Obsessive-compulsive disorder

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

Individualized gray matter morphological abnormalities unveil two neuroanatomical obsessive-compulsive disorder subtypes

Obsessive-compulsive disorder (OCD) is a highly heterogeneous disorder, with notable variations among cases in structural brain abnormalities. To address this heterogeneity, our study aimed to delineate OCD subtypes based on individualized gray matter morphological differences. We recruited 100 untreated, first-episode OCD patients and 106 healthy controls for structural imaging scans. Utilizing normative models of gray matter volume, we identified subtypes based on individual morphological abnormalities. Sensitivity analyses were conducted to validate the reproducibility of clustering outcomes. To gain deeper insights into the connectomic and molecular underpinnings of structural brain abnormalities in the identified subtypes, we investigated their associations with normal brain network architecture and the distribution of neurotransmitter receptors/transporters. Our findings revealed two distinct OCD subtypes exhibiting divergent patterns of structural brain abnormalities. Sensitivity analysis results confirmed the robustness of the identified subtypes. Subtype 1 displayed significantly increased gray matter volume in regions including the frontal gyrus, precuneus, insula, hippocampus, parahippocampal gyrus, amygdala, and temporal gyrus, while subtype 2 exhibited decreased gray matter volume in the frontal gyrus, precuneus, insula, superior parietal gyrus, temporal gyrus, and fusiform gyrus. When considering all patients collectively, structural brain abnormalities nullified. The identified subtypes were characterized by divergent disease epicenters. Specifically, subtype 1 showed disease epicenters in the middle frontal gyrus, while subtype 2 displayed disease epicenters in the striatum, thalamus and hippocampus. Furthermore, structural brain abnormalities in these subtypes displayed distinct associations with neurotransmitter receptors/transporters. The identified subtypes offer novel insights into nosology and the heterogeneous nature of OCD.

MAGNITUDE: Transcranial Magnetic Stimulation for Treatment-Resistant Obsessive-Compulsive Disorder: A Randomized Sham-Controlled Phase II Trial Protocol

Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric condition with a lifetime prevalence of 2-3%. It significantly burdens quality of life and is associated with substantial economic and disease burdens. Cognitive-behavioral therapy and high-dose selective serotonin reuptake inhibitors are considered the first-line treatments for OCD. Approximately two-thirds of patients with Obsessive-Compulsive Disorder (OCD) exhibit inadequate responses to current standard therapies, thus lacking adequate therapy, resulting in a loss of quality of life and huge economic burdens. Repetitive transcranial stimulation (rTMS) is a non-invasive, safe, and well-tolerated intervention that modulates prefrontal cortical circuits involved in OCD. A previous systematic review explored the therapeutic effects of rTMS applied to the dorsolateral prefrontal cortex (dlPFC) area in patients with treatment-resistant OCD. It showed that the application of high-frequency and low-frequency (LF) rTMS to the dlPFC region yielded controversial post-treatment Y-BOCS (Yale-Brown Obsessive-Compulsive Scale) findings due to factors such as small sample sizes, short-term study durations, and variations in rTMS protocols.

OBJECTIVES

Thus, we propose a theoretical protocol based on previous findings to assess better the effect of LF rTMS for treatment-resistant OCD patients.

METHODS

We will recruit patients with moderate to severe OCD and limited response to previous treatments from in- and outpatient clinics. We will use fMRI for precious localization of the right dlPFC and application of 1 Hz stimulation of in total 2000 pulses with three times 40 s inter-train intervals 5 days a week, in 6 consecutive weeks. The primary outcome will be the mean reduction in Y-BOCS at the end of this study.

CONCLUSIONS

This study highlights rTMS's potential to reform OCD treatment, accentuate safety, accessibility, clinical integration, and future research foundations.

Clinical features of obsessive-compulsive disorder among individuals who experience health-related obsessive-compulsive symptoms

BACKGROUND

While some obsessive-compulsive disorder (OCD) phenotypes are well-established and better understood, it is unclear whether the presence of health-related obsessive-compulsive symptoms (OCS) is associated with specific clinical characteristics. We aimed to investigate whether OCS involving concerns with illness, diseases, body parts or aspects of appearance (i.e. health-related OCS) are associated with differences in demographics, experience of stressful life events, clinical severity, clinical course, endorsement of established OCD dimensions, and psychiatric comorbidities.

