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Crowley JJ, Cappi C, Ochoa-Panaifo ME, Frederick RM, Kook M, Wiese AD, Rancourt D, Atkinson EG, Giusti-Rodriguez P, Anderberg JL, Abramowitz JS, Adorno VR, Aguirre C, Alves GS, Alves GS, Ancalade N, Arellano Espinosa AA, Arnold PD, Ayton DM, Barbosa IG, Castano LMB, Barrera CN, Berardo MC, Berrones D, Best JR, Bigdeli TB, Burton CL, Buxbaum JD, Callahan JL, Carneiro MCB, Cepeda SL, Chazelle E, Chire JM, Munoz MC, Quiroz PC, Cobite J, Comer JS, Costa DL, Crosbie J, Cruz VO, Dager G, Daza LF, de la Rosa-Gómez A, Del Río D, Delage FZ, Dreher CB, Fay L, Fazio T, Ferrão YA, Ferreira GM, Figueroa EG, Fontenelle LF, Forero DA, Fragoso DTH, Gadad BS, Garrison SR, González A, Gonzalez LD, González MA, Gonzalez-Barrios P, Goodman WK, Grice DE, Guintivano J, Guttfreund DG, Guzick AG, Halvorsen MW, Hovey JD, Huang H, Irreño-Sotomonte J, Janssen-Aguilar R, Jensen M, Jimenez Reynolds AZ, Lujambio JAJ, Khalfe N, Knutsen MA, Lack C, Lanzagorta N, Lima MO, Longhurst MO, Lozada Martinez DA, Luna ES, Marques AH, Martinez MS, de Los Angeles Matos M, Maye CE, McGuire JF, Menezes G, Minaya C, Miño T, Mithani SM, de Oca CM, Morales-Rivero A, Moreira-de-Oliveira ME, Morris OJ, Muñoz SI, Naqqash Z, Núñez Bracho AA, Núñez Bracho BE, Rojas MCO, Olavarria Castaman LA, Balmaceda TO, Ortega I, Patel DI, Patrick AK, Paz Y Mino M, Perales Orellana JL, Stumpf BP, Peregrina T, Duarte TP, Piacsek KL, Placencia M, Prieto MB, Quarantini LC, Quarantini-Alvim Y, Ramos RT, Ramos IC, Ramos VR, Ramsey KA, Ray EV, Richter MA, Riemann BC, Rivas JC, Rosario MC, Ruggero CJ, Ruiz-Chow AA, Ruiz-Velasco A, Sagarnaga MN, Sampaio AS, Saraiva LC, Schachar RJ, Schneider SC, Schweissing EJ, Seligman LD, Shavitt RG, Soileau KJ, Stewart SE, Storch SB, Strouphauer ER, Cuevas VT, Timpano KR, la Garza BTD, Vallejo-Silva A, Vargas-Medrano J, Vásquez MI, Martinez GV, Weinzimmer SA, Yanez MA, Zai G, Zapata-Restrepo LM, Zappa LM, Zepeda-Burgos RM, Zoghbi AW, Miguel EC, Rodriguez CI, Martinez Mallen MC, Moya PR, Borda T, Moyano MB, Mattheisen M, Pereira S, Lázaro-Muñoz G, Martinez-Gonzalez KG, Pato MT, Nicolini H, Storch EA. Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol. Am J Med Genet B Neuropsychiatr Genet 2024; 195:e32962. [PMID: 37946624 PMCID: PMC11076176 DOI: 10.1002/ajmg.b.32962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.
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Affiliation(s)
- James J Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carolina Cappi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Renee M Frederick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Elizabeth G Atkinson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Paola Giusti-Rodriguez
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jacey L Anderberg
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Victor R Adorno
- Hospital Psiquiátrico de Asunción, Direccion General, Asuncion, Central, Paraguay
| | - Cinthia Aguirre
- Departamento de Psiquiatría, Hospital Psiquiátrico de Asunción, Asuncion, Central, Paraguay
| | - Gilberto S Alves
- Hospital Nina Rodrigues/Universidade Federal do Maranhão (UFMA), Sao Luis do Maranhao, Maranhao, Brazil
| | - Gustavo S Alves
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Salvador, Bahia, Brazil
| | - NaEshia Ancalade
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Daphne M Ayton
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Izabela G Barbosa
- Departamento de Saúde Mental da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - María Celeste Berardo
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Dayan Berrones
- Department of Psychology, Rice University, Houston, Texas, USA
| | - John R Best
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim B Bigdeli
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- VA New York Harbor Healthcare System, Brooklyn, New York, USA
| | - Christie L Burton
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph D Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Maria Cecília B Carneiro
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Sandra L Cepeda
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Evelyn Chazelle
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Jessica M Chire
- Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Dirección de Niños y Adolescentes Lima, Lima, Peru
| | | | | | - Journa Cobite
- Department of Counseling Psychology, University of Houston, Houston, Texas, USA
| | - Jonathan S Comer
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Daniel L Costa
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Jennifer Crosbie
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Victor O Cruz
- Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Oficina Ejecutiva de Investigación, Lima, Lima, Peru
- School of Medicine, Universidad San Martin de Porres, Lima, Lima, Peru
| | - Guillermo Dager
- Corporación Universitaria Rafael Nuñez, Cartagena, Bolivar, Colombia
| | - Luisa F Daza
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
| | - Anabel de la Rosa-Gómez
- Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | | | - Fernanda Z Delage
- Departamento de Medicina Forense e Psiquiatria, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Carolina B Dreher
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Psiquiatria, Clínica Médica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucila Fay
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Tomas Fazio
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Ygor A Ferrão
- Departamento de Psiquiatria, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela M Ferreira
- Departamento de Medicina Forense e Psiquiatria, Universidade Federal do Paraná, Curitiba, Parana, Brazil
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Edith G Figueroa
- Departamento de Psiquiatría de Adultos, Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Lima, Lima, Peru
| | - Leonardo F Fontenelle
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Psiquiatria, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego A Forero
- Fundación Universitaria del Área Andina, Escuela de Salud y Ciencias del Deporte, Bogota, Bogota, Colombia
| | - Daniele T H Fragoso
- Departamento de Medicina Forense e Psiquiatria, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Bharathi S Gadad
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | | | | | - Laura D Gonzalez
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Marco A González
- Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | - Polaris Gonzalez-Barrios
- Departamento de Psiquiatría, Universidad de Puerto Rico, San Juan, Puerto Rico, USA
- Universidad de Puerto Rico Campus de Ciências Médicas, San Juan, Puerto Rico, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Dorothy E Grice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Halvorsen
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Hovey
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Hailiang Huang
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts, USA
| | - Jonathan Irreño-Sotomonte
- Center for Mental Health-Cersame, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, District of Colombia, Colombia
| | - Reinhard Janssen-Aguilar
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Subdirección de Psiquiatría, Ciudad de México, Ciudad de Mexico, Mexico
| | - Matias Jensen
- Centro de Neurociencias, Universidad de Valparaíso, Valparaiso, Chile
| | | | | | - Nasim Khalfe
- Baylor College of Medicine, School of Medicine, Houston, Texas, USA
| | - Madison A Knutsen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychology, Augustana College, Rock Island, Illinois, USA
| | - Caleb Lack
- Department of Psychology, University of Central Oklahoma, Edmond, Oklahoma, USA
| | - Nuria Lanzagorta
- Departamento de Investigación Clínica, Grupo Médico Carracci, Ciudad de México, Ciudad de Mexico, Mexico
| | - Monicke O Lima
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Melanie O Longhurst
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | | | - Elba S Luna
- Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Oficina Ejecutiva de Investigación, Lima, Lima, Peru
| | - Andrea H Marques
- National Institute of Mental Heatlh (NIMH), Bethesda, Maryland, USA
| | - Molly S Martinez
- DFW OCD Treatment Specialists, Richardson, Texas, USA
- Specialists in OCD and Anxiety Recovery (SOAR), Richardson, Texas, USA
| | - Maria de Los Angeles Matos
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Caitlyn E Maye
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gabriela Menezes
- Programa de Ansiedade, Obsessões e Compulsões, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Charlene Minaya
- Department of Psychology, Fordham University, New York, New York, USA
| | - Tomás Miño
- Centro de Neurociencias, Universidad de Valparaíso, Valparaiso, Chile
| | - Sara M Mithani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | - Maria E Moreira-de-Oliveira
- Programa de Ansiedade, Obsessões e Compulsões, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Olivia J Morris
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Sandra I Muñoz
- Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | - Zainab Naqqash
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Trinidad Olivos Balmaceda
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaiso, Valparaiso, Chile
| | - Iliana Ortega
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darpan I Patel
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ainsley K Patrick
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mariel Paz Y Mino
- Clínica de Salud Mental USFQ, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
- Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Jose L Perales Orellana
- Universidad Tegnológica Privada de Santa Cruz (UTEPSA), Santa Cruz de la Sierra, Andres Ibañez, Bolivia
| | - Bárbara Perdigão Stumpf
- Departamento de Saúde Mental da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Maritza Placencia
- Departamento Académico de Ciencias Dinámicas, Universidad Nacional Mayor de San Marcos, Lima, Lima, Peru
| | - María Belén Prieto
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Lucas C Quarantini
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Yana Quarantini-Alvim
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade Santa Casa, Faculdade de Psicologia, Salvador, Bahia, Brazil
| | - Renato T Ramos
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Iaroslava C Ramos
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Frederick Thompson Anxiety Disorders Centre, Toronto, Ontario, Canada
| | - Vanessa R Ramos
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Kesley A Ramsey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elise V Ray
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret A Richter
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Juan C Rivas
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
- Departamento de Psiquiatría, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Departamento de Psiquiatria, Universidad ICESI, Cali, Valle del Cauca, Colombia
- Departamento de Psiquiatria, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
| | - Maria C Rosario
- Departamento de Psiquiatria da, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | | | - Alejandra Ruiz-Velasco
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Melisa N Sagarnaga
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Buenos Aires, Argentina
| | - Aline S Sampaio
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Salvador, Bahia, Brazil
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Leonardo C Saraiva
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Russell J Schachar
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ethan J Schweissing
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Laura D Seligman
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Roseli G Shavitt
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Keaton J Soileau
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shaina B Storch
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Vissente Tapia Cuevas
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaiso, Valparaiso, Chile
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Alexie Vallejo-Silva
- Center for Mental Health-Cersame, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, District of Colombia, Colombia
| | - Javier Vargas-Medrano
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - María I Vásquez
- Hospital Nacional Arzobispo Loayza, Servicio de Salud Mental, Lima, Lima, Peru
| | - Guadalupe Vidal Martinez
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Saira A Weinzimmer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Mauricio A Yanez
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Gwyneth Zai
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Brain Sciences, Centre for Addiction and Mental Health, Neurogenetics Section, Toronto, Ontario, Canada
| | - Lina M Zapata-Restrepo
- Departamento de Psiquiatria, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Valle, Colombia
- Department of Neurology, Global Brain Health Institute-University of California San Francisco, San Francisco, California, USA
| | - Luz M Zappa
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Departamento de Salud Mental, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Buenos Aires, Argentina
- Hospital Universitario Austral, Materno Infantil, Buenos Aires, Buenos Aires, Argentina
| | - Raquel M Zepeda-Burgos
- Centro de Investigación en Ciencias y Humanidades, Universidad Dr. José Matías Delgado, Santa Tecla, La Libertad, El Salvador
| | - Anthony W Zoghbi
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Euripedes C Miguel
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Department of Psychiatry, Temerty Faculty of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Pablo R Moya
- Universidad de Valparaíso, Instituto de Fisiología Valparaiso, Valparaiso, Chile
- Centro Interdisciplinario de Neurociencia de Valparaiso (CINV), Valparaiso, Chile
| | - Tania Borda
- Instituto Realize, Buenos Aires, Buenos Aires, Argentina
- Facultad de Psicología, Universidad Catolica Argentina, Buenos Aires, Buenos Aires, Argentina
| | - María Beatriz Moyano
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Asociación de Psiquiatras Argentinos (APSA), Buenos Aires, Buenos Aires, Argentina
- Asociación de Psiquiatras Argentinos (APSA), Presidente del Capítulo de Investigacion en Psiquiatria, Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mattheisen
- Department of Community Health and Epidemiology & Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
- LMU Munich, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - Stacey Pereira
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard University School of Medicine, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Michele T Pato
- Department of Psychiatry, Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Humberto Nicolini
- Departamento de Psiquiatría, Ciudad de México, Grupo Médico Carracci, Ciudad de Mexico, Mexico
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Ciudad de México, Instituto Nacional de Medicina Genómica, Ciudad de Mexico, Mexico
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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Pinciotti CM, Van Kirk N, Horvath G, Storch EA, Mancebo MC, Abramowitz JS, Fontenelle LF, Goodman WK, Riemann BC, Cervin M. Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response. J Affect Disord 2024; 353:109-116. [PMID: 38452939 DOI: 10.1016/j.jad.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. METHODS The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs. RESULTS Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. LIMITATIONS Findings are limited by a naturalistic treatment sample with variation in treatment provision. CONCLUSIONS Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.
