Obsessive-compulsive symptoms in dementia: Systematic review with meta-analysis

Dementia is a highly prevalent syndrome with various causes, characterized by cognitive deficit in one or more domains, with important impairment of functioning, which frequently presents with neuropsychiatric symptoms that may include obsessive-compulsive symptoms.

OBJECTIVES

The main goal of this meta-analysis was to describe and determine the prevalence of obsessive-compulsive symptoms in dementia.

MATERIALS AND METHODS

To accomplish that, MEDLINE, CENTRAL and Psycnet databases were searched from inception to March 2023. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was applied. The principal summary measures were the mean of prevalence of obsessive-compulsive symptoms in patients with dementia and the number of each type of obsession or compulsion.

RESULTS

Of the 643 articles screened, 92 were accepted for full-text assessment. Of these, 30 with information on prevalence of obsessive-compulsive symptoms in dementia or any description of those were included, yielding a total of 37 cohorts (5 studies with two cohorts and 1 study with three cohorts). According to our results, obsessive-compulsive symptoms have considerable prevalence in dementia (35.3%, 23.1-47.6%), namely in frontotemporal dementia (48.4%, 29.8-67.0%); obsessive-compulsive symptoms were less frequent in other dementia diagnosis (17.6%, 9.1-26.2%). The more frequent obsessive contents are symmetry (28.6%) and somatic (20.0%); and the more frequent compulsions are checking (27.4%); hoarding is also a relevant symptom (27.8%).

DISCUSSION

There was considerable heterogeneity in the prevalence of obsessive-compulsive symptoms in frontotemporal dementia, that is, in part related with diagnostic criteria for dementia, as well as obsessive-compulsive symptom assessment. A careful distinction between compulsions and compulsive-like symptoms is fundamental. Hypervigilance for somatic symptoms and concerns about disease and mortality, as well as deficits in cognitive domains like attention and memory may explain why somatic obsessions and checking compulsions are more prevalent.

CONCLUSIONS

The present results indicate that obsessive-compulsive symptoms may be prevalent in the clinical course of many patients with dementia, especially frontotemporal dementia. Better instruments are needed to describe obsessive-compulsive phenomena in a reliable and comparable way, particularly in a population such as dementia patients, whose subjectivity is difficult to access.

The clinical phenomenology of skin-picking disorder - Are there any obsessive-compulsive components?

BACKGROUND

Skin-picking disorder (SPD) is currently conceptualized as a condition related to obsessive-compulsive disorder (OCD). The present study investigated whether the emotional, cognitive, and somatic components of skin-picking episodes align with this conceptual framework.

METHOD

A total of 134 patients diagnosed with SPD (mean age = 32 years; 84 % female; average symptom duration: 16 years) underwent in-person clinical assessment. Patients were asked to describe what they experienced directly before, during, and after picking their skin.

RESULTS

Patients reported a very strong urge to manipulate their skin, particularly in situations characterized by emotional and/or bodily tension. No obsession-like phenomena preceded the skin-picking episodes. Skin manipulation had an immediately rewarding effect in the majority of patients or induced 'trance-like' states. After terminating a skin-picking episode, negative self-conscious emotions were dominant.

CONCLUSIONS

The interview findings do not align with the conceptualization of SPD as an OCD-related disorder. Patients reported no obsession-like symptoms, and their skin-picking behaviors did not serve harm prevention, which is characteristic of compulsions. Instead, the rewarding nature of skin-picking and its function in experiential avoidance suggests an addiction component to this behavior.

Synaptic editing of frontostriatal circuitry prevents excessive grooming in SAPAP3-deficient mice

Synaptic dysfunction has been implicated as a key mechanism underlying the pathophysiology of psychiatric disorders. Most pharmacological therapeutics for schizophrenia, autism spectrum disorder, obsessive-compulsive disorder, and major depressive disorder temporarily augment chemical synapse function. Nevertheless, medication non-compliance is a major clinical challenge, and behavioral dysfunction often returns following pharmacotherapeutic discontinuation. Here, we deployed a designer electrical synapse to edit a single class of chemical synapses in a genetic mouse model of obsessive-compulsive disorder (OCD). Editing these synapses in juvenile mice normalized circuit function and prevented the emergence of pathological repetitive behavior in adulthood. Thus, we establish precision circuit editing as a putative strategy for preventative psychotherapeutics.