METHODS

Individuals (N = 1001) with a clinical diagnosis of OCD (M = 34.85, SD = 12.99) completed a questionnaire battery assessing clinical course (age at symptom onset, age at diagnosis, duration of illness), total and dimensional symptom severity, and psychiatric comorbidities. We ran initial univariate, and follow-up multivariate analyses where appropriate, to compare individuals reporting health-related OCS with those not reporting health-related OCS in terms of demographics, symptom severity and clinical course, OCD symptom dimensions, and psychiatric comorbidities.

RESULTS

The presence of health-related OCS was associated with higher severity of contamination, hoarding and harm symptoms. Additionally, those with health-related OCS displayed significantly lower symptom insight, increased incidence of hypochondriasis, panic disorder and anxiety, and lower depression symptoms. Overall OCD symptom severity and clinical course did not differ between participants with and without health-related OCS.

IMPLICATIONS

These novel findings provide clinicians with an enhanced understanding of health-related OCS in order to guide assessment and allow for more targeted treatment planning. Future investigations may examine the effectiveness of specialised treatment methods which target underlying clinical features of health-related OCS.

Action inflexibility and compulsive-like behavior accompany neurobiological alterations in the anterior orbitofrontal cortex and associated striatal nuclei

The orbitofrontal cortex (OFC) is a large cortical structure, expansive across anterior-posterior axes. It is essential for flexibly updating learned behaviors, and paradoxically, also implicated in inflexible and compulsive-like behaviors. Here, we investigated mice bred to display inflexible reward-seeking behaviors that are insensitive to action consequences. We found that these mice also demonstrate insensitivity to Pavlovian-to-instrumental transfer, as well as compulsive-like grooming behavior that is ameliorated by fluoxetine and inhibitory, but not excitatory, chemogenetic modulation of excitatory OFC neurons. Thus, these mice offer the opportunity to identify neurobiological factors associated with inflexible and compulsive-like behavior. Experimentally bred mice suffer excitatory dendritic spine attrition, as well as changes in inhibitory synapse-associated proteins, GAD67/GAD1 and SLITRK3, largely in the anterior and not posterior OFC (or medial frontal cortex). They also display higher levels of the excitatory synaptic marker striatin in the nucleus accumbens and lower levels of the excitatory synaptic marker SAPAP3 in the dorsal striatum, striatal nuclei that receive input from the anterior OFC. Together, our findings point to the anterior OFC as a potential locus controlling action flexibility and compulsive-like behavior alike.

Substance use and disordered eating risk among college students with obsessive-compulsive conditions

PURPOSE

College students are at higher risk for problematic substance use and disordered eating. Few studies have examined the comorbid risks associated with OCD despite the increased prevalence of OCD among young adults. This study examined substance use and disordered eating risk associated with OCD conditions among college students and how this association may vary by sex/gender.

METHODS

Data were from 92,757 undergraduate students aged 18-24 enrolled in 216 colleges between Fall 2021 and Fall 2022, from the American College Health Association-National College Health Assessment III. Regression models were used to estimate alcohol, cannabis, tobacco, and disordered eating risk among those with OCD related conditions compared to those without conditions, overall and by sex/gender, while adjusting for covariates and school clustering.

RESULTS

Students with OCD conditions displayed a higher prevalence of substance use and disordered eating risks. In adjusted models, OCD conditions were associated with increased odds of moderate/high tobacco (aOR = 1.12, 95% CI 1.05, 1.21), cannabis (aOR = 1.11, 95% CI 1.04, 1.18), alcohol (aOR = 1.14, 95% CI 1.05, 1.24) and disordered eating risk (aOR = 2.28, 95% CI 2.13, 2.43). Analyses stratified by gender revealed cis-female students with OCD conditions were at increased risk for moderate/high risk alcohol (aOR = 1.18, 95% CI 1.08, 1.29), tobacco (aOR = 1.12, 95% CI 1.03, 1.22), cannabis (aOR = 1.13, 95% CI 1.06, 1.23) and disordered eating (aOR = 2.30, 9%% CI 2.14, 2.47). Among TGNC students, OCD conditions were associated with increased risk for moderate/high tobacco risk (aOR = 1.24, 95% CI 1.05, 1.48) and disordered eating (aOR = 2.14, 95% CI 1.85, 2.47). OCD conditions was only associated with disordered eating among male students (aOR = 2.34, 95% CI 1.93, 2.83).

