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Carollo M, Carollo N, Montan G. The promise of N-acetylcysteine in the treatment of obsessive-compulsive disorder. CNS Neurosci Ther 2024; 30:e14653. [PMID: 38385640 PMCID: PMC10883097 DOI: 10.1111/cns.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/23/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Affiliation(s)
- Massimo Carollo
- Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | | | - Giulia Montan
- Department of Women's and Children's HealthUniversity of PadovaPadovaItaly
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2
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Jalal B, Chamberlain SR, Sahakian BJ. Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction. Brain Behav 2023; 13:e3000. [PMID: 37137502 PMCID: PMC10275553 DOI: 10.1002/brb3.3000] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This review provides an overview of obsessive-compulsive disorder (OCD) symptoms, including the four partially distinct subtypes of the disorder, current diagnostic criteria, and common comorbidities. Critically, it focuses on the etiology of OCD, including its underlying neuropathology, and examines cognitive dysfunction in OCD. METHODS This review study was conducted by library method. RESULTS We show how dysfunction in cortico-striato-thalamo-cortical (CSTC) circuits may underpin symptoms; and shed light on the putative neurochemistry within these loops such as the role of serotonin, dopamine, and glutamate systems. We also show how OCD is characterized by cognitive dysfunction including problems in cognitive flexibility, visuospatial memory, response inhibition, and goal-directed behavior, linked to aberrant activity within CSTC circuits. CONCLUSIONS In brief, research questions we shed light on include (1) what are the symptoms in OCD; (2) what is the etiology of the disorder and do existing models explain OCD; and (3) what are key cognitive deficits in OCD and do these improve with treatment?
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Affiliation(s)
- Baland Jalal
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Samuel R. Chamberlain
- Faculty of Medicine, Department of PsychiatryUniversity of SouthamptonSouthamptonUK
- Specialist Clinic for Impulsive and Compulsive Disorders, and the Southern Gambling ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Barbara J. Sahakian
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
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3
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Hess EM, Kassel SN, Simandl G, Raddatz N, Maunze B, Hurley MM, Grzybowski M, Klotz J, Geurts A, Liu QS, Choi S, Twining RC, Baker DA. Genetic Disruption of System xc-Mediated Glutamate Release from Astrocytes Increases Negative-Outcome Behaviors While Preserving Basic Brain Function in Rat. J Neurosci 2023; 43:2349-2361. [PMID: 36788029 PMCID: PMC10072291 DOI: 10.1523/jneurosci.1525-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/04/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
The importance of neuronal glutamate to synaptic transmission throughout the brain illustrates the immense therapeutic potential and safety risks of targeting this system. Astrocytes also release glutamate, the clinical relevance of which is unknown as the range of brain functions reliant on signaling from these cells hasn't been fully established. Here, we investigated system xc- (Sxc), which is a glutamate release mechanism with an in vivo rodent expression pattern that is restricted to astrocytes. As most animals do not express Sxc, we first compared the expression and sequence of the obligatory Sxc subunit xCT among major classes of vertebrate species. We found xCT to be ubiquitously expressed and under significant negative selective pressure. Hence, Sxc likely confers important advantages to vertebrate brain function that may promote biological fitness. Next, we assessed brain function in male genetically modified rats (MSxc) created to eliminate Sxc activity. Unlike other glutamatergic mechanisms, eliminating Sxc activity was not lethal and didn't alter growth patterns, telemetry measures of basic health, locomotor activity, or behaviors reliant on simple learning. However, MSxc rats exhibited deficits in tasks used to assess cognitive behavioral control. In a pavlovian conditioned approach, MSxc rats approached a food-predicted cue more frequently than WT rats, even when this response was punished. In attentional set shifting, MSxc rats displayed cognitive inflexibility because of an increased frequency of perseverative errors. MSxc rats also displayed heightened cocaine-primed drug seeking. Hence, a loss of Sxc-activity appears to weaken control over nonreinforced or negative-outcome behaviors without altering basic brain function.SIGNIFICANCE STATEMENT Glutamate is essential to synaptic activity throughout the brain, which illustrates immense therapeutic potential and risk. Notably, glutamatergic mechanisms are expressed by most types of brain cells. Hence, glutamate likely encodes multiple forms of intercellular signaling. Here, we hypothesized that the selective manipulation of astrocyte to neuron signaling would alter cognition without producing widespread brain impairments. First, we eliminated activity of the astrocytic glutamate release mechanism, Sxc, in rat. This impaired cognitive flexibility and increased expression of perseverative, maladaptive behaviors. Notably, eliminating Sxc activity did not alter metrics of health or noncognitive brain function. These data add to recent evidence that the brain expresses cognition-specific molecular mechanisms that could lead to highly precise, safe medications for impaired cognition.
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Affiliation(s)
- Evan M Hess
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - Sara N Kassel
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - Gregory Simandl
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - Nicholas Raddatz
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - Brian Maunze
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - Matthew M Hurley
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | | | | | | | - Qing-Song Liu
- Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - SuJean Choi
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - Robert C Twining
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
| | - David A Baker
- Department of Biomedical Sciences, Marquette University, Milwaukee, Wisconsin 53233
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4
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Anitha A, Thanseem I, Iype M, Thomas SV. Mitochondrial dysfunction in cognitive neurodevelopmental disorders: Cause or effect? Mitochondrion 2023; 69:18-32. [PMID: 36621534 DOI: 10.1016/j.mito.2023.01.002] [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: 09/24/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Mitochondria have a crucial role in brain development and neurogenesis, both in embryonic and adult brains. Since the brain is the highest energy consuming organ, it is highly vulnerable to mitochondrial dysfunction. This has been implicated in a range of brain disorders including, neurodevelopmental conditions, psychiatric illnesses, and neurodegenerative diseases. Genetic variations in mitochondrial DNA (mtDNA), and nuclear DNA encoding mitochondrial proteins, have been associated with several cognitive disorders. However, it is not yet clear whether mitochondrial dysfunction is a primary cause of these conditions or a secondary effect. Our review article deals with this topic, and brings out recent advances in mitochondria-oriented therapies. Mitochondrial dysfunction could be involved in the pathogenesis of a subset of disorders involving cognitive impairment. In these patients, mitochondrial dysfunction could be the cause of the condition, rather than the consequence. There are vast areas in this topic that remains to be explored and elucidated.
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Affiliation(s)
- Ayyappan Anitha
- Dept. of Neurogenetics, Institute for Communicative and Cognitive Neurosciences (ICCONS), Shoranur, Palakkad 679 523, Kerala, India.
| | - Ismail Thanseem
- Dept. of Neurogenetics, Institute for Communicative and Cognitive Neurosciences (ICCONS), Shoranur, Palakkad 679 523, Kerala, India
| | - Mary Iype
- Dept. of Pediatric Neurology, Government Medical College, Thiruvananthapuram 695 011, Kerala, India; Dept. of Neurology, ICCONS, Thiruvananthapuram 695 033, Kerala, India
| | - Sanjeev V Thomas
- Dept. of Neurology, ICCONS, Thiruvananthapuram 695 033, Kerala, India
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5
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Kashetsky N, Wong A, Lam JM, Wong SM, Mukovozov IM. Efficacy of N-acetylcysteine in trichotillomania (hair-pulling disorder), skin-picking disorder and onychophagia (compulsive nail-biting). J Eur Acad Dermatol Venereol 2023; 37:e73-e76. [PMID: 35964308 DOI: 10.1111/jdv.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Aaron Wong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Se Mang Wong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.,Mount St. Joseph Hospital, Vancouver, British Columbia, Canada
| | - Ilya M Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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Greenberg NR, Farhadi F, Kazer B, Potenza MN, Angarita GA. The Potential of N-acetyl Cysteine in Behavioral Addictions and Related Compulsive and Impulsive Behaviors and Disorders: a Scoping Review. CURRENT ADDICTION REPORTS 2022; 9:660-670. [PMID: 38362235 PMCID: PMC10868722 DOI: 10.1007/s40429-022-00446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Purpose of Review Behavioral addictions (also termed disorders due to addictive behaviors) contain impulsive and compulsive features and have been shown to involve glutamate dysregulation. N-acetylcysteine (NAC), a well-tolerated cysteine pro-drug and antioxidant, may reduce addictive behaviors by restoring glutamate homeostasis. The current review details and discusses the use of NAC in behavioral addictions and related impulsive and compulsive behaviors, including gambling disorder, problematic use of the internet, problematic video gaming, compulsive sexual behavior, problematic shopping/buying, problematic stealing, repetitive self-injurious behavior, and binge eating disorder. Recent Findings Preliminary results have indicated the usefulness of NAC in gambling disorder, self-injurious behaviors, and compulsive sexual behaviors. Preclinical studies indicate that NAC is effective in improving binge eating behavior, but clinical trials are limited to a small open-label trial and case report. Studies are lacking on the efficacy of NAC in problematic use of the internet, problematic video gaming, problematic stealing, and problematic shopping/buying. Summary NAC demonstrates potential for use in behavioral addictions and compulsive behaviors, particularly in gambling disorder and self-injury. However, more studies are needed to assess the effectiveness of NAC in other behavioral addictions and the mechanisms by which NAC improves these conditions.
