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Vriend C, de Joode NT, Pouwels PJW, Liu F, Otaduy MCG, Pastorello B, Robertson FC, Ipser J, Lee S, Hezel DM, van Meter PE, Batistuzzo MC, Hoexter MQ, Sheshachala K, Narayanaswamy JC, Venkatasubramanian G, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, Stein DJ, Wall M, Simpson HB, van den Heuvel OA. Age of onset of obsessive-compulsive disorder differentially affects white matter microstructure. Mol Psychiatry 2024:10.1038/s41380-023-02390-8. [PMID: 38228890 DOI: 10.1038/s41380-023-02390-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
Previous diffusion MRI studies have reported mixed findings on white matter microstructure alterations in obsessive-compulsive disorder (OCD), likely due to variation in demographic and clinical characteristics, scanning methods, and underpowered samples. The OCD global study was created across five international sites to overcome these challenges by harmonizing data collection to identify consistent brain signatures of OCD that are reproducible and generalizable. Single-shell diffusion measures (e.g., fractional anisotropy), multi-shell Neurite Orientation Dispersion and Density Imaging (NODDI) and fixel-based measures, were extracted from skeletonized white matter tracts in 260 medication-free adults with OCD and 252 healthy controls. We additionally performed structural connectome analysis. We compared cases with controls and cases with early (<18) versus late (18+) OCD onset using mixed-model and Bayesian multilevel analysis. Compared with healthy controls, adult OCD individuals showed higher fiber density in the sagittal stratum (B[SE] = 0.10[0.05], P = 0.04) and credible evidence for higher fiber density in several other tracts. When comparing early (n = 145) and late-onset (n = 114) cases, converging evidence showed lower integrity of the posterior thalamic radiation -particularly radial diffusivity (B[SE] = 0.28[0.12], P = 0.03)-and lower global efficiency of the structural connectome (B[SE] = 15.3[6.6], P = 0.03) in late-onset cases. Post-hoc analyses indicated divergent direction of effects of the two OCD groups compared to healthy controls. Age of OCD onset differentially affects the integrity of thalamo-parietal/occipital tracts and the efficiency of the structural brain network. These results lend further support for the role of the thalamus and its afferent fibers and visual attentional processes in the pathophysiology of OCD.
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Affiliation(s)
- Chris Vriend
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, and Department of Anatomy and Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands.
- Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Niels T de Joode
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, and Department of Anatomy and Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands
- Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Petra J W Pouwels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands
- Brain Imaging, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Feng Liu
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Maria C G Otaduy
- LIM44, Hospital das Clinicas HCFMUSP, Instituto e Departamento de Radiologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruno Pastorello
- LIM44, Hospital das Clinicas HCFMUSP, Instituto e Departamento de Radiologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Frances C Robertson
- Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa
| | - Jonathan Ipser
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Seonjoo Lee
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Dianne M Hezel
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Page E van Meter
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Marcelo C Batistuzzo
- Obsessive-Compulsive Spectrum Disorders Program, LIM23, Hospital das Clinicas HCFMUSP, Instituto & Departamento de Psiquiatria da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, Sao Paulo, SP, Brazil
| | - Marcelo Q Hoexter
- LIM44, Hospital das Clinicas HCFMUSP, Instituto e Departamento de Radiologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Karthik Sheshachala
- National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | | | - Christine Lochner
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Euripedes C Miguel
- Obsessive-Compulsive Spectrum Disorders Program, LIM23, Hospital das Clinicas HCFMUSP, Instituto & Departamento de Psiquiatria da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Y C Janardhan Reddy
- National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Roseli G Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, LIM23, Hospital das Clinicas HCFMUSP, Instituto & Departamento de Psiquiatria da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Melanie Wall
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Helen Blair Simpson
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, and Department of Anatomy and Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands
- Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, the Netherlands
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2
