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Miller CH, Hedges DW, Brown B, Olsen J, Baughan EC. Development of the scrupulosity inventory: A factor analysis and construct validity study. J Behav Ther Exp Psychiatry 2024; 83:101926. [PMID: 38070454 DOI: 10.1016/j.jbtep.2023.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/04/2023] [Accepted: 11/20/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Scrupulosity, despite its considerable prevalence and morbidity, remains under-investigated. The present study develops and examines the psychometric properties of a comprehensive assessment tool, the Scrupulosity Inventory (SI). METHODS The SI, along with other measures of obsessive-compulsive disorder (OCD) and perfectionism, were administered to a sample (N = 150) of college undergraduates similar in size to other scale development studies of related measures. We conducted exploratory and confirmatory factor analyses of the SI, examined its convergent and divergent validity, and assessed its ability to predict categorical diagnoses of scrupulosity using a receiver operator characteristic analysis. RESULTS We found a well-fitting confirmatory bifactor model (RMSEA = 0.049) with a strong general Scrupulosity factor ( [Formula: see text] ) and specific factors for Personal Violations ( [Formula: see text] ), Ritualized Behavior ( [Formula: see text] ), Interference with Life ( [Formula: see text] ), and Problem Pervasiveness ( [Formula: see text] ). As predicted, we also found the strongest convergence (r = 0.63) between the SI and the Penn Inventory of Scrupulosity (PIOS), intermediate convergence (r = 0.54) between the SI and Perfectionism Inventory (PI), and weaker convergence (r = 0.47) between the SI and YBOCS. Finally, we found that a categorical diagnosis of scrupulosity was highly predicted by the SI (AUC = 0.84), less well-predicted by the PIOS (AUC = 0.75) and less well predicted by the YBOCS (AUC = 0.69). LIMITATIONS This study was conducted among a sample of undergraduates at a religiously affiliated university. CONCLUSIONS These results suggest utility in using the SI to measure the severity of scrupulosity symptoms and that scrupulosity and OCD may present significantly different clinical features.
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Affiliation(s)
- Chris H Miller
- California State University, Department of Psychology, Fresno, CA 93619, USA.
| | - Dawson W Hedges
- Brigham Young University, Department of Psychology, Provo, UT 84604, USA.
| | - Bruce Brown
- Brigham Young University, Department of Psychology, Provo, UT 84604, USA.
| | - Joseph Olsen
- Brigham Young University, Department of Psychology, Provo, UT 84604, USA.
| | - Elijah C Baughan
- Brigham Young University, Department of Psychology, Provo, UT 84604, USA.
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2
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Endres D, Jelinek L, Domschke K, Voderholzer U. [Treatment-resistant obsessive-compulsive disorders]. DER NERVENARZT 2024; 95:432-439. [PMID: 38466350 DOI: 10.1007/s00115-024-01629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Obsessive-compulsive disorders (OCD) are mainly treated with disorder-specific cognitive behavioral therapy using exposure and response management and/or selective serotonin reuptake inhibitors; however, a significant subgroup of patients does not sufficiently benefit from this approach. OBJECTIVE This article provides an overview of treatment-resistant OCD. MATERIAL AND METHODS In this narrative review the definition, causes, diagnostic and therapeutic approaches to treatment-resistant OCD are addressed. RESULTS Treatment resistance can be assumed in the absence of clinically relevant improvement under therapy, in the sense of a reduction of < 25% on the Yale-Brown obsessive-compulsive scale and a score of 4 (no change) on the clinical global impression-improvement scale. The number of unsuccessful treatment attempts required to establish treatment resistance is defined differently. Causative factors include misdiagnosis, a high severity, comorbid disorders, substance use, specific symptom constellations, organic causes, environmental factors, and aggravating factors in psychotherapy and pharmacotherapy. Suggestions for diagnostic and therapeutic approaches based on the German S3 guideline on OCD are presented. CONCLUSION For patients with treatment resistance to first-line therapy, useful diagnostic and therapeutic recommendations are available (psychotherapeutic, psychopharmacological and neurostimulation procedures).
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Affiliation(s)
- Dominique Endres
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - Lena Jelinek
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Katharina Domschke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Standort Berlin, Berlin, Deutschland
| | - Ulrich Voderholzer
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- Schön Klinik Roseneck, Prien am Chiemsee, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum, Ludwig-Maximilians-Universität München, München, Deutschland
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3
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Strouphauer E, Valenzuela-Flores C, Minhajuddin A, Slater H, Riddle DB, Pinciotti CM, Guzick AG, Hettema JM, Tonarelli S, Soutullo CA, Elmore JS, Gushanas K, Wakefield S, Goodman WK, Trivedi MH, Storch EA, Cervin M. The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder. J Affect Disord 2024; 349:349-357. [PMID: 38199393 DOI: 10.1016/j.jad.2024.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth. METHODS A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis. RESULTS Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged. LIMITATIONS Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis. CONCLUSIONS Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD.
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Affiliation(s)
| | | | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA; Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David B Riddle
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Andrew G Guzick
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John M Hettema
- Department of Psychiatry and Behavioral Sciences, Texas A&M Health Sciences Center, Bryan, TX, USA
| | - Silvina Tonarelli
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Cesar A Soutullo
- UT Health Houston, Louis A. Faillace MD Department of Psychiatry and Behavioral Sciences, Houston, TX, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kimberly Gushanas
- Department of Psychiatry, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Sarah Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wayne K Goodman
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Eric A Storch
- College of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Matti Cervin
- Department of Clinical Sciences, Lund University, Lund, Sweden
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4
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Audet JS, Bourguignon L, Aardema F. What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations. Clin Psychol Psychother 2023; 30:1446-1463. [PMID: 37482945 DOI: 10.1002/cpp.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
The Diagnostic and Statistical Manual 5th ed. defines obsessions in obsessive-compulsive disorder (OCD) as frequent, persistent, intrusive, unwanted thoughts that provoke anxiety and distress and lead to attempts to neutralize them with either thoughts or actions. However, no systematic review has yet evaluated characteristics that are specific to obsessions occurring in OCD. The aim of the current systematic review and meta-analysis was to investigate the specific features of obsessions occurring in OCD by comparing them to both obsessionally and non-obsessionally-themed intrusions in non-clinical and other clinical populations. Based on a registered protocol, 832 records were found, of which 15 were included in the systematic review and meta-analysis, with a total of 1891 participants. Obsessionally-themed intrusions that occur among those with OCD caused more distress, guilt, negative emotion and interference as compared to similarly-themed intrusions that occur within the general population. The distinction between obsessionally-themed intrusions among those with OCD as compared to those occurring in anxiety and depressive disorder primarily revolves around a higher level of persistence, pervasiveness and distress associated with their occurrence. Further, unacceptability, uncontrollability, ego-dystonicity, alienness, guilt, the form of the intrusion, association with the self and lack of any basis in reality also differentiates between obsessions and intrusions occurring in other disorders. Obsessions share many characteristics with thoughts occurring in other disorders and can be distinguished using a combination of characteristics specific to individual disorders.
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Affiliation(s)
- Jean-Sébastien Audet
- Montreal Mental Health University Institute Research Center, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, University of Montréal, Montreal, Quebec, Canada
| | - Lysandre Bourguignon
- Montreal Mental Health University Institute Research Center, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Frederick Aardema
- Montreal Mental Health University Institute Research Center, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, University of Montréal, Montreal, Quebec, Canada
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5
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Miyauchi M, Matsuura N, Mukai K, Hashimoto T, Ogino S, Yamanishi K, Yamada H, Hayashida K, Matsunaga H. A prospective investigation of impacts of comorbid attention deficit hyperactivity disorder (ADHD) on clinical features and long-term treatment response in adult patients with obsessive-compulsive disorder (OCD). Compr Psychiatry 2023; 125:152401. [PMID: 37454485 DOI: 10.1016/j.comppsych.2023.152401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/13/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A close association between obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has been investigated in previous studies. However, few studies examined the relationship between lifetime comorbidity of ADHD and OCD in adults. Therefore, we sought to investigate the clinical and psychopathological features related to comorbid ADHD in Japanese adult patients with OCD. METHODS We assessed lifetime comorbidity of ADHD in 93 adult Japanese patients with OCD. Additionally, we used the Japanese version of Conners' Adult ADHD Rating Scales to assess the characteristics and severity of ADHD in each participant. According to the results, we excluded OCD patients that did not have ADHD but who exhibited elevated levels of ADHD traits. We compared OCD patients with ADHD (ADHD+ group) and those without ADHD or its trait (ADHD- group) in terms of background profiles and clinical features, such as OCD symptomatology and psychometric test results. Additionally, the 6-month treatment outcome was compared prospectively between groups. RESULTS Of the 93 OCD participants, the prevalence of lifetime comorbidity of ADHD was estimated as 16.1%. Compared with the ADHD- group, participants in the ADHD+ group had an earlier age of onset of OCD, higher frequencies of hoarding symptoms, higher levels of depressive and anxiety symptoms and lower quality of life, more elevated levels of impulsivity, and higher rates of substance or behavioral addiction and major depression. Finally, the mean improvement rate on the Yale-Brown Obsessive Compulsive Scale after 6 months of standardized OCD treatment in the ADHD+ group (16.1%) was significantly lower than that in the ADHD- group (44.6%). CONCLUSION The lifetime comorbidity of ADHD is likely to exert a significant effect on clinical features and treatment outcome in adult patients with OCD. It is important to consider that underlying ADHD pathology may function as a facilitator for increased severity of global clinical features and treatment refractory conditions in OCD patients. Further studies are required to examine treatment strategies for such patients.
