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Ramakrishnan D, Farhat LC, Vattimo EFQ, Levine JLS, Johnson JA, Artukoglu BB, Landeros-Weisenberger A, Zangen A, Pelissolo A, de B Pereira CA, Rück C, Costa DLC, Mataix-Cols D, Shannahoff-Khalsa D, Tolin DF, Zarean E, Meyer E, Hawken ER, Storch EA, Andersson E, Miguel EC, Maina G, Leckman JF, Sarris J, March JS, Diniz JB, Kobak K, Mallet L, Vulink NCC, Amiaz R, Fernandes RY, Shavitt RG, Wilhelm S, Golshan S, Tezenas du Montcel S, Erzegovesi S, Baruah U, Greenberg WM, Kobayashi Y, Bloch MH. An evaluation of treatment response and remission definitions in adult obsessive-compulsive disorder: A systematic review and individual-patient data meta-analysis. J Psychiatr Res 2024; 173:387-397. [PMID: 38598877 DOI: 10.1016/j.jpsychires.2024.03.044] [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: 07/23/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. METHODS We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. RESULTS Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. CONCLUSION While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions.
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Affiliation(s)
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Edoardo F Q Vattimo
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Jessica A Johnson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bekir B Artukoglu
- Department of Child and Adolescent Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Abraham Zangen
- Department of Life Sciences and the Zelman Center for Neuroscience, Ben Gurion University, Be'er Sheva, Israel
| | - Antoine Pelissolo
- Psychiatry Department, Henri-Mondor University Hospitals, Faculty of Medicine, Créteil, France
| | - Carlos A de B Pereira
- Mathematics and Statistics Institute, Statistics Department, University of São Paulo, São Paulo, Brazil
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Daniel L C Costa
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - David Shannahoff-Khalsa
- The Research Group for Mind-Body Dynamics, BioCircuits Institute and Center for Integrative Medicine, University of California San Diego, CA, USA; The Khalsa Foundation for Medical Science, Del Mar, CA, USA
| | - David F Tolin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; The Institute of Living, Hartford, CT, USA
| | - Elham Zarean
- Department of Psychiatry, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Elisabeth Meyer
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - James F Leckman
- Child Study Center, Department of Pediatrics and Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jerome Sarris
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia; NICM Health Research Institute, Western Sydney University, NSW, Australia
| | - John S March
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, USA
| | - Juliana B Diniz
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Luc Mallet
- Medical-University Department of Psychiatry and Addictology, Henri Mondor - Albert Chenevier University Hospitals, Créteil, France
| | - Nienke C C Vulink
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | | | - Rodrigo Yacubian Fernandes
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli G Shavitt
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Sabine Wilhelm
- OCD and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Sophie Tezenas du Montcel
- Sorbonne Universite, Institut du Cerveau Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Inria Aramis project-team, Paris, France
| | - Stefano Erzegovesi
- Department of Neurosciences, Eating Disorders Unit, IRCCS San Raffaele, Milano, Italy
| | - Upasana Baruah
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Yuki Kobayashi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Shannahoff-Khalsa D, Fernandes RY, Pereira CADB, March JS, Leckman JF, Golshan S, Vieira MSR, Polanczyk GV, Miguel EC, Shavitt RG. Kundalini Yoga Meditation Versus the Relaxation Response Meditation for Treating Adults With Obsessive-Compulsive Disorder: A Randomized Clinical Trial. Front Psychiatry 2019; 10:793. [PMID: 31780963 PMCID: PMC6859828 DOI: 10.3389/fpsyt.2019.00793] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is often a life-long disorder with high psychosocial impairment. Serotonin reuptake inhibitors (SRIs) are the only FDA approved drugs, and approximately 50% of patients are non-responders when using a criterion of 25% to 35% improvement with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). About 30% are non-responders to combined first-line therapies (SRIs and exposure and response prevention). Previous research (one open, one randomized clinical trial) has demonstrated that Kundalini Yoga (KY) meditation can lead to an improvement in symptoms of obsessive-compulsive severity. We expand here with a