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Affiliation(s)
- Norman R. Greenberg
- Department of Psychiatry, Weill Cornell Medicine, 418 E 71st Street, New York, NY, USA
| | - Farzaneh Farhadi
- Department of Psychiatry, University of Washington School of Medicine, Seattle, WA, USA
| | - Benjamin Kazer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council On Problem Gambling, Wethersfield, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Gustavo A. Angarita
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
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Treatment of refractory obsessive-compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study. CNS Spectr 2022; 27:588-597. [PMID: 34165060 DOI: 10.1017/s1092852921000638] [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] [Indexed: 01/29/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach. OBJECTIVE To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5' phosphate, and selenium. METHODS A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale (YBOCS), administered every 4 weeks. RESULTS An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of -7.13 (95% confidence interval = -9.24, -5.01), with a mean reduction of -1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered "responders" (YBOCS ≥35% reduction and "very much" or "much improved" on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD. CONCLUSIONS While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.
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Popova L, Mancuso J. Dramatic Improvement of Trichotillomania with 6 Months of Treatment With N-Acetylcysteine. Glob Pediatr Health 2022; 9:2333794X221086576. [PMID: 35647220 PMCID: PMC9133858 DOI: 10.1177/2333794x221086576] [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: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
We present a case of a 17-year-old male with recurrent hair twirling resulting in patchy alopecia, who improved dramatically on N-acetylcysteine (NAC). Trichotillomania is characterized by repetitive hair pulling, twisting, or twirling and can vary from a mild habit to an impulse-control disorder. Standard treatment for pediatric trichotillomania includes cognitive behavioral therapy or medical therapy with selective serotonin reuptake inhibitors. NAC is a more recently utilized, safe, and well-tolerated over-the-counter supplement with some evidence of benefit for habitual skin and hair disorders. For this patient, we recommended 600 mg twice daily, increasing to 1200 mg twice daily as tolerated. After 6 months, our patient reported decreased desire to twirl his hair and his hair had almost completely regrown. Pediatricians who see patients with trichotillomania or other habitual disorders can consider treating these patients with NAC given its potential benefits and favorable side effect profile.
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Affiliation(s)
- Lilia Popova
- University of Michigan Medical School, Ann
Arbor, MI, USA
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9
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Aldhahwani R, Al Hawsawi K. Neurotic excoriation presenting as solitary papule: Case report. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Bradlow RCJ, Berk M, Kalivas PW, Back SE, Kanaan RA. The Potential of N-Acetyl-L-Cysteine (NAC) in the Treatment of Psychiatric Disorders. CNS Drugs 2022; 36:451-482. [PMID: 35316513 PMCID: PMC9095537 DOI: 10.1007/s40263-022-00907-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/22/2022]
Abstract
N-acetyl-L-cysteine (NAC) is a compound of increasing interest in the treatment of psychiatric disorders. Primarily through its antioxidant, anti-inflammatory, and glutamate modulation activity, NAC has been investigated in the treatment of neurodevelopmental disorders, schizophrenia spectrum disorders, bipolar-related disorders, depressive disorders, anxiety disorders, obsessive compulsive-related disorders, substance-use disorders, neurocognitive disorders, and chronic pain. Whilst there is ample preclinical evidence and theoretical justification for the use of NAC in the treatment of multiple psychiatric disorders, clinical trials in most disorders have yielded mixed results. However, most studies have been underpowered and perhaps too brief, with some evidence of benefit only after months of treatment with NAC. Currently NAC has the most evidence of having a beneficial effect as an adjuvant agent in the negative symptoms of schizophrenia, severe autism, depression, and obsessive compulsive and related disorders. Future research with well-powered studies that are of sufficient length will be critical to better understand the utility of NAC in the treatment of psychiatric disorders.
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Affiliation(s)
| | - Michael Berk
- IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC Australia ,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Melbourne, VIC Australia ,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC Australia ,Department of Psychiatry, University of Melbourne, Parkville, VIC Australia
| | - Peter W. Kalivas
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC USA ,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC USA
| | - Sudie E. Back
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC USA ,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Richard A. Kanaan
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC Australia ,Department of Psychiatry, University of Melbourne, Parkville, VIC Australia
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Straathof M, Blezer ELA, Smeele CE, van Heijningen C, van der Toorn A, Buitelaar JK, Glennon JC, Otte WM, Dijkhuizen RM. Memantine treatment does not affect compulsive behavior or frontostriatal connectivity in an adolescent rat model for quinpirole-induced compulsive checking behavior. Psychopharmacology (Berl) 2022; 239:2457-2470. [PMID: 35419637 PMCID: PMC9293859 DOI: 10.1007/s00213-022-06139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE Compulsivity often develops during childhood and is associated with elevated glutamate levels within the frontostriatal system. This suggests that anti-glutamatergic drugs, like memantine, may be an effective treatment. OBJECTIVE Our goal was to characterize the acute and chronic effect of memantine treatment on compulsive behavior and frontostriatal network structure and function in an adolescent rat model of compulsivity. METHODS Juvenile Sprague-Dawley rats received repeated quinpirole, resulting in compulsive checking behavior (n = 32; compulsive) or saline injections (n = 32; control). Eight compulsive and control rats received chronic memantine treatment, and eight compulsive and control rats received saline treatment for seven consecutive days between the 10th and 12th quinpirole/saline injection. Compulsive checking behavior was assessed, and structural and functional brain connectivity was measured with diffusion MRI and resting-state fMRI before and after treatment. The other rats received an acute single memantine (compulsive: n = 12; control: n = 12) or saline injection (compulsive: n = 4; control: n = 4) during pharmacological MRI after the 12th quinpirole/saline injection. An additional group of rats received a single memantine injection after a single quinpirole injection (n = 8). RESULTS Memantine treatment did not affect compulsive checking nor frontostriatal structural and functional connectivity in the quinpirole-induced adolescent rat model. While memantine activated the frontal cortex in control rats, no significant activation responses were measured after single or repeated quinpirole injections. CONCLUSIONS The lack of a memantine treatment effect in quinpirole-induced compulsive adolescent rats may be partly explained by the interaction between glutamatergic and dopaminergic receptors in the brain, which can be evaluated with functional MRI.
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Affiliation(s)
- Milou Straathof
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Erwin L. A. Blezer
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Christel E. Smeele
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Caroline van Heijningen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Annette van der Toorn
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands ,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Jeffrey C. Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands ,Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Willem M. Otte
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands ,Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Rick M. Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Brierley MEE, Thompson EM, Albertella L, Fontenelle LF. Lifestyle Interventions in the Treatment of Obsessive-Compulsive and Related Disorders: A Systematic Review. Psychosom Med 2021; 83:817-833. [PMID: 34334731 DOI: 10.1097/psy.0000000000000988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lifestyle medicine is increasingly important in psychiatry for its efficacy as a transdiagnostic treatment, its preventative potential, and its increased tolerability compared with first-line strategies. Although the impact of lifestyle medicine is strong across many psychiatric illnesses, our understanding of the effectiveness of lifestyle interventions in treating obsessive-compulsive and related disorders (OCRDs) is minimal. We aimed to conduct a systematic review examining the effect of lifestyle interventions (targeting diet, exercise, sleep, stress management, and tobacco/alcohol use) on OCRD symptoms. METHODS We systematically searched four electronic databases for published randomized controlled trials reporting on lifestyle interventions for OCRDs. We qualitatively synthesized results of eligible studies and calculated mean changes in symptom severity from baseline to end point and standardized between-group effect sizes. RESULTS We identified 33 eligible studies. Poor efficacy was noted across a number of rigorous dietary supplement interventions with some promising data in four (of six) studies regarding N-acetylcysteine for trichotillomania, skin picking, and obsessive-compulsive disorder. Stress management interventions, generally characterized by high risk of bias, reported mild effectiveness with greater effects noted for mind-body exercises (yoga) for obsessive-compulsive disorder. Greater improvements may be achieved when lifestyle intervention is adjunct to first-line treatments and delivered by facilitators. CONCLUSIONS Diet (particularly N-acetylcysteine) and stress management interventions seem promising avenues for OCRDs treatment. We present an action plan to move the lifestyle interventions for OCRDs field forward. Further high-quality lifestyle interventions are required to improve the certainty of findings and to inform clinical treatment guidelines.Review Registration Number: CRD42020151407.