Marital Cohesion and Perceived Stress in Parents of Children with Special Educational Needs: A Study of the Impact on Couple Dynamics

BACKGROUND/OBJECTIVES

The presence of a child with special educational needs (SENs) necessitates that both the child and their family engage in adaptive processes and develop resilience in response to the developmental challenges that arise following an SENs diagnosis. Furthermore, it is critical to examine the impact of such a diagnosis on parental marital cohesion. Despite the recognized importance of this issue, the effects of SENs diagnoses on marital cohesion and flexibility, and the perceived stress experienced by parents, remain underexplored in the extant literature.

METHODS

Forty-seven participants (23 parents of children diagnosed with SENs and 24 parents of typically developing children, all aged between 32 and 60 years) completed this study. The instruments used were the Family Cohesion and Flexibility Evaluation Scale (couple version) and the Perceived Stress Scale.

RESULTS

No direct relationship was found between the SENs diagnosis and marital cohesion or flexibility. Furthermore, the perceived stress did not mediate the association between these variables. Nonetheless, both groups exhibited high levels of perceived stress.

CONCLUSIONS

These results underscore the necessity for further investigation into the role of emotional support and coping strategies in alleviating the perceived stress among parents and caregivers of children with SENs. A deeper understanding of these factors is essential for the development of interventions aimed at promoting parental well-being and enhancing the quality of caregiving.

Breaking New Ground With Endoxifen: Augmentation Strategies in OCD Management-A Case Series

Obsessive-compulsive (OC) disorder (OCD) is a common and potentially disabling illness with a waxing and waning course. OCD significantly disrupts the quality of life. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological treatments for OCD and benefit up to half of the patients. Augmentation with low-dose antipsychotics is an evidence-based second-line strategy. Psychotherapy, including cognitive behavior therapy (CBT), is used both as first and second-line treatment. A significant portion of patients, however, do not respond to conventional treatments. We present a case series on the use of Endoxifen as an augmenting agent in patients with OCD and multiple psychiatric comorbidities who did not respond well to conventional pharmacotherapy.

Childhood obsessive-compulsive disorder, epigenetics, and heterochrony: An evolutionary and developmental approach

Childhood obsessive-compulsive disorder (OCD) stems from a bunch of restricted and repetitive behaviors, which are part of normal behavioral repertoire up to the age of 7. The persistence of compulsive-like behaviors after that age is often associated with unique comorbidity patterns, which are age-at-onset dependent and reflect different developmental stages. In particular, OCD synchronically co-occurs with a broad constellation of neurodevelopmental disorders, whereas diachronically it is related to an increased risk of major adult psychoses. Moreover, OCD is associated with trait-like sensory phenomena, suggesting a common disrupted sensorimotor grounding.The present study is aimed at exploring the hypothesis that this specific temporal and comorbidity OCD profile may be due to a developmental heterochronic mechanism of delay in attenuation of ontogenetically early behavioral patterns. The developmental shift of highly evolutionarily conserved behavioral phenotypes might be regulated by epigenetic changes induced by different conditions of sensory unbalance. This evolutionary and developmental model allows capturing childhood OCD in light of the ultimate causes of ritual behavior throughout phylogeny, namely its "homeostatic" function over conditions of unpredictability. Moreover, it may have important clinical implications, as OCD symptoms could represent putative biomarkers of early divergent developmental trajectories, with a pathoplastic effect on course and outcome.

