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Kim J, Bong SH, Yoon D, Jeong B. Prosocial emotions predict individual differences in economic decision-making during ultimatum game with dynamic reciprocal contexts. Sci Rep 2024; 14:11397. [PMID: 38762655 PMCID: PMC11102497 DOI: 10.1038/s41598-024-62203-y] [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: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024] Open
Abstract
Social decision-making is known to be influenced by predictive emotions or the perceived reciprocity of partners. However, the connection between emotion, decision-making, and contextual reciprocity remains less understood. Moreover, arguments suggest that emotional experiences within a social context can be better conceptualised as prosocial rather than basic emotions, necessitating the inclusion of two social dimensions: focus, the degree of an emotion's relevance to oneself or others, and dominance, the degree to which one feels in control of an emotion. For better representation, these dimensions should be considered alongside the interoceptive dimensions of valence and arousal. In an ultimatum game involving fair, moderate, and unfair offers, this online study measured the emotions of 476 participants using a multidimensional affective rating scale. Using unsupervised classification algorithms, we identified individual differences in decisions and emotional experiences. Certain individuals exhibited consistent levels of acceptance behaviours and emotions, while reciprocal individuals' acceptance behaviours and emotions followed external reward value structures. Furthermore, individuals with distinct emotional responses to partners exhibited unique economic responses to their emotions, with only the reciprocal group exhibiting sensitivity to dominance prediction errors. The study illustrates a context-specific model capable of subtyping populations engaged in social interaction and exhibiting heterogeneous mental states.
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Affiliation(s)
- Jaewon Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291, Daehak-Ro, Yuseong-Gu, Daejeon, 34141, South Korea
| | - Su Hyun Bong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291, Daehak-Ro, Yuseong-Gu, Daejeon, 34141, South Korea
| | - Dayoung Yoon
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291, Daehak-Ro, Yuseong-Gu, Daejeon, 34141, South Korea
| | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291, Daehak-Ro, Yuseong-Gu, Daejeon, 34141, South Korea.
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Ivarsson T, Jensen S, Højgaard DRMA, Hybel KA, Torp NC, Melin K, Nissen JB, Weidle B, Thomsen PH, Dahl K, Skarphedinsson G. Remission and Relapse Across Three Years in Pediatric Obsessive-Compulsive Disorder Following Evidence-Based Treatments. J Am Acad Child Adolesc Psychiatry 2024; 63:519-527. [PMID: 38070870 DOI: 10.1016/j.jaac.2023.09.548] [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: 08/10/2022] [Revised: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To examine relapse rates following remission in a 3-year follow-up study in pediatric patients with obsessive-compulsive disorder (OCD) treated with cognitive-behavioral therapy (CBT) in a first step, and either continued CBT or sertraline (randomized selection) in a second step. METHOD Participants (N = 269) fulfilled DSM-IV OCD criteria with a mean severity on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) of 24.6 (SD = 5.1) and were included in analyses according to intent-to-treat principles. CBT used manualized exposure and response prevention (ERP) during both steps 1 and 2, and step 2 sertraline medication used flexible dosing. The follow-up schedules were timed to 6, 12, 24, and 36 months following step 1 CBT. Remission was defined as a CY-BOCS score ≤10 and relapse as an elevated CY-BOCS score ≥16 in those who had remitted. RESULTS A good third of our patients were in stable and full remission at all examinations (n = 98, 36.4%). Further, some in remission following treatment (n = 36, 13.4%) had mild OCD at some examinations. Relapses during follow-up were not uncommon (n = 28, 10.4%), but in many patients these improved again (n = 10, 3.7%) and were in remission at the final 3-year follow-up. Furthermore, a considerable proportion (n = 50, 18.6%) of the patients were initial non-remitters to the treatment but achieved remission at some point during the follow-up. In addition, 11.5% (n = 31) had persistent OCD but reached remission by the last follow-up. Finally, a smaller segment of our sample (9.7%, n = 26), did not attain remission at any point during the study. CONCLUSION Our outcome paints a more promising picture of pediatric OCD long-term outcome than previous studies have done. However, both relapse rates and the presence of initial non-remitters and persistent OCD show that treatments need improvement, particularly for those who respond slowly, partially, or not at all. The lack of a general psychiatric interview at follow-up is a marked limitation. CLINICAL TRIAL REGISTRATION INFORMATION Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study; https://www.isrctn.com; ISRCTN66385119.
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Affiliation(s)
- Tord Ivarsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | | | | | | | - Nor Christian Torp
- Division of Mental Health Services, Akershus University Hospital, Norway; Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway, and St. Olav's University Hospital, Trondheim, Norway
| | | | - Kitty Dahl
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo
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Chessell C, Halldorsson B, Walters S, Farrington A, Harvey K, Creswell C. Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): a non-concurrent multiple baseline case series. Behav Cogn Psychother 2024; 52:243-261. [PMID: 37840150 DOI: 10.1017/s1352465823000450] [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: 10/17/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. AIMS This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach. METHOD Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. RESULTS Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. CONCLUSIONS Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.
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Affiliation(s)
- Chloe Chessell
- School of Psychological and Clinical Language Sciences, University of Reading, UK
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
| | - Brynjar Halldorsson
- Department of Psychology, Reykjavik University, Iceland
- Landspitali, The National University Hospital of Iceland, Iceland
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
| | - Sasha Walters
- National Specialist CAMHS OCD, BDD, and Related Disorders Team, London, UK
- Oxford Psychological Intervention Centre, Oxford, UK
| | - Alice Farrington
- CAMHS Anxiety and Depression Pathway, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Kate Harvey
- School of Psychological and Clinical Language Sciences, University of Reading, UK
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
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Rueppel M, Becker HC, Iturra-Mena A, Bilek EL, Monk CS, Phan KL, Fitzgerald KD. Obsessive-Compulsive Symptoms: Baseline Prevalence, Comorbidity, and Implications in a Clinically Anxious Pediatric Sample. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01658-y. [PMID: 38355854 DOI: 10.1007/s10578-023-01658-y] [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] [Accepted: 12/13/2023] [Indexed: 02/16/2024]
Abstract
Subclinical symptoms of obsessive-compulsive disorder (i.e., obsessive compulsive symptoms, or "OCS") cause functional impairment, including for youth without full-syndrome OCD. Further, despite high rates of OCS in youth with anxiety disorders, knowledge of OCS in the context of specific anxiety disorders is limited. The present study seeks to: (1) compare OCS in pediatric patients with anxiety disorders and healthy youth, (2) determine which categorical anxiety disorder(s) associate most with OCS, and (3) determine relationships between OCS with anxiety severity and impairment. Data on OCS, anxiety, and functional impairment were collected from 153 youth with anxiety disorders and 45 healthy controls, ages 7-17 years (M = 11.84, SD = 3.17). Findings indicated that patients had significantly more OCS than healthy controls. Among patients, GAD was a significant predictor of OCS as well as OCD risk. These results suggest that OCS should be a primary diagnostic and treatment consideration for youth who present in clinical settings with GAD.
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Affiliation(s)
- Meryl Rueppel
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
- Department of Psychology, Fordham University, Bronx, NY, 10458, USA
| | - Hannah C Becker
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ann Iturra-Mena
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Emily L Bilek
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Christopher S Monk
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- New York State Psychiatric Institute, New York, NY, 10032, USA.
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Yang Z, Xiao S, Su T, Gong J, Qi Z, Chen G, Chen P, Tang G, Fu S, Yan H, Huang L, Wang Y. A multimodal meta-analysis of regional functional and structural brain abnormalities in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:165-180. [PMID: 37000246 DOI: 10.1007/s00406-023-01594-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
Numerous neuroimaging studies of resting-state functional imaging and voxel-based morphometry (VBM) have revealed abnormalities in specific brain regions in obsessive-compulsive disorder (OCD), but results have been inconsistent. We conducted a whole-brain voxel-wise meta-analysis on resting-state functional imaging and VBM studies that investigated differences of functional activity and gray matter volume (GMV) between patients with OCD and healthy controls (HCs) using seed-based d mapping (SDM) software. A total of 41 independent studies (51 datasets) for resting-state functional imaging and 42 studies (46 datasets) for VBM were included by a systematic literature search. Overall, patients with OCD displayed increased spontaneous functional activity in the bilateral inferior frontal gyrus (IFG) (extending to the bilateral insula) and bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC), as well as decreased spontaneous functional activity in the bilateral paracentral lobule, bilateral cerebellum, left caudate nucleus, left inferior parietal gyri, and right precuneus cortex. For the VBM meta-analysis, patients with OCD displayed increased GMV in the bilateral thalamus (extending to the bilateral cerebellum), right striatum, and decreased GMV in the bilateral mPFC/ACC and left IFG (extending to the left insula). The conjunction analyses found that the bilateral mPFC/ACC, left IFG (extending to the left insula) showed decreased GMV with increased intrinsic function in OCD patients compared to HCs. This meta-analysis demonstrated that OCD exhibits abnormalities in both function and structure in the bilateral mPFC/ACC, insula, and IFG. A few regions exhibited only functional or only structural abnormalities in OCD, such as the default mode network, striatum, sensorimotor areas, and cerebellum. It may provide useful insights for understanding the underlying pathophysiology of OCD and developing more targeted and efficacious treatment and intervention strategies.
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Affiliation(s)
- Zibin Yang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Shu Xiao
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Jiayin Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
- Department of Radiology, Six Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - SiYing Fu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Hong Yan
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, 510630, China.
