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Westwell-Roper C, Best JR, Naqqash Z, Afshar K, MacNeily AE, Stewart SE. Bowel and Bladder Dysfunction Is Associated with Psychiatric Comorbidities and Functional Impairment in Pediatric Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2022; 32:358-365. [PMID: 35404114 DOI: 10.1089/cap.2021.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Neuropsychiatric disorders are common in children with bowel and bladder dysfunction (BBD), a syndrome associated with urinary frequency, urgency, holding, incontinence, and constipation. We evaluated BBD symptom severity in children and youth attending a tertiary care obsessive-compulsive disorder (OCD) clinic. Methods: Consecutive patients attending initial OCD assessments between 2016 and 2020 were invited to participate in a registry study. Diagnosis of OCD and comorbidities was established by structured clinical interview. OCD severity and impact were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and the Child Obsessive Compulsive Impact Scale (COIS-R; self-report), respectively. BBD symptoms were quantified with the Vancouver Symptom Score (VSS), a validated self-report measure. Results: One hundred twelve participants completed the VSS (mean age 13.5 ± 3.3, range 7-20). Based on a cutoff score of 11 corresponding to pediatric urologist-diagnosed BBD, 30.4% of participants screened positive, including more females than males (39.3% vs. 21.4%; p = 0.04). Daytime urinary incontinence was present in a greater proportion of participants with OCD forbidden thoughts (34.8% vs. 8.2%, p = 0.002), major depressive disorder (MDD; 38.5% vs. 6.8%, p = 0.001), and somatization disorder (60% vs. 9%, p = 0.001) compared with those without. A regression model including CY-BOCS, COIS-R, psychiatric comorbidities, medications, age, and gender explained 52.2% of the variance in VSS; COIS-R, tic disorder, and MDD were significant predictors. Conclusion: BBD symptoms are common and associated with high OCD-related impairment and psychiatric comorbidities. Standardized assessment may facilitate identification of BBD symptoms in this population and is critical to mitigating long-term physical and mental health impacts. Further studies are required to assess the relationship between BBD and OCD treatment outcomes.
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Westwell-Roper C, To S, Soller L, Chan ES, Stewart SE. Decreased food allergy-specific anxiety and increased general anxiety in parents of children with food allergies during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2022; 129:242-246. [PMID: 35470036 PMCID: PMC9033624 DOI: 10.1016/j.anai.2022.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
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Westwell-Roper C, Best JR, Naqqash Z, Au A, Lin B, Lu C, Shao L, Beasley CL, Stewart SE. Severe symptoms predict salivary interleukin-6, interleukin-1β, and tumor necrosis factor-α levels in children and youth with obsessive-compulsive disorder. J Psychosom Res 2022; 155:110743. [PMID: 35190349 DOI: 10.1016/j.jpsychores.2022.110743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Childhood-onset obsessive-compulsive disorder (OCD) has been associated with immune dysregulation, including aberrant plasma inflammatory markers and increased rates of infectious and immune-mediated disorders. Saliva may provide a minimally-invasive tool for assessing oral mucosal immunity and inflammatory biomarkers in this population. The primary aim of this study was to compare salivary defense proteins and inflammatory mediators in saliva from children and youth with OCD and healthy controls, and evaluate their associations with measures of oral health and OCD phenotype. METHODS In this cross-sectional observational study, saliva was collected from 41 children and youth with childhood-onset OCD and 46 healthy controls. Levels of lysozyme, α-amylase, secretory immunoglobulin A (sIgA), C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were quantified by enzyme-linked immunosorbent assays or electrochemiluminescent-based immunoassays. RESULTS All analytes were detectable in saliva. When adjusting for salivary flow rate and total protein, multiple linear regression models including demographic variables, oral health measures, and OCD status explained a significant proportion of the variance in IL-6, IL-1β, and sIgA but not TNF-α, CRP, α-amylase, or lysozyme levels. Diagnosis of OCD was associated with significantly higher IL-6 (β = 0.403, p = 0.026), while severity of OCD was a significant predictor of increased cytokines (IL-6, β = 0.325, p = 0.009; IL-1β, β = 0.284, p = 0.020; TNF-α, β = 0.269, p = 0.036), but not other analytes. CONCLUSION These data point to the feasibility of analyzing soluble immune mediators in the saliva in childhood-onset OCD, suggesting that pro-inflammatory cytokines are associated with OCD diagnosis and symptom severity. Further work is required to elucidate the factors contributing to this association and implications for clinical practice.