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Affiliation(s)
- Masahiro Miyauchi
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naomi Matsuura
- Graduate School of Education, Mie University, Mie, Japan
| | - Keiichiro Mukai
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takuya Hashimoto
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shun Ogino
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyosuke Yamanishi
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Hayashida
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan.
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6
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Fan Y, Eisen JL, Rasmussen SA, Boisseau CL. The relationship between obsessive-compulsive disorder symptom subtypes and social adjustment. J Obsessive Compuls Relat Disord 2023; 38:100826. [PMID: 37547666 PMCID: PMC10399149 DOI: 10.1016/j.jocrd.2023.100826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Although it has been widely established that poor social functioning is a characteristic of obsessive-compulsive disorder (OCD), little research has examined the relationship between OCD symptom subtypes and domains of social functioning. Thus, the present study sought to examine the specific ways in which impairment in social adjustment occurs in each symptom subtype of OCD. Methods A total of 325 adult participants with a primary diagnosis of OCD were included in the study. Hierarchical linear regressions were used to compare the extent to which OCD symptom subtypes predicted social adjustment domains after controlling for OCD and depression severity. Results Hoarding was shown to be significantly associated with work functioning. Whereas both contamination and symmetry subtypes were significantly associated with social functioning, only the contamination subtype was associated with functioning within the family unit. The symptom subtypes of doubt and taboo thoughts were not significantly associated with any domains of social adjustment. Conclusion Consistent with previous research, our results suggest a differential impact of OCD symptom subtypes on social adjustment. They offer important implications for the specific domains to target in treatment for different symptom subtypes.
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Affiliation(s)
- Yiqing Fan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Jane L. Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Christina L. Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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7
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Rajkumar RP. SAPAP3, SPRED2, and obsessive-compulsive disorder: the search for fundamental phenotypes. Front Mol Neurosci 2023; 16:1095455. [PMID: 37324590 PMCID: PMC10264593 DOI: 10.3389/fnmol.2023.1095455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
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8
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Han S, Xu Y, Fang K, Guo HR, Wei Y, Liu L, Wen B, Liu H, Zhang Y, Cheng J. Mapping the neuroanatomical heterogeneity of OCD using a framework integrating normative model and non-negative matrix factorization. Cereb Cortex 2023:7153879. [PMID: 37150510 DOI: 10.1093/cercor/bhad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a spectrum disorder with high interindividual heterogeneity. We propose a comprehensible framework integrating normative model and non-negative matrix factorization (NMF) to quantitatively estimate the neuroanatomical heterogeneity of OCD from a dimensional perspective. T1-weighted magnetic resonance images of 98 first-episode untreated patients with OCD and matched healthy controls (HCs, n = 130) were acquired. We derived individualized differences in gray matter morphometry using normative model and parsed them into latent disease factors using NMF. Four robust disease factors were identified. Each patient expressed multiple factors and exhibited a unique factor composition. Factor compositions of patients were significantly correlated with severity of symptom, age of onset, illness duration, and exhibited sex differences, capturing sources of clinical heterogeneity. In addition, the group-level morphological differences obtained with two-sample t test could be quantitatively derived from the identified disease factors, reconciling the group-level and subject-level findings in neuroimaging studies. Finally, we uncovered two distinct subtypes with opposite morphological differences compared with HCs from factor compositions. Our findings suggest that morphological differences of individuals with OCD are the unique combination of distinct neuroanatomical patterns. The proposed framework quantitatively estimating neuroanatomical heterogeneity paves the way for precision medicine in OCD.
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Affiliation(s)
- Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Yinhuan Xu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Keke Fang
- Department of Pharmacy, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University
| | - Hui-Rong Guo
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University
| | - Yarui Wei
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Liang Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Baohong Wen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Hao Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou
- Key Laboratory of Imaging Intelligence Research Medicine of Henan Province
- Henan Engineering Research Center of Brain Function Development and Application
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9
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Naze S, Hearne LJ, Roberts JA, Sanz-Leon P, Burgher B, Hall C, Sonkusare S, Nott Z, Marcus L, Savage E, Robinson C, Tian YE, Zalesky A, Breakspear M, Cocchi L. Mechanisms of imbalanced frontostriatal functional connectivity in obsessive-compulsive disorder. Brain 2023; 146:1322-1327. [PMID: 36380526 PMCID: PMC10396323 DOI: 10.1093/brain/awac425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022] Open
Abstract
The diagnosis of obsessive-compulsive disorder (OCD) has been linked with changes in frontostriatal resting-state connectivity. However, replication of prior findings is lacking, and the mechanistic understanding of these effects is incomplete. To confirm and advance knowledge on changes in frontostriatal functional connectivity in OCD, participants with OCD and matched healthy controls underwent resting-state functional, structural and diffusion neuroimaging. Functional connectivity changes in frontostriatal systems were here replicated in individuals with OCD (n = 52) compared with controls (n = 45). OCD participants showed greater functional connectivity (t = 4.3, PFWE = 0.01) between the nucleus accumbens (NAcc) and the orbitofrontal cortex (OFC) but lower functional connectivity between the dorsal putamen and lateral prefrontal cortex (t = 3.8, PFWE = 0.04) relative to controls. Computational modelling suggests that NAcc-OFC connectivity changes reflect an increased influence of NAcc over OFC activity and reduced OFC influence over NAcc activity (posterior probability, Pp > 0.66). Conversely, dorsal putamen showed reduced modulation over lateral prefrontal cortex activity (Pp > 0.90). These functional deregulations emerged on top of a generally intact anatomical substrate. We provide out-of-sample replication of opposite changes in ventro-anterior and dorso-posterior frontostriatal connectivity in OCD and advance the understanding of the neural underpinnings of these functional perturbations. These findings inform the development of targeted therapies normalizing frontostriatal dynamics in OCD.
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Affiliation(s)
- Sebastien Naze
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Luke J Hearne
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - James A Roberts
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Paula Sanz-Leon
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Bjorn Burgher
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Caitlin Hall
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Saurabh Sonkusare
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Zoie Nott
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Leo Marcus
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Emma Savage
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Conor Robinson
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Ye Ella Tian
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne 3053, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne 3053, Australia
| | - Michael Breakspear
- College of Engineering Science and Environment, College of Health and Medicine, University of Newcastle, Callaghan 2308, Australia
| | - Luca Cocchi
- Department of Mental Health and Neuroscience, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
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10
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Worden BL, Tolin DF. Co-occurring Obsessive-Compulsive Disorder and Hoarding Disorder: A Review of the Current Literature. J Cogn Psychother 2022; 36:271-286. [PMID: 36635053 DOI: 10.1891/jcp-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Current research suggests obsessive-compulsive disorder (OCD) co-occurs in around 20% of people with hoarding disorder (HD). The article discusses the theoretical conceptualization of co-occurring HD and OCD (HD+OCD), highlighting similarities between the disorders that may contribute to comorbidity, such as potentially overlapping etiological factors, comorbidity profiles, and phenomenological aspects; and differences that are important to consider in differential diagnosis and conceptualization, such as belief patterns, ego-syntonicty/dystonicity, and trajectory. The combination of HD+OCD versus either disorder alone appears to be associated with a profile characterized by higher nonhoarding OCD symptoms, anxiety symptoms, depression, and tic disorders, and which may be more treatment-refractory. The authors discuss some commonly used measures to assess hoarding that may be relevant in the context of OCD, as differential diagnosis of hoarding behaviors is often difficult, and hoarding may be difficult to detect in patients with OCD, especially in children. The article ends with a discussion on considerations for the treatment of HD+OCD with cognitive-behavioral therapy, as hoarding symptoms are less likely to respond to gold-standard exposure and response prevention, and there are no established treatment protocols that are designed to treat co-occurring HD and OCD.
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Affiliation(s)
| | - David F Tolin
- Institute of Living, Hartford, CT.,Yale University School of Medicine, New Haven, CT
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11
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Pampaloni I, Marriott S, Pessina E, Fisher C, Govender A, Mohamed H, Chandler A, Tyagi H, Morris L, Pallanti S. The global assessment of OCD. Compr Psychiatry 2022; 118:152342. [PMID: 36007341 DOI: 10.1016/j.comppsych.2022.152342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
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Affiliation(s)
- Ilenia Pampaloni
- South West London and St Georges Mental Health Trust, London, UK.
| | - Sabina Marriott
- South West London and St Georges Mental Health Trust, London, UK
| | | | - Claire Fisher
- South West London and St Georges Mental Health Trust, London, UK
| | - Anusha Govender
- South West London and St Georges Mental Health Trust, London, UK
| | - Heba Mohamed
- South West London and St Georges Mental Health Trust, London, UK
| | - Augusta Chandler
- South West London and St Georges Mental Health Trust, London, UK
| | - Himanshu Tyagi
- University College London Hospital NHS foundation Trust, London, UK
| | - Lucy Morris
- South West London and St Georges Mental Health Trust, London, UK
| | - Stefano Pallanti
- Albert Einstein Institute, New York, USA; Istututo di Neuroscienze, Firenze, Italy
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12
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Safiloo S, Mehrabi Y, Asadi S, Khodakarim S. Response to Fluvoxamine in the Obsessive-Compulsive Disorder Patients: Bayesian Ordinal Quantile Regression. Clin Pract Epidemiol Ment Health 2021; 17:146-151. [PMID: 34880926 PMCID: PMC8595981 DOI: 10.2174/1745017902117010151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022]
Abstract
Background: Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or mental behaviors to relieve discomfort. 40-60% of patients do not respond to Serotonin Reuptake Inhibitors, including fluvoxamine therapy. Introduction: The aim of the study is to identify the predictors of fluvoxamine therapy in OCD patients by Bayesian Ordinal Quantile Regression Model. Methods: This study was performed on 109 patients with OCD. Three methods, including Bayesian ordinal quantile, probit, and logistic regression models, were applied to identify predictors of response to fluvoxamine. The accuracy and weighted kappa were used to evaluate these models. Results: Our result showed that rs3780413 (mean=-0.69, sd=0.39) and cleaning dimension (mean=-0.61, sd=0.20) had reverse effects on response to fluvoxamine therapy in Bayesian ordinal probit and logistic regression models. In the 75th quantile regression model, marital status (mean=1.62, sd=0.47) and family history (mean=1.33, sd=0.61) had a direct effect, and cleaning (mean=-1.10, sd=0.37) and somatic (mean=-0.58, sd=0.27) dimensions had reverse effects on response to fluvoxamine therapy. Conclusion: Response to fluvoxamine is a multifactorial problem and can be different in the levels of socio-demographic, genetic, and clinical predictors. Marital status, familial history, cleaning, and somatic dimensions are associated with response to fluvoxamine therapy.