DISCUSSION

Young adult college students with OCD conditions exhibit a higher prevalence of medium/high risk alcohol, tobacco, and cannabis use and disordered eating compared to their counterparts without such conditions, even after adjusting for stress, depression, and anxiety.

Contrast avoidance as a diagnostic feature of OCD: A receiver-operator characteristic curve analysis of the contrast avoidance questionnaires

BACKGROUND

Models focusing on transdiagnostic mechanisms, such as repetitive negative thinking, may be of additive value to existing conceptualizations of obsessive-compulsive disorder (OCD). One such model is the Contrast Avoidance Model (CAM), which posits that individuals with generalized anxiety disorder (GAD) are sensitive to sharp increases in emotions, and use worry to maintain heightened states of negative arousal to avoid these emotional shifts. The current study used receiver operator characteristic (ROC) curve analyses to examine the predictive utility of two contrast avoidance questionnaires in detecting probable OCD.

METHODS

Undergraduate students (N = 2880) completed measures of contrast avoidance (CAQ-GE and CAQ-W) and obsessive-compulsive symptoms. A subset of participants were selected for the probable OCD group (n = 431) and the non-OCD group (n = 433).

RESULTS

Results showed significant differences in total CAQ-GE and CAQ-W scores between the probable OCD group and the non-OCD group. Area under the curve values demonstrated excellent accuracy in predicting probable OCD on the CAQ-GE and CAQ-W, (.87 and .88, respectively). Correlation analyses for the entire screening sample revealed that certain OC symptom dimensions (e.g., Unacceptable Thoughts; Responsibility for Harm) were more closely associated with the CAQ-GE and the CAQ-W relative to other symptom dimensions.

LIMITATIONS

The study had a cross-sectional design and relied on an undergraduate sample.

CONCLUSION

Identifying shared mechanisms across OCD and its comorbidities is an important and novel approach to understanding the etiology and maintenance of symptoms.

Obsessive-compulsive disorder and its association with work addiction and job stress

BACKGROUND

Obsessive-compulsive disorder (OCD) which has come to the fore, especially with the COVID-19 pandemic is arguably neglected within the scope of working life. For this reason, there is a need for research in organizational psychology to examine OCB in working life.

OBJECTIVE

The purpose of the present study was to examine the associations of OCD tendencies of employees with work addiction and job stress.

METHODS

Quantitative research was designed to achieve the research purpose. A total of 771 white-collar employees completed a survey that included psychometric assessment tools for the three aforementioned variables.

RESULTS

Correlation analysis indicated that OCD was positively associated with both work addiction (p < 0.001) and job stress (p < 0.001). Multiple regression analysis showed that the rumination (a subscale on the OCD scale) was significantly associated with work addiction (β= 0.39 p < 0.001) and job stress (β= 0.40 p < 0.001).

CONCLUSION

The obtained findings are interpreted theoretically, empirically, and practically, and possible research suggestions regarding the examination of OCD in working life are discussed.

The deer mouse (Peromyscus maniculatus bairdii) as a model organism to explore the naturalistic psychobiological mechanisms contributing to compulsive-like rigidity: A narrative overview of advances and opportunities

Deer mice (Peromyscus maniculatus bairdii), a wildtype species native to North America, have been investigated for their spontaneous compulsive-like behaviour. The repetitive and persistence nature of three unique compulsive-like phenotypes in deer mice, i.e., high stereotypy (HS), large nesting behaviour (LNB) and high marble burying (HMB), are characterized by behavioural and cognitive rigidity. In this narrative review, we summarize key advances in the model's application to study obsessive-compulsive disorder (OCD), emphasizing how it may be used to investigate neurobiological and neurocognitive aspects of rigidity. Indeed, deer mice provide the field with a unique naturalistic and spontaneous model system of behavioural and cognitive rigidity that is useful for investigating the psychobiological mechanisms that underpin a range of compulsive-like phenotypes. Throughout the review, we highlight new opportunities for future research.