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Affiliation(s)
- Caitlin M Pinciotti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Nathaniel Van Kirk
- OCD Institute, Office of Clinical Assessment and Research (OCAR), McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Gregor Horvath
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Mancebo
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leonardo F Fontenelle
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Matti Cervin
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
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3
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Pinciotti CM, Bulkes NZ, Bailey BE, Storch EA, Abramowitz JS, Fontenelle LF, Riemann BC. Common rituals in obsessive-compulsive disorder and implications for treatment: A mixed-methods study. Psychol Assess 2023; 35:763-777. [PMID: 37470990 PMCID: PMC10527485 DOI: 10.1037/pas0001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rituals might cluster together and predict worsened severity and poorer treatment outcomes. In a retrospective sample of 641 adult patients who received intensive OCD treatment, the present study used a mixed-methods approach to (a) identify and validate treatment provider-identified rituals using the Yale-Brown Obsessive-Compulsive Scale, (b) identify clustering patterns of rituals, and (c) examine the impact of these clusters on severity and treatment outcomes. Sixty-two discrete rituals clustered into eight higher order ritual clusters: avoidance, reassurance, checking, cleaning/handwashing, just right, rumination, self-assurance, and all other rituals. At admission, reassurance predicted greater intolerance of uncertainty (IU) and rumination predicted less OCD severity. Only one ritual cluster-just right-predicted treatment outcomes; patients with just right rituals had worse IU at discharge and significantly longer length of treatment (average 7.0 days longer). Clinical observation can identify more nuanced and individualized rituals than self-report assessment alone. Patients presenting with just right rituals may benefit less from treatment focused on harm avoidance and habituation; instead, treatment should be tailored to the idiosyncrasies of incompleteness and not just the right experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro
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4
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Crowley JJ, Cappi C, Ochoa-Panaifo ME, Frederick RM, Kook M, Wiese AD, Rancourt D, Atkinson EG, Giusti-Rodriguez P, Anderberg JL, Abramowitz JS, Adorno VR, Aguirre C, Alves GS, Alves GS, Ancalade N, Espinosa AAA, Arnold PD, Ayton DM, Barbosa IG, Castano LMB, Barrera CN, Prieto MB, Berardo MC, Berrones D, Best JR, Bigdeli TB, Burton CL, Callahan JL, Carneiro MCB, Cepeda SL, Chazelle E, Chire JM, Munoz MC, Quiroz PC, Cobite J, Comer JS, Costa DL, Crosbie J, Cruz VO, Dager G, Daza LF, de la Rosa-Gómez A, Del Río D, Delage FZ, Dreher CB, Fay L, Fazio T, Ferrão YA, Ferreira GM, Figueroa EG, Fontenelle LF, Forero DA, Fragoso DT, Gadad BS, Garrison SR, González A, Gonzalez LD, González MA, Gonzalez-Barrios P, Goodman W, Guintivano J, Guttfreund DG, Guzick AG, Halvorsen MW, Hovey JD, Janssen-Aguilar R, Jensen M, Reynolds AZJ, Lujambio JAJ, Khalfe N, Knutsen MA, Lack C, Lanzagorta N, Lima MO, Longhurst MO, Martinez DAL, Luna ES, Marques AH, Martinez M, de Los Angeles Matos M, Maye CE, McGuire JF, Menezes G, Minaya C, Miño T, Mithani SM, de Oca CM, Morales-Rivero A, Moreira-de-Oliveira ME, Morris OJ, Muñoz SI, Naqqash Z, Bracho AAN, Bracho BEN, Rojas MCO, Castaman LAO, Ortega I, Patel DI, Patrick AK, Mino MPY, Orellana JLP, Stumpf BP, Peregrina T, Duarte TP, Piacsek KL, Placencia M, Quarantini LC, Quarantini-Alvim Y, Ramos RT, Ramos IC, Ramos VR, Ramsey KA, Ray EV, Richter MA, Riemann BC, Rivas JC, Rosario MC, Ruggero CJ, Ruiz-Chow AA, Ruiz-Velasco A, Sampaio AS, Saraiva LC, Schachar RJ, Schneider SC, Schweissing EJ, Seligman LD, Shavitt RG, Soileau KJ, Stewart SE, Storch SB, Strouphauer ER, Timpano KR, Treviño-de la Garza B, Vargas-Medrano J, Vásquez MI, Martinez GV, Weinzimmer SA, Yanez MA, Zai G, Zapata-Restrepo LM, Zappa LM, Zepeda-Burgos RM, Zoghbi AW, Miguel EC, Rodriguez CI, Mallen MCM, Moya PR, Borda T, Moyano MB, Mattheisen M, Pereira S, Lázaro-Muñoz G, Martinez-Gonzalez KG, Pato MT, Nicolini H, Storch EA. Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study Protocol. medRxiv 2023:2023.02.23.23286373. [PMID: 37131804 PMCID: PMC10153323 DOI: 10.1101/2023.02.23.23286373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5,000 richly-phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.
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Affiliation(s)
- James J Crowley
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
- University of North Carolina at Chapel Hill, Department of Psychiatry, Chapel Hill, North Carolina, United States of America
| | - Carolina Cappi
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York City, New York, United States of America
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | | | - Renee M Frederick
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Minjee Kook
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Andrew D Wiese
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Diana Rancourt
- University of South Florida, Department of Psychology, Tampa, Florida, United States of America
| | - Elizabeth G Atkinson
- Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas, United States of America
| | - Paola Giusti-Rodriguez
- University of Florida College of Medicine, Department of Psychiatry, Gainesville, Florida, United States of America
| | - Jacey L Anderberg
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Jonathan S Abramowitz
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, North Carolina, United States of America
| | - Victor R Adorno
- Hospital Psiquiátrico de Asunción, Direccion General, Asunción, Central, Paraguay
| | - Cinthia Aguirre
- Hospital Psiquiátrico de Asunción, Departamento de Psiquiatría, Asunción, Central, Paraguay
| | - Gustavo S Alves
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
| | - Gilberto S Alves
- Hospital Nina Rodrigues/Universidade Federal do Maranhão (UFMA), Sao Luis do Maranhão, Maranhão, Brasil
| | - NaEshia Ancalade
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
| | | | - Paul D Arnold
- University of Calgary, The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Daphne M Ayton
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Izabela G Barbosa
- Universidade Federal de Minas Gerais, Departamento de Saúde Mental da Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brasil
| | | | | | - María Belén Prieto
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - María Celeste Berardo
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Dayan Berrones
- Rice University, Department of Psychology, Houston, Texas, United States of America
| | - John R Best
- University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
| | - Tim B Bigdeli
- SUNY Downstate Health Sciences University, Department of Psychiatry and Behavioral Sciences, Brooklyn, New York, United States of America
- VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
| | - Christie L Burton
- Hospital for Sick Children, Department of Neurosciences and Mental Health, Toronto, Ontario, Canada
| | - Jennifer L Callahan
- University of North Texas, Department of Psychology, Denton, Texas, United States of America
| | - Maria Cecília B Carneiro
- Universidade Federal do Paraná, Departamento de Psiquiatria e Medicina Legal, Curitiba, Paraná, Brasil
| | - Sandra L Cepeda
- University of Miami, Department of Psychology, Coral Gables, Florida, United States of America
| | - Evelyn Chazelle
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Jessica M Chire
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Dirección de Niños y Adolescentes, Lima, Lima, Perú
| | | | | | - Journa Cobite
- University of Houston, Department of Counseling Psychology, Houston, Texas, United States of America
| | - Jonathan S Comer
- Florida International University, Department of Psychology, Miami, Florida, United States of America
| | - Daniel L Costa
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Jennifer Crosbie
- Hospital for Sick Children, Department of Neurosciences and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Victor O Cruz
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Oficina Ejecutiva de Investigación, Lima, Lima, Perú
- Universidad San Martin de Porres, School of Medicine, Lima, Lima, Perú
| | - Guillermo Dager
- Corporación Universitaria Rafael Nuñez, Cartagena, Bolivar, Colombia
| | - Luisa F Daza
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
| | - Anabel de la Rosa-Gómez
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Ciudad de México, México
| | | | - Fernanda Z Delage
- Universidade Federal do Paraná, Departamento de Medicina Forense e Psiquiatria, Curitiba, Paraná, Brasil
| | - Carolina B Dreher
- Universidade Federal do Rio Grande do Sul, Departamento de Psiquiatria, Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Psiquiatria - Clínica Médica, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lucila Fay
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Tomas Fazio
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Ygor A Ferrão
- Universidade Federal do Paraná de Porto Alegre, Departamento de Psiquiatria, Porto Alegre, Rio Grande do Sul, Brasil
| | - Gabriela M Ferreira
- Universidade Federal do Paraná, Departamento de Medicina Forense e Psiquiatria, Curitiba, Paraná, Brasil
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Parana, Brasil
| | - Edith G Figueroa
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Departamento de Psiquiatría de Adultos, Lima, Lima, Perú
| | - Leonardo F Fontenelle
- Universidade Federal do Rio de Janeiro, Departamento de Psiquiatria e Medicina Legal, Rio de Janeiro, Rio de Janeiro, Brasil
- Instituto D'Or de Pesquisa e Ensino, Departamento de Psiquiatria, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Diego A Forero
- Fundación Universitaria del Área Andina, Escuela de Salud y Ciencias del Deporte, Bogotá, Bogotá, Colombia
| | - Daniele Th Fragoso
- Universidade Federal do Paraná, Departamento de Medicina Forense e Psiquiatria, Curitiba, Paraná, Brasil
| | - Bharathi S Gadad
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - Sheldon R Garrison
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States of America
| | | | - Laura D Gonzalez
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Marco A González
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Ciudad de México, México
| | - Polaris Gonzalez-Barrios
- Universidad de Puerto Rico, Departamento de Psiquiatría, San Juan, Puerto Rico, Los Estados Unidos
- Universidad de Puerto Rico Campus de Ciências Médicas, San Juan, Puerto Rico, Los Estados Unidos
| | - Wayne Goodman
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Jerry Guintivano
- University of North Carolina at Chapel Hill, Department of Psychiatry, Chapel Hill, North Carolina, United States of America
| | | | - Andrew G Guzick
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Matthew W Halvorsen
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
| | - Joseph D Hovey
- The University of Texas Rio Grande Valley, Department of Psychological Science, Edinburg, Texas, United States of America
| | - Reinhard Janssen-Aguilar
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Subdirección de Psiquiatría, Ciudad de México, Ciudad de México, México
| | - Matias Jensen
- Universidad de Valparaíso, Centro de Neurociencias, Valparaíso, Valparaíso, Chile
| | - Alexandra Z Jimenez Reynolds
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | | | - Nasim Khalfe
- Baylor College of Medicine, School of Medicine, Houston, Texas, United States of America
| | - Madison A Knutsen
- Augustana College, Department of Psychology, Rock Island, Illinois, United States of America
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Caleb Lack
- University of Central Oklahoma, Department of Psychology, Edmond, Oklahoma, United States of America
| | - Nuria Lanzagorta
- Grupo Médico Carracci, Departamento de Investigación Clínica, Ciudad de México, Ciudad de México, México
| | - Monicke O Lima
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Melanie O Longhurst
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | | | - Elba S Luna
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Oficina Ejecutiva de Investigación, Lima, Lima, Perú
| | - Andrea H Marques
- National Institute of Mental Heatlh (NIMH), Bethesda, Maryland, United States of America
| | - Molly Martinez
- DFW OCD Treatment Specialists, Richardson, Texas, United States of America