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Affiliation(s)
- Samad Safiloo
- School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Asadi
- Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Demaria F, Pontillo M, Tata MC, Gargiullo P, Mancini F, Vicari S. Psychoeducation focused on family accommodation: a practical intervention for parents of children and adolescents with obsessive-compulsive disorder. Ital J Pediatr 2021; 47:224. [PMID: 34742338 PMCID: PMC8572476 DOI: 10.1186/s13052-021-01177-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/23/2021] [Indexed: 01/20/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that is frequently diagnosed in children and adolescents. In pediatric OCD, family plays an important role in the development and maintenance of the disease. In this relationship, both genetic and behavioral factors, such as parental modeling and family accommodation, are significant. Parental modeling concerns the daily enactment of dysfunctional behavioral patterns by a parent with OCD, which may influence children. Family accommodation, in contrast, describes the direct participation of parents in their child's compulsive rituals, by modifying daily routines or by facilitating avoidance of OCD triggers, to decrease the child's distress and time spent executing compulsions. Approximately 80-90% of the relatives of OCD patients actively participate in patients' rituals. The literature demonstrates that a high level of family accommodation is associated with OCD symptom severity, reduced response to cognitive-behavioral treatment (CBT), and a higher risk of therapy dropout.Despite this, no studies have aimed at delineating practical guidance for psychotherapists to support parents in reducing family accommodation.The main aim of this paper is to propose a psychoeducation intervention focused on cognitive-behavioral strategies to help families to manage their child's OCD behaviors without enacting dysfunctional family accommodation behaviors in order to support their child's successful therapy.
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Affiliation(s)
- Francesco Demaria
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Maria Cristina Tata
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Prisca Gargiullo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
| | - Francesco Mancini
- Scuola di Psicoterapia Cognitiva APC-SPC, Viale Castro Pretorio, 116, 00185 Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, IRCCS, Viale Ferdinando Baldelli 41, 00146 Rome, Italy
- Scuola di Psicoterapia Cognitiva APC-SPC, Viale Castro Pretorio, 116, 00185 Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
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14
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Bratiotis C, Muroff J, Lin NXY. Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:392-404. [PMID: 35747296 PMCID: PMC9063579 DOI: 10.1176/appi.focus.20210016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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15
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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16
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Krebs G, Mataix-Cols D, Rijsdijk F, Rück C, Lichtenstein P, Lundström S, Larsson H, Eley TC, Fernández de la Cruz L. Concurrent and prospective associations of obsessive-compulsive symptoms with suicidality in young adults: A genetically-informative study. J Affect Disord 2021; 281:422-430. [PMID: 33359955 PMCID: PMC7843953 DOI: 10.1016/j.jad.2020.10.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has been linked with elevated risk of suicidality. However, most previous studies have been cross-sectional, and little is known about the aetiology of the association between obsessive-compulsive symptoms (OCS) and suicidality in young adults. METHODS Participants were members of the Child and Adolescent Twin Study in Sweden, at ages 18 (n = 9,162) and 24 (n = 3,466). Twins completed self-report measures, including assessment of OCS, suicidal ideation, and suicidal attempts. Logistic regression models tested concurrent and prospective associations of total OCS and OCS dimensions with suicidality, with and without adjustment for depression and anxiety symptoms. Genetic models tested the extent to which the main phenotypic associations were accounted for by genetic and environmental influences. RESULTS Total OCS were significantly associated with concurrent reports of suicidality at age 18 and 24, even when controlling for depressive and anxiety symptoms. Taboo obsessions (e.g., sexual and aggressive thoughts) were more robustly associated with suicidality than other OCS dimensions, and prospectively predicted suicidality symptoms over time, even when controlling for baseline suicide attempts. Genetic factors accounted for most of the concurrent and longitudinal covariance between OCS and suicidality, with substantial non-shared environmental influences. LIMITATIONS We relied on self-report measures and did not include diagnostic assessment of OCD. CONCLUSIONS OCS, particularly taboo obsessions, are associated with significantly elevated risk of suicidality in late adolescence and early adulthood. This relationship is explained by a combination of common genetic liability and non-shared environmental effects, suggesting that effective OCS treatment might reduce suicidality risk in this group.
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Affiliation(s)
- Georgina Krebs
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Frühling Rijsdijk
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics, Law and Mental Health, University of Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Thalia C. Eley
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,Corresponding author: Professor Thalia Eley, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO80, De Crespigny Park, London SE5 8AF, UK
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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17
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Luo L, Li Q, You W, Wang Y, Tang W, Li B, Yang Y, Sweeney JA, Li F, Gong Q. Altered brain functional network dynamics in obsessive-compulsive disorder. Hum Brain Mapp 2021; 42:2061-2076. [PMID: 33522660 PMCID: PMC8046074 DOI: 10.1002/hbm.25345] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
Obsessive–compulsive disorder (OCD) is a debilitating and disabling neuropsychiatric disorder, whose neurobiological basis remains unclear. Although traditional static resting‐state magnetic resonance imaging (rfMRI) studies have found aberrant functional connectivity (FC) in OCD, alterations in whole‐brain FC and topological properties in the context of brain dynamics remain relatively unexplored. The rfMRI data of 29 patients with OCD and 40 healthy controls were analyzed using group independent component analysis to obtain independent components (ICs) and a sliding‐window approach to generate dynamic functional connectivity (dFC) matrices. dFC patterns were clustered into three reoccurring states, and state transition metrics were obtained. Then, graph‐theory methods were applied to dFC matrices to calculate the variability of network topological organization. The occurrence of a state (State 1) with the highest modularity index and lowest mean FC between networks was increased significantly in OCD, and the fractional time in brain State 1 was positively correlated with anxiety level in patients. State 1 was characterized by having positive connections within default mode (DMN) and salience networks (SAN), and negative coupling between the two networks. Additionally, ICs belonging to DMN and SAN showed lower temporal variability of nodal degree centrality and efficiency in patients, which was related to longer illness duration and higher current obsession ratings. Our results provide evidence of clinically relevant aberrant dynamic brain activity in OCD. Increased functional segregation among networks and impaired functional flexibility in connections among brain regions in DMN and SAN may play important roles in the neuropathology of OCD.
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Affiliation(s)
- Lekai Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Qian Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Wanfang You
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yuxia Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Wanjie Tang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Bin Li
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Yanchun Yang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.,Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, P.R. China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China
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18
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Vellozo AP, Fontenelle LF, Torresan RC, Shavitt RG, Ferrão YA, Rosário MC, Miguel EC, Torres AR. Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates. J Clin Med 2021; 10:jcm10020274. [PMID: 33451078 PMCID: PMC7828517 DOI: 10.3390/jcm10020274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
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Affiliation(s)
- Aline P. Vellozo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
- D’Or Institute for Research and Education & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Correspondence: ; Tel.: +61-3-990-29755
| | - Ricardo C. Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Roseli G. Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Ygor A. Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90570-080, Brazil;
| | - Maria C. Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil;
| | - Euripedes C. Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
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19
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Vaghi MM. Neurocognitive Endophenotypes of OCD. Curr Top Behav Neurosci 2021; 49:97-124. [PMID: 33751501 DOI: 10.1007/7854_2020_197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this chapter, I address the concept of endophenotypes for obsessive-compulsive disorder (OCD). Endophenotypes are objective and heritable quantitative traits hypothesized to be more biologically tractable than distal clinical phenotypes. This approach has been adopted to gain a better understanding of psychiatric conditions in general. It is theorized that endophenotypes will particularly assist in clarifying both the diagnostic status and aetiological origins of complex neuropsychiatric conditions such as OCD. At the cognitive level, separable constructs of relevance for OCD have been identified. The prevailing model for OCD assumes the development of abnormalities within fronto-striatal neural circuits leading to impairment of executive functions and their neuropsychological subcomponents. Here, I address whether this model can guide towards the identification of endophenotypes for this condition and discuss possible implications.
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Affiliation(s)
- Matilde M Vaghi
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK.