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Scahill L, Stewart SE. Editorial: Outcome Measurement in Pediatric Obsessive-Compulsive Disorder: Current Considerations and Future Directions. J Am Acad Child Adolesc Psychiatry 2022; 61:470-472. [PMID: 35074487 DOI: 10.1016/j.jaac.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/20/2022]
Abstract
Our understanding of pediatric obsessive-compulsive disorder (OCD) has come a long way since the important book by Paul Adams. In ;this 1973 book, Obsessive Children: A Sociopsychiatric Study, Adams described 49 youth with OCD, albeit with some blurring of OCD and obsessive-compulsive personality disorder. The proposed etiology of OCD rested on psychoanalytic principles and the social psychiatric perspective. This perspective emphasized the importance of social factors in the emergence of mental illness, including OCD. A prevailing view at the time asserted that OCD was a rare, episodic condition often with childhood onset.
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Weeland CJ, Kasprzak S, de Joode NT, Abe Y, Alonso P, Ameis SH, Anticevic A, Arnold PD, Balachander S, Banaj N, Bargallo N, Batistuzzo MC, Benedetti F, Beucke JC, Bollettini I, Brecke V, Brem S, Cappi C, Cheng Y, Cho KIK, Costa DLC, Dallaspezia S, Denys D, Eng GK, Ferreira S, Feusner JD, Fontaine M, Fouche JP, Grazioplene RG, Gruner P, He M, Hirano Y, Hoexter MQ, Huyser C, Hu H, Jaspers-Fayer F, Kathmann N, Kaufmann C, Kim M, Koch K, Bin Kwak Y, Kwon JS, Lazaro L, Li CSR, Lochner C, Marsh R, Martínez-Zalacaín I, Mataix-Cols D, Menchón JM, Minnuzi L, Moreira PS, Morgado P, Nakagawa A, Nakamae T, Narayanaswamy JC, Nurmi EL, Ortiz AE, Pariente JC, Piacentini J, Picó-Pérez M, Piras F, Piras F, Pittenger C, Reddy YCJ, Rodriguez-Manrique D, Sakai Y, Shimizu E, Shivakumar V, Simpson HB, Soreni N, Soriano-Mas C, Sousa N, Spalletta G, Stern ER, Stevens MC, Stewart SE, Szeszko PR, Takahashi J, Tanamatis T, Tang J, Thorsen AL, Tolin D, van der Werf YD, van Marle H, van Wingen GA, Vecchio D, Venkatasubramanian G, Walitza S, Wang J, Wang Z, Watanabe A, Wolters LH, Xu X, Yun JY, Zhao Q, White T, Thompson PM, Stein DJ, van den Heuvel OA, Vriend C. The thalamus and its subnuclei-a gateway to obsessive-compulsive disorder. Transl Psychiatry 2022; 12:70. [PMID: 35190533 PMCID: PMC8861046 DOI: 10.1038/s41398-022-01823-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
Larger thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population. Particular thalamic subregions may drive these differences. The ENIGMA-OCD working group conducted mega- and meta-analyses to study thalamic subregional volume in OCD across the lifespan. Structural T1-weighted brain magnetic resonance imaging (MRI) scans from 2649 OCD patients and 2774 healthy controls across 29 sites (50 datasets) were processed using the FreeSurfer built-in ThalamicNuclei pipeline to extract five thalamic subregions. Volume measures were harmonized for site effects using ComBat before running separate multiple linear regression models for children, adolescents, and adults to estimate volumetric group differences. All analyses were pre-registered ( https://osf.io/73dvy ) and adjusted for age, sex and intracranial volume. Unmedicated pediatric OCD patients (<12 years) had larger lateral (d = 0.46), pulvinar (d = 0.33), ventral (d = 0.35) and whole thalamus (d = 0.40) volumes at unadjusted p-values <0.05. Adolescent patients showed no volumetric differences. Adult OCD patients compared with controls had smaller volumes across all subregions (anterior, lateral, pulvinar, medial, and ventral) and smaller whole thalamic volume (d = -0.15 to -0.07) after multiple comparisons correction, mostly driven by medicated patients and associated with symptom severity. The anterior thalamus was also significantly smaller in patients after adjusting for thalamus size. Our results suggest that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status.