- Specialists in OCD and Anxiety Recovery (SOAR), Richardson, Texas, United States of America
| | - Maria de Los Angeles Matos
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Caitlyn E Maye
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Joseph F McGuire
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, United States of America
| | - Gabriela Menezes
- Universidade Federal do Rio de Janeiro, Programa de Ansiedade, Obsessões e Compulsões, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Charlene Minaya
- Fordham University, Department of Psychology, New York City, New York, United States of America
| | - Tomás Miño
- Universidad de Valparaíso, Centro de Neurociencias, Valparaíso, Valparaíso, Chile
| | - Sara M Mithani
- University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, United States of America
| | | | | | - Maria E Moreira-de-Oliveira
- Universidade Federal do Rio de Janeiro, Programa de Ansiedade, Obsessões e Compulsões, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Olivia J Morris
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Sandra I Muñoz
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Ciudad de México, México
| | - Zainab Naqqash
- University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
| | | | | | | | | | - Iliana Ortega
- University of Calgary, The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Darpan I Patel
- University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, United States of America
| | - Ainsley K Patrick
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, United States of America
| | - Mariel Paz Y Mino
- Universidad San Francisco de Quito, Clínica de Salud Mental USFQ, Quito, Pichincha, Ecuador
- Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Jose L Perales Orellana
- Universidad Tegnológica Privada de Santa Cruz (UTEPSA), Santa Cruz de la Sierra, Andres Ibañez, Bolivia
| | - Bárbara Perdigão Stumpf
- Universidade Federal de Minas Gerais, Departamento de Saúde Mental da Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brasil
| | | | | | - Kelly L Piacsek
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States of America
| | - Maritza Placencia
- Universidad Nacional Mayor de San Marcos, Departamento Académico de Ciencias Dinámicas, Lima, Lima, Perú
| | - Lucas C Quarantini
- Universidade Federal da Bahia, Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
| | - Yana Quarantini-Alvim
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
- Faculdade Santa Casa, Faculdade de Psicologia, Salvador, Bahia, Brasil
| | - Renato T Ramos
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Iaroslava C Ramos
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
- Frederick Thompson Anxiety Disorders Centre, Department of Psychiatry, Toronto, Ontario, Canada
| | - Vanessa R Ramos
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Kesley A Ramsey
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, United States of America
| | - Elise V Ray
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
| | - Margaret A Richter
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Bradley C Riemann
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States of America
| | - Juan C Rivas
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
- Universidad del Valle, Departamento de Psiquiatría, Cali, Valle del Cauca, Colombia
- Universidad ICESI, Departamento de Psiquiatria, Cali, Valle del Cauca, Colombia
- Fundación Valle del Lili, Departamento de Psiquiatria, Cali, Valle del Cauca, Colombia
| | - Maria C Rosario
- Departamento de Psiquiatria da Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brasil
| | - Camilo J Ruggero
- University of North Texas, Department of Psychology, Denton, Texas, United States of America
| | | | - Alejandra Ruiz-Velasco
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - Aline S Sampaio
- Universidade Federal da Bahia, Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
| | - Leonardo C Saraiva
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Russell J Schachar
- Hospital for Sick Children, Department of Neurosciences and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Sophie C Schneider
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Ethan J Schweissing
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Laura D Seligman
- The University of Texas Rio Grande Valley, Department of Psychological Science, Edinburg, Texas, United States of America
| | - Roseli G Shavitt
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Keaton J Soileau
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - S Evelyn Stewart
- University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shaina B Storch
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Emily R Strouphauer
- Baylor College of Medicine, School of Medicine, Houston, Texas, United States of America
| | - Kiara R Timpano
- University of Miami, Department of Psychology, Coral Gables, Florida, United States of America
| | | | - Javier Vargas-Medrano
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - María I Vásquez
- Hospital Nacional Arzobispo Loayza, Servicio de Salud Mental, Lima, Lima, Perú
| | - Guadalupe Vidal Martinez
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - Saira A Weinzimmer
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Mauricio A Yanez
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Gwyneth Zai
- Centre for Addiction and Mental Health, Neurogenetics Section, Molecular Brain Sciences Department, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Lina M Zapata-Restrepo
- Fundación Valle del Lili, Departamento de Psiquiatria, Cali, Valle, Colombia
- Universidad ICESI, Facultad de Ciencias de la Salud, Cali, Valle, Colombia
- Global Brain Health Institute - University of California San Francisco, Department of Neurology, San Francisco, California, United States of America
| | - Luz M Zappa
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Hospital de Niños Ricardo Gutierrez, Departamento de Salud Mental, Buenos Aires, Buenos Aires, Argentina
- Hospital Universitario Austral, Materno Infantil, Buenos Aires, Buenos Aires, Argentina
| | - Raquel M Zepeda-Burgos
- Universidad Dr. José Matías Delgado, Centro de Investigación en Ciencias y Humanidades, Santa Tecla, La Libertad, El Salvador
| | - Anthony W Zoghbi
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
- New York State Psychiatric Institute, Department of Psychiatry, New York City, New York, United States of America
| | - Euripedes C Miguel
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Carolyn I Rodriguez
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California, United States of America
- Veterans Affairs Palo Alto Health Care System, Department of Psychiatry, Temerty Faculty of Medicine, Palo Alto, California, United States of America
| | | | - Pablo R Moya
- Universidad de Valparaíso, Instituto de Fisiología, Valparaíso, Valparaíso, Chile
- Centro Interdisciplinario de Neurociencia de Valparaiso (CINV), Valparaíso, Valparaíso, Chile
| | - Tania Borda
- Instituto Realize, Buenos Aires, Buenos Aires, Argentina
- Universidad Catolica Argentina, Facultad de Psicologia, Buenos Aires, Buenos Aires, Argentina
| | - María Beatriz Moyano
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Asociacion de Psiquiatras Argentinos (APSA), Buenos Aires, Buenos Aires, Argentina
- Asociacion de Psiquiatras Argentinos (APSA), Presidente del Capitulo de Investigacion en Psiquiatria, Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mattheisen
- Dalhousie University, Department of Community Health and Epidemiology & Faculty of Computer Science, Halifax, Nova Scotia, Canada
- LMU Munich, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - Stacey Pereira
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, United States of America
| | - Gabriel Lázaro-Muñoz
- Harvard University School of Medicine, Center for Bioethics, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts, United States of America
| | | | - Michele T Pato
- Rutgers University- Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, New Jersey, United States of America
| | - Humberto Nicolini
- Grupo Médico Carracci, Departamento de Psiquiatría, Ciudad de México, Ciudad de México, México
- Instituto Nacional de Medicina Genómica, Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Ciudad de México, Ciudad de México, México
| | - Eric A Storch
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
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5
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Hellberg SN, Abramowitz JS, Ojalehto HJ, Butcher MW, Buchholz JL, Riemann BC. Co-occurring depression and obsessive-compulsive disorder: A dimensional network approach. J Affect Disord 2022; 317:417-426. [PMID: 36055534 DOI: 10.1016/j.jad.2022.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/26/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally. METHODS Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined. RESULTS Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed. CONCLUSIONS Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.
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Affiliation(s)
- Samantha N Hellberg
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA.
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Heidi J Ojalehto
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Megan W Butcher
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Jennifer L Buchholz
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
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6
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Pinciotti CM, Wetterneck CT, Riemann BC. Symptom severity and presentation in comorbid OCD and PTSD: A clinical replication. Bull Menninger Clin 2022; 86:183-203. [PMID: 36047941 DOI: 10.1521/bumc.2022.86.3.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with comorbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) experience more severe OCD symptoms and poorer treatment response. Despite some evidence linking OCD symptom domains to trauma, only one study to date has examined typical OCD and PTSD presentations in individuals with OCD+PTSD, and findings were based on a nonclinical sample. The current study sought to replicate findings in a clinical sample of 1,014 patients diagnosed with OCD (n = 928), PTSD (n = 40), and OCD+PTSD (n = 46) in specialty OCD and anxiety treatment programs. Consistent with previous research, patients with OCD+PTSD reported more severe OCD yet similar severity PTSD symptoms and did not evidence a unique phenotypic presentation once symptom overlap and comorbid mood and personality disorders were considered. OCD+PTSD is equally as heterogeneous as OCD and PTSD alone. Implications for the research and treatment of OCD+PTSD are discussed, and assessment and treatment recommendations are provided.
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Affiliation(s)
| | - Chad T Wetterneck
- Clinical Director of Trauma Recovery Services, Oconomowoc, Wisconsin
| | - Bradley C Riemann
- Chief Clinical Officer at Rogers Behavioral Health, Oconomowoc, Wisconsin
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7
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Whiteside SPH, Riemann BC, McCarthy DM. Using the Child Sheehan Disability Scale to Differentiate Severity Level in Youth With Anxiety Disorders and Obsessive Compulsive Disorder. Assessment 2022; 30:998-1008. [PMID: 35187974 DOI: 10.1177/10731911221077232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study extends the psychometric support for the Child Sheehan Disability Scale (CSDS) as a measure of impairment associated with childhood anxiety disorders, including obsessive compulsive disorder. The CSDS was completed by 1,481 predominately Caucasian youth (55.4% female) ages 8 to 17 (M = 12.68, SD = 2.78) from primarily two-parent households and a parent across community, outpatient, intensive outpatient treatment, and residential settings. The results replicated and extended the previously found strong convergent validity, discriminant validity, and treatment sensitivity with a revised parent-report item in the larger sample. Moreover, the CSDS successfully differentiated between patients receiving treatment of different levels of intensity. These data were used to develop preliminary qualitative descriptors associating individual scores with a likely level of indicated treatment to enhance the clinical applicability of the CSDS. This study establishes the CSDS as one of the briefest and most rigorously evaluated measures of impairment associated with child anxiety. However, the performance of the CSDS must be examined in more representative samples before being applied to diverse populations.