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Skarphedinsson G, Speight Kristínardóttir SÓ, Gústavsson SM, Sigurðsson JF. Parents' experience and views on the assessment and treatment of children with OCD within the public mental health system in Iceland: a qualitative study. Nord J Psychiatry 2024; 78:22-29. [PMID: 37694737 DOI: 10.1080/08039488.2023.2254758] [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: 02/13/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Obsessive-compulsive disorder (OCD) in children can lead to long-lasting symptoms and access to evidence-based evaluation and treatment is crucial for its prevention. In Iceland, the law guarantees public access to the highest quality healthcare services. To date, no study has evaluated the services available for children with OCD within the national healthcare system (NMHS). This qualitative study explored the experiences of parents navigating the Icelandic NMHS for their children with OCD. METHOD AND MATERIALS Seven parents who had sought services within the NMHS for their children diagnosed with OCD at private clinics were interviewed using a semi-structured interview. The responses were analyzed using thematic framework analysis. RESULTS Nineteen themes were identified, including three overarching themes and eight overarching sub-themes, and eight sub-themes within them. A prevalent theme was the giving up on the national mental healthcare system due to parents' experiences of accessing mental healthcare for their children being challenging. Other issues faced by parents included a lack of knowledge on where to seek help, inadequate evaluation of the issue, and the lack of access to psychotherapy for their children. The healthcare workers' responses and recommendations also resulted in parents seeking treatment at private clinics. CONCLUSIONS These findings underscore the need for clearer pathways for seeking help, improved access to trained healthcare workers, and a more centralized evaluation process. These insights can potentially guide future research and policy decisions to better support families dealing with childhood OCD in Iceland.
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Affiliation(s)
| | | | | | - Jón Friðrik Sigurðsson
- Department of Psychology, Reykjavik University, Reykjavík, Iceland
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Tibi L, van Oppen P, van Balkom AJ, Eikelenboom M, Visser H, Anholt GE. Predictors of the 6-year outcome of obsessive-compulsive disorder: Findings from the Netherlands Obsessive-Compulsive Disorder Association study. Aust N Z J Psychiatry 2023; 57:1443-1452. [PMID: 37183408 DOI: 10.1177/00048674231173342] [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] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder is characterized by a chronic course that can vary between patients. The knowledge on the naturalistic long-term outcome of obsessive-compulsive disorder and its predictors is surprisingly limited. The present research was designed to identify clinical and psychosocial predictors of the long-term outcome of obsessive-compulsive disorder. METHODS We included 377 individuals with a current diagnosis of obsessive-compulsive disorder, who participated in the Netherlands Obsessive Compulsive Disorder Association study, a multicenter naturalistic cohort study. Predictors were measured at baseline using self-report questionnaires and clinical interviews. Outcome was assessed using the Yale-Brown Obsessive Compulsive Scale at 2-, 4- and 6-year follow-up. RESULTS The overall course of obsessive-compulsive disorder was characterized by two prominent trends: the first reflected an improvement in symptom severity, which was mitigated by the second, worsening trend in the long term. Several determinants affected the course variations of obsessive-compulsive disorder, namely, increased baseline symptom severity, late age of onset, history of childhood trauma and autism traits. CONCLUSION The long-term outcome of obsessive-compulsive disorder in naturalistic settings was characterized by an overall improvement in symptom severity, which was gradually halted to the point of increased worsening. However, after 6 years, the severity of symptoms remained below the baseline level. While certain determinants predicted a more favorable course, their effect diminished over time in correspondence to the general worsening trend. The results highlight the importance of a regular and continuous monitoring for symptom exacerbations as part of the management of the obsessive-compulsive disorder, regardless of the presence of putative predictors.
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Affiliation(s)
- Lee Tibi
- Cognetica: The Israeli Center for Cognitive Behavioral Therapy, Tel-Aviv, Israel
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Anton Jlm van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Henny Visser
- Mental Health Care Institute GGZ Centraal, Amsterdam, The Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Rezaee R, Parsa Z, Ahmadzadeh L, Ahmadian L, Avazzadeh S, Marzaleh MA. Self-help application for obsessive-compulsive disorder based on exposure and response prevention technique with prototype design and usability evaluation: A cross-sectional study. Health Sci Rep 2023; 6:e1577. [PMID: 37752977 PMCID: PMC10519132 DOI: 10.1002/hsr2.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Background and Aims Obsessive-compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence-based cognitive-behavioral therapy as a first-line treatment for obsessive-compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence-based therapies while overcoming these barriers. The present study was to design and evaluate a prototype of a self-help application for people with OCD (the most common pattern of OCD) based on the exposure and response prevention (ERP) technique. Methods This work was developed in four different phases. (1) Needs assessment: a thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; (2) Creating a paper prototype: considering the functional features identified in the previous phase using wireframe sketcher software. (3) Creating a digital prototype: developing an actual prototype using Axure RP software based on the information obtained from an expert panel's evaluation of the paper prototype. (4) Prototype usability evaluation: through a heuristic evaluation with experts and usability testing with patients using the SUS questionnaire. Results After requirement analysis, requirements were defined in the areas of information and educational elements, and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in-app online self-help groups, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plans, tracking treatment progress through weekly reports provided, anxiety assessment, and setting reminders. Conclusion The results of the heuristic evaluation with experts made it possible to identify how to provide information and implement the capabilities in a way that is more appropriate and easier for the user.
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Affiliation(s)
- Rita Rezaee
- School of Health Management and Information Sciences, Clinical Education Research Center, Health Human Resources Research CenterShiraz University of Medical SciencesShirazIran
| | - Ziba Parsa
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Laaya Ahmadzadeh
- Research Center for Psychiatry and Behavioral SciencesShiraz University of Medical SciencesShirazIran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Future Studies in HealthKerman University of Medical SciencesKermanIran
| | - Sepehr Avazzadeh
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
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Pretzmann L, Christensen SH, Bryde Christensen A, Funch Uhre C, Uhre V, Thoustrup CL, Clemmesen IT, Gudmandsen TA, Korsbjerg NLJ, Mora-Jensen ARC, Ritter M, Olsen MH, Clemmensen LKH, Lindschou J, Gluud C, Thomsen PH, Vangkilde S, Hagstrøm J, Rozental A, Jeppesen P, Verhulst F, Hybel KA, Lønfeldt NN, Plessen KJ, Poulsen S, Pagsberg AK. Adverse events in cognitive behavioral therapy and relaxation training for children and adolescents with obsessive-compulsive disorder: A mixed methods study and analysis plan for the TECTO trial. Contemp Clin Trials Commun 2023; 34:101173. [PMID: 37497354 PMCID: PMC10366479 DOI: 10.1016/j.conctc.2023.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
Background Knowledge on adverse events in psychotherapy for youth with OCD is sparse. No official guidelines exist for defining or monitoring adverse events in psychotherapy. Recent recommendations call for more qualitative and quantitative assessment of adverse events in psychotherapy trials. This mixed methods study aims to expand knowledge on adverse events in psychotherapy for youth with OCD. Methods This is an analysis plan for a convergent mixed methods study within a randomized clinical trial (the TECTO trial). We include at least 128 youth aged 8-17 years with obsessive-compulsive disorder (OCD). Participants are randomized to either family-based cognitive behavioral therapy (FCBT) or family-based psychoeducation and relaxation training (FPRT). Adverse events are monitored quantitatively with the Negative Effects Questionnaire. Furthermore, we assess psychiatric symptoms, global functioning, quality of life, and family factors to investigate predictors for adverse events. We conduct semi-structured qualitative interviews with all youths and their parents on their experience of adverse events in FCBT or FPRT. For the mixed methods analysis, we will merge 1) a qualitative content analysis with descriptive statistics comparing the types, frequencies, and severity of adverse events; 2) a qualitative content analysis of the perceived causes for adverse events with prediction models for adverse events; and 3) a thematic analysis of the participants' treatment evaluation with a correlational analysis of adverse events and OCD severity. Discussion The in-depth mixed methods analysis can inform 1) safer and more effective psychotherapy for OCD; 2) instruments and guidelines for monitoring adverse events; and 3) patient information on potential adverse events. The main limitation is risk of missing data. Trial registration ClinicalTrials.gov identifier: NCT03595098. Registered on July 23, 2018.
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Affiliation(s)
- Linea Pretzmann
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Heidenheim Christensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | - Anne Bryde Christensen
- Center for Eating and feeding Disorders Research, Mental Health Center Ballerup, Capital Region of Denmark
| | - Camilla Funch Uhre
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Center for Clinical Neuropsychology, Children and Adolescents, Rigshospitalet, Copenhagen, Denmark
| | - Valdemar Uhre
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital ─ Amager and Hvidovre, Copenhagen, Denmark
| | - Christine Lykke Thoustrup
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Iben Thiemer Clemmesen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | - Tin Aaen Gudmandsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | | | - Anna-Rosa Cecilie Mora-Jensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ritter
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | | | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital ─ Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Signe Vangkilde
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | - Alexander Rozental
- Department of Clinical Neuroscience (CNS), Centre for Psychiatry Research, Karolinska Institute, Sweden
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital – Psychiatry Region Zealand, Roskilde, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | - Katja Anna Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Nicole Nadine Lønfeldt
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Stig Poulsen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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10
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Demaria F, Pontillo M, Bellantoni D, Di Vincenzo C, Vicari S. Phenomenological Considerations of the World of the Obsessive Patient. J Clin Med 2023; 12:4193. [PMID: 37445230 DOI: 10.3390/jcm12134193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Despite significant scientific advances in research on obsessive-compulsive disorder (OCD), the psychological and behavioral symptoms of this pathological condition remain hard to understand, until they seem paradoxical. The present work seeks to consider the significance and potential contribution of a phenomenological reading of OCD and how phenomenalism has influenced some cognitive models of this disorder. Transcendental phenomenology is a philosophical approach that attaches primary importance to intuitive experience and considers all phenomena intrinsically associated with the subject's inner world. Thus, the subject's intuition is considered the starting point for understanding their essential experience. This approach has had a profound influence on modern cognitive sciences. Among current cognitive models, post-rationalist cognitivism and cognitive neuropsychological psychotherapy seem most effective in capturing the world experiences of OCD patients. Both apply a phenomenological approach to identify these experiences, which are typically characterized by hyper-reflexivity, at the expense of 'natural evidence.' The models have found that OCD patients experience the world emotionally as a sterile set of rules, and this experience determines their suffering.