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Stewart SE. The Case for Prevention Research in Adolescent-Onset Mental Illness-Game On! JAMA Netw Open 2022; 5:e2149037. [PMID: 35179592 DOI: 10.1001/jamanetworkopen.2021.49037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Westwell-Roper C, Best JR, Elbe D, MacFadden M, Baer S, Tucker L, Au A, Naqqash Z, Lin B, Lu C, Stewart SE. Celecoxib versus placebo as an adjunct to treatment-as-usual in children and youth with obsessive-compulsive disorder: protocol for a single-site randomised quadruple-blind phase II study. BMJ Open 2022; 12:e054296. [PMID: 35105633 PMCID: PMC8804641 DOI: 10.1136/bmjopen-2021-054296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cyclooxygenase (COX) enzymes oxidise arachidonic acid to prostaglandins, which modulate neuronal function and inflammation in the central nervous system. Consensus guidelines suggest non-steroidal anti-inflammatory drugs as a possible adjunctive approach in adults with obsessive-compulsive disorder (OCD) and in children with acute-onset OCD subtypes. However, there is limited evidence to support this approach. The primary objective of this study is to determine the efficacy of the COX-2-selective inhibitor celecoxib as an adjunct to treatment-as-usual in children and youth with moderate-to-severe OCD. The safety of this intervention including adverse events will also be systematically assessed. METHODS The Adjunctive CElecoxib in childhood-onset OCD (ACE-OCD) study is a single-centre randomised, quadruple-blind, placebo-controlled superiority trial with two parallel groups: celecoxib 100 mg twice daily and placebo. Treatments will be added to participants' routine clinical care, which will not change over the course of the study. Target recruitment is 80 participants ages 7-18 with no recent treatment changes. The primary outcome is OCD severity after 12 weeks of treatment, measured by clinician-administered Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Secondary outcomes include CY-BOCS score after 6 weeks; difference in the proportion of participants achieving a clinically meaningful response or remission; mean clinical global impression of severity and improvement after 6 and 12 weeks; and proportion of participants reporting adverse events possibly or probably related to the study intervention. The primary analyses, carried out according to intention-to-treat principles, will compare the celecoxib to placebo group on each outcome of interest, adjusting for baseline scores using analysis of covariance or logistic regression. Participants will be offered a 12-week open-label celecoxib extension and will be invited to participate in an ancillary study for biomarker analyses. ETHICS AND DISSEMINATION This protocol has been approved by the University of British Columbia Children's and Women's Research Ethics Board and has received a No Objection Letter from Health Canada. The findings will be disseminated in peer-reviewed journals and presentations to multiple stakeholders including patients, parents and healthcare providers. TRIAL REGISTRATION NUMBER NCT04673578.