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8
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Pinciotti CM, Bulkes NZ, Horvath G, Riemann BC. Efficacy of intensive CBT telehealth for obsessive-compulsive disorder during the COVID-19 pandemic. J Obsessive Compuls Relat Disord 2022; 32:100705. [PMID: 34956827 PMCID: PMC8692880 DOI: 10.1016/j.jocrd.2021.100705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Despite evidence for the effectiveness of cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD), many individuals with OCD lack access to needed behavioral health treatment. Although some literature suggests that virtual modes of treatment for OCD are effective, it remains unclear whether intensive programs like partial hospitalization and intensive outpatient programs (PHP and IOPs) can be delivered effectively over telehealth (TH) and within the context of a global pandemic. Limited extant research suggests that clinicians perceive attenuated treatment response during the pandemic. The trajectory and outcomes of two matched samples were compared using linear mixed modeling: a pre-COVID in-person (IP) sample (n = 239) and COVID TH sample (n = 239). Findings suggested that both modalities are effective at treating OCD and depressive symptoms, although the pandemic TH group required an additional 2.6 treatment days. The current study provides evidence that PHP and IOP treatment delivered via TH during the COVID-19 pandemic is approximately as effective as pre-pandemic IP treatment and provides promising findings for the future that individuals with complicated OCD who do not have access to IP treatment can still experience significant improvement in symptoms through TH PHP and IOP treatment during and potentially after the pandemic.
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Affiliation(s)
- Caitlin M Pinciotti
- Rogers Behavioral Health System, 34700 Valley Rd., Oconomowoc, WI 53066, USA
| | - Nyssa Z Bulkes
- Rogers Behavioral Health System, 34700 Valley Rd., Oconomowoc, WI 53066, USA
| | - Gregor Horvath
- Rogers Behavioral Health System, 34700 Valley Rd., Oconomowoc, WI 53066, USA
| | - Bradley C Riemann
- Rogers Behavioral Health System, 34700 Valley Rd., Oconomowoc, WI 53066, USA
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9
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Bulkes NZ, Davis K, Kay B, Riemann BC. Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. J Psychiatr Res 2022; 145:347-352. [PMID: 34799124 PMCID: PMC8595951 DOI: 10.1016/j.jpsychires.2021.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022]
Abstract
The heightened acuity in anxiety and depressive symptoms catalyzed by the COVID-19 pandemic presents an urgent need for effective, feasible alternatives to in-person mental health treatment. While tele-mental healthcare has been investigated for practicability and accessibility, its efficacy as a successful mode for delivering high-quality, high-intensity treatment remains unclear. This study compares the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment prior to the COVID-19 pandemic (N = 1,192) to the outcomes of a distinctive group of patients who received telehealth treatment during the pandemic (N = 1,192). Outcomes are measured with respect to depressive symptoms (Quick Inventory of Depressive Symptomatology-Self-Report; QIDS-SR) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Q-LES-Q). There were no significant differences in admission score on either assessment comparing in-person and telehealth groups. Patients in the partial hospitalization level of care stayed longer when treatment was remote. Results suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups. Future research is needed to replicate these findings in other healthcare organizations in other geographical locations and diverse patient populations.
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10
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Pinciotti CM, Horvath G, Wetterneck CT, Riemann BC. Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters. J Anxiety Disord 2022; 85:102511. [PMID: 34923293 DOI: 10.1016/j.janxdis.2021.102511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.
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Affiliation(s)
- Caitlin M Pinciotti
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA.
| | - Gregor Horvath
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| | - Chad T Wetterneck
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| | - Bradley C Riemann
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
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11
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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12
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Pinciotti CM, Piacsek K, Kay B, Bailey B, Riemann BC. OCD in the time of COVID-19: A global pandemic's impact on mental health patients and their treatment providers. Bull Menninger Clin 2021; 86:91-112. [PMID: 34346726 DOI: 10.1521/bumc_2021_85_04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with obsessive-compulsive disorder (OCD) have evidenced resilience against large-scale crises, although emerging research on the impact of COVID-19 is mixed. Little is known about the impact of COVID-19 on mental health providers. Items from an instrument evaluating the impact of the September 11, 2001, terrorist attack were adapted to measure the impact of COVID-19 on emotions, cognitions, and behaviors. Using a sample of 65 patients with primary OCD diagnoses and OCD treatment providers in intensive programs for OCD and anxiety, the authors found that COVID-19 evidenced a less significant overall impact on patients than providers. Specifically, providers reported more significant impact on the amount of time spent worrying about COVID-19, taking additional cleaning and sanitization precautions, and time spent socializing with loved ones. Findings support previous literature indicating that individuals with OCD demonstrate resilience to large-scale crises, and offer insights into the specific struggles of providers who treat OCD.
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Affiliation(s)
- Caitlin M Pinciotti
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Associate research psychologist
| | - Kelly Piacsek
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Vice president of research
| | - Brian Kay
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Vice president of continuous improvement
| | - Brenda Bailey
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Clinical supervisor
| | - Bradley C Riemann
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Chief clinical officer
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13
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Pinciotti CM, Riemann BC, Abramowitz JS. Intolerance of uncertainty and obsessive-compulsive disorder dimensions. J Anxiety Disord 2021; 81:102417. [PMID: 33991818 DOI: 10.1016/j.janxdis.2021.102417] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 01/23/2023]
Abstract
Intolerance of uncertainty (IU), which can include prospective (i.e., desire for predictability) and inhibitory (i.e., uncertainty paralysis) IU, is widely understood to be a central underlying component of obsessive-compulsive disorder (OCD). IU has several treatment implications, yet research on the differences in IU underlying OCD dimensions is limited and does not account for covarying effects of overlapping symptoms, shared variance in IU, demographic variables, and comorbid psychiatric conditions like generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). A sample of 974 patients with diagnosed OCD enrolled in residential, partial hospitalization, and intensive outpatient treatment programs for OCD and anxiety completed self-report measures of OCD symptoms and IU at admission. Structural equation modeling included prospective. inhibitory IU, and common IU and covariates (i.e., race, ethnicity, level of care, and comorbid GAD and PTSD) as predictors of four common OCD dimensions found that contamination and unacceptable thoughts symptoms evidenced a unique relationship with IU. Specifically, whereas a common IU factor predicted all four OCD symptom dimensions, inhibitory IU uniquely predicted contamination and unacceptable thoughts symptoms over and above covarying effects. Individuals with contamination and unacceptable thoughts symptoms may be more likely to feel "paralyzed" by uncertainty due to overreliance on overt immediate rituals, outright avoidance, rumination, or difficulties with emotion regulation, and may benefit from additional psychoeducation, problem-solving, and accountability. Broadly, individuals with OCD may benefit from explicit discussions about IU-related expectancies and disconfirmation of fears.
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Affiliation(s)
| | - Bradley C Riemann
- Rogers Behavioral Health, 34700 Valley Rd., Oconomowoc, WI, 53066, USA
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, 235 E. Cameron Ave, Chapel Hill, NC, 27514, USA
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14
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Abstract
Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment. OCD patients receiving residential treatment based primarily on exposure and response prevention (ERP) provided data regarding symptoms of depression and OCD at admission and discharge. Patients reported large and significant reductions in OCD symptoms over the course of treatment. Change in OCD symptoms was not significantly affected by depressive symptoms, including patients with severe depressive symptoms. Change in depressive symptoms over the course of treatment was, however, robustly related to change in OCD symptoms, especially among patients who began treatment with severe symptoms of depression. These findings suggest that cognitive-behavior therapy delivered in a residential treatment setting drastically reduces OCD symptoms regardless of depressive symptoms.
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Affiliation(s)
- Chad T Wetterneck
- Trauma Recovery Services, Rogers Behavioral Health, Oconomowoc, Wisconsin
| | | | - Thomas G Adams
- Rogers Behavioral Health, Oconomowoc, Wisconsin.,Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut.,Rogers Behavioral Health, as well as the Clinical Neuroscience Division of the VA National Center for PTSD, West Haven, Connecticut
| | | | - Peter Grau
- Department of Counseling and Education at Marquette University, Milwaukee, Wisconsin
| | - Martin E Franklin
- Rogers Behavioral Health, Oconomowoc, Wisconsin.,Department of Psychiatry at the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Storch EA, Peris TS, De Nadai A, Piacentini J, Bloch M, Cervin M, McGuire J, Farrell LJ, McCracken JT, McKay D, Riemann BC, Wagner AP, Franklin M, Schneider SC, Walkup JT, Williams L, Abramowitz JS, Stewart SE, Fitzgerald KD, Goodman WK. Little Doubt That CBT Works for Pediatric OCD. J Am Acad Child Adolesc Psychiatry 2020; 59:785-787. [PMID: 32618273 DOI: 10.1016/j.jaac.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/27/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Abstract
We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.1 Although the authors' results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confused by the discordant and inappropriate conclusions that they put forward. These conclusions stem from the authors' application and interpretation of their particular qualitative methods, which could lead important stakeholders (eg, parents, patients, clinicians, and payers) to wrongly discount clear evidence for what is known to be the best evidence-based therapy for pediatric OCD.
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Affiliation(s)
| | - Tara S Peris
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | - John Piacentini
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Michael Bloch
- Yale University College of Medicine, New Haven, Connecticut
| | | | | | - Lara J Farrell
- School of Applied Psychology, Griffith University, Gold Coast Campus, Queensland, Australia
| | - James T McCracken
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | | | | | | | | | - John T Walkup
- Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine, Chicago, Illinois
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16
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Meier M, Kossakowski JJ, Jones PJ, Kay B, Riemann BC, McNally RJ. Obsessive-compulsive symptoms in eating disorders: A network investigation. Int J Eat Disord 2020; 53:362-371. [PMID: 31749199 DOI: 10.1002/eat.23196] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are complex, heterogeneous, and severe psychiatric syndromes. They are highly comorbid with obsessive-compulsive disorder (OCD) which exacerbates the course of illness and impedes treatment. However, the direct functional relations between EDs and OCD symptoms remain largely unexplored. Hence, using network analysis, we investigated the relationship between ED and OCD at the level of symptoms in a heterogeneous clinical sample. METHOD We used cross sectional data of 303 treatment-seeking patients with clinically relevant ED and OCD pathology. We constructed a regularized partial correlation network that featured both ED and OCD symptoms as nodes. To determine each symptom's influence, we calculated expected influence (EI) as an index of symptom centrality (i.e., "importance"). Bridge symptoms (i.e., symptoms from one syndromic cluster that have strong connections to symptoms of another syndromic cluster) were identified by computing bridge expected influence metrics. RESULTS Fear of weight gain and dietary restraint were especially important among the ED symptoms. Interference due to obsessions was the key feature of OCD. ED and OCD clustered distinctly with few potential bridges between clusters. DISCUSSION This study underscores the importance of cognitive symptoms for both ED and OCD although direct functional links between the two clusters are missing. Potentially, a network incorporating nodes capturing features of personality may account for diagnostic comorbidity better than specific symptoms of EDs or features of OCD do.
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Affiliation(s)
- Marieke Meier
- Department of Psychology, Harvard University, Cambridge, Massachusetts.,Department of Psychology, University of Muenster, Muenster, Germany
| | - Jolanda J Kossakowski
- Department of Psychology, Harvard University, Cambridge, Massachusetts.,Department of Psychological Research Methods, University of Amsterdam, Amsterdam, the Netherlands
| | - Payton J Jones
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Brian Kay
- Rogers Behavioral Health, Oconomowoc, Wisconsin
| | | | - Richard J McNally
- Department of Psychology, Harvard University, Cambridge, Massachusetts
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17
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Santos MM, Ullman J, Leonard RC, Puspitasari AJ, Cook J, Riemann BC. Behavioral Activation as a Mechanism of Change in Residential Treatment for Mood Problems: A Growth Curve Model Analysis. Behav Ther 2019; 50:1087-1097. [PMID: 31735244 DOI: 10.1016/j.beth.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/22/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022]
Abstract
Research on the efficacy, effectiveness, and dissemination potential of behavioral activation (BA)-focused interventions for depression and comorbid disorders has expanded rapidly. However, research that examines how BA interventions work has seen less growth. A primary purported mechanism of BA is activation, which reflects a person's meaningful (re)engagement in life. BA theory posits that depression will decrease as activation increases, and that changes in the mechanism variable will lead to changes in outcome. The current study aims to investigate activation as a potential mechanism of change in the context of a BA-focused residential treatment intervention for mood problems using repeated measures of self-reported activation and depression from a large comorbid sample (N = 578). Growth curve modeling was used to examine between-person differences in within-person change over time. Findings suggest that self-reported activation increases and depression decreases over time. Moreover, results show both linear and quadratic growth and that the rate of change in activation predicts the rate of change of depression. BA-focused residential treatment may facilitate activation, which exerts an effect on depression among residents with diagnostically complex presentations.