larger trial. Design: This trial compared two parallel run groups [KY vs. Relaxation Response meditation (RR)]. Patients were randomly allocated based on gender and Y-BOCS scores. They were told two different (unnamed) types of meditation would be compared, and informed if one showed greater benefits, the groups would merge for 12 months using the more effective intervention. Raters were blind in Phase One (0-4.5 months) to patient assignments, but not in Phase Two. Main Outcome Measures: Primary outcome variable, clinician-administered Y-BOCS. Secondary scales: Dimensional Yale-Brown Obsessive Compulsive Scale (clinician-administered), Profile of Mood Scales, Beck Anxiety Inventory, Beck Depression Inventory, Clinical Global Impression, Short Form 36 Health Survey. Results: Phase One: Baseline Y-BOCS scores: KY mean = 26.46 (SD 5.124; N = 24), RR mean = 26.79 (SD = 4.578; N = 24). An intent-to-treat analysis with the last observation carried forward for dropouts showed statistically greater improvement with KY compared to RR on the Y-BOCS, and statistically greater improvement on five of six secondary measures. For completers, the Y-BOCS showed 40.4% improvement for KY (N = 16), 17.9% for RR (N = 11); 31.3% in KY were judged to be in remission compared to 9.1% in RR. KY completers showed greater improvement on five of six secondary measures. At the end of Phase Two (12 months), patients, drawn from the initial groups, who elected to receive KY continued to show improvement in their Y-BOCS scores. Conclusion: KY shows promise as an add-on option for OCD patients unresponsive to first line therapies. Future studies will establish KY's relative efficacy compared to Exposure and Response Prevention and/or medications, and the most effective treatment schedule. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01833442.
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Affiliation(s)
- David Shannahoff-Khalsa
- BioCircuits Institute, University of California, San Diego, La Jolla, CA, United States.,Center for Integrative Medicine, University of California, San Diego, La Jolla, CA, United States.,The Khalsa Foundation for Medical Science, Del Mar, CA, United States
| | - Rodrigo Yacubian Fernandes
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carlos A de B Pereira
- Mathematics and Statistics Institute, Statistics Department, University of São Paulo, São Paulo, Brazil
| | - John S March
- Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC, United States
| | - James F Leckman
- Child Study Center, Department of Pediatrics and Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Shahrokh Golshan
- Center for Integrative Medicine, University of California, San Diego, La Jolla, CA, United States.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | | | - Guilherme V Polanczyk
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Euripedes C Miguel
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli G Shavitt
- The National Institute of Developmental Psychiatry for Children and Adolescents (INPD), Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
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Vêncio RZN, Varuzza L, de B Pereira CA, Brentani H, Shmulevich I. Simcluster: clustering enumeration gene expression data on the simplex space. BMC Bioinformatics 2007; 8:246. [PMID: 17625017 PMCID: PMC2147035 DOI: 10.1186/1471-2105-8-246] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 07/11/2007] [Indexed: 02/06/2023] Open
Abstract
Background Transcript enumeration methods such as SAGE, MPSS, and sequencing-by-synthesis EST "digital northern", are important high-throughput techniques for digital gene expression measurement. As other counting or voting processes, these measurements constitute compositional data exhibiting properties particular to the simplex space where the summation of the components is constrained. These properties are not present on regular Euclidean spaces, on which hybridization-based microarray data is often modeled. Therefore, pattern recognition methods commonly used for microarray data analysis may be non-informative for the data generated by transcript enumeration techniques since they ignore certain fundamental properties of this space. Results Here we present a software tool, Simcluster, designed to perform clustering analysis for data on the simplex space. We present Simcluster as a stand-alone command-line C package and as a user-friendly on-line tool. Both versions are available at: http://xerad.systemsbiology.net/simcluster. Conclusion Simcluster is designed in accordance with a well-established mathematical framework for compositional data analysis, which provides principled procedures for dealing with the simplex space, and is thus applicable in a number of contexts, including enumeration-based gene expression data.