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Affiliation(s)
- Francesco Demaria
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | - Maria Pontillo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | - Domenica Bellantoni
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | - Cristina Di Vincenzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, 00146 Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
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11
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Lauri KO, Andersson E, Mataix-Cols D, Norlin L, Eriksson V, Melin K, Lenhard F, Serlachius E, Aspvall K. Long-term effect of stepped-care vs in-person cognitive behavioral therapy for pediatric obsessive-compulsive disorder. Internet Interv 2023; 32:100613. [PMID: 37033903 PMCID: PMC10073887 DOI: 10.1016/j.invent.2023.100613] [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] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Long-term follow-up data from trials of digital mental health interventions are rare. This study reports 2-year follow-up data from a non-inferiority trial (N = 152) comparing stepped-care (internet-delivered cognitive behavioral therapy [CBT] followed by traditional in-person CBT if needed) vs in-person CBT for pediatric obsessive-compulsive disorder. Both treatment groups had comparable long-term effects, with the majority of participants being responders (stepped-care 66 %; in-person CBT 71 %) 2 years after the end of treatment.
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12
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Early Identification and Intervention in Pediatric Obsessive-Compulsive Disorder. Brain Sci 2023; 13:brainsci13030399. [PMID: 36979207 PMCID: PMC10046131 DOI: 10.3390/brainsci13030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and course from adult OCD. Delayed and inadequate treatment is associated with a worse prognosis, making the need for early identification and intervention in pediatric OCD very urgent. In this paper, we reflected on the current constraints that make early interventions for pediatric OCD unpromoted and reviewed the approaches with potential application for early identification and early intervention in pediatric OCD, categorized by three-level prevention stages corresponding to a clinical staging model. Since the etiology of pediatric OCD is still unclear, primary prevention is most lacking, and early interventions for pediatric OCD are currently focused on the secondary prevention stage, which aims to prevent the conversion of obsessive-compulsive symptoms into full-blown OCD; tertiary prevention mostly focuses on the alleviation of mild to moderate OCD, while interventions for co-morbidities are still in their infancy. We closed by considering the important research questions on this topic.
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13
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Salazar de Pablo G, Pascual-Sánchez A, Panchal U, Clark B, Krebs G. Efficacy of remotely-delivered cognitive behavioural therapy for obsessive-compulsive disorder: An updated meta-analysis of randomised controlled trials. J Affect Disord 2023; 322:289-299. [PMID: 36395988 DOI: 10.1016/j.jad.2022.11.007] [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: 12/26/2021] [Revised: 09/12/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite remotely-delivered cognitive behavioural therapy (CBT) being an emerging field, the evidence of its efficacy in obsessive-compulsive disorder (OCD) is limited. We aimed to estimate the efficacy of remotely-delivered CBT for OCD, compared to face-to-face CBT and non-CBT control conditions. METHODS Randomised clinical trials (RCTs) identified through a systematic literature search of PubMed, Ovid/PsychINFO and Web of Science until 21/06/2021. Eligible studies included individuals with OCD evaluating at least one form of remotely-delivered CBT versus a control condition. Random-effects meta-analyses, sub-analyses, meta-regressions, heterogeneity analyses, publication bias assessment and quality assessment. RESULTS Twenty-two RCTs were included (n = 1796, mean age = 27.7 years, females = 59.1 %). Remotely-delivered CBT was more efficacious than non-CBT control conditions for OCD symptoms (g = 0.936 95 % CI = 0.597-1.275, p < .001), depressive symptoms (g = 0.358, 95 % CI = 0.125-0.590, p = .003) and anxiety symptoms (g = 0.468, 95 % CI = 0.135-0.800, p = .006). There were no significant differences in efficacy between remotely-delivered CBT and face-to-face CBT for OCD symptoms (g = -0.104 95 % CI = -0.391-0.184, p = .479), depressive symptoms (g = 0.138, 95 % CI = -0.044-0.320, p = .138), anxiety symptoms (g = 0.166, 95 % CI = -0.456-0.780, p = .601) or quality of life (g = 0.057, 95 % CI = -0.178-0.292, p = .489). Higher baseline severity of OCD symptoms was associated with a lower efficacy of remotely-delivered CBT compared to face-to-face CBT (β = -0.092, p = .036). The quality of the included studies was mostly identified as "low risk of bias" (45.5 %) or "some concerns" (45.5 %). LIMITATIONS Heterogeneity and limited evidence for some outcomes. CONCLUSIONS Remotely-delivered CBT appears efficacious in reducing OCD symptoms and other relevant outcomes and is therefore a viable option for increasing treatment access. Preliminary evidence suggests some individuals with severe OCD may benefit more from face-to-face than remotely-delivered CBT.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Ana Pascual-Sánchez
- Division of Psychiatry, Department of Brain Sciences, Imperial College, London, UK
| | - Urvashi Panchal
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Bruce Clark
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK
| | - Georgina Krebs
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical, Educational and Health Psychology, University College London, UK
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14
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Duholm CS, Jensen S, Rask CU, Thomsen PH, Ivarsson T, Skarphedinsson G, Torp NC, Weidle B, Nissen JB, Højgaard DRMA. Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01480-y. [PMID: 36510026 DOI: 10.1007/s10578-022-01480-y] [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] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.
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Affiliation(s)
- Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
- Akershus University Hospital, Oslo, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Segal SC, Carmona NE. A systematic review of sleep problems in children and adolescents with obsessive compulsive disorder. J Anxiety Disord 2022; 90:102591. [PMID: 35728382 DOI: 10.1016/j.janxdis.2022.102591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 05/15/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Abstract
There is growing interest in the relationship between obsessive-compulsive disorder (OCD) and sleep problems in youth, including the development of a theoretical model proposing how these disorders maintain each other. The model suggests that OCD symptoms are proposed to interfere with sleep duration (e.g., via increased arousal and delayed bedtime), which compounds OCD symptom severity during the daytime and into the evening, feeding back into the model. Whether the recent influx of research on sleep problems in youth with OCD supports this model is unknown. The primary aim of this systematic review was to characterize sleep problems in youth with OCD and evaluate whether current research supports previous theoretical inferences. Findings across 20 studies revealed a high prevalence of sleep problems among youth with OCD and support a bidirectional relationship. Studies largely did not assess hypothesized relationships proposed by the model; support for the model is therefore preliminary. A secondary aim was to assess the impacts of comorbidity and developmental stage. Findings suggest that in childhood, comorbid anxiety disorders may initially predate sleep problems, but they become mutually maintained over time; the role of comorbid depression appears to increase with age. Limitations, future directions, and clinical implications are discussed.
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Affiliation(s)
- Shira C Segal
- Toronto Metropolitan University, Department of Psychology, 350 Victoria St, Toronto, ON M5B 2K3, Canada.
| | - Nicole E Carmona
- Toronto Metropolitan University, Department of Psychology, 350 Victoria St, Toronto, ON M5B 2K3, Canada.
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16
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Obsessive-Compulsive Symptoms in an Adolescent with Intellectual Disability. Case Rep Psychiatry 2022; 2022:4943485. [PMID: 35360258 PMCID: PMC8964226 DOI: 10.1155/2022/4943485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Abstract
Individuals with intellectual disability (ID) experience various psychiatric comorbidities including anxiety, depression, and obsessive-compulsive disorder (OCD) in a rate that is equivalent or higher than individuals without ID. Unfortunately, these cooccurring conditions are often missed during the evaluations due to various reasons, including their atypical presentation. In this case report, we present the clinical symptoms of an adolescent with mild ID who presented with irritability and was diagnosed with OCD following a comprehensive assessment. The treatment course is also summarized as well as the positive outcome to selective serotonin reuptake inhibitor (SSRI) medication. In this report, we discuss potential factors that increase the rate of psychiatric comorbidities including OCD in individuals with ID. Furthermore, in the context of limited research in this area, we recommend additional studies in order to build a detailed understanding of the clinical presentation of psychiatric cooccurring disorders in individuals with ID with the goal of enhancing assessment tools in the future.