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Westwell-Roper C, To S, Andjelic G, Lu C, Lin B, Soller L, Chan ES, Stewart SE. Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review. Pediatr Allergy Immunol 2022; 33:e13695. [PMID: 34779046 DOI: 10.1111/pai.13695] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenting a child with food allergy (FA) can lead to impaired quality of life and family functioning. Anxiety is a critical component of FA-associated distress and a potential target for therapeutic intervention. This systematic review aimed to clarify the concept of FA-specific anxiety (FAA) and its antecedents, consequences, and correlates and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA. METHODS MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for qualitative and quantitative studies examining distress or anxiety in parents of children with FA through August 2020. This review was registered with PROSPERO (CRD42020208316) and conducted in accordance with PRISMA guidelines. RESULTS Ninety-eight studies were included in the final narrative synthesis. Most participants were mothers, and reporting of demographic data was limited. Parents identified anxiety as the most burdensome form of FA-specific emotional distress. Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress. However, affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures for general anxiety symptoms and FA-specific parental factors. CONCLUSIONS FAA contributes to distress and functional impairment among parents of children with FA. Current FA-specific parent measures fail to adequately capture dimensions of FAA, suggesting that further work is needed to improve the assessment and monitoring of FAA and its impacts. Characterization of this construct represents an initial step in developing standardized methods for assessing and monitoring FAA in clinical populations.
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van den Heuvel OA, Boedhoe PS, Bertolin S, Bruin WB, Francks C, Ivanov I, Jahanshad N, Kong X, Kwon JS, O'Neill J, Paus T, Patel Y, Piras F, Schmaal L, Soriano‐Mas C, Spalletta G, van Wingen GA, Yun J, Vriend C, Simpson HB, van Rooij D, Hoexter MQ, Hoogman M, Buitelaar JK, Arnold P, Beucke JC, Benedetti F, Bollettini I, Bose A, Brennan BP, De Nadai AS, Fitzgerald K, Gruner P, Grünblatt E, Hirano Y, Huyser C, James A, Koch K, Kvale G, Lazaro L, Lochner C, Marsh R, Mataix‐Cols D, Morgado P, Nakamae T, Nakao T, Narayanaswamy JC, Nurmi E, Pittenger C, Reddy YJ, Sato JR, Soreni N, Stewart SE, Taylor SF, Tolin D, Thomopoulos SI, Veltman DJ, Venkatasubramanian G, Walitza S, Wang Z, Thompson PM, Stein DJ. An overview of the first 5 years of the ENIGMA obsessive-compulsive disorder working group: The power of worldwide collaboration. Hum Brain Mapp 2022; 43:23-36. [PMID: 32154629 PMCID: PMC8675414 DOI: 10.1002/hbm.24972] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging has played an important part in advancing our understanding of the neurobiology of obsessive-compulsive disorder (OCD). At the same time, neuroimaging studies of OCD have had notable limitations, including reliance on relatively small samples. International collaborative efforts to increase statistical power by combining samples from across sites have been bolstered by the ENIGMA consortium; this provides specific technical expertise for conducting multi-site analyses, as well as access to a collaborative community of neuroimaging scientists. In this article, we outline the background to, development of, and initial findings from ENIGMA's OCD working group, which currently consists of 47 samples from 34 institutes in 15 countries on 5 continents, with a total sample of 2,323 OCD patients and 2,325 healthy controls. Initial work has focused on studies of cortical thickness and subcortical volumes, structural connectivity, and brain lateralization in children, adolescents and adults with OCD, also including the study on the commonalities and distinctions across different neurodevelopment disorders. Additional work is ongoing, employing machine learning techniques. Findings to date have contributed to the development of neurobiological models of OCD, have provided an important model of global scientific collaboration, and have had a number of clinical implications. Importantly, our work has shed new light on questions about whether structural and functional alterations found in OCD reflect neurodevelopmental changes, effects of the disease process, or medication impacts. We conclude with a summary of ongoing work by ENIGMA-OCD, and a consideration of future directions for neuroimaging research on OCD within and beyond ENIGMA.