Behavioral disorders in multiple sclerosis: a comprehensive review

Multiple sclerosis (MS) is a heterogenous autoimmune-mediated disease of the central nervous system (CNS) characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of neuropsychiatric symptoms, behavioral changes are common, even from the early stages of the disease, while they are associated with cognitive deficits in advanced MS. According to DSM-5, behavioral disorders include attention deficits, oppositional, defiant and conduct disorders, anxiety, panic, obsessive-compulsive disorders (OCD), disruptive and emotional disorders, while others include also irritability, agitation, aggression and executive dysfunctions. Approximately 30 to 80% of individuals with MS demonstrate behavioral changes associated with disease progression. They are often combined with depression and other neuropsychiatric disorders, but usually not correlated with motor deficits, suggesting different pathomechanisms. These and other alterations contribute to disability in MS. While no specific neuropathological data for behavioral changes in MS are available, those in demyelination animal models share similarities with white matter and neuroinflammatory abnormalities in humans. Neuroimaging revealed prefrontal cortical atrophy, interhemispheric inhibition and disruption of fronto-striato-thalamic and frontoparietal networks. This indicates multi-regional patterns of cerebral disturbances within the MS pathology although their pathogenic mechanisms await further elucidation. Benefits of social, psychological, behavioral interventions and exercise were reported. Based on systematical analysis of PubMed, Google Scholar and Cochrane library, current epidemiological, clinical, neuroimaging and pathogenetic evidence are reviewed that may aid early identification of behavioral symptoms in MS, and promote new therapeutic targets and strategies.

Ketogenic Diet as a Nutritional Metabolic Intervention for Obsessive-Compulsive Disorder: A Narrative Review

The substantial evidence supporting the ketogenic diet (KD) in epilepsy management has spurred research into its effects on other neurological and psychiatric conditions. Despite differences in characteristics, symptoms, and underlying mechanisms, these conditions share common pathways that the KD may influence. The KD reverses metabolic dysfunction. Moreover, it has been shown to support neuroprotection through mechanisms such as neuronal energy support, inflammation reduction, amelioration of oxidative stress, and reversing mitochondrial dysfunction. The adequate intake of dietary nutrients is essential for maintaining normal brain functions, and strong evidence supports the role of nutrition in the treatment and prevention of many psychiatric and neurological disorders. Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition marked by persistent, distressing thoughts or impulses (obsessions) and repetitive behaviors performed in response to these obsessions (compulsions). Recent studies have increasingly examined the role of nutrition and metabolic disorders in OCD. This narrative review examines current evidence on the potential role of the KD in the treatment of OCD. We explore research on the KD's effects on psychiatric disorders to assess its potential relevance for OCD treatment. Additionally, we identify key gaps in the preclinical and clinical research that warrant further study in applying the KD as a metabolic therapy for OCD.

Obsessive-compulsive disorder triggered by news reports of contaminated food

We present a case of a woman in her early 30s who developed severe obsessive-compulsive disorder (OCD) symptoms following exposure to news reports about instant noodles allegedly contaminated with a carcinogenic substance. The news triggered an overwhelming fear of ingesting harmful food associated with persistent and intrusive thoughts about contamination in this patient. As a result, she adopted extreme food avoidance behaviours and restricted her oral intake for 2 weeks, causing significant weight loss and anxiety. Following a visit to her psychiatrist and a prescription for a selective serotonin reuptake inhibitor, her eating behaviours improved, and she could take her food without overwhelming fear. This case shows how OCD may mimic eating disorders and highlights how food-related obsessions can have a severe impact on health.

Glutamate dynamics and BOLD response during OCD symptom provocation in the lateral occipital cortex: A 7 Tesla fMRI-fMRS study