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Affiliation(s)
- Mary-Ellen E Brierley
- From the BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences (Brierley, Thompson, Albertella, Fontenelle), Monash University, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry (Fontenelle), Federal University of Rio de Janeiro (UFRJ); and D'Or Institute for Research and Education (Fontenelle), Rio de Janeiro, Brazil
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13
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Zhao X, Wang S, Hong X, Lu S, Tang S, Shen Y, Feng M, Guo P, Fang Y. A case of trichotillomania with binge eating disorder: combined with N-acetylcysteine synergistic therapy. Ann Gen Psychiatry 2021; 20:46. [PMID: 34563228 PMCID: PMC8467022 DOI: 10.1186/s12991-021-00369-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Obsessive-compulsive and related disorders (OCRDs) are a group of intractable and chronic mental disorders. Trichotillomania (TTM) is a common type of OCRDs characterized by repetitive hair pulling, driven by escalating tension before the action and during the attempts to resist it. Binge eating disorder (BED) is a common type of eating disorder characterized by recurrent compulsive episodes of binge eating. Both have common psychological processes (tension or impulsion) and pathological manifestations (out of control), but the pathological mechanisms are still unclear and the current clinical treatments are often unsatisfactory for these two disorders. CASE PRESENTATION A 25-year-old woman with TTM comorbid BED came to our hospital for treatment. She had accepted systematic cognitive behavioral therapy (CBT) and also monotherapy or multidrug therapy with sertraline, fluvoxamine, bupropion, risperidone in full dosage and duration for 2 years, but all of them did not work. We treated this case with N-acetylcysteine (NAC) as a synergist on the basis of recent treatment (fluvoxamine 150 mg/day and bupropion 300 mg/day). The pathological hair plucking behavior and binge eating symptoms were both significantly and rapidly improved, and the follow-up in next 14 weeks showed that the effect was still maintained. CONCLUSION To our knowledge, this may be the first case report of using NAC as a synergist to treat TTM comorbid BED successfully, which suggest that these two disorders may have a common pathophysiological mechanism. Moreover, NAC can be one choice as a synergistic treatment for OCRDs.
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Affiliation(s)
- Xudong Zhao
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Shikai Wang
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China.
| | - Xiujuan Hong
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Shaojia Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sufang Tang
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Yue Shen
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Ming Feng
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Ping Guo
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Yu Fang
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
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Way H, Williams G, Hausman-Cohen S, Reeder J. Genomics as a Clinical Decision Support Tool: Successful Proof of Concept for Improved ASD Outcomes. J Pers Med 2021; 11:jpm11070596. [PMID: 34202628 PMCID: PMC8305264 DOI: 10.3390/jpm11070596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023] Open
Abstract
Considerable evidence is emerging that Autism Spectrum Disorder (ASD) is most often triggered by a range of different genetic variants that interact with environmental factors such as exposures to toxicants and changes to the food supply. Up to 80% of genetic variations that contribute to ASD found to date are neither extremely rare nor classified as pathogenic. Rather, they are less common single nucleotide polymorphisms (SNPs), found in 1-15% or more of the population, that by themselves are not disease-causing. These genomic variants contribute to ASD by interacting with each other, along with nutritional and environmental factors. Examples of pathways affected or triggered include those related to brain inflammation, mitochondrial dysfunction, neuronal connectivity, synapse formation, impaired detoxification, methylation, and neurotransmitter-related effects. This article presents information on four case study patients that are part of a larger ongoing pilot study. A genomic clinical decision support (CDS) tool that specifically focuses on variants and pathways that have been associated with neurodevelopmental disorders was used in this pilot study to help develop a targeted, personalized prevention and intervention strategy for each child. In addition to an individual's genetic makeup, each patient's personal history, diet, and environmental factors were considered. The CDS tool also looked at genomic SNPs associated with secondary comorbid ASD conditions including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections/pediatric acute-onset neuropsychiatric syndrome (PANDAS/PANS). The interpreted genomics tool helped the treating clinician identify and develop personalized, genomically targeted treatment plans. Utilization of this treatment approach was associated with significant improvements in socialization and verbal skills, academic milestones and intelligence quotient (IQ), and overall increased ability to function in these children, as measured by autism treatment evaluation checklist (ATEC) scores and parent interviews.
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Affiliation(s)
- Heather Way
- The Australian Centre for Genomic Analysis, Brisbane, QLD 4069, Australia;
| | | | - Sharon Hausman-Cohen
- IntellxxDNA™, Austin, TX 78731, USA; (G.W.); (J.R.)
- Correspondence: ; Tel.: +1-512-717-3300
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15
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Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113858. [PMID: 33770712 DOI: 10.1016/j.psychres.2021.113858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/06/2021] [Indexed: 12/28/2022]
Abstract
Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.
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16
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The Role of Antioxidants in the Management of Obsessive-Compulsive Disorder. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021. [DOI: 10.1155/2021/6661514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that has a significant effect on the quality of life. The most effective treatment for OCD is the combination of selective serotonin reuptake inhibitors (SSRI) with cognitive behavior therapy (CBT). However, several adverse effects have been linked with this usual pharmacotherapy, and it is unsuccessful in many patients. The exact pathophysiology of OCD is not completely known, though the role of oxidative stress in its pathogenesis has been proposed recently. This review presents an overview of animal and human studies of antioxidant treatment for OCD. The use of antioxidants against oxidative stress is a novel treatment for several neurodegenerative and neuropsychiatric disorders. Among antioxidants, NAC was one of the most studied drugs on OCD, and it showed a significant improvement in OCD symptoms. Thus, antioxidants could be promising as an adjuvant treatment for OCD. However, a limited number of human studies are conducted on these agents, and for better judgment, human studies with a large sample size are necessary.
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17
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Thiol (-SH) substituent as functional motif for effective corrosion protection: A review on current advancements and future directions. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2020.115111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Batistuzzo MC, Sottili BA, Shavitt RG, Lopes AC, Cappi C, de Mathis MA, Pastorello B, Diniz JB, Silva RMF, Miguel EC, Hoexter MQ, Otaduy MC. Lower Ventromedial Prefrontal Cortex Glutamate Levels in Patients With Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:668304. [PMID: 34168581 PMCID: PMC8218991 DOI: 10.3389/fpsyt.2021.668304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Recent studies using magnetic resonance spectroscopy (1H-MRS) indicate that patients with obsessive-compulsive disorder (OCD) present abnormal levels of glutamate (Glu) and gamma aminobutyric acid (GABA) in the frontal and striatal regions of the brain. These abnormalities could be related to the hyperactivation observed in cortico-striatal circuits of patients with OCD. However, most of the previous 1H-MRS studies were not capable of differentiating the signal from metabolites that overlap in the spectrum, such as Glu and glutamine (Gln), and referred to the detected signal as the composite measure-Glx (sum of Glu and Gln). In this study, we used a two-dimensional JPRESS 1H-MRS sequence that allows the discrimination of overlapping metabolites by observing the differences in J-coupling, leading to higher accuracy in the quantification of all metabolites. Our objective was to identify possible alterations in the neurometabolism of OCD, focusing on Glu and GABA, which are key neurotransmitters in the brain that could provide insights into the underlying neurochemistry of a putative excitatory/inhibitory imbalance. Secondary analysis was performed including metabolites such as Gln, creatine (Cr), N-acetylaspartate, glutathione, choline, lactate, and myo-inositol. Methods: Fifty-nine patients with OCD and 42 healthy controls (HCs) underwent 3T 1H-MRS in the ventromedial prefrontal cortex (vmPFC, 30 × 25 × 25 mm3). Metabolites were quantified using ProFit (version 2.0) and Cr as a reference. Furthermore, Glu/GABA and Glu/Gln ratios were calculated. Generalized linear models (GLMs) were conducted using each metabolite as a dependent variable and age, sex, and gray matter fraction (fGM) as confounding factors. GLM analysis was also used to test for associations between clinical symptoms and neurometabolites. Results: The GLM analysis indicated lower levels of Glu/Cr in patients with OCD (z = 2.540; p = 0.011). No other comparisons reached significant differences between groups for all the metabolites studied. No associations between metabolites and clinical symptoms were detected. Conclusions: The decreased Glu/Cr concentrations in the vmPFC of patients with OCD indicate a neurochemical imbalance in the excitatory neurotransmission that could be associated with the neurobiology of the disease and may be relevant for the pathophysiology of OCD.