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17
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Pagsberg AK, Uhre C, Uhre V, Pretzmann L, Christensen SH, Thoustrup C, Clemmesen I, Gudmandsen AA, Korsbjerg NLJ, Mora-Jensen ARC, Ritter M, Thorsen ED, Halberg KSV, Bugge B, Staal N, Ingstrup HK, Moltke BB, Kloster AM, Zoega PJ, Mikkelsen MS, Harboe GS, Larsen KF, Clemmesen LKH, Lindschou J, Jakobsen JC, Engstrøm J, Gluud C, Siebner HR, Thomsen PH, Hybel K, Verhulst F, Jeppesen P, Jepsen JRM, Vangkilde S, Olsen MH, Hagstrøm J, Lønfeldt NN, Plessen KJ. Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial). BMC Psychiatry 2022; 22:204. [PMID: 35305587 PMCID: PMC8933964 DOI: 10.1186/s12888-021-03669-2] [Citation(s) in RCA: 4] [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] [Received: 12/03/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the recommended first-line treatment for children and adolescents with obsessive-compulsive disorder (OCD), but evidence concerning treatment-specific benefits and harms compared with other interventions is limited. Furthermore, high risk-of-bias in most trials prevent firm conclusions regarding the efficacy of CBT. We investigate the benefits and harms of family-based CBT (FCBT) versus family-based psychoeducation and relaxation training (FPRT) in youth with OCD in a trial designed to reduce risk-of-bias. METHODS This is an investigator-initiated, independently funded, single-centre, parallel group superiority randomised clinical trial (RCT). Outcome assessors, data managers, statisticians, and conclusion drawers are blinded. From child and adolescent mental health services we include patients aged 8-17 years with a primary OCD diagnosis and an entry score of ≥16 on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). We exclude patients with comorbid illness contraindicating trial participation; intelligence quotient < 70; or treatment with CBT, PRT, antidepressant or antipsychotic medication within the last 6 months prior to trial entry. Participants are randomised 1:1 to the experimental intervention (FCBT) versus the control intervention (FPRT) each consisting of 14 75-min sessions. All therapists deliver both interventions. Follow-up assessments occur in week 4, 8 and 16 (end-of-treatment). The primary outcome is OCD symptom severity assessed with CY-BOCS at end-of-trial. Secondary outcomes are quality-of-life and adverse events. Based on sample size estimation, a minimum of 128 participants (64 in each intervention group) are included. DISCUSSION In our trial design we aim to reduce risk-of-bias, enhance generalisability, and broaden the outcome measures by: 1) conducting an investigator-initiated, independently funded RCT; 2) blinding investigators; 3) investigating a representative sample of OCD patients; 3) using an active control intervention (FPRT) to tease apart general and specific therapy effects; 4) using equal dosing of interventions and therapist supervision in both intervention groups; 5) having therapists perform both interventions decided by randomisation; 6) rating fidelity of both interventions; 7) assessing a broad range of benefits and harms with repeated measures. The primary study limitations are the risk of missing data and the inability to blind participants and therapists to the intervention. TRIAL REGISTRATION ClinicalTrials.gov : NCT03595098, registered July 23, 2018.
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Affiliation(s)
- Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Camilla Uhre
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Valdemar Uhre
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Linea Pretzmann
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Heidenheim Christensen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Christine Thoustrup
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Iben Clemmesen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Amanda Aaen Gudmandsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Nicoline Løcke Jepsen Korsbjerg
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Anna-Rosa Cecilie Mora-Jensen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Melanie Ritter
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Emilie D. Thorsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Klara Sofie Vangstrup Halberg
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Birgitte Bugge
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Nina Staal
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Helga Kristensen Ingstrup
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Birgitte Borgbjerg Moltke
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Anne Murphy Kloster
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Pernille Juul Zoega
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Marie Sommer Mikkelsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Gitte Sommer Harboe
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Katrin Frimann Larsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Line Katrine Harder Clemmesen
- grid.5170.30000 0001 2181 8870Applied Mathematics and Computer Science, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Jane Lindschou
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Engstrøm
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Hartwig Roman Siebner
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark ,grid.411702.10000 0000 9350 8874Department of Neurology, Copenhagen University Hospital Bispebjerg and Fredriksberg, Copenhagen, Denmark
| | - Per Hove Thomsen
- grid.154185.c0000 0004 0512 597XDepartment of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Copenhagen, Denmark
| | - Katja Hybel
- grid.154185.c0000 0004 0512 597XDepartment of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Copenhagen, Denmark
| | - Frank Verhulst
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Pia Jeppesen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.480615.e0000 0004 0639 1882Child and Adolescent Psychiatric Department, Region Zealand Psychiatry, Research Unit, Roskilde, Denmark
| | - Jens Richardt Møllegaard Jepsen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.4973.90000 0004 0646 7373Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark
| | - Signe Vangkilde
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, Faculty Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus Harboe Olsen
- grid.4973.90000 0004 0646 7373Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ,grid.475435.4Department of Neuroanaesthesiology, The Neuroscience Centre, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Julie Hagstrøm
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Nicole Nadine Lønfeldt
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- grid.4973.90000 0004 0646 7373Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark ,grid.8515.90000 0001 0423 4662Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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18
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Isaacs D, Key AP, Cascio CJ, Conley AC, Riordan H, Walker HC, Wallace MT, Claassen DO. Cross-disorder comparison of sensory over-responsivity in chronic tic disorders and obsessive-compulsive disorder. Compr Psychiatry 2022; 113:152291. [PMID: 34952304 PMCID: PMC8792289 DOI: 10.1016/j.comppsych.2021.152291] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sensory over-responsivity (SOR) refers to excessively intense and/or prolonged behavioral responses to environmental stimuli typically perceived as non-aversive. SOR is prevalent in several neurodevelopmental disorders, including chronic tic disorders (CTDs) and obsessive-compulsive disorder (OCD). Few studies have examined the extent and clinical correlates of SOR across disorders, limiting insights into the phenomenon's transdiagnostic clinical and biological relevance. Such cross-disorder comparisons are of particular interest for CTDs and OCD given their frequent co-occurrence. OBJECTIVE We sought to compare the magnitude of SOR between adults with CTD and adults with OCD and to identify the clinical factors most strongly associated with SOR across these disorders. METHODS We enrolled 207 age- and sex-matched participants across four diagnostic categories: CTD without OCD (designated "CTD/OCD-"; n = 37), CTD with OCD ("CTD/OCD+"; n = 32), OCD without tic disorder ("OCD"; n = 69), and healthy controls (n = 69). Participants completed a self-report battery of rating scales assessing SOR (Sensory Gating Inventory, SGI), obsessive-compulsive symptoms (Dimensional Obsessive-Compulsive Scale, DOCS), inattention and hyperactivity (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-5), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9). CTD participants were also administered the Yale Global Tic Severity Scale (YGTSS). To examine between-group differences in SOR, we compared SGI score across all groups and between pairs of groups. To examine the relationship of SOR with other clinical factors, we performed multivariable linear regression. RESULTS CTD/OCD-, CTD/OCD+, and OCD participants were 86.7%, 87.6%, and 89.5%, respectively, more likely to have higher SGI total scores than healthy controls. SGI total score did not differ between CTD/OCD-, CTD/OCD+, and OCD groups. In the regression model of log-transformed SGI total score, OCD diagnosis, DOCS score, and ASRS-5 score each contributed significantly to model goodness-of-fit, whereas CTD diagnosis and YGTSS total tic score did not. CONCLUSION SOR is prevalent in adults with CTD and in adults with OCD but does not significantly differ in magnitude between these disorders. Across CTD, OCD, and healthy control adult populations, SOR is independently associated with both obsessive-compulsive and ADHD symptoms, suggesting a transdiagnostic relationship between these sensory and psychiatric manifestations. Future cross-disorder, longitudinal, and translational research is needed to clarify the role and prognostic import of SOR in CTDs, OCD, and other neurodevelopmental disorders.
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Affiliation(s)
- David Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Alexandra P Key
- Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, United States; Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States.
| | - Carissa J Cascio
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States; Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Alexander C Conley
- Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Heather Riordan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Mark T Wallace
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, United States; Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States; Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Pharmacology, Vanderbilt University, Nashville, TN, United States; Department of Psychology, Vanderbilt University, Nashville, TN, United States.
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
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19
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Efe A, Açıkel SB, Uygun SD, Canlı M, Temeltürk RD, Gürel Y, Çetinkaya M, Çakmak FH. A Retrospective Evaluation on Demographic, Phenomenological, and Comorbidity Features of Pediatric Obsessive-Compulsive Disorder. J Nerv Ment Dis 2022; 210:6-25. [PMID: 34417423 DOI: 10.1097/nmd.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The impacts of sex, age of onset, phenotype, and comorbidity on clinical features were explored in a large clinical sample with pediatric obsessive-compulsive disorder (p-OCD) (n = 457), along with concomitant specific features in the framework of different symptom dimensions/phenotypes, by a retrospective cross-sectional evaluation design. The most prevalent phenotype was obsession/checking (almost half), and the clinical features belonging to different phenotypes varied among sexes, age of onset, severity, and comorbidities. The contamination and aggressive obsessions, along with the compulsions such as cleaning and repeating routine activities, were the most prevalent symptoms, which were prevalently accompanied by generalized anxiety disorder, attention deficit hyperactivity disorder, and depression. Females with OCD were likely prone to exhibit comorbid internalizing disorders, whereas males were prone to externalizing. This recent study on a large Turkish clinical sample of p-OCD followed up within 5 years, highlighting separate evidence on subtyping of p-OCD in phenotype and comorbidity frame.
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Affiliation(s)
- Ayşegül Efe
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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20
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Preti A, Meneghelli A, Poletti M, Raballo A. Through the prism of comorbidity: A strategic rethinking of early intervention in obsessive-compulsive disorder. Schizophr Res 2022; 239:128-133. [PMID: 34875511 DOI: 10.1016/j.schres.2021.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/09/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
The diagnostic criteria for obsessive-compulsive disorder (OCD) have undergone minor changes in DSM-5 yet a major turnaround intervened in the overarching categorical allocation. OCD indeed has been separated from the anxiety disorders and included in an autonomous class of OCD-related disorders. Converging factors, i.e., the specificity of the clinical phenotype, the robust evidence for familial aggregation, the availability of effective treatments, and the increasing awareness of the role of environmental factors in its onset and course make OCD a suited target for tailored early intervention programs. However, studies on the topic are still scarce and OCD remains marginally conceptualized within an overdue early detection/intervention framework. Starting from the consolidated clinical evidence of OCD extensive comorbidity with schizophrenia-spectrum and bipolar disorders, we articulate a strategic proposal for a more integral incorporation of OCD within early detection and intervention paradigm.