A New Perspective on the Etiology of Overactive Bladder Syndrome-Could Overactive Bladder Syndrome Be Associated With Altered Perception of Somatic Sensations as a Result of Obsessive-Compulsive Disorder? A Case-Control Study

PURPOSE

This study aimed to investigate the potential role of obsessive-compulsive disorder (OCD), altered perception of bodily sensations, and somatization in the etiology of overactive bladder (OAB).

METHODS

A total of 124 participants were included in the study. The case group consisted of 63 female patients diagnosed with OAB, and the control group comprised 61 age-matched healthy females. Demographic data were collected from all participants. All participants completed the OAB Questionnaire-V8 (OABQ-V8), Obsessive Beliefs Questionnaire-44 (OBQ-44), Body Sensations Questionnaire (BSQ), and Somatosensory Amplification Scale (SSAS).

RESULTS

There were no statistically significant differences between the groups in terms of age, education, or marital status. The OAB group demonstrated significantly higher scores on the OABQ-V8, OBQ-44, BSQ, and SSAS. Furthermore, the OABQ-V8 score exhibited a significant positive correlation with the OBQ-44, BSQ, and SSAS scores.

CONCLUSION

This study offers a new perspective on the psychological aspects of OAB, suggesting that OAB symptoms may result from heightened bodily sensations and subsequent somatization associated with OCD.

A network analysis of obsessive-compulsive symptoms and their comorbidity with other disorders

OBJECTIVES

To improve our understanding of the heterogeneity of obsessive-compulsive disorder (OCD) and its comorbidity with other disorders by using network analysis.

METHODS

An existing data base of 257 participants with a primary diagnosis of OCD and whose symptoms were evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was subjected to network analysis.

RESULTS

The analysis revealed eight clusters of characteristics. Two clusters were too small in numbers to reach any meaningful conclusion. The other six clusters included patients with: 1) contamination and cleaning symptoms with little comorbidity; 2) high prevalence checking symptoms with comorbid depression and anxiety disorders; 3) high prevalence contamination and cleaning symptoms with aggressive obsessions and checking compulsions; 4) high prevalence hoarding symptoms with comorbid depression and anxiety; 5) high prevalence impulsive aggressive, sexual and checking symptoms, hair-pulling and comorbid body dysmorphic disorder; and 6) high prevalence hoarding with impulsive aggressive and checking symptoms with comorbid alcohol use disorder and psychosis.

CONCLUSIONS

This study highlights the potential role of comorbidity. Contamination/cleaning symptoms were observed to have less psychiatric comorbidity. Symmetry/ordering symptoms did not feature prominently in the symptom clusters, whilst checking compulsions were common to multiple clusters.

Increased Amygdala Activation During Symptom Provocation Predicts Response to Combined Repetitive Transcranial Magnetic Stimulation and Exposure Therapy in Obsessive-Compulsive Disorder in a Randomized Controlled Trial

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) combined with exposure and response prevention is a promising treatment modality for treatment-refractory obsessive-compulsive disorder (OCD). However, not all patients respond sufficiently to this treatment. We investigated whether brain activation during a symptom provocation task could predict treatment response.

METHODS

Sixty-one adults with OCD (39 female/22 male) underwent symptom provocation with OCD- and fear-related visual stimuli during functional magnetic resonance imaging prior to an 8-week combined rTMS and exposure and response prevention treatment regimen. Participants received one of the following 3 rTMS treatments as part of a randomized controlled trial: 1) 10-Hz rTMS (110% resting motor threshold) to the left dorsolateral prefrontal cortex, 2) 10-Hz rTMS (110% resting motor threshold) to the left presupplementary motor area, or 3) 10-Hz control rTMS (60% resting motor threshold) to the vertex. Multiple regression and correlation were used to examine the predictive value of task-related brain activation for treatment response in the following regions of interest: the dorsomedial prefrontal cortex, amygdala, dorsolateral prefrontal cortex, and left presupplementary motor area.