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18
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Hezel DM, Stewart SE, Riemann BC, McNally RJ. Standard of proof and intolerance of uncertainty in obsessive-compulsive disorder and social anxiety disorder. J Behav Ther Exp Psychiatry 2019; 64:36-44. [PMID: 30818107 DOI: 10.1016/j.jbtep.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Researchers have identified intolerance of uncertainty (IU) as a dysfunctional thought that contributes to OCD. Case examples of OCD suggest that uncertainty and anxiety persist despite low likelihoods of feared outcomes. In this study we examined how people with OCD react to minimal amounts of uncertainty relative to non-anxious individuals and a clinical comparison group of people with social anxiety disorder (SAD). METHODS We created a questionnaire to measure the distress people feel when there is only minimal uncertainty regarding a given outcome and if they prefer situations with the certainty of negative outcomes in the present versus living with uncertainty. Part two of our study tested whether IU is related to performance on neutral and idiographic versions of the Beads Task. RESULTS OCD and SAD subjects reacted to hypothetical scenarios involving minimal risk with greater negative affect than did non-anxious subjects; however, after repeating analyses to account for comorbid disorders, OCD subjects' scores did not differ from those of non-anxious subjects. Only SAD subjects showed a preference for negative information in the present versus the uncertainty of a future outcome. Part two of our study revealed that self-reported IU was only marginally associated with performance on the neutral Beads Task. LIMITATIONS High rates of comorbidity made it difficult to identify the specific relationship of IU with other anxiety disorders. CONCLUSIONS IU for general, non-OCD specific scenarios may not figure prominently in all individuals with OCD, but rather may play a larger, more consistent role in anxiety disorders such as SAD. Additionally, the number of beads or words viewed on Beads Task may be an inadequate behavioral measure of IU.
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Affiliation(s)
- Dianne M Hezel
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - S Evelyn Stewart
- University of British Columbia, Vancouver, BC, Canada; B.C. Children's Hospital, Vancouver, BC, Canada
| | - Bradley C Riemann
- The Obsessive-Compulsive Disorder Center, Rogers Memorial Hospital, Oconomowoc, WI, USA
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19
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Buchholz JL, Blakey SM, Abramowitz JS, Leonard RC, Riemann BC. Predictors of concurrent depressive symptoms in patients with obsessive-compulsive disorder. Psychiatry Res 2019; 279:267-271. [PMID: 30955863 DOI: 10.1016/j.psychres.2019.03.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 01/22/2023]
Abstract
Many patients with obsessive-compulsive disorder (OCD) exhibit concurrent depressive symptoms, which are associated with negative psychological outcomes. Yet little research has focused on identifying factors that predict depressive symptoms in OCD. The current study examined three transdiagnostic constructs-anxiety sensitivity (AS), intolerance of uncertainty (IU), and worry-as predictors of depressive symptom severity in a sample of treatment-seeking adults with a primary diagnosis of OCD (N = 93). Strong, positive associations between depressive symptoms and measures of AS, IU, and worry were detected, and AS and worry (but not IU) remained significant unique predictors of depression after controlling for the severity of OCD symptoms. The conceptual and clinical implications of these findings, as well as study limitations and future directions, are discussed.
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Affiliation(s)
- Jennifer L Buchholz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA.
| | - Shannon M Blakey
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA
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20
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Siwiec SG, Riemann BC, Lee HJ. Predictors of acute outcomes for intensive residential treatment of obsessive-compulsive disorder. Clin Psychol Psychother 2019; 26:661-672. [PMID: 31273851 DOI: 10.1002/cpp.2389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022]
Abstract
For those who suffer with chronic and disruptive obsessive-compulsive disorder (OCD), who have not been sufficiently helped by outpatient treatments or medications, intensive residential treatment (IRT) is often the next best treatment option. To date, research of the predictors of treatment outcome in IRT for OCD are mixed and sometimes contradictory. Additionally, although comorbidity is common for patients in this setting, the inclusion of comorbidity as a potential predictor of outcome has been mostly lacking in research to date. The current study aimed to address these issues by utilizing optimal indices of treatment outcomes, while incorporating comorbidity into our analyses, in order to identify the predictors of treatment outcomes in the IRT for OCD setting. To this end, we analysed outcome data from 379 patients receiving IRT for OCD at the Rogers Memorial OCD Center between August 2012, and December 2017. Results indicated that the most important predictor of treatment outcome was obsession severity at admission. Specifically, higher obsession severity at admission predicted poorer treatment outcomes at discharge. Clinical implications and suggestions for future research were discussed in the manuscript.
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Affiliation(s)
- Stephan G Siwiec
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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21
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Gregory ST, Kay B, Smith J, Hall K, De Nadai AS, Quast T, Riemann BC, Storch EA. Treatment-Refractory Obsessive-Compulsive Disorder in Adults: A Cost-Effectiveness Analysis of Treatment Strategies. J Clin Psychiatry 2019; 79. [PMID: 29419948 DOI: 10.4088/jcp.17m11552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study sought to assess the cost-effectiveness of 7 treatment strategies for treatment-refractory obsessive-compulsive disorder (OCD) in adults. METHODS A model was developed to evaluate treatment alternatives for adults (18-64 years old) that consisted of 2 parts: a decision analytic model and a Markov model. The decision analytic model stratified 7 outpatient treatment strategies, and the Markov model accumulated benefits and costs across the life expectancy of a simulated cohort of individuals. The model was parameterized with probabilistic and deterministic parameters from the literature and an outcomes database to perform a Monte Carlo simulation of a hypothetical cohort of 100,000 adults with OCD to estimate net health benefits (NHBs), costs, and incremental cost-effectiveness ratio (ICER) for each treatment strategy. OCD was considered treatment refractory in adults with an OCD diagnosis who failed first-line therapies. Encounters took place from 2012 to 2015, and the analyses were performed from November 2016 to February 2017. RESULTS Partial hospitalization with step-down to intensive outpatient treatment was the most cost-effective of the 7 strategies, with an estimated ICER of $7,983 and mean (SD) NHB of 10.96 (0.53) quality-adjusted life-years (QALYs) remaining. This result was 2.2 QALYs greater than that of the trial-based antidepressant and cognitive-behavioral therapy (ADM + CBT) strategy. Three additional ADM + CBT strategies were estimated not to be statistically significantly different from each other. These 4 ADM + CBT strategies outperformed both pharmacotherapy-only strategies. CONCLUSIONS Treatment strategies that include higher-intensity CBT, with effectiveness outcomes that approached efficacy estimates, were superior to real-world CBT strategies. However, given the limited availability of high-quality CBT, especially through use of commercial insurance networks, specialized treatment programs offer greater effectiveness than real-world therapies in achieving wellness for this severe patient population.
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Affiliation(s)
- Sean T Gregory
- Department of Politics and International Affairs, Northern Arizona University, 5 E McConnell Dr, Flagstaff, AZ 86011 .,Department of Politics and International Affairs, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
| | - Joseph Smith
- Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Kristin Hall
- Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Alessandro S De Nadai
- Department of Psychology, University of South Florida, Tampa, Florida, USA.,Department of Psychiatry, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Troy Quast
- Department of Health Policy & Management, College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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22
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Højgaard DRMA, Schneider SC, La Buissonnière-Ariza V, Kay B, Riemann BC, Jacobi D, Eken S, Lake P, Nadeau J, Goodman WK, McIngvale E, Storch EA. Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive-compulsive disorder (OCD). Cogn Behav Ther 2019; 49:294-306. [PMID: 31203735 DOI: 10.1080/16506073.2019.1614977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD. The sample comprised 314 adolescents aged 13-17 years with treatment-resistant OCD and a Children's Yale-Brown Obsessive-Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response. Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response. Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response.
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Affiliation(s)
- Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital , Aarhus N, Denmark
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | | | - Brian Kay
- Rogers Memorial Hospital , Milwaukee, WI, USA
| | | | | | | | - Peter Lake
- Rogers Memorial Hospital , Milwaukee, WI, USA
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
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23
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Smith KE, Mason TB, Crosby RD, Cao L, Leonard RC, Wetterneck CT, Smith BER, Farrell NR, Riemann BC, Wonderlich SA, Moessner M. A comparative network analysis of eating disorder psychopathology and co-occurring depression and anxiety symptoms before and after treatment. Psychol Med 2019; 49:314-324. [PMID: 29655386 PMCID: PMC6310232 DOI: 10.1017/s0033291718000867] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Network analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety symptoms before and after treatment for EDs. METHOD Participants from residential or partial hospital ED treatment programs (N = 446) completed assessments upon admission and discharge. Networks were estimated using regularized Graphical Gaussian Models using 38 items from the Eating Disorders Examination-Questionnaire, Quick Inventory of Depressive Symptomatology, and State-Trait Anxiety Inventory. RESULTS ED symptoms with high centrality indices included a desire to lose weight, guilt about eating, shape overvaluation, and wanting an empty stomach, while restlessness, self-esteem, lack of energy, and feeling overwhelmed bridged ED to depression and anxiety symptoms. Comparisons between admission and discharge networks indicated the global network strength did not change significantly, though symptom severity decreased. Participants with denser networks at admission evidenced less change in ED symptomatology during treatment. CONCLUSIONS Findings suggest that symptoms related to shape and weight concerns and guilt are central ED symptoms, while physical symptoms, self-esteem, and feeling overwhelmed are links that may underlie comorbidities in EDs. Results provided some support for the validity of network approaches, in that admission networks conveyed prognostic information. However, the lack of correspondence between symptom reduction and change in network strength indicates that future research is needed to examine network dynamics in the context of intervention and relapse prevention.
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Affiliation(s)
| | - Tyler B Mason
- Department of Preventive Medicine,University of Southern California,Los Angeles, California,USA
| | - Ross D Crosby
- Neuropsychiatric Research Institute,Fargo, North Dakota,USA
| | - Li Cao
- Neuropsychiatric Research Institute,Fargo, North Dakota,USA
| | | | | | | | | | | | | | - Markus Moessner
- Center for Psychotherapy Research,University Hospital Heidelberg,Heidelberg,Germany
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24
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Schaefer LM, Smith KE, Leonard R, Wetterneck C, Smith B, Farrell N, Riemann BC, Frederick DA, Schaumberg K, Klump KL, Anderson DA, Thompson JK. Identifying a male clinical cutoff on the Eating Disorder Examination-Questionnaire (EDE-Q). Int J Eat Disord 2018; 51:1357-1360. [PMID: 30480321 PMCID: PMC6310481 DOI: 10.1002/eat.22972] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Evidence suggests that eating disorders (EDs) may be under-detected in males. Commonly used measures of EDs such as the Eating Disorder Examination-Questionnaire (EDE-Q) were initially developed within female samples, raising concern regarding the extent to which these instruments may be appropriate for detecting EDs in males. The current study used receiver operating characteristic curve analysis to (a) examine the accuracy of the EDE-Q global score in correctly classifying males with and without clinically significant ED pathology, and (b) establish the optimal EDE-Q global clinical cutoff for males. METHOD Participants were a clinical sample of 245 male ED patients and a control sample of 205 male undergraduates. RESULTS Eating Disorder Examination-Questionnaire global scores demonstrated moderate-high accuracy in predicting ED status (area under the curve = 0.85, 95% CI: 0.82-0.89). The optimal cutoff of 1.68 yielded a sensitivity of 0.77 and specificity of 0.77. DISCUSSION Overall, results provide preliminary support for the discriminant validity of EDE-Q scores among males. However, concerns remain regarding the measure's ability to comprehensively assess domains of disordered eating most relevant to males. Therefore, careful attention to the possibility for measurement bias and continued evaluation of the scale in males is encouraged.