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Affiliation(s)
- Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy.
| | - Anna Meneghelli
- Programma2000-Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
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21
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Krishnakumar P, Rajith R. Clinical profile of obsessive-compulsive disorder in children. J Family Med Prim Care 2022; 11:251-255. [PMID: 35309610 PMCID: PMC8930109 DOI: 10.4103/jfmpc.jfmpc_1328_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 11/04/2022] Open
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22
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Petersen J, Ona PZ, Blythe M, Möller CM, Twohig M. Intensive outpatient acceptance and commitment therapy with exposure and response prevention for adolescents. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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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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Wang E, Reardon B, Cherian B, George WT, Xavier RM. Disorder agnostic network structure of psychopathology symptoms in youth. J Psychiatr Res 2021; 143:246-253. [PMID: 34509785 DOI: 10.1016/j.jpsychires.2021.09.026] [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: 05/20/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Youth mental health disorders are strong predictors of adult mental health disorders. Early identification of mental health disorders in youth is important as it could aid early intervention and prevention. In a disorder agnostic manner, we aimed to identify influential psychopathology symptoms that could impact mental health in youth. METHODS This study sampled 6063 participants from the Philadelphia Neurodevelopmental Cohort and comprised of youth of ages 12-21 years. A mixed graphical model was used to estimate the network structure of 115 symptoms corresponding to 16 psychopathology domains. Importance of individual symptoms in the network were assessed using node influence measures such as strength centrality and predictability. RESULTS The generated network had stronger associations between symptoms within a psychopathological domain; overall had no negative associations. A conduct disorder symptom eliciting threatening others and a depression symptom - persistent sadness or depressed mood - had the greatest strength centralities (β = 2.85). Fear of traveling in a car and compulsively going in and out a door had the largest predictability (classification accuracy = 0.99). Conduct disorder, depression, and obsessive compulsive disorder symptoms generally had the largest strength centralities. Suicidal thoughts had the largest bridge strength centrality (β = 2.85). Subgroup networks revealed that network structure differed by socioeconomic status (low versus high, p = 0.04) and network connectivity patterns differed by sex (p = 0.01), but not for age or race. CONCLUSIONS Psychopathology symptom networks offer insights that could be leveraged for early identification, intervention, and possibly prevention of mental health disorders.
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Affiliation(s)
- Emily Wang
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brandy Reardon
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Cherian
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wales T George
- Southern Virginia Mental Health Institute, Danville, VA, USA
| | - Rose Mary Xavier
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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25
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Kabukçu Başay B, Başay Ö, Tanriverdi Ç, Tunç-Ata M, Aydin SÜ. Elevated serum S100B levels in medication naïve children and adolescents with obsessive-compulsive disorder. Nord J Psychiatry 2021; 75:502-508. [PMID: 33752558 DOI: 10.1080/08039488.2021.1895309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Obsessive-compulsive disorder (OCD) is a condition characterized by obsessions and/or compulsions. S100B protein is shown to be involved in microglial activation besides intracellular signaling, intercellular communication and cell growth. The relation between S100B protein and various psychiatric disorders except OCD has been studied so far. This study aimed to analyze serum S100B levels for the first time in medication naive OCD diagnosed children and adolescents and to compare them with the control group. MATERIALS AND METHODS Peripheral blood S100B levels of 27 children and adolescents with OCD were compared to 27 control group subjects to assess any possible association between OCD and S100B levels. All the children and adolescents completed the child version of the Obsessive-Compulsive Inventory (OCI - CV). RESULTS Compared to control group, higher serum S100B levels were found in OCD group (z = -2.258, p = 0.024). We also found that obsessing and washing subscales' scores and total score of OCI - CV were statistically significantly correlated with S100B levels (respectively, r = .292, p = 0.032; r = .306, p = 0.025; r = .296, p = 0.030). CONCLUSIONS The present study's findings are in accord with previous studies demonstrating the significance of S100B protein in other psychiatric disorders and suggesting a relation in children and adolescents with OCD for the first time. The role of S100B protein in OCD etiology and pathogenesis should be evaluated further.
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Affiliation(s)
- Bürge Kabukçu Başay
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ömer Başay
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Çiğdem Tanriverdi
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Melek Tunç-Ata
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Sezai Üstün Aydin
- Department of Child and Adolescent Psychiatry, Denizli State Hospital, Denizli, Turkey
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26
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Ozkan Y, Kandemir H, Yalın Sapmaz S, Taneli F, Ozdemir H, Gozaçanlar Ozkan O. Thiol/disulfide homeostasis in medication-naive children and adolescents with obsessive-compulsive disorder. J Psychiatr Res 2021; 140:159-164. [PMID: 34116441 DOI: 10.1016/j.jpsychires.2021.05.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/31/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Abstract
Obsessive-compulsive disorder (OCD) causes significant psychic distress and affects children's social and academic functioning. Approximately 80% of OCD cases begin in childhood. Earlier onset is associated with more severe OC symptoms, poorer treatment response, and a more unfavorable clinical course. A particular oxidative stress marker, thiol/disulfide homeostasis, using a new, comparatively inexpensive, easily calculated, easily accessible, repeatable, and fully automated method was investigated between pediatric patients diagnosed with OCD and a healthy control group in this study. This study is the first to address this subject in pediatric patients with OCD and aims to contribute to our knowledge of the etiopathogenesis and treatment of pediatric OCD. The study included children with OCD (n = 35, 52.2%) (drug free, comorbidity free) between 11 and 18 years of age and age- and sex-matched healthy controls (n = 32, 47.8%). The total thiol (p = 0.025) and disulfide (p = 0.001) levels and the disulfide/native thiol (p = 0.001) and disulfide/total thiol ratios (p = 0.001) were significantly different between the groups. Also, in the patient group, biochemical analysis revealed that the disulfide level (p = 0.05) and the disulfide/native thiol (p = 0.034) and disulfide/total thiol ratios (p = 0.039) differed significantly according to the presence of a family history of psychiatric disorders. Consequently, the results of our study show that thiol/disulfide homeostasis may affect the etiopathogenesis of pediatric OCD and can be utilized as a new method when evaluating oxidative stress.
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Affiliation(s)
- Yekta Ozkan
- Clinic of Child and Adolescent Psychiatry, Cankiri State Hospital, Cankiri, 18100, Turkey.
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Manisa Celal Bayar University, Faculty of Medicine, Manisa, 45030, Turkey.
| | - Sermin Yalın Sapmaz
- Department of Child and Adolescent Psychiatry, Manisa Celal Bayar University, Faculty of Medicine, Manisa, 45030, Turkey.
| | - Fatma Taneli
- Department of Biochemistry, Manisa Celal Bayar University, Faculty of Medicine, Manisa, 45030, Turkey.
| | - Habib Ozdemir
- Department of Biochemistry, Basaksehir Cam and Sakura City Hospital, Istanbul, 34480, Turkey.
| | - Ozge Gozaçanlar Ozkan
- Department of Child and Adolescent Psychiatry, Manisa Celal Bayar University, Faculty of Medicine, Manisa, 45030, Turkey.
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27
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Developmental Trajectories of Pediatric Obsessive-Compulsive Symptoms. Res Child Adolesc Psychopathol 2021; 49:1635-1648. [PMID: 34236586 DOI: 10.1007/s10802-020-00742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
Children who experience obsessive-compulsive symptoms (OCS) may be at risk for developing Obsessive-Compulsive Disorder (OCD). The current study aimed to investigate developmental trajectories of OCS, as well as possible predictors, within a community-based sample of children. Children (N = 1147) from the longitudinal NICHD Study of Early Child Care and Youth Development (SECCYD) were assessed for OCS, via the Child Behavioral Checklist - Obsessive-Compulsive Scale (OCS-8), eight times between Pre-Kindergarten (54 months; Pre-K) and High School (15 years of age; HS.) Participants were recruited within the United States and included only maternal caregivers. Preliminary analyses indicated that approximately 3% of the sample was above the diagnostic cutoff score on the OCS-8 at the High School time-point. Latent growth models tested symptom trajectories. Findings demonstrated three groups of OCS trajectories. Most children fell within a low symptomatology group (the No Peak group) with low OCS across all time points. Two additional OCS trajectories were also demonstrated: Pre-K Peak (high to low OCS across time) and HS Peak (low to high OCS across time). Both higher attention problems and greater depression/anxiety symptoms at the Pre-K time point predicted children's membership in the Pre-K Peak or HS Peak groups compared to the No Peak group. Membership within the HS Peak group predicted a high likelihood of children's OCS being above previously established cutoff scores for an OCD diagnosis at age 15 years. Membership within either the Pre-K Peak or No Peak groups predicted a low likelihood. This study provides new evidence for the existence of different developmental trajectories for youth with OCS. From a clinical perspective, these results may have important implications when considering the identification and early intervention of childhood OCS and OCD within the community.