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Affiliation(s)
- Marcelo C Batistuzzo
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, Brazil
| | - Bruna A Sottili
- Laboratory of Magnetic Resonance (LIM44), Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), São Paulo, Brazil
| | - Roseli G Shavitt
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Antonio C Lopes
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Carolina Cappi
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria Alice de Mathis
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno Pastorello
- Laboratory of Magnetic Resonance (LIM44), Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), São Paulo, Brazil
| | - Juliana B Diniz
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Renata M F Silva
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Euripedes C Miguel
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Q Hoexter
- Department & Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria C Otaduy
- Laboratory of Magnetic Resonance (LIM44), Department and Institute of Radiology, University of São Paulo (InRad-FMUSP), São Paulo, Brazil
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19
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Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
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Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
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20
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Whittington J, Holland A. Developing an understanding of skin picking in people with Prader-Willi syndrome: A structured literature review and re-analysis of existing data. Neurosci Biobehav Rev 2020; 112:48-61. [DOI: 10.1016/j.neubiorev.2020.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/09/2020] [Accepted: 01/22/2020] [Indexed: 11/17/2022]
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21
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Antioxidants as a Potential Target against Inflammation and Oxidative Stress in Attention-Deficit/Hyperactivity Disorder. Antioxidants (Basel) 2020; 9:antiox9020176. [PMID: 32098021 PMCID: PMC7070894 DOI: 10.3390/antiox9020176] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
Psychostimulants and non-psychostimulants are the medications prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD). However, several adverse results have been linked with an increased risk of substance use and side effects. The pathophysiology of ADHD is not completely known, although it has been associated with an increase in inflammation and oxidative stress. This review presents an overview of findings following antioxidant treatment for ADHD and describes the potential amelioration of inflammation and oxidative stress using antioxidants that might have a future as multi-target adjuvant therapy in ADHD. The use of antioxidants against inflammation and oxidative conditions is an emerging field in the management of several neurodegenerative and neuropsychiatric disorders. Thus, antioxidants could be promising as an adjuvant ADHD therapy.
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22
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Step-wise Drug Therapy for Comorbid Bipolar and Obsessive-Compulsive Disorders. Am J Ther 2020; 26:e668-e670. [PMID: 30418229 DOI: 10.1097/mjt.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Karthik S, Sharma LP, Narayanaswamy JC. Investigating the Role of Glutamate in Obsessive-Compulsive Disorder: Current Perspectives. Neuropsychiatr Dis Treat 2020; 16:1003-1013. [PMID: 32368062 PMCID: PMC7173854 DOI: 10.2147/ndt.s211703] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
Glutamate is a ubiquitous excitatory neurotransmitter, which is involved in normal physiology, a variety of central nervous system (CNS) functions, including excitotoxicity and neuronal migration. It is implicated in the pathogenesis of various neuropsychiatric disorders including epilepsy, Parkinson's disease, Alzheimer's dementia, schizophrenia and obsessive compulsive disorder (OCD). Over the years, a growing body of evidence has helped researchers understand the mechanisms underlying glutamatergic involvement in the pathogenesis of these disorders. In this review, we attempt to elucidate the role of glutamate in OCD, which is a chronic psychiatric condition with significant morbidity. This article provides current perspectives on the role played by glutamate in the pathogenesis, clinical symptoms and treatment response in OCD, a critical analysis of existing and emerging evidence, both clinical and preclinical, followed by a summary and future directions.
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Affiliation(s)
- Sheshachala Karthik
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Lavanya P Sharma
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
| | - Janardhanan C Narayanaswamy
- OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
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24
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Nasir M, Trujillo D, Levine J, Dwyer JB, Rupp ZW, Bloch MH. Glutamate Systems in DSM-5 Anxiety Disorders: Their Role and a Review of Glutamate and GABA Psychopharmacology. Front Psychiatry 2020; 11:548505. [PMID: 33329087 PMCID: PMC7710541 DOI: 10.3389/fpsyt.2020.548505] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Serotonin reuptake inhibitors and benzodiazepines are evidence-based pharmacological treatments for Anxiety Disorders targeting serotonin and GABAergic systems, respectively. Although clearly effective, these medications fail to improve anxiety symptoms in a significant proportion of patients. New insights into the glutamate system have directed attention toward drugs that modulate glutamate as potential alternative treatments for anxiety disorders. Here we summarize the current understanding of the potential role of glutamate neurotransmission in anxiety disorders and highlight specific glutamate receptors that are potential targets for novel anxiety disorder treatments. We also review clinical trials of medications targeting the glutamate system in DSM-5 anxiety disorders. Understanding the role of the glutamate system in the pathophysiology of anxiety disorder may aid in developing novel pharmacological agents that are effective in treating anxiety disorders.
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Affiliation(s)
- Madeeha Nasir
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Daniel Trujillo
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Jessica Levine
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Jennifer B Dwyer
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Yale Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Zachary W Rupp
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Frank H. Netter School of Medicine, Quinnipiac University, North Haven, CT, United States
| | - Michael H Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Yale Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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25
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26
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Maia A, Oliveira J, Lajnef M, Mallet L, Tamouza R, Leboyer M, Oliveira-Maia AJ. Oxidative and nitrosative stress markers in obsessive-compulsive disorder: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 139:420-433. [PMID: 30873609 DOI: 10.1111/acps.13026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a chronic, prevalent, and highly impairing psychiatric illness. Although the pathophysiology of OCD remains unknown, pathways involved in oxidative and nitrosative stress (O&NS) have been implicated. The present study aims to systematically review the literature for quantitative evidence that patients with OCD have altered measures of blood O&NS markers. METHODS Independent random-effects meta-analyses using standardized mean differences were conducted to assess each marker separately. Additionally, data from multiple markers were pooled together in a meta-analysis for measures of oxidant activity and another for measures of antioxidant activity. RESULTS Thirteen studies met inclusion criteria, involving 433 OCD patients and 459 controls. Eleven blood O&NS markers were eligible for independent quantitative analyses. We found that, in OCD patients, the oxidant markers 8-hydroxydeoxyguanosine and malondialdehyde, and the antioxidants glutathione peroxidase and superoxide dismutase, were significantly increased while total antioxidant status, vitamin C, and vitamin E were significantly decreased, when comparing with controls. Regarding pooled meta-analyses, we found a statistically significant increase in oxidant markers, but non-significant results regarding antioxidant markers. CONCLUSIONS Our meta-analysis suggests that OCD patients have a systemic oxidative imbalance that is not adequately buffered by the antioxidant system. Additional studies are needed in order to support this association.
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Affiliation(s)
- A Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - J Oliveira
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - M Lajnef
- INSERM U955, Translational Psychiatry, Université Paris-Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France
| | - L Mallet
- Fondation Fondamental, Créteil, France.,CNRS, INSERM, Institut du cerveau et de la moelle épinière, Sorbonne Universités, UPMC Univ Paris 06, Paris, France.,Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris-Est Créteil, Créteil, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - R Tamouza
- Fondation Fondamental, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris-Est Créteil, Créteil, France
| | - M Leboyer
- INSERM U955, Translational Psychiatry, Université Paris-Est-Créteil, Créteil, France.,Fondation Fondamental, Créteil, France.,Assistance Publique-Hôpitaux de Paris, Pôle de psychiatrie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris-Est Créteil, Créteil, France
| | - A J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
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Janeczek M, Moy L, Riopelle A, Vetter O, Reserva J, Tung R, Swan J. The Potential Uses of N-acetylcysteine in Dermatology: A Review. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:20-26. [PMID: 31320973 PMCID: PMC6561714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: In recent studies, N-acetylcysteine has been shown to be efficacious in several dermatologic conditions. Objective: The aim was to review clinical trials that assess the efficacy of N-acetylcysteine in cutaneous disorders. Design: The PubMed database was searched and a manual search of clinical trials in the references was performed. Studies included randomized, controlled studies, uncontrolled studies, meta-analyses, and systemic reviews published between years 1966 and 2017. Results: Efficacy of N-acetylcysteine was shown in excoriation disorder, onychophagia disorder, trichotillomania, acne vulgaris, Type I lamellar ichthyosis, bullous morphea, systemic sclerosis, toxic epidermal necrolysis, atopic dermatitis, xeroderma pigmentosum, and pseudoporphyria. Studies also show benefits in wound healing and photoprotection. Conclusion: The review of available literature suggests that N-acetylcysteine could potentially serve as a safe, tolerable, and effective therapeutic option for a variety of dermatologic conditions.
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Affiliation(s)
- Monica Janeczek
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
| | - Lauren Moy
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
| | - Alexandria Riopelle
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
| | - Olivia Vetter
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
| | - Jeave Reserva
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
| | - Rebecca Tung
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
| | - James Swan
- Drs. May, Reservo, Tung, and Swan are with the Department of Dermatology at the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois. Mses. Janeczek, Riopelle, and Vetter are with the Stritch School of Medicine at Loyola University Chicago in May wood, Illinois
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Naderi S, Faghih H, Aqamolaei A, Mortazavi SH, Mortezaei A, Sahebolzamani E, Rezaei F, Akhondzadeh S. Amantadine as adjuvant therapy in the treatment of moderate to severe obsessive-compulsive disorder: A double-blind randomized trial with placebo control. Psychiatry Clin Neurosci 2019; 73:169-174. [PMID: 30488617 DOI: 10.1111/pcn.12803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 12/15/2022]
Abstract
AIM The role of the glutamatergic system in the pathogenesis of obsessive-compulsive disorder (OCD) has been shown by numerous studies. The aim of the present randomized, double-blind, placebo-controlled, 12-week trial was to assess the efficacy and tolerability of amantadine as an adjuvant to fluvoxamine in the treatment of patients with moderate to severe OCD. METHODS One hundred patients diagnosed with moderate to severe OCD were randomized into two parallel groups to receive fluvoxamine (100 mg twice a day) plus placebo or fluvoxamine (100 mg twice a day) plus amantadine (100 mg daily) for 12 weeks. All patients received 100 mg/day fluvoxamine for 28 days followed by 200 mg/day for the rest of the trial, regardless of their treatment groups. Patients were evaluated for response to treatment using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at Weeks 4, 10, and 12. The main outcome measure was to assess the efficacy of amantadine in improving the OCD symptoms. RESULTS Repeated-measure analysis of variance showed a significant effect for Time × Treatment interaction (Greenhouse-Geisser corrected: F = 3.84, d.f. = 1.50, P = 0.03) in the Y-BOCS total score and a significant effect for Time × Treatment interaction (Greenhouse-Geisser corrected: F = 5.67, d.f. = 1.48, P < 0.01) in the Y-BOCS Obsession subscale score between the two groups. CONCLUSION The results of this study suggest that amantadine may be effective as an augmentative agent in the treatment of moderate-to-severe OCD.
