Disruption of consciousness depends on insight in OCD and on positive symptoms in schizophrenia

Disruption of conscious access contributes to the advent of psychotic symptoms in schizophrenia but could also explain lack of insight in other psychiatric disorders. In this study, we explored how insight and psychotic symptoms related to disruption of consciousness. We explored consciousness in patients with schizophrenia, patients with obsessive-compulsive disorder (OCD) with good vs. poor insight and matched controls. Participants underwent clinical assessments and performed a visual masking task allowing us to measure individual consciousness threshold. We used a principal component analysis to reduce symptom dimensionality and explored how consciousness measures related to symptomatology. We found that clinical dimensions could be well summarized by a restricted set of principal components which also correlated with the extent of consciousness disruption. More specifically, positive symptoms were associated with impaired conscious access in patients with schizophrenia whereas the level of insight delineated two subtypes of OCD patients, those with poor insight who had consciousness impairments similar to patients with schizophrenia, and those with good insight who resemble healthy controls. Our study provides new insights about consciousness disruption in psychiatric disorders, showing that it relates to positive symptoms in schizophrenia and with insight in OCD. In OCD, it revealed a distinct subgroup sharing neuropathological features with schizophrenia. Our findings refine the mapping between symptoms and cognition, paving the way for a better treatment selection.

Obsessive Beliefs and Clinical Features in Patients with Comorbid Obsessive-Compulsive Disorder and Attention-Deficit/Hyperactivity Disorder

Background

Obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) are two common neuropsychiatric conditions. Obsessive beliefs, comprising the importance and control of intrusive thoughts, inflated sense of responsibility for harm, overestimations of threat, perfectionism, and intolerance of uncertainty have been suggested to influence OCD symptomatology. Although OCD patients with ADHD have been reported to have different clinical characteristics compared to patients with OCD without ADHD, it has not been previously investigated whether OCD patients with and without ADHD differ in terms of obsessive beliefs. The aim of this study was to compare the obsessive beliefs and obsessive-compulsive symptoms of OCD patients with and without ADHD.

Methods

The study included a total of 197 OCD patients who were assessed with the sociodemographic data form, Wender Utah Rating Scale, Turgay's Adult ADD/ADHD Diagnosis and Evaluation Scale, The Adult ADHD Self-Report Scale, Obsessive Beliefs Questionnaire-44 (OBQ-44), Yale-Brown Obsessions and Compulsions Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).

Results

The scores of all subscales of OBQ-44, the responsibility, unacceptable thoughts, and symmetry subscales of DOCS, BDI, and BAI scores were higher in the OCD with ADHD group than in the OCD only group. The results showed that when depression and anxiety were controlled, "the importance and control of intrusive thoughts" domain of obsessive beliefs was the unique predictor of OCD and ADHD comorbidity.

Conclusion

These findings provide a better understanding of cognitive features in OCD patients with ADHD.

The effect of circadian preferences on insomnia severity and depressive symptoms via sleep hygiene in older adults with depression and healthy controls

BACKGROUND

The elderly population is increasing globally. Thus, researches focus on the causes and treatment of insomnia, a noteworthy ageing problem. This study aims to investigate the relationship between chronotype and insomnia and whether sleep hygiene mediates this relationship in older adults with depression (OAD).

METHODS

We assessed subjective insomnia severity, sleep hygiene, chronotype, depressive symptoms, and anxiety symptoms of 82 OAD and 70 healthy controls using the Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), Morningness-Eveningness Questionnaire (MEQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI).

RESULTS

The mediation effect of SHI and ISI scores were evaluated in the relationship between MEQ and BDI total scores in OAD. The results showed that MEQ performed its effect on BDI through ISI with full mediation (effect = -0.16, SE: 0.07, 95% CI: -0.3230 to -0.0336). The mediation effect of SHI and BDI scores were evaluated in the relationship between MEQ and ISI total scores in OAD. In this model, it was found that MEQ significantly performed its effect on ISI through SHI and BDI. BDI and SHI predicted the ISI variable as partial mediators (respectively, effect = -0.05, SE: 0.03, 95% CI: -0.1073 to -0.0100; effect = -0.06, SE: 0.02, 95% CI: -0.1051 to -0.0129).

CONCLUSIONS

Sleep hygiene practices could be essential for the natural functioning of the biological clock and the interrelation of depression and insomnia. Longitudinal follow-up studies of structured sleep hygiene approaches are needed in terms of cost-effectiveness, in OAD.

The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students

Internet addiction (IA) is currently becoming a serious mental health problem. The aim of this study was to estimate the prevalence of IA among undergraduate medical students and evaluate the relationship of IA with social anxiety, impulsivity, self-esteem, and depression. The study included 392 undergraduate medical students. Evaluations were made with the sociodemographic data form, the Internet Addiction Test (IAT), the Liebowitz Social Anxiety Scale (LSAS), the Barratt Impulsivity Scale-11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The IA group had significantly higher scores on LSAS, BDI, BAI and lower scores on RSES than the control group but the BIS-11 scores were similar among groups. IAT severity was positively correlated with LSAS, BDI, and BAI and negatively with RSES. No correlation was observed between IAT severity and BIS-11. In the hierarchical linear regression analysis, the avoidance domain of social anxiety was the strongest predictor of the severity of IA. The present study suggests that undergraduate medical students with IA exhibit higher social anxiety, lower self-esteem and are more depressed than those without IA, thus, indicating that social anxiety, rather than impulsivity, seemed to play a prominent role in IA psychopathology.

The effectiveness of cognitive behavioral group psychotherapy for obsessive-compulsive disorder

OBJECTIVE

The aim of this study was to determine the effectiveness of cognitive behavioral group therapy (CBGT) in the treatment of the obsessive-compulsive disorder (OCD).

MATERIALS AND METHODS

The study included 82 patients diagnosed as OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). In all, 37 patients that had their diagnosis confirmed via the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and agreed to participate were provided group therapy as 14 weekly 90-120-min sessions. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Yale-Brown Obsessive Compulsive Scale-Symptom Checklist (Y-BOCS-SC), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to the patients prior to group therapy (baseline) and again after sessions 2, 5, 8, 12, and 14.

RESULTS

In all, 8 patients dropped out of the study for various reasons and 29 completed the group therapy. There were significant reductions in BAI, BDI, and Y-BOCS scores in the patients that completed the group therapy. Additionally, BAI, BDI, and Y-BOCS score did not differ according to age, gender, or level of education.

CONCLUSIONS

CBGT was associated with significant improvement in OCD symptoms. Neither demographic characteristics (age, gender, and education level), nor clinical characteristics (disease duration, type of obsession, compulsion type, treatment history, and comorbidity pattern) had an effect on treatment outcome. In light of these findings, we think CBGT is an effective option for the treatment of OCD.