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Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P, Lu C, Garg K, Thomas TL, Au ACL, Selles RR, Højgaard DRMA, Skarphedinsson G, Stewart SE. Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:703701. [PMID: 34858219 PMCID: PMC8631971 DOI: 10.3389/fpsyt.2021.703701] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs. Systematic Review Registration: Unique Identifier: CRD42020215904.
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Fung R, Elbe D, Stewart SE. Response to " Clomipramine in Combination with Fluvoxamine: A Potent Medication Combination for Severe or Refractory Pediatric OCD". JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:278-279. [PMID: 34777511 PMCID: PMC8561858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Fung R, Elbe D, Stewart SE. Retrospective Review of Fluvoxamine-Clomipramine Combination Therapy in Obsessive-Compulsive Disorder in Children and Adolescents. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:150-155. [PMID: 34381507 PMCID: PMC8315223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To inform dosing and describe the pharmacokinetic interaction, efficacy and safety of fluvoxamine-clomipramine combination therapy for treatment-resistant pediatric obsessive-compulsive disorder (OCD). METHODS A retrospective chart review of OCD-affected patients at a tertiary care children's hospital between January 2010 and August 2017 was conducted. Those included were 18 years of age or younger at initiation of fluvoxamine-clomipramine combination therapy and had at least one set of serum concentration values capturing clomipramine and desmethylclomipramine levels. RESULTS Six adolescents met study inclusion criteria. Fluvoxamine adequately inhibited clomipramine metabolism to desmethylclomipramine in a dose-dependent manner. Fluvoxamine-clomipramine combination therapy was generally well tolerated with no serious or life-threatening adverse effects reported. CONCLUSION Fluvoxamine-clomipramine combination therapy permits use of lower clomipramine doses than typically used as clomipramine monotherapy and appears to be a safe alternative for pediatric OCD patients failing sequential selective serotonin reuptake inhibitor monotherapy trials. Inter-patient variability and saturable kinetics support therapeutic drug monitoring of serum clomipramine and desmethylclomipramine concentrations to optimize therapy. A proposed algorithm that aligns with current OCD treatment guidelines is described. Further study is needed to evaluate efficacy of this approach.
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Novins DK, Stoddard J, Althoff RR, Charach A, Cortese S, Cullen KR, Frazier JA, Glatt SJ, Henderson SW, Herringa RJ, Hulvershorn L, Kieling C, McBride AB, McCauley E, Middeldorp CM, Reiersen AM, Rockhill CM, Sagot AJ, Scahill L, Simonoff E, Stewart SE, Szigethy E, Taylor JH, White T, Zima BT. Editors' Note and Special Communication: Research Priorities in Child and Adolescent Mental Health Emerging From the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2021; 60:544-554.e8. [PMID: 33741474 PMCID: PMC9188438 DOI: 10.1016/j.jaac.2021.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 01/07/2023]
Abstract
Over the last year, the coronavirus disease 2019 (COVID-19) pandemic has resulted in profound disruptions across the globe, with school closures, social isolation, job loss, illness, and death affecting the lives of children and families in myriad ways. In an Editors' Note in our June 2020 issue,1 our senior editorial team described this Journal's role in advancing knowledge in child and adolescent mental health during the pandemic and outlined areas we identified as important for science and practice in our field. Since then, the Journal has published articles on the impacts of the pandemic on child and adolescent mental health and service systems,2-5 which are available in a special collection accessible through the Journal's website.6 Alongside many opinion papers, the pace of publication of empirical research in this area is rapidly expanding, covering important issues such as increased frequency of mental health symptoms among children and adolescents3,5,7-10 and changes in patterns of clinical service use such as emergency department visits.11-14 As the Senior Editors prepared that Editors' Note, they were acutely aware that the priorities that they identified were broad and generated by only a small group of scientists and clinicians. Although this had the advantage of enabling us to get this information out to readers quickly, we decided that a more systematic approach to developing recommendations for research priorities would be of greater long-term value. We were particularly influenced by the efforts of the partnership between the UK Academy of Medical Scientists and a UK mental health research charity (MQ: Transforming Mental Health) to detail COVID-19-related research priorities for "Mental Health Science" that was published online by Holmes et al. in The Lancet Psychiatry in April 2020.15 Consistent with its focus on mental health research across the lifespan, several recommendations highlighted child development and children's mental health. However, a more detailed assessment of research priorities related to child and adolescent mental health was beyond the scope of that paper. Furthermore, the publication of that position paper preceded the death of George Floyd at the hands of Minneapolis police on May 25, 2020, which re-energized efforts to acknowledge and to address racism and healthcare disparities in the United States and many other countries. To build upon the JAACAP Editors' Note1 and the work of Holmes et al.,15 we conducted an international survey of professionals-practitioners and researchers-working on child and adolescent development and pediatric mental health to identify concerns about the impact of the pandemic on children, adolescents, and their families, as well as what is helping families navigate these impacts, and the specific research topics that are of greatest importance.