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Affiliation(s)
- Sina Naderi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Heidar Faghih
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Aqamolaei
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hosein Mortazavi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Mortezaei
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sahebolzamani
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Rezaei
- Qods Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Braun TL, Patel V, DeBord LC, Rosen T. A review of N-acetylcysteine in the treatment of grooming disorders. Int J Dermatol 2019; 58:502-510. [PMID: 30667049 DOI: 10.1111/ijd.14371] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pathologic grooming disorders can lead to clinically significant distress and functional impairment. Studies on treatment of these disorders with selective serotonin reuptake inhibitors (SSRIs) and anticonvulsants have led to inconsistent findings. N-acetylcysteine (NAC) has shown promise in treatment of obsessive-compulsive and related disorders. The objective of this article is to perform an updated review of NAC in the treatment of grooming disorders. METHODS PubMed was searched from inception to October 2017 to identify literature on the use of NAC in the management of trichotillomania, onychophagia, and pathological skin picking. Case reports, case series, and randomized controlled trials were included. Data on study design, dosing regimens, comorbidities, concurrent treatment, and side effects were extracted from the included articles. RESULTS Fifteen articles were included in this review, which consisted of 10 case reports, one case series, and four randomized controlled trials. Dosing of oral NAC ranged from 450 to 2,400 mg per day, and treatment periods lasted from 1 to 8 months. Side effects were uncommon, mild, and usually gastrointestinal in nature, with severe aggression reported in one child. CONCLUSIONS While there are multiple reports of the safety and efficacy of NAC in the treatment of grooming disorders, there are currently few randomized controlled trials on this topic, and more research is needed to develop a formal treatment algorithm. While current data should be considered very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects. A trial of NAC may be a viable option for pathologic grooming disorders, especially in patients who have failed prior psychologic or pharmacologic treatment.
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Affiliation(s)
- Tara L Braun
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Viraat Patel
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Logan C DeBord
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Theodore Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
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Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. Clin Dermatol 2018; 36:728-736. [DOI: 10.1016/j.clindermatol.2018.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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N-Acetylcysteine for the Treatment of Psychiatric Disorders: A Review of Current Evidence. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2469486. [PMID: 30426004 PMCID: PMC6217900 DOI: 10.1155/2018/2469486] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/09/2018] [Indexed: 01/09/2023]
Abstract
N-acetylcysteine, a sulphur-containing amino acid for the treatment of paracetamol overdose and chronic obstructive pulmonary disease, is a widely available off-the-shelf oral antioxidant supplement in many countries. With the potential to modulate several neurological pathways, including glutamate dysregulation, oxidative stress, and inflammation that can be beneficial to the brain functions, N-acetylcysteine is being explored as an adjunctive therapy for many psychiatric conditions. This narrative review synthesises and presents the current evidence from systematic reviews, meta-analyses, and latest clinical trials on N-acetylcysteine for addiction and substance abuse, schizophrenia, obsessive-compulsive and related disorders, and mood disorders. Good evidence exists to support the use of N-acetylcysteine as an adjunct treatment to reduce the total and negative symptoms of schizophrenia. N-acetylcysteine also appears to be effective in reducing craving in substance use disorders, especially for the treatment of cocaine and cannabis use among young people, in addition to preventing relapse in already abstinent individuals. Effects of N-acetylcysteine on obsessive-compulsive and related disorders, as well as on mood disorders, remain unclear with mixed reviews, even though promising evidence does exist. Larger and better-designed studies are required to further investigate the clinical effectiveness of N-acetylcysteine in these areas. Oral N-acetylcysteine is safe and well tolerated without any considerable adverse effects. Current evidence supports its use as an adjunctive therapy clinically for psychiatric conditions, administered concomitantly with existing medications, with a recommended dosage between 2000 and 2400 mg/day.
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Farnia V, Gharehbaghi H, Alikhani M, Almasi A, Golshani S, Tatari F, Davarinejad O, Salemi S, Sadeghi Bahmani D, Holsboer-Trachsler E, Brand S. Efficacy and tolerability of adjunctive gabapentin and memantine in obsessive compulsive disorder: Double-blind, randomized, placebo-controlled trial. J Psychiatr Res 2018; 104:137-143. [PMID: 30044966 DOI: 10.1016/j.jpsychires.2018.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND In the search for additional pharmacologic treatments of patients with obsessive-compulsive disorders (OCD), the glutamatergic system is attracting growing interest. While adjuvant memantine to a standard medication with a selective serotonin-reuptake inhibitor (SSRI) appears to reduce OCD symptoms, the adjuvant effect of gabapentin is less certain. The aim of the present randomized, double-blind and three-arm clinical trial was therefore to assess whether, compared to placebo, gabapentin (GAB) or memantine (MEM) adjuvant to a standard medication with an SSRI (fluoxetine; FLU) might lead to further improvements. METHODS A total of 99 outpatients (mean age: 29.59 years; 49.5% females) diagnosed with OCD were randomly assigned to one of the following three conditions: FLU + gabapentin (FLU + GAB); FLU + memantine (FLU + MEM); FLU + placebo (FLU + PLA). Experts rated patients' symptoms of OCD with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at baseline, and 4 and 8 weeks later. RESULTS YBOCS scores did not decrease over time. No group differences were observed. However, the significant Time by Group interaction showed that Y-BOCS scores decreased significantly over time in the FLU + PLA group. Response rates did not differ between the three study conditions. Typical side-effects were rash (FLU + MEM), drowsiness (FLU + GAB), anxiety (FLU + GAB; FLU + PLA), and drowsiness plus anxiety (FLU + GAB). CONCLUSIONS The present pattern of results suggests that glutamatergic medications such as gabapentin and memantine adjuvant to a standard treatment with an SSRI have no additional positive impact on patients with OCD, as measured with the Y-BOCS. Additionally, side-effects were reported. Future studies should use more fine-grained tools to assess, for example, patients' sleep and cognitive functioning, and patients' view of symptoms.
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Affiliation(s)
- Vahid Farnia
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Haniyeh Gharehbaghi
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Afshin Almasi
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sanobar Golshani
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faeze Tatari
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Omran Davarinejad
- Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Safora Salemi
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi Bahmani
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; Sleep Disorders Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; University of Basel, Psychiatric Clinics, Centre for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics, Centre for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - Serge Brand
- Substance Abuse Prevention Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; Sleep Disorders Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran; University of Basel, Psychiatric Clinics, Centre for Affective, Stress and Sleep Disorders, Basel, Switzerland; University of Basel, Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, Basel, Switzerland.
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Kılıç F, Keleş S. Trichotillomania treated with n-acetylcysteine. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1472907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Faruk Kılıç
- Department of Psychiatry, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Süleyman Keleş
- Department of Psychiatry, School of Medicine, Suleyman Demirel University, Isparta, Turkey
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Moore K. N-Acetyl Cysteine and Curcumin in Pediatric Acute-Onset Neuropsychiatric Syndrome. J Child Adolesc Psychopharmacol 2018; 28:293-294. [PMID: 29641241 DOI: 10.1089/cap.2017.0165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Keonie Moore
- ReMed Natural Medicine Clinic , Lower Plenty, Victoria, Australia
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35
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Zheng W, Zhang QE, Cai DB, Yang XH, Qiu Y, Ungvari GS, Ng CH, Berk M, Ning YP, Xiang YT. N-acetylcysteine for major mental disorders: a systematic review and meta-analysis of randomized controlled trials. Acta Psychiatr Scand 2018; 137:391-400. [PMID: 29457216 DOI: 10.1111/acps.12862] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N-acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia. METHODS The PubMed, Cochrane Library, PsycINFO, CNKI, CBM, and WanFang databases were independently searched and screened by two researchers. Standardized mean differences (SMDs), risk ratios, and their 95% confidence intervals (CIs) were computed. RESULTS Six RCTs (n = 701) of NAC for schizophrenia (three RCTs, n = 307), bipolar disorder (two RCTs, n = 125), and MDD (one RCT, n = 269) were identified and analyzed as separate groups. Adjunctive NAC significantly improved total psychopathology (SMD = -0.74, 95% CI: -1.43, -0.06; I2 = 84%, P = 0.03) in schizophrenia, but it had no significant effect on depressive and manic symptoms as assessed by the Young Mania Rating Scale in bipolar disorder and only a small effect on major depressive symptoms. Adverse drug reactions to NAC and discontinuation rates between the NAC and control groups were similar across the three disorders. CONCLUSIONS Adjunctive NAC appears to be a safe treatment that has efficacy for schizophrenia, but not for bipolar disorder or MDD. Further higher quality RCTs are warranted to determine the role of adjunctive NAC in the treatment of major psychiatric disorders.