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Batistuzzo MC, Sheshachala K, Alschuler DM, Hezel DM, Lewis-Fernándes R, de Joode NT, Vriend C, Lempert KM, Narayan M, Marincowitz C, Lochner C, Stein DJ, Narayanaswamy JC, van den Heuvel OA, Simpson HB, Wall M. Cross-national harmonization of neurocognitive assessment across five sites in a global study. Neuropsychology 2023; 37:284-300. [PMID: 35786960 PMCID: PMC10164281 DOI: 10.1037/neu0000838] [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: 11/08/2022] Open
Abstract
OBJECTIVE Cross-national work on neurocognitive testing has been characterized by inconsistent findings, suggesting the need for improved harmonization. Here, we describe a prospective harmonization approach in an ongoing global collaborative study. METHOD Visuospatial N-Back, Tower of London (ToL), Stop Signal task (SST), Risk Aversion (RA), and Intertemporal Choice (ITC) tasks were administered to 221 individuals from Brazil, India, the Netherlands, South Africa, and the USA. Prospective harmonization methods were employed to ensure procedural similarity of task implementation and processing of derived task measures across sites. Generalized linear models tested for between-site differences controlling for sex, age, education, and socioeconomic status (SES). Associations with these covariates were also examined and tested for differences by site with site-by-covariate interactions. RESULTS The Netherlands site performed more accurately on N-Back and ToL than the other sites, except for the USA site on the N-Back. The Netherlands and the USA sites performed faster than the other three sites during the go events in the SST. Finally, the Netherlands site also exhibited a higher tolerance for delay discounting than other sites on the ITC, and the India site showed more risk aversion than other sites on the RA task. However, effect size differences across sites on the five tasks were generally small (i.e., partial eta-squared < 0.05) after dropping the Netherlands (on ToL, N-Back, ITC, and SST tasks) and India (on the RA task). Across tasks, regardless of site, the N-Back (sex, age, education, and SES), ToL (sex, age, and SES), SST (age), and ITC (SES) showed associations with covariates. CONCLUSIONS Four out of the five sites showed only small between-site differences for each task. Nevertheless, despite our extensive prospective harmonization steps, task score performance deviated from the other sites in the Netherlands site (on four tasks) and the India site (on one task). Because the procedural methods were standardized across sites, and our analyses were adjusted for covariates, the differences found in cognitive performance may indicate selection sampling bias due to unmeasured confounders. Future studies should follow similar cross-site prospective harmonization procedures when assessing neurocognition and consider measuring other possible confounding variables for additional statistical control. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - Karthik Sheshachala
- OCD clinic, Department of Psychiatry, National Institute of Mental health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Dianne M. Hezel
- The New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
| | | | - Niels T. de Joode
- Depaartment of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
| | - Chris Vriend
- Depaartment of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
| | - Karolina M. Lempert
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104
| | - Madhuri Narayan
- OCD clinic, Department of Psychiatry, National Institute of Mental health and Neurosciences, Bengaluru, Karnataka, India
| | - Clara Marincowitz
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Dan J. Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Janardhanan C. Narayanaswamy
- OCD clinic, Department of Psychiatry, National Institute of Mental health and Neurosciences, Bengaluru, Karnataka, India
| | - Odile A. van den Heuvel
- Depaartment of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, de Boelelaan 1117, Amsterdam, Netherlands
| | - Helen Blair Simpson
- The New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
| | - Melanie Wall
- The New York State Psychiatric Institute, New York, NY, 10032, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
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3
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Shavitt RG, Sheshachala K, Hezel DM, Wall MM, Balachander S, Lochner C, Narayanaswamy JC, Costa DLC, de Mathis MA, van Balkom AJLM, de Joode NT, Narayan M, van den Heuvel OA, Stein DJ, Miguel EC, Simpson HB, Reddy YCJ. Measurement fidelity of clinical assessment methods in a global study on identifying reproducible brain signatures of obsessive-compulsive disorder. Neuropsychology 2023; 37:330-343. [PMID: 36442004 PMCID: PMC10073274 DOI: 10.1037/neu0000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/29/2022] Open
Abstract