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Affiliation(s)
| | - Kathryn E. Smith
- Sanford Research, Fargo, North Dakota, USA,University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
| | | | | | - Brad Smith
- Rogers Memorial Hospital, Oconomowoc, Wisconsin, USA
| | | | | | | | - Katherine Schaumberg
- University of Wisconsin-Madison, Department of Psychiatry, Madison, Wisconsin, USA
| | - Kelly L. Klump
- Michigan State University, Department of Psychology, East Lansing, Michigan, USA
| | - Drew A. Anderson
- University at Albany-State University of New York, Department of Psychology, Albany, New York, USA
| | - J. Kevin Thompson
- University of South Florida, Department of Psychology, Tampa, Florida, USA
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25
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Meyer JM, Clapp JD, Whiteside SP, Dammann J, Kriegshauser KD, Hale LR, Jacobi DM, Riemann BC, Deacon BJ. Predictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety. Behav Ther 2018; 49:580-593. [PMID: 29937259 DOI: 10.1016/j.beth.2017.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 11/20/2022]
Abstract
Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.
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Affiliation(s)
| | | | | | | | | | - Lisa R Hale
- Kansas City Center for Anxiety Treatment; University of Missouri-Kansas City
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26
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Schneider SC, La Buissonnière-Ariza V, Højgaard DRMA, Kay BS, Riemann BC, Eken SC, Lake P, Nadeau JM, Storch EA. Multimodal Residential Treatment for Adolescent Anxiety: Outcome and Associations with Pre-treatment Variables. Child Psychiatry Hum Dev 2018; 49:434-442. [PMID: 28988322 DOI: 10.1007/s10578-017-0762-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to determine the effect of a multimodal residential treatment program for severe adolescent anxiety, and examine whether treatment outcome was associated with pre-treatment anxiety, comorbid disorders, or participant age or gender. Participants were 70 adolescents (61.4% female, mean age = 15.4 years) with a primary anxiety disorder who received residential treatment involving cognitive behavioral therapy and medication management. Treatment outcome was assessed both as the change in adolescent-reported anxiety symptoms, and using treatment response criteria. Results indicated a strong effect of the intervention on symptoms of anxiety, depression, and anxiety-related life interference. Most pre-treatment variables were not associated with treatment outcome. However, higher adolescent-reported pre-treatment anxiety was associated with a greater reduction in anxiety at post-treatment, and the presence of a comorbid anxiety disorder was associated with poorer odds of treatment response. Findings indicate that residential treatment is a robust intervention for adolescent anxiety.
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Affiliation(s)
- Sophie C Schneider
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida, St. Petersburg, FL, USA. .,Rothman Center for Neuropsychiatry, Suite 460, 880 6th Street South, St. Petersburg, FL, 33701, USA.
| | - Valérie La Buissonnière-Ariza
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida, St. Petersburg, FL, USA
| | - Davíð R M A Højgaard
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Brian S Kay
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | | | | | - Peter Lake
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | | | - Eric A Storch
- Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida, St. Petersburg, FL, USA.,Rogers Behavioral Health - Tampa, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Health Management and Policy, University of South Florida, Tampa, FL, USA.,Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Iniesta-Sepúlveda M, Nadeau JM, Ramos A, Kay B, Riemann BC, Storch EA. An Initial Case Series of Intensive Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Adolescents with Autism Spectrum Disorder. Child Psychiatry Hum Dev 2018; 49:9-19. [PMID: 28389841 DOI: 10.1007/s10578-017-0724-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Obsessive-compulsive disorder (OCD) is prevalent among youth with autism spectrum disorder (ASD). Cognitive-behavioral therapy (CBT) with ASD-specific modifications has support for treating OCD in this population; however, use of intensive CBT in youth with ASD and severe OCD has not been tested. The current study examined the preliminary effectiveness of an individualized intensive CBT protocol for OCD in adolescents with ASD. Nine adolescents (aged 11-17 years) completed a regimen of intensive CBT (range 24-80 daily sessions) incorporating exposure with response prevention (ERP). Treatment materials, language and techniques were modified in accordance with evidence-based findings for this population. Seven of nine participants (78%) were treatment responders, and large treatment effects (d = 1.35-2.58) were obtained on primary outcomes (e.g., obsessive-compulsive symptom severity). Preliminary findings suggest that an intensive CBT approach for OCD is effective among adolescents with ASD.
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Affiliation(s)
- Marina Iniesta-Sepúlveda
- Department of Psychology, Catholic University of Murcia, Murcia, Spain. .,Department of Education, Catholic University of Murcia, 35 Campus de los Jerónimos, 30107, Guadalupe, Spain.
| | - Joshua M Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Amaya Ramos
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | | | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Rogers Memorial Hospital, Oconomowoc, WI, USA.,Department of Health Policy and Management, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA.,Department of Psychology, University of South Florida, St. Petersburg, FL, USA.,All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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Jones PJ, Mair P, Riemann BC, Mugno BL, McNally RJ. A network perspective on comorbid depression in adolescents with obsessive-compulsive disorder. J Anxiety Disord 2018; 53:1-8. [PMID: 29125957 DOI: 10.1016/j.janxdis.2017.09.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/18/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
Abstract
People with obsessive-compulsive disorder [OCD] frequently suffer from depression, a comorbidity associated with greater symptom severity and suicide risk. We examined the associations between OCD and depression symptoms in 87 adolescents with primary OCD. We computed an association network, a graphical LASSO, and a directed acyclic graph (DAG) to model symptom interactions. Models showed OCD and depression as separate syndromes linked by bridge symptoms. Bridges between the two disorders emerged between obsessional problems in the OCD syndrome, and guilt, concentration problems, and sadness in the depression syndrome. A directed network indicated that OCD symptoms directionally precede depression symptoms. Concentration impairment emerged as a highly central node that may be distinctive to adolescents. We conclude that the network approach to mental disorders provides a new way to understand the etiology and maintenance of comorbid OCD-depression. Network analysis can improve research and treatment of mental disorder comorbidities by generating hypotheses concerning potential causal symptom structures and by identifying symptoms that may bridge disorders.
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Affiliation(s)
- Payton J Jones
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA.
| | - Patrick Mair
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - Bradley C Riemann
- OCD Center and Cognitive-Behavioral Therapy Services, Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI, 53066, USA
| | - Beth L Mugno
- OCD Center and Cognitive-Behavioral Therapy Services, Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI, 53066, USA
| | - Richard J McNally
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
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29
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La Buissonnière-Ariza V, Schneider SC, Højgaard D, Kay BC, Riemann BC, Eken SC, Lake P, Nadeau JM, Storch EA. Family accommodation of anxiety symptoms in youth undergoing intensive multimodal treatment for anxiety disorders and obsessive-compulsive disorder: Nature, clinical correlates, and treatment response. Compr Psychiatry 2018; 80:1-13. [PMID: 28892781 DOI: 10.1016/j.comppsych.2017.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Family accommodation is associated with a range of clinical features including symptom severity, functional impairment, and treatment response. However, most previous studies in children and adolescents investigated family accommodation in samples of youth with obsessive-compulsive disorder (OCD) or anxiety disorders receiving non-intensive outpatient services. AIMS In this study, we aimed to investigate family accommodation of anxiety symptoms in a sample of youth with clinical anxiety levels undergoing an intensive multimodal intervention for anxiety disorders or OCD. PROCEDURES We first assessed the internal consistency of the Family Accommodation Scale - Anxiety (FASA). We next examined family accommodation presentation and correlates. RESULTS The FASA showed high internal consistency for all subscales and total score, and good item and subscale correlations with the total score. All parents reported at least mild accommodation, and the mean levels of family accommodation were particularly high. Child age, anxiety severity, and comorbid depressive symptoms predicted baseline accommodation. However, the association between anxiety severity and family accommodation no longer remained significant after adding the other factors to the model. In addition, family accommodation partially mediated the relationship between anxiety severity and functional impairment. Finally, post-treatment changes in family accommodation predicted changes in symptom severity and functional impairment. CONCLUSIONS These findings suggest the FASA is an appropriate tool to assess family accommodation in intensive treatment samples. Further, they underline the importance of addressing family accommodation in this population given the particularly high levels of accommodating behaviors and the evidence for adverse outcomes associated with this feature.
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Affiliation(s)
- Valérie La Buissonnière-Ariza
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA
| | - Sophie C Schneider
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA
| | - Davíð Højgaard
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark
| | - Brian C Kay
- Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066, USA
| | - Bradley C Riemann
- Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066, USA
| | - Stephanie C Eken
- Rogers Behavioral Health - Nashville, 4230 Harding Road, Suite 707, Nashville, TN 37205, USA
| | - Peter Lake
- Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066, USA
| | - Joshua M Nadeau
- Rogers Behavioral Health - Tampa, 2002, North Lois Ave, Tampa Bay, Tampa, FL, 33607, USA
| | - Eric A Storch
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA; Rogers Behavioral Health - Tampa, 2002, North Lois Ave, Tampa Bay, Tampa, FL, 33607, USA; Department of Psychology, University of South Florida, 4202 East Fowler Ave, PCD4118G, Tampa, FL 33620, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave., Tampa, FL 33613, USA; Department of Health Management and Policy, University of South Florida, 13201 Bruce B. Downs Blvd., MDC56, Tampa, FL 33612-3805, USA; Johns Hopkins All Children's Hospital, 501 6th Avenue South, St. Petersburg, FL 33701, USA.
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Blakey SM, Abramowitz JS, Reuman L, Leonard RC, Riemann BC. Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2017; 57:113-117. [PMID: 28505489 DOI: 10.1016/j.jbtep.2017.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 02/20/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed.
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Affiliation(s)
- Shannon M Blakey
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | | | - Lillian Reuman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Iniesta Sepúlveda M, Nadeau JM, Whelan MK, Oiler CM, Ramos A, Riemann BC, Storch EA. Intensive family exposure-based cognitive-behavioral treatment for adolescents with anorexia nervosa. Psicothema 2017; 29:433-439. [PMID: 29048300 DOI: 10.7334/psicothema2016.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anorexia nervosa exhibits high comorbidity rates and shared features with anxiety disorders and obsessive-compulsive disorder. Anxiety-based etiological models have proposed that fear of eating-related stimuli is the central mechanism around which avoidance of food and food-related rituals are performed. Building on this approach, exposure-based interventions have demonstrated promising results. Limited evidence in adolescents encourages the evaluation of exposure approaches in this population. METHOD The current study presents a preliminary evaluation, in eight adolescents with anorexia nervosa, of an exposure-based CBT featuring an intensive format and parental involvement. RESULTS significant improvements in physical and psychological outcomes were observed. CONCLUSIONS this case series provides preliminary support for the efficacy of intensive family exposure-based CBT for treating adolescents with severe anorexia nervosa.