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20
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Balachander S, Meier S, Matthiesen M, Ali F, Kannampuzha AJ, Bhattacharya M, Kumar Nadella R, Sreeraj VS, Ithal D, Holla B, Narayanaswamy JC, Arumugham SS, Jain S, Reddy YJ, Viswanath B. Are There Familial Patterns of Symptom Dimensions in Obsessive-Compulsive Disorder? Front Psychiatry 2021; 12:651196. [PMID: 33959055 PMCID: PMC8093508 DOI: 10.3389/fpsyt.2021.651196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is a heterogeneous illness, and emerging evidence suggests that different symptom dimensions may have distinct underlying neurobiological mechanisms. We aimed to look for familial patterns in the occurrence of these symptom dimensions in a sample of families with at least two individuals affected with OCD. Methods: Data from 153 families (total number of individuals diagnosed with DSM-5 OCD = 330) recruited as part of the Accelerator Program for Discovery in Brain Disorders using Stem Cells (ADBS) was used for the current analysis. Multidimensional Item Response Theory (IRT) was used to extract dimensional scores from the Yale-Brown Obsessive-Compulsive Scale (YBOCS) checklist data. Using linear mixed-effects regression models, intra-class correlation coefficients (ICC), for each symptom dimension, and within each relationship type were estimated. Results: IRT yielded a four-factor solution with Factor 1 (Sexual/Religious/Aggressive), Factor 2 (Doubts/Checking), Factor 3 (Symmetry/Arranging), and Factor 4 (Contamination/Washing). All except for Factor 1 were found to have significant ICCs, highest for Factor 3 (0.41) followed by Factor 4 (0.29) and then Factor 2 (0.27). Sex-concordant dyads were found to have higher ICC values than discordant ones, for all the symptom dimensions. No major differences in the ICC values between parent-offspring and sib-pairs were seen. Conclusions: Our findings indicate that there is a high concordance of OCD symptom dimensions within multiplex families. Symptom dimensions of OCD might thus have significant heritability. In view of this, future genetic and neurobiological studies in OCD should include symptom dimensions as a key parameter in their analyses.
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Affiliation(s)
- Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Manuel Matthiesen
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,Department of Psychiatry Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany.,Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Furkhan Ali
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Anand Jose Kannampuzha
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Mahashweta Bhattacharya
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Ravi Kumar Nadella
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Vanteemar S Sreeraj
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Dhruva Ithal
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Bharath Holla
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Janardhanan C Narayanaswamy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Shyam Sundar Arumugham
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India
| | - Sanjeev Jain
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Yc Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore, India.,Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - Biju Viswanath
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
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21
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Blanco-Vieira T, Hoexter MQ, Batistuzzo MC, Alvarenga P, Szejko N, Fumo AMT, Miguel EC, do Rosário MC. Association Between Obsessive-Compulsive Symptom Dimensions in Mothers and Psychopathology in Their Children. Front Psychiatry 2021; 12:674261. [PMID: 34262490 PMCID: PMC8273307 DOI: 10.3389/fpsyt.2021.674261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The non-clinical presentation of obsessive-compulsive symptoms (OCS) in women may impact not only their daily lives and well-being but also increase the risk for emotional and behavioral problems in their children. This study aims to investigate the OCS dimension distribution in a large sample of mothers from a cohort of school age children and the association between these OCS dimensions with their own psychopathology, and with the presence of OCS and other psychopathology in their children. Method: Our final sample consisted of 2,511 mother-children dyads recruited from the elementary schools of two large cities. Throughout multiple regression analysis, we examined the correlations between demographic and clinical variables of mothers assessed by the Mini International Psychiatric Interview (MINI) and the Dimensional Yale-Brown Obsessive-Compulsive Scale-Short Version (DY-BOCS-SV) with children's psychopathology status reported by the Child Behavior Checklist (CBCL). Results: The overall prevalence of mothers who reported experiencing at least one OCS was 40% (N = 1,004). "Aggression/violence" was the most frequent symptom dimension (32.2%), followed by the "symmetry/ordering" (16.4%) and the "sexual/religious" dimensions (13.8%). There was a significant correlation between the presence of OCS and maternal psychopathology in general (p < 0.001, r = 0.397). Not only the presence but also the severity of the mother's OCS were strongly correlated to the total (p < 0.001), internalizing (p < 0.001), externalizing (p < 0.001), and OCS subscale scores (p < 0.001) on the CBCL. Conclusion: OCS dimensions are highly prevalent in women. Presence and severity of maternal OCS are related to children's psychopathology and behavioral problems.
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Affiliation(s)
- Thiago Blanco-Vieira
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo Queiroz Hoexter
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Marcelo C Batistuzzo
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, Brazil
| | - Pedro Alvarenga
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Sírio-Libanês Hospital, São Paulo, Brazil
| | - Natalia Szejko
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.,Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Afonso Mazine Tiago Fumo
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Hospital Central da Beira, Beira, Mozambique
| | - Eurípedes C Miguel
- Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Maria Conceição do Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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22
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Koumantanou L, Kasvikis Y, Giaglis G, Skapinakis P, Mavreas V. Differentiation of 2 Obsessive-Compulsive Disorder Subgroups with Regard to Demographic and Phenomenological Characteristics Combining Multiple Correspondence and Latent Class Analysis. Psychopathology 2021; 54:315-324. [PMID: 34749367 DOI: 10.1159/000518906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions. OBJECTIVE AND METHODS This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used. RESULTS MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup. CONCLUSIONS Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.
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Affiliation(s)
- Lia Koumantanou
- Behavior Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Yiannis Kasvikis
- Behavior Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Georgios Giaglis
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Skapinakis
- Department of Psychiatry, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry, University of Ioannina, School of Medicine, Ioannina, Greece
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23
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Cervin M, Perrin S, Olsson E, Aspvall K, Geller DA, Wilhelm S, McGuire J, Lázaro L, Martínez-González AE, Barcaccia B, Pozza A, Goodman WK, Murphy TK, Seçer İ, Piqueras JA, Rodríguez-Jiménez T, Godoy A, Rosa-Alcázar AI, Rosa-Alcázar Á, Ruiz-García BM, Storch EA, Mataix-Cols D. The Centrality of Doubting and Checking in the Network Structure of Obsessive-Compulsive Symptom Dimensions in Youth. J Am Acad Child Adolesc Psychiatry 2020; 59:880-889. [PMID: 31421234 PMCID: PMC7219532 DOI: 10.1016/j.jaac.2019.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 06/24/2019] [Accepted: 07/10/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to investigate the internal structure of these dimensions in unselected schoolchildren and in children with OCD. METHOD We estimated the network structure of OCD symptom dimensions in 6,991 schoolchildren and 704 children diagnosed with OCD from 18 sites across 6 countries. All participants completed the Obsessive-Compulsive Inventory-Child Version. RESULTS In both the school-based and clinic-based samples, the OCD dimensions formed an interconnected network with doubting/checking emerging as a highly central node, that is, having strong connections to other symptom dimensions in the network. The centrality of the doubting/checking dimension was consistent across countries, sexes, age groups, clinical status, and tic disorder comorbidity. Network differences were observed for age and sex in the school-based but not the clinic-based samples. CONCLUSION The centrality of doubting/checking in the network structure of childhood OCD adds to classic and recent conceptualizations of the disorder in which the important role of doubt in disorder severity and maintenance is highlighted. The present results suggest that doubting/checking is a potentially important target for further research into the etiology and treatment of childhood OCD.
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Affiliation(s)
- Matti Cervin
- Lund University, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden.
| | | | - Elin Olsson
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Kristina Aspvall
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Daniel A Geller
- Massachusetts General Hospital and Harvard Medical School, Boston Massachusetts
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston Massachusetts
| | - Joseph McGuire
- Johns Hopkins University School of Medicine, Baltimore Maryland
| | - Luisa Lázaro
- Hospital Clínic, IDIBAPS, CIBERSAM, University of Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - David Mataix-Cols
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
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24
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Lavallé L, Bation R, Dondé C, Mondino M, Brunelin J. Dissociable source-monitoring impairments in obsessive-compulsive disorder and schizophrenia. Eur Psychiatry 2020; 63:e54. [PMID: 32406366 PMCID: PMC7355175 DOI: 10.1192/j.eurpsy.2020.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the observed clinical overlap between obsessive-compulsive disorder (OCD) and schizophrenia (SCZ), both conditions may share, at least in part, common cognitive underpinnings. Among the cognitive deficits that could be involved, it has been hypothesized that patients share a failure in their abilities to monitor their own thoughts (source monitoring), leading to confusion between what they actually did or perceived and what they imagined. Although little is known regarding source-monitoring performances in patients with OCD, numerous studies in patients with SCZ have observed a relationship between delusions and/or hallucinations and deficits in both internal source- and reality-monitoring abilities. METHODS The present work compared source-monitoring performances (internal source and reality monitoring) between patients with OCD (n = 32), patients with SCZ (n = 38), and healthy controls (HC; n = 29). RESULTS We observed that patients with OCD and patients with SCZ displayed abnormal internal source-monitoring abilities compared to HC. Only patients with SCZ displayed abnormalities in reality monitoring compared to both patients with OCD and HC. CONCLUSIONS Internal source-monitoring deficits are shared by patients with OCD and SCZ and may contribute to the shared cognitive deficits that lead to obsessions and delusions. In contrast, reality-monitoring performance seems to differentiate patients with OCD from patients with SCZ.