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To S, Westwell-Roper C, Soller L, Chan E, Stewart SE. Development and Initial Validation of a Food Allergy Associated Parental Anxiety Screening Tool: IMPAACT. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wang JJ, Lin S, Best JR, Selles RR, Stewart SE. Race and ethnicity in pediatric OCD: An exploratory study of a clinical North American sample. Ann Clin Psychiatry 2021; 33:4-17. [PMID: 33125453 DOI: 10.12788/acp.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Influences of race and ethnicity have received limited attention in pediatric obsessive-compulsive disorder (OCD), despite noted importance in other psychiatric diseases. We sought to compare racially defined groups presenting to a North American tertiary care pediatric OCD subspecialty clinic. METHODS Clinician-rated and parent/child-reported information was extracted from a research data registry comprising OCD-affected youth assessed between 2011 and 2018. The study population was aggregated into racial groups, defined as Caucasian, Asian, and "other." Country of origin and spoken language were used as ethnicity proxies. Obsessivecompulsive disorder phenotype, clinical course, and family environment were compared, with inclusion of mixed Asian-Caucasians in post-hoc analyses. RESULTS Asian youth reported significantly later ages of OCD symptom onset, clinical diagnosis, and treatment compared with Caucasian youth and were significantly less likely to have participated in OCD-specific treatment, despite similar clinician recommendation rates. Obsessivecompulsive disorder severity and comorbidities did not differ across groups. Asian parents reported significantly higher levels of family blame and conflict than Caucasian parents, but similar prevalence of OCD family history. CONCLUSIONS Clinically relevant differences were identified between Asians and Caucasians, highlighting the need for individualized care that respects the influences of ethnicity and race in pediatric OCD. Replication and future study of additional racial groups is warranted.
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Selles RR, Naqqash Z, Best JR, Franco-Yamin D, Qiu ST, Ferreira JS, Deng X, Hannesdottir DK, Oberth C, Belschner L, Negreiros J, Farrell LJ, Stewart SE. Effects of Treatment Setting on Outcomes of Flexibly-Dosed Intensive Cognitive Behavioral Therapy for Pediatric OCD: A Randomized Controlled Pilot Trial. Front Psychiatry 2021; 12:669494. [PMID: 34079488 PMCID: PMC8165233 DOI: 10.3389/fpsyt.2021.669494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority. Methods: Youth were randomized to receive intensive CBT at a hospital clinic (n = 14) or within their home (n = 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed. Results: Families' satisfaction with the treatment program was high. Of study completers (n = 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment). Discussion: Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant. Clinical Trial Registration: www.ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03672565, identifier: NCT03672565.