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Affiliation(s)
- W Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Q-E Zhang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - D-B Cai
- Clinics of Chinese Medicine, the First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X-H Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Y Qiu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - G S Ungvari
- The University of Notre Dame Australia/Graylands Hospital, Perth, WA, Australia
| | - C H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Vic., Australia
| | - M Berk
- School of Medicine, IMPACT Strategic Research Centre, Barwon Health, Deakin University, Geelong, Vic., Australia.,Orygen, The Centre of Excellence in Youth Mental Health, Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Y-P Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Y-T Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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36
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Casarotto PC, Biojone C, Montezuma K, Cunha FQ, Joca SRL, Castren E, Guimaraes FS. Inducible nitric oxide synthase (NOS2) knockout mice as a model of trichotillomania. PeerJ 2018; 6:e4635. [PMID: 29682419 PMCID: PMC5909682 DOI: 10.7717/peerj.4635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/27/2018] [Indexed: 01/17/2023] Open
Abstract
Background Trichotillomania (TTM) is an impulse control disorder characterized by repetitive hair pulling/trimming. Barbering behavior (BB) observed in laboratory animals is proposed as a model of TTM. The neurobiological basis of TTM is unclear, but involves striatal hyperactivity and hypoactivation of the prefrontal cortex. Methods In this study, we evaluated the BB in knockout mice for the inducible isoform of nitric oxide synthase (NOS2KO) and the consequences of silencing this enzyme in PC12 cell differentiation. Results NOS2KO exhibit exacerbated BB, starting four weeks of age, and increased repetitive movements compared to wild-type mice (WT). The expression of BB was attenuated by repeated treatment with clomipramine, a clinically approved drug to treat TTM in humans, or memantine, an antagonist of NMDA receptors, as well as partial rescue of NOS2 expression in haploinsufficient animals. The silencing of NOS2 expression reduced the MAP2 (microtubule-associated protein 2) levels in activity-induced differentiated PC12 cells. Discussion Our data led us to propose that NOS2 is putatively involved in the neuronal maturation of the inhibitory afferent pathways during neurodevelopment, and such inadequate inhibition of motor programs might be associated to the observed phenotype.
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Affiliation(s)
- Plinio C Casarotto
- Neuroscience Center, University of Helsinki, Helsinki, Finland.,Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Caroline Biojone
- Neuroscience Center, University of Helsinki, Helsinki, Finland.,Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Montezuma
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Q Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Samia R L Joca
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eero Castren
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Francisco S Guimaraes
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,NAPNA: Center for Interdisciplinary Research on Applied Neurosciences, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Leon M, Sawmiller D, Shytle RD, Tan J. Therapeutic Cocktail Approach for Treatment of Hyperhomocysteinemia in Alzheimer's Disease. CELL MEDICINE 2018; 10:2155179017722280. [PMID: 32634177 PMCID: PMC6172991 DOI: 10.1177/2155179017722280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the United States, Alzheimer's disease (AD) is the most common cause of dementia, accompanied by substantial economic and emotional costs. During 2015, more than 15 million family members who provided care to AD patients had an estimated total cost of 221 billion dollars. Recent studies have shown that elevated total plasma levels of homocysteine (tHcy), a condition known as hyperhomocysteinemia (HHcy), is a risk factor for AD. HHcy is associated with cognitive decline, brain atrophy, and dementia; enhances the vulnerability of neurons to oxidative injury; and damages the blood-brain barrier. Many therapeutic supplements containing vitamin B12 and folate have been studied to help decrease tHcy to a certain degree. However, a therapeutic cocktail approach with 5-methyltetrahydrofolate, methyl B12, betaine, and N-acetylcysteine (NAC) have not been studied. This novel approach may help target multiple pathways simultaneously to decrease tHcy and its toxicity substantially.
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Affiliation(s)
- Michael Leon
- Department of Psychiatry and Behavioral Neurosciences, Rashid Laboratory for Developmental Neurobiology, Silver Child Development Center, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Darrell Sawmiller
- Department of Psychiatry and Behavioral Neurosciences, Rashid Laboratory for Developmental Neurobiology, Silver Child Development Center, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - R Douglas Shytle
- Department of Neurosurgery and Brain Repair, Center for Excellence in Aging and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jun Tan
- Department of Psychiatry and Behavioral Neurosciences, Rashid Laboratory for Developmental Neurobiology, Silver Child Development Center, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Barroso LAL, Sternberg F, Souza MNIDFE, Nunes GJDB. Trichotillomania: a good response to treatment with N-acetylcysteine. An Bras Dermatol 2017; 92:537-539. [PMID: 28954106 PMCID: PMC5595604 DOI: 10.1590/abd1806-4841.20175435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/18/2016] [Indexed: 12/21/2022] Open
Abstract
Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one's hair, resulting in secondary alopecia. It affects 1% of the adult population, and 2 to 4.4% of psychiatric patients meet the diagnostic criteria. It can occur at any age and is more prevalent in adolescents and females. Its occurrence in childhood is not uncommon and tends to have a more favorable clinical course. The scalp, eyebrows and eyelashes are the most commonly affected sites. Glutamate modulating agents, such as N-acetylcysteine, have been shown to be a promising treatment. N-acetylcysteine acts by reducing oxidative stress and normalizing glutaminergic transmission. In this paper, we report a case of trichotillomania with an excellent response to N-acetylcysteine.
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Affiliation(s)
- Livia Ariane Lopes Barroso
- Trichology Outpatient Clinic, Department of Cosmetology, Universidade Federal de São Paulo (Unifesp) - São Paulo (SP), Brazil
| | - Flavia Sternberg
- Trichology Outpatient Clinic, Department of Cosmetology, Universidade Federal de São Paulo (Unifesp) - São Paulo (SP), Brazil
| | | | - Gisele Jacobino de Barros Nunes
- Trichology Outpatient Clinic, Department of Cosmetology, Universidade Federal de São Paulo (Unifesp) - São Paulo (SP), Brazil
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Duailibi MS, Cordeiro Q, Brietzke E, Ribeiro M, LaRowe S, Berk M, Trevizol AP. N-acetylcysteine in the treatment of craving in substance use disorders: Systematic review and meta-analysis. Am J Addict 2017; 26:660-666. [DOI: 10.1111/ajad.12620] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/12/2017] [Accepted: 08/17/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Quirino Cordeiro
- Department of Psychiatry; Federal University of São Paulo; São Paulo Brazil
| | - Elisa Brietzke
- Department of Psychiatry; Federal University of São Paulo; São Paulo Brazil
| | - Marcelo Ribeiro
- Department of Psychiatry; Federal University of São Paulo; São Paulo Brazil
- Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD); São Paulo State Secretariat of Health; São Paulo São Paulo Brazil
| | - Steve LaRowe
- Department of Psychiatry; Center for Drug and Alcohol Programs; Medical University of South Carolina; Charleston South Carolina
| | - Michael Berk
- School of Medicine; IMPACT Strategic Research Centre; Deakin University; Geelong Victoria Australia
- Department of Psychiatry; The Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre; University of Melbourne; Parkville Victoria Australia
| | - Alisson Paulino Trevizol
- Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD); São Paulo State Secretariat of Health; São Paulo São Paulo Brazil
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Anzengruber F, Ruhwinkel K, Ghosh A, Klaghofer R, Lang UE, Navarini AA. Wide range of age of onset and low referral rates to psychiatry in a large cohort of acne excoriée at a Swiss tertiary hospital. J DERMATOL TREAT 2017; 29:277-280. [PMID: 28784003 DOI: 10.1080/09546634.2017.1364693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Repetitive skin manipulation is the key symptom in skin picking disorder (SPD) or acne excoriée des jeunes filles Brocq. The diagnostic and statistical manual of mental disorders (DSM-5) has recognized SPD as an independent disease, namely an obsessive-compulsive disorder. Thus, psychiatric treatment is indicated. Therefore, in a large cohort of SPD, we asked whether dermatologists' treatment strategy includes routine referrals to psychiatry. In addition, we describe epidemiological data, treatments and follow up. METHODS We performed a retrospective study, searching in our hospital database between January 1 2011 and December 31 2016. RESULTS A total of 154 (141 female, 13 male) patients were included in our study. In less than 5% a referral to a psychologist or psychiatrist occurred. More than 90% of all patients received topical and almost 40% systemical anti-acne treatment. The loss of follow-up was very high. DISCUSSION Our study shows that dermatologists focus on treating acne-like lesions in SPD, but rarely refer to psychiatry. Possible reasons include considerations of patients' reactions who often reject the idea of a psychological origin of the disease. Our results suggest that new treatment strategies should be created to address SPD correctly, i.e. by combined consultations with psychiatrists or specific training of dermatologists in psychiatric therapy and diagnostics.