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Affiliation(s)
- Layla Lavallé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
| | - Rémy Bation
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France.,Psychiatry Unit, Wertheimer Hospital, CHU, LyonF-69500, France
| | - Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
| | - Marine Mondino
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
| | - Jérome Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
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25
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Bralten J, Widomska J, Witte WD, Yu D, Mathews CA, Scharf JM, Buitelaar J, Crosbie J, Schachar R, Arnold P, Lemire M, Burton CL, Franke B, Poelmans G. Shared genetic etiology between obsessive-compulsive disorder, obsessive-compulsive symptoms in the population, and insulin signaling. Transl Psychiatry 2020; 10:121. [PMID: 32341337 PMCID: PMC7186226 DOI: 10.1038/s41398-020-0793-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/11/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022] Open
Abstract
Obsessive-compulsive symptoms (OCS) in the population have been linked to obsessive-compulsive disorder (OCD) in genetic and epidemiological studies. Insulin signaling has been implicated in OCD. We extend previous work by assessing genetic overlap between OCD, population-based OCS, and central nervous system (CNS) and peripheral insulin signaling. We conducted genome-wide association studies (GWASs) in the population-based Philadelphia Neurodevelopmental Cohort (PNC, 650 children and adolescents) of the total OCS score and six OCS factors from an exploratory factor analysis of 22 questions. Subsequently, we performed polygenic risk score (PRS)-based analysis to assess shared genetic etiologies between clinical OCD (using GWAS data from the Psychiatric Genomics Consortium), the total OCS score and OCS factors. We then performed gene-set analyses with a set of OCD-linked genes centered around CNS insulin-regulated synaptic function and PRS-based analyses for five peripheral insulin signaling-related traits. For validation purposes, we explored data from the independent Spit for Science population cohort (5,047 children and adolescents). In the PNC, we found a significant shared genetic etiology between OCD and 'guilty taboo thoughts'. In the Spit for Science cohort, we additionally observed genetic sharing between 'symmetry/counting/ordering' and 'contamination/cleaning'. The CNS insulin-linked gene-set also associated with 'symmetry/counting/ordering' in the PNC. Further, we identified genetic sharing between peripheral insulin signaling-related traits: type 2 diabetes with 'aggressive taboo thoughts', and levels of fasting insulin and 2 h glucose with OCD. In conclusion, OCD, OCS in the population and insulin-related traits share genetic risk factors, indicating a common etiological mechanism underlying somatic and psychiatric disorders.
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Affiliation(s)
- Janita Bralten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Joanna Widomska
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ward De Witte
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carol A Mathews
- Department of Psychiatry and Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| | - Jennifer Crosbie
- Neurosciences & Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Russell Schachar
- Neurosciences & Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Arnold
- Genetics & Genome Biology, Hospital for Sick Children, Toronto, ON, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
- Departments of Psychiatry & Medical Genetics; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mathieu Lemire
- Neurosciences & Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Christie L Burton
- Neurosciences & Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
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26
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Lavallé L, Brunelin J, Bation R, Mondino M. Review of source-monitoring processes in obsessive-compulsive disorder. World J Psychiatry 2020; 10:12-20. [PMID: 32149045 PMCID: PMC7049523 DOI: 10.5498/wjp.v10.i2.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 02/05/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a severe mental illness characterized by persistent, intrusive and distressing obsessions and/or compulsions. Such symptoms have been conceptualized as resulting from a failure in source-monitoring processes, suggesting that patients with OCD fail to distinguish actions they perform from those they just imagine doing. In this study, we aimed to provide an updated and exhaustive review of the literature examining the relationship between source-monitoring and OCD. A systematic search in the literature through January 2019 allowed us to identify 13 relevant publications investigating source-monitoring abilities in patients with OCD or participants with subclinical compulsive symptoms. Most of the retrieved studies did not report any source-monitoring deficits in clinical and subclinical subjects compared with healthy volunteers. However, most of the studies reported that patients with OCD and subclinical subjects displayed reduced confidence in source-monitoring judgments or global cognitive confidence compared to controls. The present review highlighted some methodological and statistical limitations. Consequently, further studies are needed to explore source monitoring with regard to the subcategories of OCD symptoms (i.e., symmetry-ordering, contamination-washing, hoarding, aggressive obsession-checking, sexual-religious thoughts) and to clarify the relationship between source-monitoring subtypes (i.e., reality or internal source-monitoring) and confidence in these populations.
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Affiliation(s)
- Layla Lavallé
- French National Institute of Health and Medical Research U1028, Centre National de la Recherche Scientifique UMR5292, Lyon Neuroscience Research Center, Lyon 69000, France
- Lyon University, Lyon 69000, France
- Centre Hospitalier le Vinatier, Batiment 416, Bron 69678, France
| | - Jérome Brunelin
- French National Institute of Health and Medical Research U1028, Centre National de la Recherche Scientifique UMR5292, Lyon Neuroscience Research Center, Lyon 69000, France
- Lyon University, Lyon 69000, France
- Centre Hospitalier le Vinatier, Batiment 416, Bron 69678, France
| | - Rémy Bation
- French National Institute of Health and Medical Research U1028, Centre National de la Recherche Scientifique UMR5292, Lyon Neuroscience Research Center, Lyon 69000, France
- Lyon University, Lyon 69000, France
- Centre Hospitalier le Vinatier, Batiment 416, Bron 69678, France
- Psychiatric Unit, Wertheimer Neurologic Hospital, Bron 69500, France
| | - Marine Mondino
- French National Institute of Health and Medical Research U1028, Centre National de la Recherche Scientifique UMR5292, Lyon Neuroscience Research Center, Lyon 69000, France
- Lyon University, Lyon 69000, France
- Centre Hospitalier le Vinatier, Batiment 416, Bron 69678, France
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27
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Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol 2020; 17:710-736. [PMID: 30101713 PMCID: PMC7059159 DOI: 10.2174/1570159x16666180813155017] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization. Objective: Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field. Methods: We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics. Results: Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance. Conclusions: SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.
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Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Alessio Padovano
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
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28
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Mattina GF, Slyepchenko A, Steiner M. Obsessive–compulsive and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:369-386. [DOI: 10.1016/b978-0-444-64123-6.00025-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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29
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Højgaard DRMA, Skarphedinsson G, Ivarsson T, Weidle B, Nissen JB, Hybel KA, Torp NC, Melin K, Thomsen PH. Hoarding in children and adolescents with obsessive-compulsive disorder: prevalence, clinical correlates, and cognitive behavioral therapy outcome. Eur Child Adolesc Psychiatry 2019; 28:1097-1106. [PMID: 30656432 DOI: 10.1007/s00787-019-01276-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/07/2019] [Indexed: 12/27/2022]
Abstract
Hoarding, common in pediatric obsessive-compulsive disorder (OCD), has specific clinical correlates and is associated with poor prognosis. However, there are few studies of hoarding in pediatric OCD. This study estimates the occurrence of hoarding symptoms in a sample of children and adolescents with OCD, investigating possible differences in demographic and clinical variables between pediatric OCD with and without hoarding symptoms. Furthermore, the study investigates whether hoarding symptoms predict poorer treatment outcomes after cognitive behavioral therapy (CBT). The study sample comprised 269 children and adolescents with OCD, aged 7-17 years, from Denmark, Sweden, and Norway, who were all included in the Nordic long-term obsessive-compulsive disorder Treatment Study. All had an OCD diagnosis according to the DSM-IV and were treated with 14 weekly sessions of manualized, exposure-based CBT. Hoarding symptoms and OCD severity were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale and group differences in treatment outcome were analyzed using linear mixed-effect modelling. Seventy-two patients (26.8%) had one or more symptoms of hoarding. Comorbid tic disorders (p = 0.005) and indecision (p = 0.024) were more prevalent among those with hoarding symptoms than those without hoarding symptoms. In addition, youth with hoarding symptoms had a different OCD symptom profile. Having symptoms of hoarding did not affect CBT outcome (p = 0.933). Results from the study suggest that CBT is equally effective for those with and without hoarding-related OCD.
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Affiliation(s)
- Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Århus, Denmark.
| | | | - Tord Ivarsson
- The Center for Child and Adolescent Mental Health. Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Bernhard Weidle
- Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Århus, Denmark
| | - Katja A Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Århus, Denmark
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Karin Melin
- Department of Child and Adolescent Psychiatry, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Århus, Denmark.,Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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30
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Cameron DH, Streiner DL, Summerfeldt LJ, Rowa K, McKinnon MC, McCabe RE. A comparison of cluster and factor analytic techniques for identifying symptom-based dimensions of obsessive-compulsive disorder. Psychiatry Res 2019; 278:86-96. [PMID: 31163302 DOI: 10.1016/j.psychres.2019.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 01/05/2023]
Abstract
A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.
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Affiliation(s)
- Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Department of Psychiatry, University of Toronto, Canada
| | | | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
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31
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Nakao T, Kanba S. Pathophysiology and treatment of hoarding disorder. Psychiatry Clin Neurosci 2019; 73:370-375. [PMID: 31021515 DOI: 10.1111/pcn.12853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
Hoarding disorder (HD) is a newly listed disease in the new category of Obsessive-Compulsive and Related Disorders in the DSM-5. Patients with HD find it difficult to discard possessions regardless of their actual value and to organize those things. As a result, the possessions overflow the living space and hinder living functions. Though the hoarding symptom had been regarded as a subtype of obsessive-compulsive disorder (OCD) to date, recent studies have revealed many differences in clinical characteristics, including onset, course, degree of insight, and treatment responses, between hoarding and other subtypes. Moreover, several neuroimaging studies have found specific changes of brain structure and function in OCD patients with hoarding symptoms compared to patients with non-hoarding OCD. Meanwhile, strategies for treatment of HD have not been standardized. At present, psychological treatment using cognitive behavioral therapy techniques has a certain effect. In this review, we outline the pathophysiology and treatment of HD.