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Affiliation(s)
- Ricardo ZN Vêncio
- Institute for Systems Biology, 1441 North 34th street, Seattle, WA 98103-8904, USA
| | - Leonardo Varuzza
- BIOINFO-USP – Núcleo de Pesquisas em Bioinformática, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos A de B Pereira
- BIOINFO-USP – Núcleo de Pesquisas em Bioinformática, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ilya Shmulevich
- Institute for Systems Biology, 1441 North 34th street, Seattle, WA 98103-8904, USA
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Baptista CS, Vêncio RZN, Abdala S, Carranza JC, Westenberger SJ, Silva MN, Pereira CADB, Galvão LMC, Gontijo ED, Chiari E, Sturm NR, Zingales B. Differential transcription profiles in Trypanosoma cruzi associated with clinical forms of Chagas disease: Maxicircle NADH dehydrogenase subunit 7 gene truncation in asymptomatic patient isolates. Mol Biochem Parasitol 2006; 150:236-48. [PMID: 16996148 DOI: 10.1016/j.molbiopara.2006.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 08/18/2006] [Accepted: 08/21/2006] [Indexed: 01/08/2023]
Abstract
The majority of individuals in the chronic phase of Chagas disease are asymptomatic (indeterminate form). Every year 2-3% of these individuals develop severe clinical manifestations (cardiac and digestive forms). In this study a Trypanosoma cruzi DNA microarray was used to compare the transcript profiles of six human isolates: three from asymptomatic and three from cardiac patients. Seven signals were expressed differentially between the two classes of isolates, including tryparedoxin, surface protease GP63, cyclophilin, some hypothetical proteins and the pre-edited maxicircle gene NADH dehydrogenase subunit 7 (ND7). The approximately 30-fold greater signal in cardiac strains for ND7 was the most pronounced of the group, and differential levels of pre-edited ND7 transcript confirmed the microarray analysis. The ND7 gene from asymptomatic isolates showed a deletion of 455bp from nt 222 to nt 677 relative to ND7 of the CL Brener reference strain. The ND7 gene structure correlated with disease manifestation for 20 isolates from clinically characterised, chronic phase patients. The ND7 lesion produces a truncated product that could impair the function of mitochondrial complex I. Possible links between the integrity of the electron transport chain and symptom presentation are discussed. We propose that ND7 and other genes of the pathway constitute valuable targets for PCR assays in the differential diagnosis of the infective T. cruzi strain. While this hypothesis requires validation by the examination of additional recent parasite isolates from patients with defined pathologies, the identification of specific molecular markers represents a promising advance in the association between parasite genetics and disease pathology.
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Affiliation(s)
- Cassio S Baptista
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Avenida Professor Lineu Prestes, 748 CEP 05508-000, São Paulo, SP, Brazil
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Vêncio RZN, Koide T, Gomes SL, de B Pereira CA. BayGO: Bayesian analysis of ontology term enrichment in microarray data. BMC Bioinformatics 2006; 7:86. [PMID: 16504085 PMCID: PMC1440873 DOI: 10.1186/1471-2105-7-86] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 02/23/2006] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The search for enriched (aka over-represented or enhanced) ontology terms in a list of genes obtained from microarray experiments is becoming a standard procedure for a system-level analysis. This procedure tries to summarize the information focussing on classification designs such as Gene Ontology, KEGG pathways, and so on, instead of focussing on individual genes. Although it is well known in statistics that association and significance are distinct concepts, only the former approach has been used to deal with the ontology term enrichment problem. RESULTS BayGO implements a Bayesian approach to search for enriched terms from microarray data. The R source-code is freely available at http://blasto.iq.usp.br/~tkoide/BayGO in three versions: Linux, which can be easily incorporated into pre-existent pipelines; Windows, to be controlled interactively; and as a web-tool. The software was validated using a bacterial heat shock response dataset, since this stress triggers known system-level responses. CONCLUSION The Bayesian model accounts for the fact that, eventually, not all the genes from a given category are observable in microarray data due to low intensity signal, quality filters, genes that were not spotted and so on. Moreover, BayGO allows one to measure the statistical association between generic ontology terms and differential expression, instead of working only with the common significance analysis.
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Affiliation(s)
- Ricardo ZN Vêncio
- BIOINFO-USP Núcleo de Pesquisas em Bioinformática, Universidade de São Paulo, Rua do Matão 1010, 05508-090 São Paulo, Brazil
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, 05651-901 São Paulo, Brazil
| | - Tie Koide
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, 05508-000 São Paulo, Brazil
| | - Suely L Gomes
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, Av. Prof. Lineu Prestes 748, 05508-000 São Paulo, Brazil
| | - Carlos A de B Pereira
- BIOINFO-USP Núcleo de Pesquisas em Bioinformática, Universidade de São Paulo, Rua do Matão 1010, 05508-090 São Paulo, Brazil
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade de São Paulo, Rua do Matão 1010, 05508-090 São Paulo, Brazil
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