OBJECTIVE To describe the steps of ensuring measurement fidelity of core clinical measures in a five-country study on brain signatures of obsessive-compulsive disorder (OCD). METHOD We collected data using standardized instruments, which included the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Dimensional YBOCS (DYBOCS), the Brown Assessment of Beliefs Scale (BABS), the 17-item Hamilton Depression Scale (HAM-D), the Hamilton Anxiety Scale (HAM-A), and the Structured Clinical Interview for DSM-5 (SCID). Steps to ensure measurement fidelity included translating instruments, developing a clinical decision manual, and continuing reliability training with 11-13 transcripts of each instrument by 13 independent evaluators across sites over 4 years. We use multigroup confirmatory factor analysis (MGCFA) to report interrater reliability (IRR) among the evaluators and factor structure for each scale in 206 participants with OCD. RESULTS The overall IRR for most scales was high (ICC > 0.94) and remained good to excellent throughout the study. Consistent factor structures (configural invariance) were found for all instruments across the sites, while similarity in the factor loadings for the items (metric invariance) could be established only for the DYBOCS and the BABS. CONCLUSIONS It is feasible to achieve measurement fidelity of clinical measures in multisite, multilinguistic global studies, despite the challenges inherent to such endeavors. Future studies should not only report IRR but also consider reporting methods of standardization of data collection and measurement invariance to identify factor structures of core clinical measures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Roseli G Shavitt
- Obsessive-Compulsive Spectrum Disorders Program (PROTOC-IPq-HCFMUSP)
| | | | | | | | | | - Christine Lochner
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders
| | | | - Daniel L C Costa
- Obsessive-Compulsive Spectrum Disorders Program (PROTOC-IPq-HCFMUSP)
| | | | | | | | | | | | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders
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4
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Pouwels PJW, Vriend C, Liu F, de Joode NT, Otaduy MCG, Pastorello B, Robertson FC, Venkatasubramanian G, Ipser J, Lee S, Batistuzzo MC, Hoexter MQ, Lochner C, Miguel EC, Narayanaswamy JC, Rao R, Janardhan Reddy YC, Shavitt RG, Sheshachala K, Stein DJ, van Balkom AJLM, Wall M, Simpson HB, van den Heuvel OA. Global multi-center and multi-modal magnetic resonance imaging study of obsessive-compulsive disorder: Harmonization and monitoring of protocols in healthy volunteers and phantoms. Int J Methods Psychiatr Res 2023; 32:e1931. [PMID: 35971639 PMCID: PMC9976605 DOI: 10.1002/mpr.1931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We describe the harmonized MRI acquisition and quality assessment of an ongoing global OCD study, with the aim to translate representative, well-powered neuroimaging findings in neuropsychiatric research to worldwide populations. METHODS We report on T1-weighted structural MRI, resting-state functional MRI, and multi-shell diffusion-weighted imaging of 140 healthy participants (28 per site), two traveling controls, and regular phantom scans. RESULTS Human image quality measures (IQMs) and outcome measures showed smaller within-site variation than between-site variation. Outcome measures were less variable than IQMs, especially for the traveling controls. Phantom IQMs were stable regarding geometry, SNR, and mean diffusivity, while fMRI fluctuation was more variable between sites. CONCLUSIONS Variation in IQMs persists, even for an a priori harmonized data acquisition protocol, but after pre-processing they have less of an impact on the outcome measures. Continuous monitoring IQMs per site is valuable to detect potential artifacts and outliers. The inclusion of both cases and healthy participants at each site remains mandatory.
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Affiliation(s)
- Petra J. W. Pouwels
- Department of Radiology and Nuclear MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam NeuroscienceAmsterdamThe Netherlands
| | - Chris Vriend
- Department of PsychiatryDepartment of Anatomy and NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdam NeuroscienceAmsterdamThe Netherlands
| | - Feng Liu
- Columbia University Irving Medical CenterColumbia UniversityNew York State Psychiatric InstituteNew YorkNYUSA
| | - Niels T. de Joode
- Department of PsychiatryDepartment of Anatomy and NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdam NeuroscienceAmsterdamThe Netherlands
| | - Maria C. G. Otaduy
- Department of RadiologyLIM44, InstituteHospital Das Clinicas‐HCFMUSPUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Bruno Pastorello
- Department of RadiologyLIM44, InstituteHospital Das Clinicas‐HCFMUSPUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Frances C. Robertson
- Cape Universities Body Imaging CentreUniversity of Cape TownCape TownSouth Africa
| | | | - Jonathan Ipser
- Department of PsychiatrySAMRC Unit on Risk & Resilience in Mental DisordersNeuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Seonjoo Lee
- Columbia University Irving Medical CenterColumbia UniversityNew York State Psychiatric InstituteNew YorkNYUSA
| | - Marcelo C. Batistuzzo
- Obsessive‐Compulsive Spectrum Disorders ProgramDepartmento de Psiquiatria da Faculdade de MedicinaLIM23Hospital Das Clinicas HCFMUSPUniversidade de São PauloSao PauloSPBrazil
- Department of Methods and Techniques in PsychologyPontifical Catholic UniversitySao PauloSPBrazil
| | - Marcelo Q. Hoexter
- Obsessive‐Compulsive Spectrum Disorders ProgramDepartmento de Psiquiatria da Faculdade de MedicinaLIM23Hospital Das Clinicas HCFMUSPUniversidade de São PauloSao PauloSPBrazil
| | - Christine Lochner
- Department of PsychiatrySAMRC Unit on Risk & Resilience in Mental DisordersStellenbosch UniversityCape TownSouth Africa
| | - Euripedes C. Miguel
- Obsessive‐Compulsive Spectrum Disorders ProgramDepartmento de Psiquiatria da Faculdade de MedicinaLIM23Hospital Das Clinicas HCFMUSPUniversidade de São PauloSao PauloSPBrazil