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Affiliation(s)
- Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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32
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Miguel EC, Lopes AC, McLaughlin NCR, Norén G, Gentil AF, Hamani C, Shavitt RG, Batistuzzo MC, Vattimo EFQ, Canteras M, De Salles A, Gorgulho A, Salvajoli JV, Fonoff ET, Paddick I, Hoexter MQ, Lindquist C, Haber SN, Greenberg BD, Sheth SA. Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder. Mol Psychiatry 2019; 24:218-240. [PMID: 29743581 PMCID: PMC6698394 DOI: 10.1038/s41380-018-0054-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 11/08/2022]
Abstract
For more than half a century, stereotactic neurosurgical procedures have been available to treat patients with severe, debilitating symptoms of obsessive-compulsive disorder (OCD) that have proven refractory to extensive, appropriate pharmacological, and psychological treatment. Although reliable predictors of outcome remain elusive, the establishment of narrower selection criteria for neurosurgical candidacy, together with a better understanding of the functional neuroanatomy implicated in OCD, has resulted in improved clinical efficacy for an array of ablative and non-ablative intervention techniques targeting the cingulum, internal capsule, and other limbic regions. It was against this backdrop that gamma knife capsulotomy (GKC) for OCD was developed. In this paper, we review the history of this stereotactic radiosurgical procedure, from its inception to recent advances. We perform a systematic review of the existing literature and also provide a narrative account of the evolution of the procedure, detailing how the procedure has changed over time, and has been shaped by forces of evidence and innovation. As the procedure has evolved and adverse events have decreased considerably, favorable response rates have remained attainable for approximately one-half to two-thirds of individuals treated at experienced centers. A reduction in obsessive-compulsive symptom severity may result not only from direct modulation of OCD neural pathways but also from enhanced efficacy of pharmacological and psychological therapies working in a synergistic fashion with GKC. Possible complications include frontal lobe edema and even the rare formation of delayed radionecrotic cysts. These adverse events have become much less common with new radiation dose and targeting strategies. Detailed neuropsychological assessments from recent studies suggest that cognitive function is not impaired, and in some domains may even improve following treatment. We conclude this review with discussions covering topics essential for further progress of this therapy, including suggestions for future trial design given the unique features of GKC therapy, considerations for optimizing stereotactic targeting and dose planning using biophysical models, and the use of advanced imaging techniques to understand circuitry and predict response. GKC, and in particular its modern variant, gamma ventral capsulotomy, continues to be a reliable treatment option for selected cases of otherwise highly refractory OCD.
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Affiliation(s)
- Euripedes C Miguel
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
| | - Antonio C Lopes
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Nicole C R McLaughlin
- Departments of Psychiatry and Human Behavior and Neurosurgery, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center of Providence, Providence, RI, USA
| | - Georg Norén
- Departments of Psychiatry and Human Behavior and Neurosurgery, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center of Providence, Providence, RI, USA
| | - André F Gentil
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Harquail Centre for Neuromodulation, University of Toronto, Toronto, Ontario, Canada
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marcelo C Batistuzzo
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Edoardo F Q Vattimo
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Miguel Canteras
- Discipline of Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Erich Talamoni Fonoff
- Department of Neurology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ian Paddick
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Marcelo Q Hoexter
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Suzanne N Haber
- University of Rochester School of Medicine, Rochester, New York, USA
- McLean Hospital, Harvard University, Boston, USA
| | - Benjamin D Greenberg
- Departments of Psychiatry and Human Behavior and Neurosurgery, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center of Providence, Providence, RI, USA
| | - Sameer A Sheth
- Discipline of Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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33
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du Mortier JAM, Visser HAD, van Balkom AJLM, van Megen HJGM, Hoogendoorn AW, Glas G, van Oppen P. Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist. Psychiatry Res 2019; 271:299-305. [PMID: 30521999 DOI: 10.1016/j.psychres.2018.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 10/18/2018] [Accepted: 11/18/2018] [Indexed: 12/20/2022]
Abstract
Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.
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Affiliation(s)
| | - Henny A D Visser
- GGz Centraal, Innova Postbus 3051, 3800 DB Amersfoort, The Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | | | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Gerrit Glas
- Dimence Groep, Postbus 473, 8000 AL Zwolle, The Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
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34
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Abstract
Obsessive-compulsive disorder (OCD) is a debilitating mental illness characterized by an early onset and chronic course. Evidence from several lines of research suggests significant neuropsychological deficits in patients with OCD; executive dysfunction and nonverbal memory deficits have been reported consistently in OCD. These deficits persist despite controlling potential confounders such as comorbidity, severity of illness, and medications. Neuropsychological impairments are independent of illness severity, thus suggesting that the neuropsychological deficits are trait markers of the disease. In addition, these deficits are seen in first-degree relatives of individuals with OCD. These reports suggest that neuropsychological deficits are potential endophenotype markers in OCD. Neuropsychological studies in pediatric OCD are limited; they show impairments of small effect size across multiple domains but with doubtful clinical significance. Preliminary evidence shows that different symptom dimensions of OCD may have unique neuropsychological deficits suggestive of discrete but overlapping neuroanatomical regions for individual symptom dimensions. Overall, neuropsychological deficits further support the role of frontostriatal circuits in the neurobiology of OCD. In addition, emerging literature also suggests the important role of other areas, in particular parietal cortex. Preliminary evidence suggests the possible role of neuropsychological deficits to be markers of treatment response but needs to be examined in future. Longitudinal studies with examination of patients at different time points and examination of their potential utility as predictors of treatment response are needed in future.
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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35
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Senova S, Clair AH, Palfi S, Yelnik J, Domenech P, Mallet L. Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach. Front Psychiatry 2019; 10:905. [PMID: 31920754 PMCID: PMC6923766 DOI: 10.3389/fpsyt.2019.00905] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder featuring repetitive intrusive thoughts and behaviors associated with a significant handicap. Of patients, 20% are refractory to medication and cognitive behavioral therapy. Refractory OCD is associated with suicidal behavior and significant degradation of social and professional functioning, with high health costs. Deep brain stimulation (DBS) has been proposed as a reversible and controllable method to treat refractory patients, with meta-analyses showing 60% response rate following DBS, whatever the target: anterior limb of the internal capsule (ALIC), ventral capsule/ventral striatum (VC/VS), nucleus accumbens (NAcc), anteromedial subthalamic nucleus (amSTN), or inferior thalamic peduncle (ITP). But how do we choose the "best" target? Functional neuroimaging studies have shown that ALIC-DBS requires the modulation of the fiber tract within the ventral ALIC via the ventral striatum, bordering the bed nucleus of the stria terminalis and connecting the medial prefrontal cortex with the thalamus to be successful. VC/VS effective sites of stimulation were found within the VC and primarily connected to the medial orbitofrontal cortex (OFC) dorsomedial thalamus, amygdala, and the habenula. NAcc-DBS has been found to reduce OCD symptoms by decreasing excessive fronto-striatal connectivity between NAcc and the lateral and medial prefrontal cortex. The amSTN effective stimulation sites are located at the inferior medial border of the STN, primarily connected to lateral OFC, dorsal anterior cingulate, and dorsolateral prefrontal cortex. Finally, ITP-DBS recruits a bidirectional fiber pathway between the OFC and the thalamus. Thus, these functional connectivity studies show that the various DBS targets lie within the same diseased neural network. They share similar efficacy profiles on OCD symptoms as estimated on the Y-BOCS, the amSTN being the target supported by the strongest evidence in the literature. VC/VS-DBS, amSTN-DBS, and ALIC-DBS were also found to improve mood, behavioral adaptability and potentially both, respectively. Because OCD is such a heterogeneous disease with many different symptom dimensions, the ultimate aim should be to find the most appropriate DBS target for a given refractory patient. This quest will benefit from further investigation and understanding of the individual functional connectivity of OCD patients.
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Affiliation(s)
- Suhan Senova
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,IMRB UPEC/INSERM U 955 Team 14, Créteil, France
| | - Anne-Hélène Clair
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Stéphane Palfi
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,IMRB UPEC/INSERM U 955 Team 14, Créteil, France
| | - Jérôme Yelnik
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Philippe Domenech
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Luc Mallet
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
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36
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Abstract
Obsessive-compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak - in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long-term outcomes in OCD are not necessarily bleak and that at least half the treatment-seeking patients with OCD show symptomatic remission over long term. A short duration illness, of low severity that is treated early and intensively, with continued maintenance treatment over long term possibly has a good outcome. Recent studies have also identified neuroimaging and neuropsychological correlates of good outcome, but these need further replication. This paper presents an overview of conceptual issues and studies on long-term outcome of OCD and predictors of outcome.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Goletz H, Döpfner M. [The clinical assessment of obsessive-compulsive symptoms in children and adolescents - A study with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS-D)]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 48:178-193. [PMID: 30556768 DOI: 10.1024/1422-4917/a000642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The clinical assessment of obsessive-compulsive symptoms in children and adolescents - A study with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS-D) Abstract. Objective: The CY-BOCS is internationally the most widely used instrument for the assessment of juvenile obsessive-compulsive disorder (OCD). In this study, for the first time, the psychometric properties of a German version of the CY-BOCS (CY-BOCS-D) are examined in a pediatric OCD sample (n = 169; age 11-18 years). Method: The factor structure, internal consistencies, convergent and divergent validity are analyzed. Results: The exploratory factor analyses confirm a two-factor structure of the CY-BOCS-D Rating Scale and reveal a four-factor structure of the CY-BOCS-D Checklist. The internal consistencies are satisfactory to very good, convergent and divergent validity are confirmed. Conclusions: The results support the CY-BOCS as a "gold standard" also for OCD-diagnostics in German-speaking countries.