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Reuman L, Jacoby RJ, Blakey SM, Riemann BC, Leonard RC, Abramowitz JS. Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder. Psychiatry Res 2017; 256:417-422. [PMID: 28697487 DOI: 10.1016/j.psychres.2017.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Illness anxiety and OCD symptoms appear to overlap in their presentation as well as in other conceptually important ways (e.g., dysfunctional cognitions). Little research, however, has directly examined these putative relationships. The present study examined the extent to which illness anxiety symptoms were associated with OCD symptom dimensions and relevant cognitive factors in a large treatment-seeking sample of patients with OCD. Patients completed a battery of self-report measures of OCD and health anxiety symptoms and related cognitive biases. Results from regression analyses indicated that illness anxiety symptoms were associated with harm obsessions and checking rituals, as well as with the tendency to overestimate threat and responsibility for harm. Illness anxiety was not associated with perfectionism. Conceptual and clinical implications of these findings are discussed.
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Affiliation(s)
- Lillian Reuman
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan J Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Shannon M Blakey
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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33
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Smith KE, Mason TB, Murray SB, Griffiths S, Leonard RC, Wetterneck CT, Smith BER, Farrell NR, Riemann BC, Lavender JM. Male clinical norms and sex differences on the Eating Disorder Inventory (EDI) and Eating Disorder Examination Questionnaire (EDE-Q). Int J Eat Disord 2017; 50:769-775. [PMID: 28436086 PMCID: PMC5741972 DOI: 10.1002/eat.22716] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Evidence indicates that males account for a significant minority of patients with eating disorders (EDs). However, prior research has been limited by inclusion of small and predominantly non-clinical samples of males. This study aimed to (1) provide male clinical norms for widely used ED measures (Eating Disorder Examination Questionnaire [EDE-Q] and Eating Disorder Inventory-3 [EDI-3]) and (2) examine sex differences in overall ED psychopathology. METHOD Participants were 386 male and 1,487 female patients with an ED diagnosis aged 16 years and older who completed the EDE-Q and EDI-3 upon admission to a residential or partial hospital ED treatment program. RESULTS Normative data were calculated for the EDE-Q (global and subscales) and the EDI-3 (drive for thinness, body dissatisfaction, and bulimia). Analyses of variance (ANOVAs) used to examine sex, ED diagnosis, and their interaction in relation to overall ED psychopathology revealed a consistent pattern of greater severity among females for ED psychopathology. DISCUSSION This study provides clinical norms on the EDE-Q and the EDI-3 for males with clinically diagnosed EDs. It is unclear whether the greater severity observed in females reflects qualitative differences in ED presentation or true quantitative differences in ED severity. Additional research examining the underlying nature of these differences and utilizing male-specific ED measures with clinical samples is warranted.
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Affiliation(s)
- Kathryn E. Smith
- Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Tyler B. Mason
- Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Stuart B. Murray
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Scott Griffiths
- Research School of Psychology, Australian National University, Australia,Centre for Applied Psychology, University of Canberra, Australia,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | - Jason M. Lavender
- Department of Psychiatry, University of California, San Diego, La Jolla, California
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Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is often co-morbid with depression. Using the methods of network analysis, we computed two networks that disclose the potentially causal relationships among symptoms of these two disorders in 408 adult patients with primary OCD and co-morbid depression symptoms. METHOD We examined the relationship between the symptoms constituting these syndromes by computing a (regularized) partial correlation network via the graphical LASSO procedure, and a directed acyclic graph (DAG) via a Bayesian hill-climbing algorithm. RESULTS The results suggest that the degree of interference and distress associated with obsessions, and the degree of interference associated with compulsions, are the chief drivers of co-morbidity. Moreover, activation of the depression cluster appears to occur solely through distress associated with obsessions activating sadness - a key symptom that 'bridges' the two syndromic clusters in the DAG. CONCLUSIONS Bayesian analysis can expand the repertoire of network analytic approaches to psychopathology. We discuss clinical implications and limitations of our findings.
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Affiliation(s)
- R J McNally
- Department of Psychology,Harvard University,33 Kirkland Street, Cambridge, MA 02138,USA
| | - P Mair
- Department of Psychology,Harvard University,33 Kirkland Street, Cambridge, MA 02138,USA
| | - B L Mugno
- OCD Center and Cognitive-Behavioral Therapy Services,Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066,USA
| | - B C Riemann
- OCD Center and Cognitive-Behavioral Therapy Services,Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066,USA
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35
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Olatunji BO, Ebesutani C, Kim J, Riemann BC, Jacobi DM. Disgust proneness predicts obsessive-compulsive disorder symptom severity in a clinical sample of youth: Distinctions from negative affect. J Affect Disord 2017; 213:118-125. [PMID: 28222359 DOI: 10.1016/j.jad.2017.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/09/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although studies have linked disgust proneness to the etiology and maintenance of obsessive-compulsive disorder (OCD) in adults, there remains a paucity of research examining the specificity of this association among youth. METHOD The present study employed structural equation modeling to examine the association between disgust proneness, negative affect, and OCD symptom severity in a clinical sample of youth admitted to a residential treatment facility (N =471). RESULTS Results indicate that disgust proneness and negative affect latent factors independently predicted an OCD symptom severity latent factor. However, when both variables were modeled as predictors simultaneously, latent disgust proneness remained significantly associated with OCD symptom severity, whereas the association between latent negative affect and OCD symptom severity became nonsignificant. Tests of mediation converged in support of disgust proneness as a significant intervening variable between negative affect and OCD symptom severity. Subsequent analysis showed that the path from disgust proneness to OCD symptom severity in the structural model was significantly stronger among those without a primary diagnosis of OCD compared to those with a primary diagnosis of OCD. LIMITATIONS Given the cross-sectional design, the causal inferences that can be made are limited. The present study is also limited by the exclusive reliance on self-report measures. CONCLUSIONS Disgust proneness may play a uniquely important role in OCD among youth.
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Affiliation(s)
| | | | - Jingu Kim
- Konkuk University, Republic of Korea
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Abstract
This study evaluated the psychometric properties of the Child Disgust Scale (CDS) among 457 youth (ages 8-17, M = 14.77 ± 1.98 years) initiating residential treatment for obsessive-compulsive disorder and anxiety disorders. Confirmatory factor analysis supported a bifactor model with two distinct factors of Disgust Avoidance and Disgust Affect, in addition to an overall General Disgust factor. Strong internal consistency was observed for the CDS total and factor scores. In addition, CDS scores demonstrated generally modest and positive correlations with child-reported obsessive-compulsive and anxiety symptoms, weaker correlations with parent-reported anxiety and child-rated impairment, and non-significant correlations with parent-rated impairment. Findings suggest that the CDS displays strong psychometric properties and is developmentally appropriate for use in pediatric clinical populations with obsessive-compulsive and anxiety disorders.
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Affiliation(s)
- Joshua M Nadeau
- Department of Pediatrics, University of South Florida, Tampa, FL, USA.
- Rogers Memorial Hospital, Tampa, FL, USA.
| | - Alessandro S De Nadai
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | | | - Bunmi O Olatunji
- Rogers Memorial Hospital, Tampa, FL, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | | | - Brian Kay
- Rogers Memorial Hospital, Tampa, FL, USA
| | | | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
- Rogers Memorial Hospital, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
- Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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Storch EA, Nadeau JM, De Nadai AS, Cepeda SL, Riemann BC, Seibell P, Kay B. Symptom correspondence between clinicians and patients on the Yale-Brown Obsessive Compulsive Scale. Compr Psychiatry 2017; 73:105-110. [PMID: 27930951 DOI: 10.1016/j.comppsych.2016.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 12/30/2022] Open
Abstract
The present study examined concordance between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and its self-report version (Y-BOCS-SR), as well as theoretically derived moderators. Sixty-seven adults (ages 18-67) with obsessive-compulsive disorder (OCD) were administered the Y-BOCS prior to completing self-report measures. The Y-BOCS-SR generated lower scores relative to the clinician-administered Y-BOCS (5.3 points lower). Strong correspondence was shown between the Y-BOCS and Y-BOCS-SR; however, many items exhibited fair to moderate agreement, particularly the resistance and control against obsessions/compulsions items. Depression significantly moderated correspondence such that Y-BOCS-SR scores significantly predicted Y-BOCS scores in the presence of low and average depression levels in our sample, but not for patients with high levels of depression relative to the rest of our sample; gender, generalized anxiety and obsessionality did not significantly impact agreement. Synthesizing the present data, the Y-BOCS-SR demonstrates modest agreement with the Y-BOCS and may underestimate clinical severity especially for those with high levels of depression.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Health Management and Policy, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children's Hospital-Johns Hopkins Medicine, St. Petersburg, FL, USA.
| | - Joshua M Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
| | | | - Sandra L Cepeda
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Philip Seibell
- OCD and Anxiety Psychiatry of Westchester, P.C., Hawthorne, NY, USA
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, WI, USA
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Knowles KA, Viar-Paxton MA, Riemann BC, Jacobi DM, Olatunji BO. Is disgust proneness sensitive to treatment for OCD among youth?: Examination of diagnostic specificity and symptom correlates. J Anxiety Disord 2016; 44:47-54. [PMID: 27744071 DOI: 10.1016/j.janxdis.2016.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/26/2016] [Accepted: 09/29/2016] [Indexed: 11/27/2022]
Abstract
Although disgust proneness has been implicated in obsessive-compulsive disorder (OCD), there is a paucity of research examining change in disgust proneness during treatment as well as the correlates of such change, especially in children. This study examined the relationship between changes in disgust proneness and disorder-specific symptoms during residential treatment among youth with OCD, anxiety, and mood disorders. Youth ages 12-18 (n=472) completed pre- and post-outcome measures of OCD, anxiety, and mood symptoms and disgust proneness. Results indicate that although disgust proneness decreases during treatment for youth with OCD, anxiety, and mood disorders, youth with primary OCD experienced the greatest decrease in disgust proneness over the course of treatment. Reductions in disgust proneness during treatment were significantly correlated with reductions in multiple symptom measures, with the strongest correlations between reductions in disgust proneness and OCD symptoms. Implications and directions for future research are discussed.
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Affiliation(s)
- Kelly A Knowles
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
| | | | | | | | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Rogers Memorial Hospital, Oconomowoc, WI, USA
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Leonard RC, Franklin ME, Wetterneck CT, Riemann BC, Simpson HB, Kinnear K, Cahill SP, Lake PM. Residential treatment outcomes for adolescents with obsessive-compulsive disorder. Psychother Res 2015; 26:727-36. [PMID: 26308588 DOI: 10.1080/10503307.2015.1065022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context. METHOD One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed measures at admission and discharge. Almost all (92.4%) participants had at least two diagnoses and nearly half (44.2%) had three or more. Treatment consisted of intensive ERP (i.e., approximately 26.5 hr per week), additional cognitive behavioral therapy interventions, and medication management within a residential setting. In contrast to the samples reported on in the vast majority of other pediatric OCD trials, participants in the current study were living apart from their families and were immersed within the treatment setting, with staff members available at all times. RESULTS Paired sample t-tests revealed significant decreases in OCD and depression severity. CONCLUSIONS Results suggest that residential treatment for adolescents with OCD using a multimodal approach emphasizing ERP can be effective for complex cases with significant comorbidity. Results were comparable with several randomized controlled trials.