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White matter microstructure and its relation to clinical features of obsessive-compulsive disorder: findings from the ENIGMA OCD Working Group. Transl Psychiatry 2021; 11:173. [PMID: 33731673 PMCID: PMC7969744 DOI: 10.1038/s41398-021-01276-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/15/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
Microstructural alterations in cortico-subcortical connections are thought to be present in obsessive-compulsive disorder (OCD). However, prior studies have yielded inconsistent findings, perhaps because small sample sizes provided insufficient power to detect subtle abnormalities. Here we investigated microstructural white matter alterations and their relation to clinical features in the largest dataset of adult and pediatric OCD to date. We analyzed diffusion tensor imaging metrics from 700 adult patients and 645 adult controls, as well as 174 pediatric patients and 144 pediatric controls across 19 sites participating in the ENIGMA OCD Working Group, in a cross-sectional case-control magnetic resonance study. We extracted measures of fractional anisotropy (FA) as main outcome, and mean diffusivity, radial diffusivity, and axial diffusivity as secondary outcomes for 25 white matter regions. We meta-analyzed patient-control group differences (Cohen's d) across sites, after adjusting for age and sex, and investigated associations with clinical characteristics. Adult OCD patients showed significant FA reduction in the sagittal stratum (d = -0.21, z = -3.21, p = 0.001) and posterior thalamic radiation (d = -0.26, z = -4.57, p < 0.0001). In the sagittal stratum, lower FA was associated with a younger age of onset (z = 2.71, p = 0.006), longer duration of illness (z = -2.086, p = 0.036), and a higher percentage of medicated patients in the cohorts studied (z = -1.98, p = 0.047). No significant association with symptom severity was found. Pediatric OCD patients did not show any detectable microstructural abnormalities compared to controls. Our findings of microstructural alterations in projection and association fibers to posterior brain regions in OCD are consistent with models emphasizing deficits in connectivity as an important feature of this disorder.
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Liu J, Cui Y, Yu L, Wen F, Wang F, Yan J, Yan C, Li Y. Long-Term Outcome of Pediatric Obsessive-Compulsive Disorder: A Meta-Analysis. J Child Adolesc Psychopharmacol 2021; 31:95-101. [PMID: 33395547 DOI: 10.1089/cap.2020.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The outcome of pediatric obsessive-compulsive disorder (OCD) is still unclear. In the present study, long-term rates and predictors of remission were used to identify potential factors influencing the outcome of pediatric OCD. Methods: Using meta-analysis techniques, we calculated the pooled rate of remission and performed subgroup analyses to identify potential heterogeneities, and the meta-regression analysis was used as a predictor. Results: A total of 18 studies including 1389 participants were identified, and the follow-up periods ranged from 1 to 16 years. The pooled remission rate of pediatric OCD was 62% (95% confidence interval: 52-72). Shorter duration of OCD at baseline (R2 = 78.04%, p < 0.0001) predicted higher rates of remission. Conclusions: The outcome of pediatric OCD seems to be better than the past. Shorter duration of illness appears to be related to a better outcome. Early detection of pediatric OCD and early intervention play an important role in good prognosis. In the future, studies based on multicenter, longer follow-up studies with larger samples were needed to confirm these issues for the outcome of pediatric OCD.
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Affiliation(s)
- Jingran Liu
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liping Yu
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Wen
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Wang
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Chunmei Yan
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Psychiatry, National Center for Children Healthy, Beijing Children's Hospital, Capital Medical University, Beijing, China
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30
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Tjelle K, Opstad HB, Solem S, Launes G, Hansen B, Kvale G, Hagen K. Treatment Adherence as Predictor of Outcome in Concentrated Exposure Treatment for Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:667167. [PMID: 34248703 PMCID: PMC8264255 DOI: 10.3389/fpsyt.2021.667167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (EX/RP). Previous studies have demonstrated that treatment adherence predicts treatment outcome for patients with OCD, but there is little knowledge on its role in concentrated exposure treatment for OCD. Method: In the present study, 42 patients received EX/RP treatment using the Bergen 4-day format. Adherence was measured with the Exposure and Response Prevention Adherence Scale (PEAS, rated both by patients and therapists) after the second and third day. Treatment outcome (symptoms of OCD, depression, anxiety, work- and social functioning, and well-being) was assessed at 3-month follow-up. Results: At follow-up, 71.4% were in remission. High adherence was reported (mean score of 6 on a 1-7 scale). The combination of patient- and therapist rated adherence was significantly associated with treatment outcome whilst controlling for age, sex, and pre-treatment scores. Patients with higher degree of adherence reported less symptoms, higher functioning, and more well-being at follow-up. Conclusions: The results of the present study indicated that adherence in concentrated exposure treatment is significantly associated with a wide range of treatment outcomes for OCD.
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Affiliation(s)
- Kristian Tjelle
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, Norway.,Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Berg Opstad
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunvor Launes
- Division of Psychiatry, Sørlandet Hospital, Kristiansand, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, Norway.,Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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31
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Cervin M, Perrin S, Olsson E, Claesdotter-Knutsson E, Lindvall M. Involvement of fear, incompleteness, and disgust during symptoms of pediatric obsessive-compulsive disorder. Eur Child Adolesc Psychiatry 2021; 30:271-281. [PMID: 32211970 PMCID: PMC7932948 DOI: 10.1007/s00787-020-01514-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 03/16/2020] [Indexed: 12/24/2022]
Abstract
Fear has been assigned a central role in models of obsessive-compulsive disorder (OCD), but empirical investigations into the emotions that underpin OCD symptoms are few, especially in pediatric samples. Using validated, clinician-led structured interviews, 124 youth with OCD reported on the presence and severity of symptoms across the main symptom dimensions of OCD (aggressive, symmetry, contamination) and the degree to which fear, incompleteness, and disgust accompanied these symptoms. For comparison purposes, the degree of fear, incompleteness, and disgust during symptoms was obtained also from youth with social anxiety disorder (SAD; n = 27) and generalized anxiety disorder (GAD; n = 28). Participants with OCD reported that all three emotions were involved in their symptoms; however, fear was most strongly linked to aggressive symptoms, incompleteness to symmetry symptoms, and disgust to contamination symptoms. Incompleteness differentiated youth with OCD from those with SAD and GAD. No differences for these emotions were found for youth with OCD with versus without the tic-disorder subtype or comorbid autism. A positive association between incompleteness and self-reported hoarding emerged among youth with OCD. Further studies of the emotional architecture of pediatric OCD, and its relationship to etiology and treatment, are warranted.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden.
- Skåne Child and Adolescent Psychiatry, Lund, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Elin Olsson
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Emma Claesdotter-Knutsson
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Magnus Lindvall
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden
- Skåne Child and Adolescent Psychiatry, Lund, Sweden
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32
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Screening for Pediatric Obsessive-Compulsive Disorder Using the Obsessive-Compulsive Inventory-Child Version. Child Psychiatry Hum Dev 2020; 51:888-899. [PMID: 32030629 DOI: 10.1007/s10578-020-00966-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The study assessed the ability of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) to detect pediatric obsessive-compulsive disorder (OCD) using receiver operating characteristic analyses. The sample consisted of 114 cases with current OCD, 340 cases with other psychiatric disorders (OPD), and 301 healthy controls (HC) ages 7 to 18 years. All 755 participants were assessed with two semi-structured interviews and seven rating scales. In a comparison of current OCD cases and all other participants, the optimal OCI-CV cut-score was 11 with an area under the curve (AUC) of .88. In a comparison of current OCD cases and OPD cases, the optimal OCI-CV cut-score was 11 with an AUC of .82. In a comparison of current OCD cases and HC, the optimal OCI-CV cut-score was 10 with an AUC of .94. The results indicate that the OCI-CV provides an effective screen for pediatric OCD using empirically derived cut-scores.
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33
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Jensen S, Højgaard DRMA, Hybel KA, Mortensen EL, Skarphedinsson G, Melin K, Ivarsson T, Nissen JB, Weidle B, Valderhaug R, Torp NC, Dahl K, Compton S, Thomsen PH. Distinct trajectories of long-term symptom severity in pediatric obsessive-compulsive disorder during and after stepped-care treatment. J Child Psychol Psychiatry 2020; 61:969-978. [PMID: 31736082 DOI: 10.1111/jcpp.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/02/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND First-line treatments for pediatric obsessive-compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). No studies have thus far identified distinct classes and associated predictors of long-term symptom severity during and after treatment. Yet, these could form the basis for more personalized treatment in pediatric OCD. METHOD The study included 269 OCD patients aged 7-17 years from the Nordic Long-term OCD Treatment Study (NordLOTS). All participants received stepped-care treatment starting with 14 weekly sessions of manualized CBT. Nonresponders were randomized to either prolonged CBT or SSRIs. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale at seven time points from pre- to post-treatment and over a three-year follow-up. Latent class growth analysis (LCGA) was performed to identify latent classes of symptom severity trajectories. Univariate and multivariate analyses were used to detect differences between classes and identify predictors of trajectory class membership including several clinical and demographic variables. TRIAL REGISTRY Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. RESULTS Three LCGA classes were identified: (a) acute, sustained responders (54.6%); (b) slow, continued responders (23.4%); and (c) limited long-term responders (21.9%). Class membership was predicted by distinct baseline characteristics pertaining to age, symptom severity, contamination/cleaning and anxiety symptoms. CONCLUSIONS The LCGA suggests three distinct trajectory classes of long-term symptom severity during and after treatment in pediatric OCD with different clinical profiles at pretreatment. The results point to required clinical attention for adolescent patients with contamination/cleaning and anxiety symptoms who do not show convincing responses to first-line treatment even though they may have reached the established cutoff for treatment response.