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Affiliation(s)
- Hildegard Goletz
- Ausbildungsinstitut für Kinder- und Jugendlichenpsychotherapie (AKiP), Klinikum der Universität zu Köln, Köln
| | - Manfred Döpfner
- Ausbildungsinstitut für Kinder- und Jugendlichenpsychotherapie (AKiP), Klinikum der Universität zu Köln, Köln.,Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Klinikum der Universität zu Köln, Köln
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38
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Kloft L, Steinel T, Kathmann N. Systematic review of co-occurring OCD and TD: Evidence for a tic-related OCD subtype? Neurosci Biobehav Rev 2018; 95:280-314. [PMID: 30278193 DOI: 10.1016/j.neubiorev.2018.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this review is to summarize the current knowledge of associated features of co-occurring obsessive-compulsive disorder (OCD) and tic disorders (TD) and to critically evaluate hypotheses regarding the nature of their comorbidity. METHOD We conducted a systematic review following PRISMA guidelines. To this aim, the PubMed, PsychInfo and ISI Web of Knowledge databases were searched up to August 30, 2018. For gender and age-of-onset we additionally conducted meta-analyses. RESULTS One hundred eighty-nine studies met inclusion criteria. We substantiate some acknowledged features and report evidence for differential biological mechanisms and treatment response. In general, studies were of limited methodological quality. CONCLUSIONS Several specific features are reliable associated with co-occurring OCD + TD. The field lacks methodological sound studies. The review found evidence against and in favor for different hypotheses regarding the nature of comorbidity of OCD and TD. This could indicate the existence of a stepwise model of co-morbidity, or could be an artefact of the low methodological quality of studies.
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Affiliation(s)
- Lisa Kloft
- Humboldt-Universität zu Berlin, Berlin, Germany.
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Bragdon LB, Gibb BE, Coles ME. Does neuropsychological performance in OCD relate to different symptoms? A meta-analysis comparing the symmetry and obsessing dimensions. Depress Anxiety 2018; 35:761-774. [PMID: 29920848 DOI: 10.1002/da.22785] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 04/05/2018] [Accepted: 05/29/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Investigations of neuropsychological functioning in obsessive-compulsive disorder (OCD) have produced mixed results for deficits in executive functioning (EF), attention, and memory. One potential explanation for varied findings may relate to the heterogeneity of symptom presentations, and different clinical or neurobiological characteristics may underlie these different symptoms. METHODS We investigated differences in neuropsychological functioning between two symptoms groups, obsessing/checking (O/C) and symmetry/ordering (S/O), based on data suggesting an association with different motivations: harm avoidance and incompleteness, respectively. Ten studies (with 628 patients) were included and each investigation assessed at least one of 14 neuropsychological domains. RESULTS The S/O domain demonstrated small, negative correlations with overall neuropsychological functioning, performance in EF, memory, visuospatial ability, cognitive flexibility, and verbal working memory. O/C symptoms demonstrated small, negative correlations with memory and verbal memory performance. A comparison of functioning between symptom groups identified large effect sizes showing that the S/O dimension was more strongly related to poorer neuropsychological performance overall, and in the domains of attention, visuospatial ability, and the subdomain of verbal working memory. CONCLUSIONS Findings support existing evidence suggesting that different OCD symptoms, and their associated core motivations, relate to unique patterns of neuropsychological functioning, and, potentially dysfunction in different neural circuits.
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Affiliation(s)
- Laura B Bragdon
- Department of Psychology, Binghamton University, Binghamton, NY
| | - Brandon E Gibb
- Department of Psychology, Binghamton University, Binghamton, NY
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40
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Ivanov VZ, Enander J, Mataix‐Cols D, Serlachius E, Månsson KN, Andersson G, Flygare O, Tolin D, Rück C. Enhancing group cognitive-behavioral therapy for hoarding disorder with between-session Internet-based clinician support: A feasibility study. J Clin Psychol 2018; 74:1092-1105. [PMID: 29411356 PMCID: PMC6686153 DOI: 10.1002/jclp.22589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/27/2017] [Accepted: 12/06/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hoarding disorder (HD) is difficult to treat. In an effort to increase efficacy and engagement in cognitive-behavioral therapy (CBT), we developed and evaluated a novel intervention comprising group CBT combined with between-session Internet-based clinician support for people with HD. METHOD Twenty participants with HD received group CBT combined with an Internet-support system enabling therapist-participant communication between group sessions. RESULTS The treatment was associated with a significant reduction on the Saving Inventory-Revised (SI-R) and a large effect size (Cohen's d = 1.57) was found at posttreatment. Treatment gains were maintained at the 3-month follow-up. Group attendance was high and no participants dropped out from treatment prematurely. Between-session motivational support from the therapist was most frequently mentioned as the main strength of the system. CONCLUSION The results of this study support adding Internet-based clinician support to group CBT for HD to increase treatment adherence and, potentially, improve the overall efficacy of CBT.
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Affiliation(s)
- Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - David Mataix‐Cols
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Kristoffer N.T. Månsson
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Department of PsychologyStockholm UniversityStockholmSweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden
| | - Oskar Flygare
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
| | - David Tolin
- The Institute of LivingYale University School of MedicineNew HavenCTUSA
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
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41
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Nakajima A, Matsuura N, Mukai K, Yamanishi K, Yamada H, Maebayashi K, Hayashida K, Matsunaga H. Ten-year follow-up study of Japanese patients with obsessive-compulsive disorder. Psychiatry Clin Neurosci 2018; 72:502-512. [PMID: 29652103 DOI: 10.1111/pcn.12661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/09/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Abstract
AIM Obsessive-compulsive disorder (OCD) is a well-known chronic illness. This study retrospectively investigated 10-year outcomes and associated clinical factors in Japanese OCD patients. We focused on the impact of several sociocultural factors, including medical expenses and insurance systems specific to each country, on the differences or biases in follow-up procedures of OCD. METHODS Seventy-nine patients diagnosed with OCD who received a standardized combination of treatments for 10 continuous years were divided into three groups according to their improvement rates on the Yale-Brown Obsessive-Compulsive Scale after 10 years of treatment. RESULTS A survival analysis revealed that the rate of patients achieving full remission increased every year. Following 10 years of treatment, 56% of OCD patients experienced 'full remission' for at least 1 year. Consequently, 48% exhibited full remission, and 37% exhibited partial remission at the end-point of this study. We identified several factors that were predictive of poorer outcomes, including lower Global Assessment of Functioning Scale scores and the presence of hoarding symptoms or involvement behaviors. In addition, improvement rates after 1 year significantly predicted better 10-year outcomes. CONCLUSION Our findings highlight the transcultural nature of long-term outcomes of OCD treatment, which appear to be independent of sociocultural differences.
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Affiliation(s)
- Akihiro Nakajima
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Naomi Matsuura
- Special Education Course, Faculty of Education, Mie University, Tsu, Japan
| | - Keiichiro Mukai
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Kyosuke Yamanishi
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Kensei Maebayashi
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | | | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
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Borda T, Gardini DH, Neziroglu F. Comorbid Hoarding and Obsessive Compulsive Disorder Manifested During Early Childhood. Clin Case Stud 2018. [DOI: 10.1177/1534650118782652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This case report outlines the use of cognitive behavioral therapy (CBT) used to treat an 11-year-old female, “Gabriela,” with comorbid hoarding and obsessive compulsive disorder (OCD). Gabriela participated in treatment involving CBT and exposure and response prevention (ERP) sessions for OCD and hoarding, following a cognitive rehabilitation software program designed for cognitive impairment. Upon completion of the treatment, Gabriela no longer exhibited behaviors consistent with a comorbid hoarding and OCD diagnosis and demonstrated marked improvements in her presenting problems (mental rituals; hoarding items for magical thinking purposes). This case report supports the focus of research, continuing to explore hoarding and comorbidity diagnoses across the life span.
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Affiliation(s)
- Tania Borda
- Bio Behavioral Institute, Buenos Aires, Argentina
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Schulze D, Kathmann N, Reuter B. Getting it just right: A reevaluation of OCD symptom dimensions integrating traditional and Bayesian approaches. J Anxiety Disord 2018; 56:63-73. [PMID: 29739633 DOI: 10.1016/j.janxdis.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 02/09/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022]
Abstract
Previous research using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) suggests that the heterogeneous symptoms of obsessive-compulsive disorder (OCD) may reflect four underlying dimensions. However, past results vary substantially, which may be due to (a) the reliance on aggregated scores, (b) the common use of exploratory factor analyses, and (c) the exclusion of several symptoms. The present study tested the homogeneity of the original Y-BOCS categories using confirmatory factor analysis and modified categories where necessary. To test multidimensional models, data were further analyzed with Bayesian structural equation models, which better capture item heterogeneity in contrast to ordinary factor analysis. All analyses were run with two samples of patients with OCD allowing for cross-validation. Only a minority of the original Y-BOCS categories proved to be homogeneous. Modification yielded 10 homogeneous first-order factors, which can be reduced to four second-order factors: Incompleteness, Taboo Thoughts, Responsibility, and Contamination. This two-level factor model outperformed competing factor structures. The results corroborate the notion of four broader symptom dimensions in OCD, although the specific factor structure deviates from previous research. Differences presumably derive from using the full range of OCD symptoms and the combined exploratory and confirmatory approach with BSEM as a theoretically more appropriate analytical framework.