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Patel Y, Parker N, Shin J, Howard D, French L, Thomopoulos SI, Pozzi E, Abe Y, Abé C, Anticevic A, Alda M, Aleman A, Alloza C, Alonso-Lana S, Ameis SH, Anagnostou E, McIntosh AA, Arango C, Arnold PD, Asherson P, Assogna F, Auzias G, Ayesa-Arriola R, Bakker G, Banaj N, Banaschewski T, Bandeira CE, Baranov A, Bargalló N, Bau CHD, Baumeister S, Baune BT, Bellgrove MA, Benedetti F, Bertolino A, Boedhoe PSW, Boks M, Bollettini I, Del Mar Bonnin C, Borgers T, Borgwardt S, Brandeis D, Brennan BP, Bruggemann JM, Bülow R, Busatto GF, Calderoni S, Calhoun VD, Calvo R, Canales-Rodríguez EJ, Cannon DM, Carr VJ, Cascella N, Cercignani M, Chaim-Avancini TM, Christakou A, Coghill D, Conzelmann A, Crespo-Facorro B, Cubillo AI, Cullen KR, Cupertino RB, Daly E, Dannlowski U, Davey CG, Denys D, Deruelle C, Di Giorgio A, Dickie EW, Dima D, Dohm K, Ehrlich S, Ely BA, Erwin-Grabner T, Ethofer T, Fair DA, Fallgatter AJ, Faraone SV, Fatjó-Vilas M, Fedor JM, Fitzgerald KD, Ford JM, Frodl T, Fu CHY, Fullerton JM, Gabel MC, Glahn DC, Roberts G, Gogberashvili T, Goikolea JM, Gotlib IH, Goya-Maldonado R, Grabe HJ, Green MJ, Grevet EH, Groenewold NA, Grotegerd D, Gruber O, Gruner P, Guerrero-Pedraza A, Gur RE, Gur RC, Haar S, Haarman BCM, Haavik J, Hahn T, Hajek T, Harrison BJ, Harrison NA, Hartman CA, Whalley HC, Heslenfeld DJ, Hibar DP, Hilland E, Hirano Y, Ho TC, Hoekstra PJ, Hoekstra L, Hohmann S, Hong LE, Höschl C, Høvik MF, Howells FM, Nenadic I, Jalbrzikowski M, James AC, Janssen J, Jaspers-Fayer F, Xu J, Jonassen R, Karkashadze G, King JA, Kircher T, Kirschner M, Koch K, Kochunov P, Kohls G, Konrad K, Krämer B, Krug A, Kuntsi J, Kwon JS, Landén M, Landrø NI, Lazaro L, Lebedeva IS, Leehr EJ, Lera-Miguel S, Lesch KP, Lochner C, Louza MR, Luna B, Lundervold AJ, MacMaster FP, Maglanoc LA, Malpas CB, Portella MJ, Marsh R, Martyn FM, Mataix-Cols D, Mathalon DH, McCarthy H, McDonald C, McPhilemy G, Meinert S, Menchón JM, Minuzzi L, Mitchell PB, Moreno C, Morgado P, Muratori F, Murphy CM, Murphy D, Mwangi B, Nabulsi L, Nakagawa A, Nakamae T, Namazova L, Narayanaswamy J, Jahanshad N, Nguyen DD, Nicolau R, O'Gorman Tuura RL, O'Hearn K, Oosterlaan J, Opel N, Ophoff RA, Oranje B, García de la Foz VO, Overs BJ, Paloyelis Y, Pantelis C, Parellada M, Pauli P, Picó-Pérez M, Picon FA, Piras F, Piras F, Plessen KJ, Pomarol-Clotet E, Preda A, Puig O, Quidé Y, Radua J, Ramos-Quiroga JA, Rasser PE, Rauer L, Reddy J, Redlich R, Reif A, Reneman L, Repple J, Retico A, Richarte V, Richter A, Rosa PGP, Rubia KK, Hashimoto R, Sacchet MD, Salvador R, Santonja J, Sarink K, Sarró S, Satterthwaite TD, Sawa A, Schall U, Schofield PR, Schrantee A, Seitz J, Serpa MH, Setién-Suero E, Shaw P, Shook D, Silk TJ, Sim K, Simon S, Simpson HB, Singh A, Skoch A, Skokauskas N, Soares JC, Soreni N, Soriano-Mas C, Spalletta G, Spaniel F, Lawrie SM, Stern ER, Stewart SE, Takayanagi Y, Temmingh HS, Tolin DF, Tomecek D, Tordesillas-Gutiérrez D, Tosetti M, Uhlmann A, van Amelsvoort T, van der Wee NJA, van der Werff SJA, van Haren NEM, van Wingen GA, Vance A, Vázquez-Bourgon J, Vecchio D, Venkatasubramanian G, Vieta E, Vilarroya O, Vives-Gilabert Y, Voineskos AN, Völzke H, von Polier GG, Walton E, Weickert TW, Weickert CS, Weideman AS, Wittfeld K, Wolf DH, Wu MJ, Yang TT, Yang K, Yoncheva Y, Yun JY, Cheng Y, Zanetti MV, Ziegler GC, Franke