RESULTS

The different treatment groups responded equally to treatment. Higher pretreatment task-related activation of the right amygdala to OCD-related stimuli showed a positive association with treatment response in all groups. Exploratory whole-brain analyses showed positive associations between activation in multiple task-relevant regions and treatment response. Only dorsal anterior cingulate cortex activation to fear-related stimuli showed a negative association with treatment outcome.

CONCLUSIONS

Higher pretreatment right amygdala activation during symptom provocation predicts better treatment response to combined rTMS and exposure and response prevention in OCD.

Transcranial direct current stimulation in patients with obsessive-compulsive disorder: a meta-analysis of randomised controlled trials

OBJECTIVE

Efficacy and safety of transcranial direct current stimulation (tDCS) in the treatment of obsessive-compulsive disorder (OCD) were explored by meta-analysis.

METHOD

Four electronic databases (Cochrane, PubMed, Embase, Web of Science) were retrieved at 25/06/23. From our inclusion criteria, seven studies (N = 201 patients) were included, and we performed a meta-analysis using Stata15.0.

RESULTS

Results suggested that the total Y-BOCS (Yale-Brown obsessive com-pulsive scale) scale was significantly lower in patients with OCD after tDCS treatment [SMD= -0.46, 95%CI (-0.84, -0.07), I2=39%, p = 0.02, Grade: high]. Subgroup analysis showed statistically significant results when treatment duration ≤ 20 days [SMD= -0.95, 95%CI (-1.80, -0.10), p = 0.03]. Moreover, tDCS and sham tDCS-treated OCD patients showed neither significantly different depressive symptoms nor significantly different adverse events [RR= -0.21, 95%CI (-0.58, 0.15), p = 0.25, Grade: moderate] and [RR = 3.98, 95%CI (0.04, 374.99), p = 0.55, Grade: very low], respectively.

CONCLUSION

tDCS maybe reduce the Y-BOCS total scores in OCD patients and depressive symptoms, but for adverse reactions. the results are inconclusive.

Patterns, delays, and associated factors of help-seeking behaviour for lifetime mood disorders and anxiety disorders: A national representative survey

BACKGROUND

Utilisation of health services is low and delayed among individuals with mood mental disorders and anxiety disorders, despite high disease burdens and available effective treatments. This study aims to examine patterns and delays in help-seeking and associated factors among individuals with lifetime disorder of mood disorders and/or anxiety disorders.

METHODS

We used data from the China Mental Health Survey (CMHS), a nationally representative multistage clustered-area probability sample study across 31 provinces. We assessed lifetime mental disorders and help-seeking behaviour using the Composite International Diagnostic Interview (CIDI). Logistic regression analyses were used to examine sociodemographic and clinical correlates of delay to seek health care.

RESULTS

Among 32,552 participants, we identified 3075 patients with lifetime mood and/or anxiety disorders; 486 (15.5 % [95 % CI: 13.6-17.5 %]) have sought health care. Of these, 163 (4.8 % [95 % CI: 3.7-6.3]) ever sought specialized mental health services. The delays to initial health care were 1.0 (IQR: 0-7.1), 1.9 (0-10.0), and 10.0 (1.0-22.1) years for depressive, bipolar, and anxiety disorders. Patients with comorbidities, later age of onset, and living in urban areas showed a higher propensity for help-seeking (all p < 0.05). Older cohort was associated with longer delays in seeking health care, while a later age of onset was associated with shorter delays (all p < 0.05).

LIMITATIONS

The cross-sectional retrospective design and self-assessment approach may add bias.

CONCLUSIONS

Failure and delays in help-seeking are common in China. National strategies are needed to promote health care utilisation.