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Affiliation(s)
- Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Katja A Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Robert Valderhaug
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Kitty Dahl
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
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34
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Brezinka V, Mailänder V, Walitza S. Obsessive compulsive disorder in very young children - a case series from a specialized outpatient clinic. BMC Psychiatry 2020; 20:366. [PMID: 32653035 PMCID: PMC7353707 DOI: 10.1186/s12888-020-02780-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Paediatric obsessive-compulsive disorder (OCD) is a chronic condition often associated with severe disruptions of family functioning, impairment of peer relationships and academic performance. Mean age of onset of juvenile OCD is 10.3 years; however, reports on young children with OCD show that the disorder can manifest itself at an earlier age. Both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD. There seems to be difficulty for health professionals to recognize and diagnose OCD in young children appropriately, which in turn may prolong the interval between help seeking and receiving an adequate diagnosis and treatment. The objective of this study is to enhance knowledge about the clinical presentation, diagnosis and possible treatment of OCD in very young children. CASE PRESENTATION We describe a prospective 6 month follow-up of five cases of OCD in very young children (between 4 and 5 years old). At the moment of first presentation, all children were so severely impaired that attendance of compulsory Kindergarten was uncertain. Parents were deeply involved in accommodating their child's rituals. Because of the children's young age, medication was not indicated. Therefore, a minimal CBT intervention for parents was offered, mainly focusing on reducing family accommodation. Parents were asked to bring video tapes of critical situations that were watched together. They were coached to reduce family accommodation for OCD, while enhancing praise and reward for adequate behaviors of the child. CY-BOCS scores at the beginning and after 3 months show an impressive decline in OCD severity that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child was admitted to the next level / class. CONCLUSIONS Disseminating knowledge about the clinical presentation, diagnosis and treatment of early OCD may shorten the long delay between first OCD symptoms and disease-specific treatment that is reported as main predictor for persistent OCD.
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Affiliation(s)
- Veronika Brezinka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Neumünsterallee 3, 8032, Zurich, Switzerland.
| | - Veronika Mailänder
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Neumünsterallee 3, 8032, Zurich, Switzerland
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Kuckertz JM, Piacentini J, Amir N. Towards a Clinically Valid Mechanistic Assessment of Exposure and Response Prevention: Preliminary Utility of an Exposure Learning Tool for Children with OCD. J Obsessive Compuls Relat Disord 2020; 25:100528. [PMID: 32500008 PMCID: PMC7271823 DOI: 10.1016/j.jocrd.2020.100528] [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: 10/24/2022]
Abstract
Despite advances in understanding mechanisms underlying fear processes, there remains a significant gap between insights produced via laboratory assessment and concrete tools for harnessing these insights in clinical practice. In addressing this gap, researchers would ideally introduce tools that are feasible for patients in clinical practice, easily disseminated to practitioners, and clinically useful. We present pilot data on the Exposure Experience Questionnaire (EEQ), a brief measure designed to assess exposure learning mechanisms. Ten children (ages 8-15) with a primary diagnosis of obsessive-compulsive disorder (OCD) underwent exposure and response prevention in which they completed weekly exposures in clinic and at home. During each exposure, children completed an exposure practice form which included the EEQ. Results suggest the preliminary feasibility and internal consistency of this measure, with comparable utility in clinic and home settings. The EEQ was associated in the expected direction with slope of OCD symptoms, such that greater exposure learning in both clinic and homework exposures predicted improved outcome. Although limited by small sample size, these data support the continued research on the feasibility and utility of the EEQ and suggest that quantifying learning processes following exposure may be a useful addition to mechanistic research in OCD.
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Affiliation(s)
- Jennie M. Kuckertz
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, 6363 Alvarado Court, Suite 102, San Diego, CA 92120
- Department of Psychiatry, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095
| | - Nader Amir
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, 6363 Alvarado Court, Suite 102, San Diego, CA 92120
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36
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Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS. J Am Acad Child Adolesc Psychiatry 2020; 59:244-253. [PMID: 30768383 DOI: 10.1016/j.jaac.2019.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/15/2019] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. METHOD This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. RESULTS Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. CONCLUSION The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. CLINICAL TRIAL REGISTRATION INFORMATION Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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37
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MATTA RMD, RAMOS DG. THE APPLICATION OF SANDPLAY THERAPY IN CHILDREN WITH OBSESSIVE COMPULSIVE DISORDER. PSYCHOLOGIA 2020. [DOI: 10.2117/psysoc.2020-b009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Reinalda M. da MATTA
- International Association of Sandplay Therapy
- Pontifical Catholic University in São Paulo
| | - Denise G. RAMOS
- International Association of Sandplay Therapy
- Pontifical Catholic University in São Paulo
- Brazilian Society of Analytical Psychology (IAAP)
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38
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Early detection and intervention for obsessive-compulsive disorder in childhood and adolescence. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:99-101. [PMID: 31784243 DOI: 10.1016/s2352-4642(19)30376-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/24/2022]
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39
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Rodríguez N, Morer A, González-Navarro EA, Serra-Pages C, Boloc D, Torres T, Martinez-Pinteño A, Mas S, Lafuente A, Gassó P, Lázaro L. Altered frequencies of Th17 and Treg cells in children and adolescents with obsessive-compulsive disorder. Brain Behav Immun 2019; 81:608-616. [PMID: 31344493 DOI: 10.1016/j.bbi.2019.07.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/01/2019] [Accepted: 07/20/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder with an etiopathophysiology that seems to include immune alterations. Previous studies have suggested that variations in the levels of circulating T cell subpopulations may be involved in psychiatric diseases. However, the role of these cells in OCD remains unexplored. Hence, the present study aimed to examine the levels of T helper 1 (Th1), Th2, Th17 and regulatory T (Treg) cells in patients with early-onset OCD and healthy controls. METHODS The assessment was performed in 99 children and adolescents with OCD and 46 control subjects. The percentages of circulating Th1, Th2, Th17 and Treg cells were evaluated using flow cytometry. RESULTS OCD patients had significantly higher levels of Th17 cells and lower percentages of Treg cells than healthy controls (p = 0.001 and p = 0.005, respectively). Furthermore, levels of Th17 cells progressively increased with the duration (p = 0.005) and severity of OCD (p = 0.008), whereas the percentages of Treg cells significantly declined with the duration of the disorder (p = 1.8 × 10-5). CONCLUSIONS These results provide more evidence of the involvement of immune dysregulation, specifically an imbalance in the levels of circulating T helper and regulatory T cells, in the pathophysiology of early-onset OCD.
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Affiliation(s)
| | - Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - E Azucena González-Navarro
- Immunology Service, Hospital Clinic de Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Carles Serra-Pages
- Immunology Service, Hospital Clinic de Barcelona, Spain; Department of Biomedicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Daniel Boloc
- Department of Medicine, University of Barcelona, Spain.
| | - Teresa Torres
- Department of Basic Clinical Practice, University of Barcelona, Spain.
| | | | - Sergi Mas
- Department of Basic Clinical Practice, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Amalia Lafuente
- Department of Basic Clinical Practice, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Patricia Gassó
- Department of Basic Clinical Practice, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Luisa Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, Spain; Department of Medicine, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
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40
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Højgaard DRMA, Schneider SC, La Buissonnière-Ariza V, Kay B, Riemann BC, Jacobi D, Eken S, Lake P, Nadeau J, Goodman WK, McIngvale E, Storch EA. Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive-compulsive disorder (OCD). Cogn Behav Ther 2019; 49:294-306. [PMID: 31203735 DOI: 10.1080/16506073.2019.1614977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD. The sample comprised 314 adolescents aged 13-17 years with treatment-resistant OCD and a Children's Yale-Brown Obsessive-Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response. Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response. Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response.
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Affiliation(s)
- Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital , Aarhus N, Denmark
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | | | - Brian Kay
- Rogers Memorial Hospital , Milwaukee, WI, USA
| | | | | | | | - Peter Lake
- Rogers Memorial Hospital , Milwaukee, WI, USA
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
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41
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Early intervention for obsessive compulsive disorder: An expert consensus statement. Eur Neuropsychopharmacol 2019; 29:549-565. [PMID: 30773387 DOI: 10.1016/j.euroneuro.2019.02.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/04/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.
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Abstract
Obsessive-compulsive disorder (OCD) affects 1%-3% of children worldwide and has a profound impact on quality of life for patients and families. Although our understanding of the underlying etiology remains limited, data from neuroimaging and genetic studies as well as the efficacy of serotonergic medications suggest the disorder is associated with the fundamental alterations in the function of cortico-striato-thalamocortical circuits. Significant delays to diagnosis are common, ultimately leading to more severe functional impairment with long-term developmental consequences. The clinical assessment requires a detailed history of specific OCD symptoms as well as psychiatric and medical comorbidities. Standardized assessment tools may aid in evaluating and tracking symptom severity and both individual and family functioning. In the majority of children, an interdisciplinary approach that combines cognitive behavioral therapy with a serotonin reuptake inhibitor leads to meaningful symptom improvement, although some patients experience a chronic, episodic course. There are limited data to guide the management of treatment-refractory illness in children, although atypical antipsychotics and glutamate-modulating agents may be used cautiously as augmenting agents. This review outlines a clinical approach to the diagnosis and management of OCD, highlighting associated challenges, and limitations to our current knowledge.
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Affiliation(s)
- Clara Westwell-Roper
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - S Evelyn Stewart
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada.,BC Mental Health and Substance Use Research Institute, Vancouver, Canada
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43
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Cervin M, Perrin S, Olsson E, Claesdotter-Knutsson E, Lindvall M. Validation of an interview-only version of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) in treatment-seeking youth with obsessive-compulsive disorder. Psychiatry Res 2019; 271:171-177. [PMID: 30481695 DOI: 10.1016/j.psychres.2018.11.048] [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: 10/19/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
There is a growing body of evidence suggesting that individuals with obsessive-compulsive disorder (OCD) may be sub-typed along different symptom dimensions. These dimensions may help explain responsiveness to current treatments. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a validated instrument involving a self-report screening tool followed by a structured interview in which the presence/absence and severity of OCD symptom dimensions are assessed and rated. The present study investigated the validity of a briefer, interview-only version of the DY-BOCS modified for use in routine care. Clinically-referred children and adolescents (N = 119) with OCD were administered the DY-BOCS along with other measures of OCD, anxiety, depression, and overall functioning and a subset (N = 100) were reassessed on average 14 months after initial assessment. This briefer, interview-only version of the DY-BOCS demonstrated high levels of internal consistency and correlated in the moderate to strong range with alternative measures of OCD severity and OCD symptom dimensions. Change scores on the DY-BOCS from baseline to follow-up were significantly correlated with change scores on the alternative measures of OCD and clinician-rated improvement, suggesting that this brief version of the DY-BOCS is valid and sensitive to the effects of treatment for OCD delivered in routine clinical care.