Obsessive-compulsive disorder (OCD) is linked with dysfunction in frontal-striatal, fronto-limbic, and visual brain regions. Research using proton magnetic resonance spectroscopy (1H-MRS) suggests that altered neurometabolite levels, like glutamate, may contribute to this dysfunction. However, static neurometabolite levels in OCD patients have shown inconsistent results, likely due to previous studies' limited focus on neurometabolite dynamics. We employ functional MRS (fMRS) and functional magnetic resonance imaging (fMRI) to explore these dynamics and brain activation during OCD symptom provocation. We utilized a combined 7-tesla fMRI-fMRS setup to examine task-related BOLD response and glutamate changes in the lateral occipital cortex (LOC) of 30 OCD participants and 34 matched controls during an OCD-specific symptom provocation task. The study examined main effects and between-group differences in brain activation and glutamate levels during the task. A whole sample task-effects analysis on data meeting predefined quality criteria showed significant glutamate increases (n = 41 (22 OCD, 19 controls), mean change: 3.2 %, z = 3.75, p < .001) and task activation (n = 54 (26 OCD, 28 controls), p < .001) in the LOC during OCD blocks compared to neutral blocks. However, no differences in task-induced glutamate dynamics or activation between groups were found, nor a correlation between glutamate levels and task activation. We were able to measure task-induced increases in glutamate and BOLD levels, emphasizing its feasibility for OCD research. The absence of group differences highlights the need for further exploration to discern to what extent neurometabolite dynamics differ between OCD patients and controls. Once established, future studies can use pre-post intervention fMRS-fMRI to probe the effects of therapies modulating glutamate pathways in OCD.

Functional Magnetic Resonance Imaging-Specific Alternations in the Default Mode Network in Obsessive-Compulsive Disorder: A Voxel-Based Meta-Analysis

BACKGROUND

Obsessive-compulsive disorder (OCD) is a common and debilitating mental disorder. Neuroimaging studies have highlighted that a dysfunctional default mode network (DMN) plays a key role in the pathophysiological mechanisms of OCD. However, findings of impaired DMN regions in OCD have been inconsistent. We used meta-analysis to identify functional magnetic resonance imaging (fMRI)-specific abnormalities of the DMN in OCD.

METHODS

PubMed, Web of Science, and Embase were searched to screen resting-state fMRI studies of the amplitude of low-frequency fluctuation/fractional amplitude of low-frequency fluctuation (ALFF/fALFF) and regional homogeneity of the DMN in patients with OCD. Based on the activation likelihood estimation algorithm, we compared all patients with OCD and a control group in a primary meta-analysis and analyzed unmedicated OCD patients without comorbidities in secondary meta-analyses.

RESULTS

A total of 26 eligible studies with 1219 patients with OCD (707 men) and 1238 healthy control participants (684 men) were included in the primary meta-analysis. We identified specific changes in brain regions of the DMN, mainly in the left medial frontal gyrus, bilateral superior temporal gyrus, bilateral inferior parietal lobule, bilateral precuneus, bilateral posterior cingulate cortex, and right parahippocampal gyrus.

CONCLUSIONS

Patients with OCD showed dysfunction in the DMN, including impaired local important nodal brain regions. The parietal cingulate cortex/precuneus appeared to be the most affected regions within the DMN, providing valuable insights into understanding the potential pathophysiology of OCD and targets for clinical interventions.

Obsessive-Compulsive Disorder with a Religious Focus: An Observational Study

Background: Obsessive-compulsive disorder (OCD) is a psychiatric disorder with poorly detailed subtypes/dimensions, such as religious OCD (ROCD). To date, little is known about ROCD characteristics. This work aimed to describe the sociodemographic and clinical characteristics, along with the religiosity and spirituality, of Lebanese Muslim citizens diagnosed with OCD and exhibiting religious symptoms. Methods: Participants were Lebanese Muslims, outpatients with OCD and religious symptoms, aged 18 or above, who could complete a questionnaire. Exclusion criteria were as follows: other psychiatric disorders and cognitive or physical impairments preventing participation. They completed a questionnaire including the 25-item Arabic Scale of Obsessions and Compulsions (10 questions addressing obsessions, 10 questions addressing compulsions, and 5 filler items, all of which were rated on a 4-point Likert scale, with higher total scores indicating increasing severity), the 26-item Spiritual Involvement and Beliefs Scale (rated on a 5-point Likert scale, with higher scores indicating higher spirituality), and questions assessing sociodemographic, clinical, and religiosity variables. Results: Fifty adults (62% females, 52% aged between 18 and 29 years) completed the study. They had mild (26%), moderate (48%), and severe (26%) OCD symptoms. The majority attended religious school at least at one point in their life and described a moderate to very high degree of self-religiosity and parental religiosity. Group comparisons (patients with mild vs. moderate vs. severe OCD symptoms) showed significant differences with regard to a family history of psychiatric disorders (p = 0.043), the frequency of self-questioning if they prayed correctly (p = 0.005), a higher rating of partial ablution repetition (p = 0.006), and the frequency of partial ablution repetitions (p = 0.041). No significant group differences were noted with regard to sociodemographic or spirituality outcomes. The prevalence of religious doubts (i.e., self-questioning if praying correctly) and specific rituals (partial ablution repetition) among severe OCD patients were 100% (13/13) and 77% (10/13), respectively. Conclusions: The results suggest a link between specific religious practices and OCD severity, underscoring the need for culturally sensitive approaches in diagnosing and treating ROCD.