| | | | - Rashmi Rao
- National Institute of Mental Health & Neurosciences (NIMHANS)BangaloreIndia
| | | | - Roseli G. Shavitt
- Obsessive‐Compulsive Spectrum Disorders ProgramDepartmento de Psiquiatria da Faculdade de MedicinaLIM23Hospital Das Clinicas HCFMUSPUniversidade de São PauloSao PauloSPBrazil
| | | | - Dan J. Stein
- Department of PsychiatrySAMRC Unit on Risk & Resilience in Mental DisordersNeuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Anton J. L. M. van Balkom
- Department of PsychiatryAmsterdam UMCVrije UniversiteitAmsterdam Public Health Research InstituteSpecialised Mental Health CareAmsterdamThe Netherlands
| | - Melanie Wall
- Columbia University Irving Medical CenterColumbia UniversityNew York State Psychiatric InstituteNew YorkNYUSA
| | - Helen Blair Simpson
- Columbia University Irving Medical CenterColumbia UniversityNew York State Psychiatric InstituteNew YorkNYUSA
| | - Odile A. van den Heuvel
- Department of PsychiatryDepartment of Anatomy and NeuroscienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdam NeuroscienceAmsterdamThe Netherlands
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5
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Simpson HB, van den Heuvel OA, Miguel EC, Reddy YCJ, Stein DJ, Lewis-Fernández R, Shavitt RG, Lochner C, Pouwels PJW, Narayanawamy JC, Venkatasubramanian G, Hezel DM, Vriend C, Batistuzzo MC, Hoexter MQ, de Joode NT, Costa DL, de Mathis MA, Sheshachala K, Narayan M, van Balkom AJLM, Batelaan NM, Venkataram S, Cherian A, Marincowitz C, Pannekoek N, Stovezky YR, Mare K, Liu F, Otaduy MCG, Pastorello B, Rao R, Katechis M, Van Meter P, Wall M. Toward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative. BMC Psychiatry 2020; 20:68. [PMID: 32059696 PMCID: PMC7023814 DOI: 10.1186/s12888-020-2439-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. METHODS We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. DISCUSSION Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
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Affiliation(s)
- Helen Blair Simpson
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Odile A. van den Heuvel
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Euripedes C. Miguel
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Y. C. Janardhan Reddy
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Dan J. Stein
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Roberto Lewis-Fernández
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Roseli Gedanke Shavitt
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Christine Lochner
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Petra J. W. Pouwels
- grid.12380.380000 0004 1754 9227Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Janardhanan C. Narayanawamy
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Dianne M. Hezel
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Chris Vriend
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Marcelo C. Batistuzzo
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Marcelo Q. Hoexter
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Niels T. de Joode
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Daniel Lucas Costa
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Maria Alice de Mathis
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Karthik Sheshachala
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Madhuri Narayan
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Shivakumar Venkataram
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anish Cherian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Clara Marincowitz
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Nienke Pannekoek
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Yael R. Stovezky
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Karen Mare
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Feng Liu
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Maria Concepcion Garcia Otaduy
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Bruno Pastorello
- grid.11899.380000 0004 1937 0722Institute of Radiology, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rashmi Rao
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Martha Katechis
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Page Van Meter
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Melanie Wall
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
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6
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Abstract
Proven treatment strategies for obsessive-compulsive disorder (OCD) include pharmacotherapy with serotonin reuptake inhibitors and cognitive behavior therapy (CBT). A significant proportion of patients (25%-30%) fail to respond to these treatment options, necessitating the need for additional treatment options to improve treatment outcomes and quality of life in patients with OCD. Augmentation strategies using various glutamatergic agents have been explored, with diverse outcomes. The aim of this review is to give an overview of the glutamatergic system in the brain with a focus on glutamatergic abnormalities in OCD and to review the existing evidence for various glutamatergic agents used for augmentation.
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Affiliation(s)
- Karthik Sheshachala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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