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Affiliation(s)
- Florian Anzengruber
- a Department of Dermatology , University Hospital Zurich , Zurich , Switzerland
| | - Katrin Ruhwinkel
- b Department of Psychiatry , University Hospital Zurich , Zurich , Switzerland
| | - Adhideb Ghosh
- a Department of Dermatology , University Hospital Zurich , Zurich , Switzerland.,c Competence Center for Personalized Medicine UZH/ETH , Zurich , Switzerland
| | - Richard Klaghofer
- d Department of Psychiatry and Psychotherapy , University Hospital of Zurich , Zurich , Switzerland
| | - Undine E Lang
- e Universitäre Psychiatrische Kliniken Basel, Universität Basel , Basel , Switzerland
| | - Alexander A Navarini
- a Department of Dermatology , University Hospital Zurich , Zurich , Switzerland.,c Competence Center for Personalized Medicine UZH/ETH , Zurich , Switzerland
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Arabzadeh S, Shahhossenie M, Mesgarpour B, Rezaei F, Shalbafan MR, Ghiasi Z, Akhondzadeh S. L-carnosine as an adjuvant to fluvoxamine in treatment of obsessive compulsive disorder: A randomized double-blind study. Hum Psychopharmacol 2017; 32. [PMID: 28485008 DOI: 10.1002/hup.2584] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dysregulation of glutamate is implicated in the pathogenesis of obsessive-compulsive disorder (OCD). Consistently, glutamate-modulating agents, such as riluzole and memantine have been used in OCD treatment. Previous research has identified some neuroprotective role for L-carnosine potentially via its modulatory effect on glutamate. Here, we assessed the efficacy of L-carnosine as adjuvant to fluvoxamine in OCD treatment. METHODS Forty-four patients diagnosed with moderate to severe OCD were recruited in a randomized double-blind trial. Patients received either L-carnosine or placebo as adjuvant to fluvoxamine for 10 weeks. The Yale- Brown Obsessive Compulsive Scale (Y-BOCS) was used for assessing the severity of symptoms at baseline and at weeks 4, 8, and 10. RESULTS General linear model repeated measure showed significant effects for Time × Treatment interaction on total Y-BOCS [F (2.10, 88.42) = 8.66, p < 0.001], obsession [F (1.88, 79.34) = 4.96, p = 0.01] and compulsion [F (1.88, 79.11) = 4.57, p = 0.01]. At week 10, the change from baseline in Y-BOCS scores was 8.86 ± 2.89 (mean ± SD) in the L-carnosine group compared to 5.86 ± 2.88 in the placebo group. CONCLUSION L-carnosine results in significant reduction of obsessive-compulsive symptoms when used as an adjuvant to fluvoxamine.
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Affiliation(s)
- Somaye Arabzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shahhossenie
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Farzin Rezaei
- Qods Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Reza Shalbafan
- Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghiasi
- Department of Psychiatry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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42
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SanMartín CD, Veloso P, Adasme T, Lobos P, Bruna B, Galaz J, García A, Hartel S, Hidalgo C, Paula-Lima AC. RyR2-Mediated Ca 2+ Release and Mitochondrial ROS Generation Partake in the Synaptic Dysfunction Caused by Amyloid β Peptide Oligomers. Front Mol Neurosci 2017; 10:115. [PMID: 28487634 PMCID: PMC5403897 DOI: 10.3389/fnmol.2017.00115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022] Open
Abstract
Amyloid β peptide oligomers (AβOs), toxic aggregates with pivotal roles in Alzheimer's disease, trigger persistent and low magnitude Ca2+ signals in neurons. We reported previously that these Ca2+ signals, which arise from Ca2+ entry and subsequent amplification by Ca2+ release through ryanodine receptor (RyR) channels, promote mitochondrial network fragmentation and reduce RyR2 expression. Here, we examined if AβOs, by inducing redox sensitive RyR-mediated Ca2+ release, stimulate mitochondrial Ca2+-uptake, ROS generation and mitochondrial fragmentation, and also investigated the effects of the antioxidant N-acetyl cysteine (NAC) and the mitochondrial antioxidant EUK-134 on AβOs-induced mitochondrial dysfunction. In addition, we studied the contribution of the RyR2 isoform to AβOs-induced Ca2+ release, mitochondrial Ca2+ uptake and fragmentation. We show here that inhibition of NADPH oxidase type-2 prevented the emergence of RyR-mediated cytoplasmic Ca2+ signals induced by AβOs in primary hippocampal neurons. Treatment with AβOs promoted mitochondrial Ca2+ uptake and increased mitochondrial superoxide and hydrogen peroxide levels; ryanodine, at concentrations that suppress RyR activity, prevented these responses. The antioxidants NAC and EUK-134 impeded the mitochondrial ROS increase induced by AβOs. Additionally, EUK-134 prevented the mitochondrial fragmentation induced by AβOs, as previously reported for NAC and ryanodine. These findings show that both antioxidants, NAC and EUK-134, prevented the Ca2+-mediated noxious effects of AβOs on mitochondrial function. Our results also indicate that Ca2+ release mediated by the RyR2 isoform causes the deleterious effects of AβOs on mitochondrial function. Knockdown of RyR2 with antisense oligonucleotides reduced by about 50% RyR2 mRNA and protein levels in primary hippocampal neurons, decreased by 40% Ca2+ release induced by the RyR agonist 4-chloro-m-cresol, and significantly reduced the cytoplasmic and mitochondrial Ca2+ signals and the mitochondrial fragmentation induced by AβOs. Based on our results, we propose that AβOs-induced Ca2+ entry and ROS generation jointly stimulate RyR2 activity, causing mitochondrial Ca2+ overload and fragmentation in a feed forward injurious cycle. The present novel findings highlight the specific participation of RyR2-mediated Ca2+ release on AβOs-induced mitochondrial malfunction.
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Affiliation(s)
- Carol D SanMartín
- Department of de Neurology and Neurosurgery, Clinical Hospital Universidad de ChileSantiago, Chile.,Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Pablo Veloso
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de ChileSantiago, Chile
| | - Tatiana Adasme
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Centro Integrativo de Biología y Química Aplicada, Universidad Bernardo O HigginsSantiago, Chile
| | - Pedro Lobos
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Barbara Bruna
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Jose Galaz
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Alejandra García
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Anatomy and Developmental Biology Program, Institute of Biomedical Sciences, Center of Medical Informatics and Telemedicine and National Center for Health Information Systems, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Steffen Hartel
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Anatomy and Developmental Biology Program, Institute of Biomedical Sciences, Center of Medical Informatics and Telemedicine and National Center for Health Information Systems, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Cecilia Hidalgo
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Physiology and Biophysics Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de ChileSantiago, Chile
| | - Andrea C Paula-Lima
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de ChileSantiago, Chile.,Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de ChileSantiago, Chile
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43
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Marinova Z, Chuang DM, Fineberg N. Glutamate-Modulating Drugs as a Potential Therapeutic Strategy in Obsessive-Compulsive Disorder. Curr Neuropharmacol 2017; 15:977-995. [PMID: 28322166 PMCID: PMC5652017 DOI: 10.2174/1570159x15666170320104237] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/27/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a mental disease commonly associated with severe distress and impairment of social functioning. Serotonin reuptake inhibitors and/or cognitive behavioural therapy are the therapy of choice, however up to 40% of patients do not respond to treatment. Glutamatergic signalling has also been implicated in OCD. The aim of the current study was to review the clinical evidence for therapeutic utility of glutamate-modulating drugs as an augmentation or monotherapy in OCD patients. METHODS We conducted a search of the MEDLINE database for clinical studies evaluating the effect of glutamate-modulating drugs in OCD. RESULTS Memantine is the compound most consistently showing a positive effect as an augmentation therapy in OCD. Anti-convulsant drugs (lamotrigine, topiramate) and riluzole may also provide therapeutic benefit to some OCD patients. Finally, ketamine may be of interest due to its potential for a rapid onset of action. CONCLUSION Further randomized placebo-controlled trials in larger study populations are necessary in order to draw definitive conclusions on the utility of glutamate-modulating drugs in OCD. Furthermore, genetic and epigenetic factors, clinical symptoms and subtypes predicting treatment response to glutamate-modulating drugs need to be investigated systematically.