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Affiliation(s)
| | - Martin E Franklin
- b Department of Psychiatry , University of Pennsylvania School of Medicine , Philadelphia , PA , USA
| | | | | | - H Blair Simpson
- c Department of Psychiatry , Columbia University , New York , NY , USA.,d Division of Clinical Therapeutics , New York State Psychiatric Institute , New York , NY , USA
| | | | - Shawn P Cahill
- e Department of Psychology , University of Wisconsin - Milwaukee , Milwaukee , WI , USA
| | - Peter M Lake
- a Rogers Memorial Hospital , Oconomowoc , WI , USA
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Chase T, Wetterneck CT, Bartsch RA, Leonard RC, Riemann BC. Investigating Treatment Outcomes Across OCD Symptom Dimensions in a Clinical Sample of OCD Patients. Cogn Behav Ther 2015; 44:365-76. [DOI: 10.1080/16506073.2015.1015162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thibodeau MA, Leonard RC, Abramowitz JS, Riemann BC. Secondary Psychometric Examination of the Dimensional Obsessive-Compulsive Scale: Classical Testing, Item Response Theory, and Differential Item Functioning. Assessment 2014; 22:681-9. [PMID: 25422521 DOI: 10.1177/1073191114559123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Dimensional Obsessive-Compulsive Scale (DOCS) is a promising measure of obsessive-compulsive disorder (OCD) symptoms but has received minimal psychometric attention. We evaluated the utility and reliability of DOCS scores. The study included 832 students and 300 patients with OCD. Confirmatory factor analysis supported the originally proposed four-factor structure. DOCS total and subscale scores exhibited good to excellent internal consistency in both samples (α = .82 to α = .96). Patient DOCS total scores reduced substantially during treatment (t = 16.01, d = 1.02). DOCS total scores discriminated between students and patients (sensitivity = 0.76, 1 - specificity = 0.23). The measure did not exhibit gender-based differential item functioning as tested by Mantel-Haenszel chi-square tests. Expected response options for each item were plotted as a function of item response theory and demonstrated that DOCS scores incrementally discriminate OCD symptoms ranging from low to extremely high severity. Incremental differences in DOCS scores appear to represent unbiased and reliable differences in true OCD symptom severity.
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Taylor S, McKay D, Miguel EC, De Mathis MA, Andrade C, Ahuja N, Sookman D, Kwon JS, Huh MJ, Riemann BC, Cottraux J, O'Connor K, Hale LR, Abramowitz JS, Fontenelle LF, Storch EA. Musical obsessions: a comprehensive review of neglected clinical phenomena. J Anxiety Disord 2014; 28:580-9. [PMID: 24997394 DOI: 10.1016/j.janxdis.2014.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 05/09/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N=96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.
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Affiliation(s)
| | | | | | | | | | - Niraj Ahuja
- Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | | | | | | | | | | | - Kieron O'Connor
- Centre de Recherche, University Institute of Mental Health at Montreal, PQ, Canada
| | - Lisa R Hale
- Kansas City Center for Anxiety Treatment, KS, USA
| | | | | | - Eric A Storch
- Rogers Memorial Hospital, WI, USA; University of South Florida, FL, USA
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Riemann BC, Kuckertz JM, Rozenman M, Weersing VR, Amir N. Augmentation of youth cognitive behavioral and pharmacological interventions with attention modification: a preliminary investigation. Depress Anxiety 2013; 30:822-8. [PMID: 23658147 PMCID: PMC4005412 DOI: 10.1002/da.22127] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 12/22/2012] [Accepted: 02/22/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent research suggests the efficacy of attention modification programs (AMP) in treating adult anxiety.([1]) Though some research supports the success of AMP treatment in anxious youths,([2, 3]) to date no study has examined the efficacy of AMP as an adjunctive treatment to other psychosocial and pharmacological interventions for anxious youths within the community. METHODS In the current study, we examined the efficacy of AMP as an adjunctive treatment to standard care at a residential anxiety treatment facility. Adolescents (N = 42) completed either an active (attention modification program, AMP; n = 21) or a control (attention control condition, ACC; n = 21) condition, in addition to the facility's standard treatment protocol, which included cognitive behavioral therapy with or without medication. RESULTS While anxiety symptoms decreased for participants across both groups, participants in the AMP group experienced a significantly greater decrease in anxiety symptoms from point of intake to point of discharge, in comparison to participants in the ACC group. CONCLUSIONS These results suggest that AMP is an effective adjunctive treatment to the standard treatments of choice for anxiety disorders, and may hold promise for improving treatment response in highly anxious youths.
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Affiliation(s)
| | - Jennie M. Kuckertz
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Michelle Rozenman
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Nader Amir
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
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Jacoby RJ, Fabricant LE, Leonard RC, Riemann BC, Abramowitz JS. Just to be certain: Confirming the factor structure of the intolerance of uncertainty scale in patients with obsessive-compulsive disorder. J Anxiety Disord 2013; 27:535-42. [PMID: 23973743 DOI: 10.1016/j.janxdis.2013.07.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/24/2013] [Accepted: 07/27/2013] [Indexed: 11/26/2022]
Abstract
Intolerance of uncertainty (IU) is a cognitive construct in obsessive-compulsive disorder (OCD); yet no studies exist confirming the factor structure of the most widely used measure of IU, the intolerance of uncertainty scale (IUS), in OCD patients. Moreover, no studies have examined how scores on this measure relate to OCD symptom dimensions. Accordingly, the present study examined a 12-item two-factor revised version of the IUS (IUS-12) in 205 OCD patients. Confirmatory factor analysis verified the scale's two-factor structure. The measure also demonstrated high internal consistency and the IUS-12 was correlated moderately with another self-report measure of IU. Finally, theoretically consistent and specific relationships emerged between the IUS-12 and OCD symptom dimensions. These findings are discussed in terms of implications for the assessment and treatment of OCD, and specifically how elevated scores on the IUS-12 subscales may be utilized to identify subtleties in the presentation of OCD-related problems with IU.
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Affiliation(s)
- Ryan J Jacoby
- University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, NC 27599, USA.
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Simpson HB, Wetterneck CT, Cahill SP, Steinglass JE, Franklin ME, Leonard RC, Weltzin TE, Riemann BC. Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cogn Behav Ther 2013; 42:64-76. [PMID: 23316878 DOI: 10.1080/16506073.2012.751124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. METHODS A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale--Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures. MAIN RESULTS Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission. CONCLUSION Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases.
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Affiliation(s)
- H Blair Simpson
- Department of Psychiatry, Columbia University, New York, USA.
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Adams TG, Riemann BC, Wetterneck CT, Cisler JM. Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder. Cogn Behav Ther 2012; 41:203-11. [PMID: 22309121 DOI: 10.1080/16506073.2011.621969] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Cognitive accounts of obsessive compulsive disorder (OCD) assert that core beliefs are crucial to the development, maintenance, and treatment of the disorder. There are a number of obsessive beliefs that are considered fundamental to OCD, including personal responsibility, threat estimation, perfectionism, need for certainty, importance of thoughts, and thought control. The present study investigated if pretreatment severity of obsessive beliefs, as well as the change in obsessive beliefs following treatment, predicted intensive, residential cognitive behavioral therapy (CBT) treatment outcome. A series of hierarchical regression analyses were carried out to investigate the relations between obsessive beliefs and treatment outcome. Results indicated that inflated pretreatment responsibility/threat estimation beliefs were significantly related to less overall obsessive compulsive (OC) symptom reduction at discharge, explaining 2% of the overall variance. Changes in obsessive beliefs broadly, and importance/control of thoughts specifically, were positively related to overall OC symptom reduction at discharge, respectively explaining 18% and 3.6% variance. Results are modestly consistent with a number of theoretical models, which argue that inflated responsibility, threat estimation, and thought control are important to the maintenance and treatment of OCD.
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Affiliation(s)
- Thomas G Adams
- University of Arkansas, Fayetteville, Arkansas, United States.
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Manos RC, Cahill SP, Wetterneck CT, Conelea CA, Ross AR, Riemann BC. The impact of experiential avoidance and obsessive beliefs on obsessive-compulsive symptoms in a severe clinical sample. J Anxiety Disord 2010; 24:700-8. [PMID: 20627655 DOI: 10.1016/j.janxdis.2010.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 11/29/2022]
Abstract
The present study sought to replicate and extend a study by Abramowitz et al. (2009), who examined how well experiential avoidance (EA) and obsessive beliefs predicted obsessive-compulsive (OC) symptoms in a non-clinical sample. The current study utilized a severe, clinical, treatment-seeking sample (N=108), and examined how well EA and obsessive beliefs predicted changes in OC symptoms from pre- to post-treatment. Findings were generally consistent with Abramowitz et al. EA was generally not related to OC severity and did not add significantly to the prediction of OC symptom domains above and beyond depression or general anxiety, whereas obsessive beliefs did. Pre- to post-treatment change in one type of obsessive belief (perfectionism/certainty), but not change in EA, predicted global change in OC severity. Results suggest that EA as it is measured currently may not play a significant role in OC severity or changes in OC severity across treatment.
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Affiliation(s)
- Rachel C Manos
- Department of Psychology, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, USA.
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Abramowitz JS, Deacon BJ, Olatunji BO, Wheaton MG, Berman NC, Losardo D, Timpano KR, McGrath PB, Riemann BC, Adams T, Björgvinsson T, Storch EA, Hale LR. Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychol Assess 2010; 22:180-98. [PMID: 20230164 DOI: 10.1037/a0018260] [Citation(s) in RCA: 412] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although several measures of obsessive-compulsive (OC) symptoms exist, most are limited in that they are not consistent with the most recent empirical findings on the nature and dimensional structure of obsessions and compulsions. In the present research, the authors developed and evaluated a measure called the Dimensional Obsessive-Compulsive Scale (DOCS) to address limitations of existing OC symptom measures. The DOCS is a 20-item measure that assesses the four dimensions of OC symptoms most reliably replicated in previous structural research. Factorial validity of the DOCS was supported by exploratory and confirmatory factor analyses of 3 samples, including individuals with OC disorder, those with other anxiety disorders, and nonclinical individuals. Scores on the DOCS displayed good performance on indices of reliability and validity, as well as sensitivity to treatment and diagnostic sensitivity, and hold promise as a measure of OC symptoms in clinical and research settings.
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Affiliation(s)
- Jonathan S Abramowitz
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Wheaton MG, Abramowitz JS, Berman NC, Riemann BC, Hale LR. The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder. Behav Res Ther 2010; 48:949-54. [PMID: 20800750 DOI: 10.1016/j.brat.2010.05.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 05/17/2010] [Accepted: 05/21/2010] [Indexed: 01/12/2023]
Abstract
Research findings on the specific relationships between beliefs and OCD symptoms have been inconsistent, yet the existing studies vary in their approach to measuring the highly heterogeneous symptoms of this disorder. The Dimensional Obsessive-Compulsive Scale (DOCS) is a new measure that allows for the assessment of OCD symptom dimensions, rather than types of obsessions and compulsions per se. The present study examined the relationship between OCD symptom dimensions and dysfunctional (obsessive) beliefs believed to underlie these symptom dimensions using a large clinical sample of treatment-seeking adults with OCD. Results revealed that certain obsessive beliefs predicted certain OCD symptom dimensions in a manner consistent with cognitive-behavioral conceptual models. Specifically, contamination symptoms were predicted by responsibility/threat estimation beliefs, symmetry symptoms were predicted by perfectionism/certainty beliefs, unacceptable thoughts were predicted by importance/control of thoughts beliefs and symptoms related to being responsible for harm were predicted by responsibility/threat estimation beliefs. Implications for cognitive conceptualizations of OCD symptom dimensions are discussed.
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Abstract
An inflated sense of responsibility often characterizes patients with obsessive-compulsive disorder (OCD). In this study, we asked OCD patients (n=20) and control participants (n=18) to resolve a series of moral dilemmas embedded in hypothetical scenarios. Each scenario required participants to choose one of two undesirable courses of action, both involving loss of life. The utilitarian option required them to act, thereby causing the death of one person, but indirectly saving the lives of others whose death would otherwise have occurred. The other option involved no action on their part, but their failure to act resulted in the deaths of people. The groups did not differ significantly in the options chosen, or in their latencies to resolve moral dilemmas. However, within the OCD group, the higher patients' scores on the Responsibility Attitude Scale, the less likely they were to act to kill one person to save the lives of others. In summary, these data imply a stronger association between moral reasoning patterns and responsibility attitudes than to OCD per se.
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