The Efficacy of Fluvoxamine in Anxiety Disorders and Obsessive-Compulsive Disorder: An Overview of Systematic Reviews and Meta-Analyses

Objective: This systematic review aims to evaluate the efficacy of fluvoxamine in the treatment of anxiety disorders and obsessive-compulsive disorder (OCD) by synthesizing evidence from systematic reviews and meta-analyses. Methods: We conducted a literature search in PubMed and the Cochrane Central Register of Controlled Trials, focusing on fluvoxamine's efficacy in generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and OCD. We included systematic reviews and meta-analyses of randomized controlled trials (RCTs) comparing fluvoxamine to a placebo or other drugs. The quality of evidence from the included reviews was assessed using A Measurement Tool to Assess Systematic Reviews-version 2 (AMSTAR-2). Results: The study included fourteen systematic reviews (five for OCD, three for SAD, and six for PD), covering thirty-seven RCTs (sixteen for OCD, six for SAD, and fifteen for PD), with a total of 3621 patients (1745 with OCD, 1034 with SAD, and 842 with PD). A high-quality systematic review demonstrated that fluvoxamine is superior to a placebo in improving symptoms and the response rates for OCD. Three meta-analyses comparing fluvoxamine to clomipramine in OCD found no significant differences in efficacy regarding symptom improvement. Two additional systematic reviews, both rated as high quality, confirmed the superiority of fluvoxamine in reducing symptom severity and improving the response rates in patients with SAD compared to a placebo. However, the findings for PD were inconsistent. A meta-analysis, also rated as high quality, found that while fluvoxamine showed better response rates than a placebo, the difference was not statistically significant. Conclusions: Overall, the efficacy of fluvoxamine in the treatment of OCD and SAD was demonstrated. While some reviews highlighted its potential in alleviating GAD, its impact on panic-specific outcomes remained inconsistent.

The midline thalamic nucleus reuniens promotes compulsive-like grooming in rodents

Obsessive-compulsive disorder (OCD), a disabling and notoriously treatment-resistant neuropsychiatric disorder, affects 2-3% of the general population and is characterized by recurring, intrusive thoughts (obsessions) and repetitive, ritualistic behaviors (compulsions). Although long associated with dysfunction within the cortico-striato-thalamic-cortical circuits, the thalamic role in OCD pathogenesis remains highly understudied in the literature. Here, we identified a rat thalamic nucleus - the reuniens (NRe) - that mediates persistent, compulsive self-grooming behavior. Optogenetic activation of this nucleus triggers immediate, excessive grooming with strong irresistibility, increases anxiety, and induces negative affective valence. A thalamic-hypothalamic pathway linking NRe to the dorsal premammillary nucleus (PMd) was discovered to mediate excessive self-grooming behavior and render it a defensive coping response to stress, mirroring the compulsions faced by OCD patients. Given the close resemblance between this self-grooming behavior and the clinical manifestations of OCD, the results from this study highlight the role of NRe in mediating OCD-like compulsive behaviors. This can be attributed to NRe's position at the nexus of an extensive frontal-striatal-thalamic network regulating cognition, emotion, and stress-related behaviors, suggesting NRe as a potential novel target for intervention.

Obsessive‒compulsive symptoms and associated factors among people with schizophrenia attending services at referral hospitals in Eastern Ethiopia

BACKGROUND

Obsessive-compulsive symptoms are mental health conditions marked by the presence of obsessions and/or compulsions. Even though significant portion people with schizophrenia are reportedly affected by obsessive-compulsive symptoms, there is scarce of information related to this topic in Africa, and particularly in study area.

OBJECTIVE

This study aimed to assess the magnitude and associated factors of obsessive‒compulsive symptoms among people with schizophrenia attending services at referral hospitals in Eastern Ethiopia from February 15 to March 15, 2024.

METHODS

An institutional-based, cross-sectional study was conducted among adults with schizophrenia. Systematic sampling was used to select 422 study participants. The Yale-Brown Obsessive-Compulsive Scale was used to assess obsessive-compulsive symptoms. Data entry and analysis were performed by EpiData 4.6 and STATA 14, respectively. Bivariable and multivariable logistic regression were performed, and variables with p values < 0.05 were considered statistically significant.