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Affiliation(s)
- Zoya Marinova
- Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - De-Maw Chuang
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Welwyn Garden City, AL8 6HG, United Kingdom
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44
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Zamanian Azodi M, Rezaei Tavirani M, Arefi Oskouie A, Hamdieh M, Derakhshan MK, Ahmadzadeh A, Zayeri F, Nejadi N, Rezaei Tavirani M, Mansouri V, Rostami-Nejad M, Vafaee R. Fluoxetine Regulates Ig Kappa Chain C Region Expression Levels in the Serum of Obsessive-Compulsive Disorder Patients: A proteomic Approach. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2017; 16:1264-1271. [PMID: 29201116 PMCID: PMC5610783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is one of the most common mental conditions. Proteome profiling may help identifying important proteins and finally shed lights to complexity of OCD underlying mechanisms. Here, by the application gel-based proteomic approach the proteome profile of patients with washing subtype of OCD before and after treatment with Fluoxetine (positive responders) are compared to healthy matched controls. However, only one of the differentially expressed proteins is examined and introduced in this paper. Proteomic analysis was done by the application of two-dimensional polyacrylamide gel electrophoresis (2-D PAGE), combined with (MALDI-TOF-TOF MS)-based. Furthermore, network analysis and biological annotation were handled by Cytoscape Plug-in and CluePedia. The proteome comparison between groups identified protein with the significant expression changes (p<0.05 and fold change ≥ 1.5). While the expression level of Ig Kappa Chain C Region is significantly decreased in OCD patients before any treatments, the trend is almost normalized after treatment with Fluoxetine in positive responders. In addition, interaction profile of IGKC shows that the interacting proteins may be affected as the expression pattern of IGKC changes in OCD patients. In conclusion, IGKC may be introduced as potential biomarker in our study; yet, investigation in bigger sample size and application of validation methods is a requirement.
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Affiliation(s)
- Mona Zamanian Azodi
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mostafa Rezaei Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Corresponding author: E-mail: *
| | - Afsaneh Arefi Oskouie
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mostafa Hamdieh
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Kamran Derakhshan
- Psychosomatic Department, Taleghani Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Alireza Ahmadzadeh
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farid Zayeri
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Naser Nejadi
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Vahid Mansouri
- Physiotherapy Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran .
| | - Mohammad Rostami-Nejad
- Research Institute for Gastroenterology and Liver Diseases, Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Vafaee
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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45
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Trichotillomania as a Manifestation of Dementia. Case Rep Psychiatry 2016; 2016:9782702. [PMID: 27840761 PMCID: PMC5093278 DOI: 10.1155/2016/9782702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 09/25/2016] [Accepted: 10/04/2016] [Indexed: 12/11/2022] Open
Abstract
Pathological hair-pulling or trichotillomania, which is commonly associated with anxiety and depression, obsessive-compulsive disorder, and neurodevelopmental disorders, has been rarely associated with dementing illnesses. Investigators have not clarified the neural correlates and treatment of trichotillomania in dementia. We report a patient who developed an early-onset cognitive decline with genetic, cerebrospinal fluid biomarker and structural and functional neuroimaging studies consistent with Alzheimer's disease. Eight years into her disease, she developed severe, repetitive hair-pulling behavior leading to marked hair loss, along with other repetitive and “frontal” behaviors. Selective serotonin reuptake inhibitors (SSRIs) were ineffective in controlling her hair-pulling behavior, which subsequently responded to quetiapine 150 mg/day. This patient and a review of the literature suggest that trichotillomania may be a compulsive-related symptom in dementias of different etiologies as they involve frontal areas and release primitive grooming behavior from frontostriatal dysfunction. Dopamine blockade, rather than SSRIs, may be effective in managing trichotillomania in dementia.
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46
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Özcan D, Seçkin D. N-Acetylcysteine in the treatment of trichotillomania: remarkable results in two patients. J Eur Acad Dermatol Venereol 2016; 30:1606-8. [DOI: 10.1111/jdv.13690] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/10/2016] [Indexed: 01/31/2023]
Affiliation(s)
- D. Özcan
- Department of Dermatology; Başkent University Faculty of Medicine; Ankara Turkey
| | - D. Seçkin
- Department of Dermatology; Başkent University Faculty of Medicine; Ankara Turkey
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47
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Brennan BP, Jensen JE, Perriello C, Pope HG, Jenike MA, Hudson JI, Rauch SL, Kaufman MJ. LOWER POSTERIOR CINGULATE CORTEX GLUTATHIONE LEVELS IN OBSESSIVE-COMPULSIVE DISORDER. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:116-124. [PMID: 26949749 DOI: 10.1016/j.bpsc.2015.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several lines of evidence support the hypothesis that lower cerebral levels of glutathione (GSH), associated with increased oxidative stress, may contribute to obsessive-compulsive disorder (OCD). However, no studies to date have investigated brain GSH levels in individuals with OCD. METHODS Twenty-nine individuals with OCD and 25 age-, sex-, and race-matched comparison individuals without OCD underwent single voxel 2D J-resolved proton magnetic resonance spectroscopy (MRS) to examine GSH levels in the posterior cingulate cortex (PCC). MRS data were analyzed using LCModel and a simulated basis set. Group metabolite differences referenced to total creatine (Cr), as well as relationships between metabolite ratios and symptom severity as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), were analyzed using linear regression with adjustment for age, sex, and race. RESULTS One OCD participant failed to produce usable PCC MRS data. We found significantly lower PCC GSH/Cr in OCD participants compared with non-OCD participants (β = -0.027 [95% CI: -0.049 to -5.9 × 10-3]; P = 0.014). PCC GSH/Cr was not significantly associated with total Y-BOCS score in the OCD group (β = 5.7 × 10-4 [95% CI: -4.8 × 10-3 to 5.9 × 10-3]; P = 0.83). CONCLUSIONS Lower PCC GSH/Cr may be indicative of increased oxidative stress secondary to hypermetabolism in this brain region in OCD. Future MRS studies are warranted to investigate GSH levels in other brain regions that comprise the cortico-striato-thalamo-cortical circuit thought to be abnormal in OCD.
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Affiliation(s)
- Brian P Brennan
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA; Obsessive-Compulsive Disorders Institute, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - J Eric Jensen
- Department of Psychiatry, Harvard Medical School, Boston, MA; McLean Imaging Center, McLean Hospital, Belmont, MA
| | | | - Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Michael A Jenike
- Obsessive-Compulsive Disorders Institute, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - James I Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Marc J Kaufman
- Department of Psychiatry, Harvard Medical School, Boston, MA; McLean Imaging Center, McLean Hospital, Belmont, MA
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48
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Sarris J, Oliver G, Camfield DA, Dean OM, Dowling N, Smith DJ, Murphy J, Menon R, Berk M, Blair-West S, Ng CH. N-Acetyl Cysteine (NAC) in the Treatment of Obsessive-Compulsive Disorder: A 16-Week, Double-Blind, Randomised, Placebo-Controlled Study. CNS Drugs 2015; 29:801-9. [PMID: 26374743 DOI: 10.1007/s40263-015-0272-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a disabling mental illness for which pharmacological and psychosocial interventions are all too often inadequate. Recent preclinical and clinical studies have implicated dysfunction of glutamatergic neurotransmission in the pathophysiology of OCD. The amino acid-based nutraceutical N-acetyl cysteine (NAC) is a safe and readily available agent that has been found to modify the synaptic release of glutamate in subcortical brain regions via modulation of the cysteine-glutamate antiporter. OBJECTIVE The aim of this study was to assess the efficacy and safety of NAC in treating OCD. METHODS A 16-week, double-blind, placebo-controlled, randomised trial using 3 g/day of NAC (1.5 g twice daily) in 44 participants (aged 18-70 years) with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)-diagnosed OCD, during 2013-2015. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS), conducted every 4 weeks. RESULTS Analysis of the full sample (intention-to-treat) with repeated measures mixed linear modelling revealed a nonsignificant time × treatment interaction for the YBOCS scale total score (p = 0.39). A per-protocol analysis removing protocol violators also failed to show a significant time × treatment interaction for YBOCS total score (p = 0.15). However, a significant time × treatment interaction was observed for the YBOCS 'Compulsions' subscale in favour of NAC (p = 0.013), with a significant reduction observed at week 12 (dissipating at week 16). At 16 weeks, only four (20%) participants were considered 'responders' (YBOCS ≥35% reduction at endpoint) versus four (27%) in the placebo group. The NAC was well-tolerated, aside from more cases of heartburn occurring compared with placebo (p = 0.045). CONCLUSION Further research involving NAC for OCD may require larger samples to detect moderate or small effect sizes, involve dosage or formulation differences, use in concert with exposure therapy, or an additional post-study observational period to mitigate study withdrawal. TRIAL REGISTRATION ACTRN12613000310763.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia. .,Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia.
| | - Georgina Oliver
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
| | - David A Camfield
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Olivia M Dean
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Nathan Dowling
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
| | - Deidre J Smith
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
| | - Jenifer Murphy
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
| | - Ranjit Menon
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Melbourne, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Scott Blair-West
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury St, Richmond, Melbourne, VIC, 3121, Australia
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