Neurobiology of Obsessive-Compulsive Disorder from Genes to Circuits: Insights from Animal Models

Obsessive-compulsive disorder (OCD) is a chronic, severe psychiatric disorder that has been ranked by the World Health Organization as one of the leading causes of illness-related disability, and first-line interventions are limited in efficacy and have side-effect issues. However, the exact pathophysiology underlying this complex, heterogeneous disorder remains unknown. This scenario is now rapidly changing due to the advancement of powerful technologies that can be used to verify the function of the specific gene and dissect the neural circuits underlying the neurobiology of OCD in rodents. Genetic and circuit-specific manipulation in rodents has provided important insights into the neurobiology of OCD by identifying the molecular, cellular, and circuit events that induce OCD-like behaviors. This review will highlight recent progress specifically toward classic genetic animal models and advanced neural circuit findings, which provide theoretical evidence for targeted intervention on specific molecular, cellular, and neural circuit events.

Decreased Functional and Structural Connectivity is Associated with Core Symptom Improvement in Children with Autism Spectrum Disorder After Mini-basketball Training Program

Exercise intervention has been proven helpful to ameliorate core symptoms of Autism Spectrum Disorder (ASD). However, the underlying mechanisms are not fully understood. In this study, we carried out a 12-week mini-basketball training program (MBTP) on ASD children and examined the changes of brain functional and structural networks before and after exercise intervention. We applied individual-based method to construct functional network and structural morphological network, and investigated their alterations following MBTP as well as their associations with the change in core symptom. Structural MRI and resting-state functional MRI data were obtained from 58 ASD children aged 3-12 years (experiment group: n = 32, control group: n = 26). ASD children who received MBTP intervention showed several distinguishable alternations compared to the control without special intervention. These included decreased functional connectivity within the sensorimotor network (SM) and between SM and the salience network, decreased morphological connectivity strength in a cortical-cortical network centered on the left inferior temporal gyrus, and a subcortical-cortical network centered on the left caudate. Particularly, the aforementioned functional and structural changes induced by MBTP were associated with core symptoms of ASD. Our findings suggested that MBTP intervention could be an effective approach to improve core symptoms in ASD children, decrease connectivity in both structure and function networks, and may drive the brain change towards normal-like neuroanatomy.

Concurrent oculomotor hyperactivity and deficient anti-saccade performance in obsessive-compulsive disorder

Existing studies mainly focused on the inhibition of the task-interfering response to understand the inhibitory deficits of obsessive-compulsive disorder (OCD). However, recent studies suggested that inhibitory function is broadly involved in response preparation and implementation. It is yet unknown if the inhibition dysfunction in OCD extends beyond the task-interfering response to the general inhibitory function. Here we address this issue based on the multidimensional eye-movement measurements, which can better capture the inhibitory deficits than manual responses. Thirty-one OCD patients and 32 healthy controls (HCs) completed the anti-saccade task where multidimensional eye-movement features were developed. Confirmatory factor analysis (CFA) suggested two components of inhibitory function that negatively correlated with each other: one component of oculomotor hyperactivity in generating oculomotor output which is characterized with early premature saccades, early cross rates and saccade number; the other component of task-specific oculomotor efficiency which is characterized with task accuracy, saccade latency, correction rate, and amplitude gain. Importantly, OCD showed both stronger oculomotor hyperactivity and deficient oculomotor efficiency than HCs, and the machine-learning-based classifications showed that the features of oculomotor hyperactivity had higher prediction accuracy than the features of oculomotor efficiency in distinguishing OCD from HCs. Our results suggested that OCD has concurrent deficits in oculomotor hyperactivity and oculomotor efficiency, which may originate from a common inhibitory dysfunction.