RESULTS

The proportion with obsessive‒compulsive symptoms in this study was 44.07% (95% CI, 39.33%-48.92%). After adjusting for possible confounders, duration of schizophrenia from 3-4 years (AOR = 3.41; 95% CI, 1.28-9.05), duration of schizophrenia 5 years and above (AOR = 6.08; 95% CI, 2.26-16.31), current use of alcohol (AOR = 2.12; 95% CI, 1.09-4.12), current use of khat (AOR = 6.09; 95% CI, 3.15-11.74), being a probable case of anxiety (AOR = 3.57; 95% CI, 1.95-6.53), being a probable case of depression (AOR = 4.56; 95% CI, 2.39-8.66), being on Risperidone (AOR = 5.08; 95% CI, 2.52-10.23) and being on Olanzapine (AOR = 5.95; 95% CI, 2.72-13.04) were significantly associated with obsessive‒compulsive symptoms. CONCLUSIONS AND RECOMMENDATION: The prevalence of obsessive‒compulsive symptoms was relatively high. Timely detection and appropriate interventions are crucial and special consideration is better to be given for those with comorbid substance use, comorbid anxiety and depression, as well as those taking second-generation antipsychotics.

Dysregulated connectivity configuration of triple-network model in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is signified by altered functional network connectivity (FNC), particularly within the default mode network (DMN), salience network (SAL), and fronto-parietal network (FPN). While previous studies suggest disruptions within triple networks, dynamic causal interactions across networks remain unaddressed. This study seeks to validate previous findings of static dysconnectivity between triple networks and further delineate the time-varying interactions and causal relationships among these networks in OCD. A resting-state functional magnetic resonance imaging study was performed on a relatively large and well-characterized clinical sample, comprising 88 medication-free OCD patients and 93 healthy controls (HC). Group independent component analysis, combined with a sliding window approach and k-means clustering analysis, was used to assess static and dynamic time-varying FNC within triple networks. Spectral dynamic causal modelling and parametric empirical Bayes framework were utilized to explore the abnormal effective connectivity among these networks in OCD patients. Our results proposed a novel dysregulated connectivity configuration of the triple-network model for OCD. With the self-inhibition increase in the left FPN, the excitatory effect onto the right FPN decrease, resulting in a weakened static connectivity between the left and right FPNs. Concurrently, time-varying hypoconnectivity patterns are observed between the left FPN and DMN, as well as the right FPN and SAL in OCD. Additionally, the excitatory influence from the DMN to the SAL suggests an atypical modulation within OCD's network pathology. These findings advance our understanding of the dysregulated information transfer and the complex interplay of brain networks in OCD, potentially guiding future therapeutic strategies.

Multiple forms of discrimination and obsessive-compulsive disorder: a prospective cohort study

BACKGROUND

Discrimination increases the risk for adverse mental health in minority populations, with studies showing elevated rates of obsessive-compulsive disorder (OCD) in Black adults facing racial discrimination. Yet, there is a lack of longitudinal research on the different forms of discrimination in relation to OCD risk in early adolescence. The objective of this study was to examine the prospective associations between multiple forms of discrimination and OCD in a national sample of U.S. early adolescents.

METHODS

We examined prospective cohort data from Year 2 (2018-2020, ages 10-13) and Year 3 (2019-2021) of the Adolescent Brain Cognitive Development Study (N = 7,983). Multiple logistic regression models were used to analyze associations between Year 2 past 12-month experiences of discrimination (based on race and ethnicity, country of origin, sexual orientation, weight, and combined multi-discrimination) and Year 3 probable OCD (Child Behavior Checklist; based on dichotomized t-score indicating high risk), adjusting for theoretically relevant covariates including age, sex, sexual orientation, race and ethnicity, country of origin, household income, parent education, depression, body mass index category, study site, and Year 2 probable OCD.