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Affiliation(s)
- Daniel Schulze
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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44
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Grover S, Sarkar S, Gupta G, Kate N, Ghosh A, Chakrabarti S, Avasthi A. Factor analysis of symptom profile in early onset and late onset OCD. Psychiatry Res 2018; 262:631-635. [PMID: 29033063 DOI: 10.1016/j.psychres.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/02/2017] [Accepted: 10/01/2017] [Indexed: 02/08/2023]
Abstract
This study aimed to assess the factor structure of early and late onset OCD. Additionally, cluster analysis was conducted in the same sample to assess the applicability of the factors. 345 participants were assessed with Yale Brown Obsessive Compulsive Scale symptom checklist. Patients were classified as early onset (onset of symptoms at age ≤ 18 years) and late onset (onset at age > 18 years) OCD depending upon the age of onset of the symptoms. Factor analysis and cluster analysis of early-onset and late-onset OCD was conducted. The study sample comprised of 91 early onset and 245 late onset OCD subjects. Males were more common in the early onset group. Differences in the frequency of phenomenology related to contamination related, checking, repeating, counting and ordering/arranging compulsions were present across the early and late onset groups. Factor analysis of YBOCS revealed a 3 factor solution for both the groups, which largely concurred with each other. These factors were named as hoarding and symmetry (factor-1), contamination (factor-2) and aggressive, sexual and religious factor (factor-3). To conclude this study shows that factor structure of symptoms of OCD seems to be similar between early-onset and late-onset OCD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Siddharth Sarkar
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Gourav Gupta
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Natasha Kate
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Thorsen AL, Kvale G, Hansen B, van den Heuvel OA. Symptom dimensions in obsessive-compulsive disorder as predictors of neurobiology and treatment response. ACTA ACUST UNITED AC 2018; 5:182-194. [PMID: 30237966 DOI: 10.1007/s40501-018-0142-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose of review Specific symptom dimensions of obsessive-compulsive disorder (OCD) have been suggested as an approach to reduce the heterogeneity of obsessive-compulsive disorder, predict treatment outcome, and relate to brain structure and function. Here, we review studies addressing these issues. Recent findings The contamination and symmetry/ordering dimensions have not been reliably associated with treatment outcome. Some studies found that greater severity of sexual/aggressive/religious symptoms predicted a worse outcome after cognitive behavioral therapy (CBT) and a better outcome after serotonin reuptake inhibitors (SRIs). Contamination symptoms have been related to increased amygdala and insula activation in a few studies, while sexual/aggressive/religious symptoms have also been related to more pronounced alterations in the function and structure of the amygdala. Increased pre-treatment limbic responsiveness has been related to better outcomes of CBT, but most imaging studies show important limitations and replication in large-scale studies is needed. We review possible reasons for the strong limbic involvement of the amygdala in patients with more sexual/aggressive/religious symptoms, in relation to their sensitivity to CBT. Summary Symptom dimensions may predict treatment outcome, and patients with sexual/religious/aggressive symptoms are at a greater risk of not starting or delaying treatment. This is likely partly due to more shame and perceived immorality which is also related to stronger amygdala response. Competently delivered CBT is likely to help these patients improve to the same degree as patients with other symptoms.
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Affiliation(s)
- Anders Lillevik Thorsen
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Department of Anatomy & Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands
| | - Gerd Kvale
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- OCD-team, Haukeland University Hospital, Bergen, Norway.,Department of Anatomy & Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands.,Department of Psychiatry, VUmc, Amsterdam, The Netherlands.,Neuroscience Amsterdam, Amsterdam, The Netherlands
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46
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Sharma M, Reeves K, Deogaonkar M, Rezai AR. Deep Brain Stimulation for Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hasanpour H, Ghavamizadeh Meibodi R, Navi K, Asadi S. Novel ensemble method for the prediction of response to fluvoxamine treatment of obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2018; 14:2027-2038. [PMID: 30127613 PMCID: PMC6091249 DOI: 10.2147/ndt.s173388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE About 30% of obsessive-compulsive disorder (OCD) patients exhibit an inadequate response to pharmacotherapy. The detection of clinical variables associated with treatment response may result in achievement of remission in shorter period, preventing illness development and reducing socioeconomic costs. METHODS In total, 330 subjects with OCD diagnosis underwent 12-week pharmacotherapy with fluvoxamine (150-300 mg). Treatment response was ≥25% reduction in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score. In total, 36 clinical attributes of 151 subjects who had completed their treatment course were analyzed. Data mining algorithms included missing value handling, feature selection, and new analytical method based on ensemble classification. The results were compared with those of other traditional classification algorithms such as decision tree, support vector machines, k-nearest neighbor, and random forest. RESULTS Sexual and contamination obsessions are high-ranked predictors of resistance to fluvoxamine pharmacotherapy as well as high Y-BOCS obsessive score. Our results showed that the proposed analysis strategy has good ability to distinguish responder and nonresponder patients according to their clinical features with 86% accuracy, 79% sensitivity, and 89% specificity. CONCLUSION This study proposed an analytical approach which is an accurate and a sensitive method for the analysis of high-dimensional medical data sets containing more number of missing values. The treatment of OCD could be improved by better understanding of the predictors of pharmacotherapy, which may lead to more effective treatment of patients with OCD.
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Affiliation(s)
- Hesam Hasanpour
- Department of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran
| | | | - Keivan Navi
- Department of Computer Science and Engineering, Shahid Beheshti University, Tehran, Iran
| | - Sareh Asadi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
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Hood SD, Broyd A, Robinson H, Lee J, Hudaib AR, Hince DA. Effects of tryptophan depletion on selective serotonin reuptake inhibitor-remitted patients with obsessive compulsive disorder. J Psychopharmacol 2017; 31:1615-1623. [PMID: 29095069 DOI: 10.1177/0269881117736916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serotonergic antidepressants are first-line medication therapies for obsessive-compulsive disorder, however it is not known if synaptic serotonin availability is important for selective serotonin reuptake inhibitor efficacy. The present study tested the hypothesis that temporary reduction in central serotonin transmission, through acute tryptophan depletion, would result in an increase in anxiety in selective serotonin reuptake inhibitor-remitted obsessive-compulsive disorder patients. METHODS Eight patients (four males) with obsessive-compulsive disorder who showed sustained clinical improvement with selective serotonin reuptake inhibitor treatment underwent acute tryptophan depletion in a randomized, double-blind, placebo-controlled, within-subjects design, over two days one week apart. Five hours after consumption of the depleting/sham drink the participants performed a personalized obsessive-compulsive disorder symptom exposure task. Psychological responses were measured using the Spielberger State Anxiety Inventory, Yale-Brown Obsessive Compulsive Scale and Visual Analogue Scales. RESULTS Free plasma tryptophan to large neutral amino acid ratio decreased by 93% on the depletion day and decreased by 1% on the sham day, as anticipated. Psychological rating scores as measured by Visual Analogue Scale showed a significant decrease in perceived control and increase in interfering thoughts at the time of provocation on the depletion day but not on the sham day. A measure of convergent validity, namely Visual Analogue Scale Similar to past, was significantly higher at the time of provocation on both the depletion and sham days. Both the depletion and time of provocation scores for Visual Analogue Scale Anxiety, Spielberger State Anxiety Inventory, Yale-Brown Obsessive Compulsive Scale and blood pressure were not significant. CONCLUSIONS Acute tryptophan depletion caused a significant decrease in perceived control and increase in interfering thoughts at the time of provocation. Acute tryptophan depletion had no effect on the Spielberger State Anxiety Inventory or Visual Analogue Scale Anxiety measures, which suggests that the mechanism of action of selective serotonin reuptake inhibitors may be different to that seen in panic, social anxiety and post-traumatic stress disorder. Successful selective serotonin reuptake inhibitor treatment of obsessive-compulsive disorder may involve the ability of serotonin to switch habitual responding to goal-directed behaviour.
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Affiliation(s)
- Sean D Hood
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
| | - Annabel Broyd
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
| | - Hayley Robinson
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
| | - Jessica Lee
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
| | - Abdul-Rahman Hudaib
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
| | - Dana A Hince
- Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
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Abstract
Trichotillomania is a functionally impairing, often overlooked disorder with no Food and Drug Administration-approved medications indicated for its treatment. The ability of clinical trials to detect the beneficial effects of pharmacologic treatment in trichotillomania has been hampered by the high placebo response rate. Very little is known about baseline demographic and clinical characteristics that may be predictive of placebo response in such patients. Overall, 104 participants assigned to placebo were pooled from five double-blind trials conducted at three sites in the USA and Canada. Participants were classified as placebo responders or nonresponders on the basis of a cutoff of a 35% reduction in symptom severity on the Massachusetts General Hospital Hair Pulling Scale. Baseline group differences were characterized using t-tests and equivalent nonparametric tests as appropriate. Thirty-one percent of individuals assigned to placebo treatment showed a significant clinical response to placebo. Placebo responders (n=32) and nonresponders (n=72) did not differ significantly on any demographic or clinical variable. Predictors of placebo response for trichotillomania remain elusive and do not appear to be similar to those reported for other mental health disorders.
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50
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Gillan CM, Fineberg NA, Robbins TW. A trans-diagnostic perspective on obsessive-compulsive disorder. Psychol Med 2017; 47:1528-1548. [PMID: 28343453 PMCID: PMC5964477 DOI: 10.1017/s0033291716002786] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/01/2022]
Abstract
Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.
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Affiliation(s)
- C. M. Gillan
- Department of Psychology,
New York University, New York, NY,
USA
- Department of Psychology,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neuroscience Institute,
University of Cambridge, Cambridge,
UK
| | - N. A. Fineberg
- National Obsessive Compulsive Disorders Specialist
Service, Hertfordshire Partnership NHS University Foundation
Trust, UK
- Department of Postgraduate Medicine,
University of Hertfordshire, Hatfield,
UK
| | - T. W. Robbins
- Department of Psychology,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neuroscience Institute,
University of Cambridge, Cambridge,
UK
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