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Affiliation(s)
- Matti Cervin
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skane University Hospital, Lund, Sweden.
| | - Sean Perrin
- Lund University, Department of Psychology, Lund, Sweden
| | | | - Emma Claesdotter-Knutsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skane University Hospital, Lund, Sweden
| | - Magnus Lindvall
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skane University Hospital, Lund, Sweden
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Are punitive parenting and stressful life events environmental risk factors for obsessive-compulsive symptoms in youth? A longitudinal twin study. Eur Psychiatry 2018; 56:35-42. [PMID: 30496954 PMCID: PMC6386579 DOI: 10.1016/j.eurpsy.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background Punitive parenting and stressful life events are associated with obsessive-compulsive symptoms (OCS). However, the lack of longitudinal, genetically-informative studies means it remains unclear whether these factors represent environmentally-mediated risks for the development of OCS. Methods Twins and siblings from the Genesis1219 study completed self-report questionnaires two years apart (Time 1: N = 2616, mean age = 15.0; Time 2: N = 1579, mean age = 17.0 years) assessing OCS, maternal and paternal punitive parenting, and dependent stressful life events. Multiple regression models tested cross-sectional and longitudinal associations between the putative environmental risk factors and obsessive-compulsive symptoms using: (a) individual scores; and (b) monozygotic twin difference scores. The aetiologies of significant phenotypic associations between putative risk factors and OCS were further examined using multivariate genetic models. Results At a phenotypic level, maternal and paternal punitive parenting and stressful life events were all associated with OCS both cross-sectionally and longitudinally. However, only stressful life events predicted the subsequent development of OCS, after controlling for earlier symptoms. Genetic models indicated that the association between life events and change in OCS symptoms was due to both genetic (48%) and environmental (52%) influences. Overall, life events associated with change in OCS accounted for 1.2% of variation in OCS at Time 2. Conclusions Stressful life events, but not punitive parenting, predict OCS change during adolescence at a phenotypic level. This association exists above and beyond genetic confounding, consistent with the hypothesis that stressful life events play a causal role in the development of obsessive-compulsive symptoms.
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Melin K, Skarphedinsson G, Skärsäter I, Haugland BSM, Ivarsson T. A solid majority remit following evidence-based OCD treatments: a 3-year naturalistic outcome study in pediatric OCD. Eur Child Adolesc Psychiatry 2018; 27:1373-1381. [PMID: 29502315 DOI: 10.1007/s00787-018-1137-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
This study reports follow-up 2 and 3 years after the initial assessment of a sample of youth with a primary diagnosis of OCD. Participants were 109 children and adolescents, aged 5-17 years, recruited from a specialized, outpatient OCD clinic in Sweden. Patients were treated with cognitive behavioral therapy (CBT), augmented when indicated by selective serotonin reuptake inhibitor (SSRI). In cases where SSRIs were insufficient, augmentation with a second-generation antipsychotic (SGA) was applied. Participants were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), Children's OCD Impact Scale (COIS), and Children's Depressive Inventory (CDI) at follow-ups 2 and 3 years after baseline assessment. Treatment response was defined as CY-BOCS total score ≤ 15, and remission was defined as CY-BOCS total score ≤ 10. Analyzing the outcomes with linear mixed-effects models (LME) showed a decrease in OCD symptom load from 23 to 6.9 at the 3-year follow-up. Moreover, two of three (66.1%) participants were in remission, and another 19.2% had responded to treatment at the 3-year follow-up. Thus, 85.3% of participants responded to treatment. Moreover, during the follow-up period, participants' psychosocial functioning had significantly improved, and depressive symptoms had significantly decreased. The results suggest that evidence-based treatment for pediatric OCD, following expert consensus guidelines, has long-term positive effects for most children and adolescents diagnosed with OCD. The results also indicate that improvements are maintained over a 3-year period, at least, and that improvement is also found with regard to psychosocial functioning and depressive symptoms.
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Affiliation(s)
- Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Child and Adolescent Psychiatry, CAP Specialized unit, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.
| | | | - Ingela Skärsäter
- School of Social and Health and Sciences, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Postboks 7810, 5008, Bergen, Norway
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623, Nydalen, 0405, Oslo, Norway
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46
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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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Nair A, Turner C, Heyman I, Mataix-Cols D, Lovell K, Krebs G, Lang K, Byford S, O’Kearney R. Moderators and predictors of outcomes in telephone delivered compared to face-to-face cognitive behaviour therapy for paediatric obsessive–compulsive disorder: preliminary evidence from a non-inferiority RCT. Cogn Behav Ther 2018; 48:353-368. [DOI: 10.1080/16506073.2018.1513555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Nair
- Research School of Psychology, Australian National University, Canberra, Australia
| | - C. Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - I. Heyman
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - D. Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - K. Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - G. Krebs
- Kings College London, Institute of Psychiatry, London, United Kingdom
| | - K. Lang
- Kings College London, Institute of Psychiatry, London, United Kingdom
| | - S. Byford
- Kings College London, Institute of Psychiatry, London, United Kingdom
| | - R. O’Kearney
- Research School of Psychology, Australian National University, Canberra, Australia
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48
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Freeman J, Benito K, Herren J, Kemp J, Sung J, Georgiadis C, Arora A, Walther M, Garcia A. Evidence Base Update of Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder: Evaluating, Improving, and Transporting What Works. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 47:669-698. [DOI: 10.1080/15374416.2018.1496443] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jennifer Freeman
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Kristen Benito
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Jennifer Herren
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Joshua Kemp
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Jenna Sung
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Christopher Georgiadis
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Aishvarya Arora
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Michael Walther
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Abbe Garcia
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
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Fatori D, de Bragança Pereira CA, Asbahr FR, Requena G, Alvarenga PG, de Mathis MA, Rohde LA, Leckman JF, March JS, Polanczyk GV, Miguel EC, Shavitt RG. Adaptive treatment strategies for children and adolescents with Obsessive-Compulsive Disorder: A sequential multiple assignment randomized trial. J Anxiety Disord 2018; 58:42-50. [PMID: 30025255 DOI: 10.1016/j.janxdis.2018.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/19/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This sequential multiple assignment randomized trial (SMART) tested the effect of beginning treatment of childhood OCD with fluoxetine (FLX) or group cognitive-behavioral therapy (GCBT) accounting for treatment failures over time. METHODS A two-stage, 28-week SMART was conducted with 83 children and adolescents with OCD. Participants were randomly allocated to GCBT or FLX for 14 weeks. Responders to the initial treatment remained in the same regimen for additional 14 weeks. Non-responders, defined by less than 50% reduction in baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, were re-randomized to either switch to or add the other treatment. Assessments were performed at baseline, 7, 14, 21, and 28 weeks. RESULTS Among the 43 children randomized to FLX who completed the first stage, 15 (41.7%) responded to treatment and 21 non-responders were randomized to switch to (N = 9) or add GCBT (N = 12). Among the 40 children randomized to GCBT who completed the first stage, 18 (51.4%) responded to treatment and 17 non-responders were randomized to switch to (N = 9) or add FLX (N = 8). Primary analysis showed that significant improvement occurred in children initially treated with either FLX or GCBT. Each time point was statistically significant, showing a linear trend of symptom reduction. Effect sizes were large within (0.76-0.78) and small between (-0.05) groups. CONCLUSIONS Fluoxetine and GCBT are similarly effective initial treatments for childhood OCD considering treatment failures over time. Consequently, provision of treatment for childhood OCD could be tailored according to the availability of local resources.
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Affiliation(s)
- Daniel Fatori
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.
| | | | - Fernando R Asbahr
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Guaraci Requena
- Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro G Alvarenga
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Luis A Rohde
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil; Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - James F Leckman
- Child Study Center, School of Medicine, Yale University, New Haven, CT, USA
| | - John S March
- Division of Neurosciences Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Guilherme V Polanczyk
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes C Miguel
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Roseli G Shavitt
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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50
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Oppositional behavior and longitudinal predictions of early adulthood mental health problems in chronic tic disorders. Psychiatry Res 2018; 266:301-308. [PMID: 29576412 DOI: 10.1016/j.psychres.2018.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/24/2018] [Accepted: 03/13/2018] [Indexed: 11/23/2022]
Abstract
Chronic tic disorders (TD) are associated with a number of psychological problems such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) as well as anxious and depressive symptoms. ODD is often considered a risk factor for many psychological symptoms and recent work suggests that different ODD dimensions show independent predictions of later psychological problems. This study examined the longitudinal predictions between ODD dimensions of Irritability and Defiance and the most frequent comorbidities in TD from childhood to early adulthood. From an initial sample of 135, parent reports were obtained on 58 participants with TD using standard clinical questionnaires and semi-structured interviews. Defiance symptoms decreased from baseline to follow-up whereas Irritability symptoms were more stable over time. In multiple regressions, Irritability in childhood predicted anxiety and OCB in early adulthood while Defiance in childhood predicted ADHD and conduct disorder symptoms in early adulthood. No developmental link was found for depressive symptoms. Results indicate that ODD dimensions are developmentally linked to both internalizing and externalizing adult mental health symptoms in TD.
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