RESULTS

Adjusting for all covariates, multi-discrimination (OR = 1.67; 95% CI 1.23, 2.27), racial discrimination (OR = 2.77; 95% CI 1.32, 5.80), sexual orientation discrimination (OR = 2.51; 95% CI 1.11, 5.64), and weight discrimination (OR = 2.51; 95% CI 1.13, 5.59) at Year 2 were prospectively associated with developing probable OCD at Year 3. There were no significant findings for discrimination based on country of origin.

CONCLUSIONS

Early adolescents who have experienced several forms of discrimination have higher odds of developing probable OCD, suggesting the utility of screening for OCD in even younger adolescents who have encountered discrimination. Educators can play a role in guiding adolescents experiencing discrimination to appropriate resources for accessing mental healthcare.

Development and validation of a machine learning model to predict cognitive behavioral therapy outcome in obsessive-compulsive disorder using clinical and neuroimaging data

Cognitive behavioral therapy (CBT) is a first-line treatment for obsessive-compulsive disorder (OCD), but clinical response is difficult to predict. In this study, we aimed to develop predictive models using clinical and neuroimaging data from the multicenter Enhancing Neuro-Imaging and Genetics through Meta-Analysis (ENIGMA)-OCD consortium. Baseline clinical and resting-state functional magnetic imaging (rs-fMRI) data from 159 adult patients aged 18-60 years (88 female) with OCD who received CBT at four treatment/neuroimaging sites were included. Fractional amplitude of low frequency fluctuations, regional homogeneity and atlas-based functional connectivity were computed. Clinical CBT response and remission were predicted using support vector machine and random forest classifiers on clinical data only, rs-fMRI data only, and the combination of both clinical and rs-fMRI data. The use of only clinical data yielded an area under the ROC curve (AUC) of 0.69 for predicting remission (p=0.001). Lower baseline symptom severity, younger age, an absence of cleaning obsessions, unmedicated status, and higher education had the highest model impact in predicting remission. The best predictive performance using only rs-fMRI was obtained with regional homogeneity for remission (AUC=0.59). Predicting response with rs-fMRI generally did not exceed chance level. Machine learning models based on clinical data may thus hold promise in predicting remission after CBT for OCD, but the predictive power of multicenter rs-fMRI data is limited.

A systematic review of structural neuroimaging markers of psychotherapeutic and pharmacological treatment for obsessive-compulsive disorder

Identifying individual difference factors associated with treatment response and putative mechanisms of therapeutic change may improve treatment for Obsessive Compulsive Disorder (OCD). Our systematic review of structural neuroimaging markers (i.e., morphometry, structural connectivity) of psychotherapy and medication treatment response for OCD identified 26 eligible publications from 20 studies (average study total n=54 ± 41.6 [range: 11-175]; OCD group n=29 ± 19) in child, adolescent, and adult samples evaluating baseline brain structure correlates of treatment response as well as treatment-related changes in brain structure. Findings were inconsistent across studies; significant associations within the anterior cingulate cortex (3/5 regional, 2/8 whole brain studies) and orbitofrontal cortex (5/10 regional, 2/7 whole brain studies) were most common, but laterality and directionality were not always consistent. Structural neuroimaging markers of treatment response do not currently hold clinical utility. Given increasing evidence that associations between complex behavior and brain structure are characterized by small, but potentially meaningful, effects, much larger samples are likely needed. Multivariate approaches (e.g., machine learning) may also improve the clinical predictive utility of neuroimaging data.

Bibliometric analysis of OCD prevalence in youth populations of developing countries

This paper is a bibliometric analysis of research of adolescent obsessive-compulsive disorder (OCD) in developing nations. An analysis of 4,807 papers was conducted to show trends in these areas. The most significant research came from developed countries - with the United States and England having the most publications and the strongest citation strength. However, developing countries play an important role in the development of OCD research because of how they deliver different perspectives into the field given their more distant associations with developed nation's research. This study will use multiple indicators of bibliometrics, most notably bibliographic coupling and citation strength, to draw conclusions to show the various contributions of different nations to the field of adolescent OCD.