B, Hoogman M, Buitelaar JK, van Rooij D, Andreassen OA, Ching CRK, Veltman DJ, Schmaal L, Stein DJ, van den Heuvel OA, Turner JA, van Erp TGM, Pausova Z, Thompson PM, Paus T. Virtual Histology of Cortical Thickness and Shared Neurobiology in 6 Psychiatric Disorders. JAMA Psychiatry 2021; 78:47-63. [PMID: 32857118 PMCID: PMC7450410 DOI: 10.1001/jamapsychiatry.2020.2694] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/12/2020] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Large-scale neuroimaging studies have revealed group differences in cortical thickness across many psychiatric disorders. The underlying neurobiology behind these differences is not well understood. OBJECTIVE To determine neurobiologic correlates of group differences in cortical thickness between cases and controls in 6 disorders: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Profiles of group differences in cortical thickness between cases and controls were generated using T1-weighted magnetic resonance images. Similarity between interregional profiles of cell-specific gene expression and those in the group differences in cortical thickness were investigated in each disorder. Next, principal component analysis was used to reveal a shared profile of group difference in thickness across the disorders. Analysis for gene coexpression, clustering, and enrichment for genes associated with these disorders were conducted. Data analysis was conducted between June and December 2019. The analysis included 145 cohorts across 6 psychiatric disorders drawn from the ENIGMA consortium. The numbers of cases and controls in each of the 6 disorders were as follows: ADHD: 1814 and 1602; ASD: 1748 and 1770; BD: 1547 and 3405; MDD: 2658 and 3572; OCD: 2266 and 2007; and schizophrenia: 2688 and 3244. MAIN OUTCOMES AND MEASURES Interregional profiles of group difference in cortical thickness between cases and controls. RESULTS A total of 12 721 cases and 15 600 controls, ranging from ages 2 to 89 years, were included in this study. Interregional profiles of group differences in cortical thickness for each of the 6 psychiatric disorders were associated with profiles of gene expression specific to pyramidal (CA1) cells, astrocytes (except for BD), and microglia (except for OCD); collectively, gene-expression profiles of the 3 cell types explain between 25% and 54% of variance in interregional profiles of group differences in cortical thickness. Principal component analysis revealed a shared profile of difference in cortical thickness across the 6 disorders (48% variance explained); interregional profile of this principal component 1 was associated with that of the pyramidal-cell gene expression (explaining 56% of interregional variation). Coexpression analyses of these genes revealed 2 clusters: (1) a prenatal cluster enriched with genes involved in neurodevelopmental (axon guidance) processes and (2) a postnatal cluster enriched with genes involved in synaptic activity and plasticity-related processes. These clusters were enriched with genes associated with all 6 psychiatric disorders. CONCLUSIONS AND RELEVANCE In this study, shared neurobiologic processes were associated with differences in cortical thickness across multiple psychiatric disorders. These processes implicate a common role of prenatal development and postnatal functioning of the cerebral cortex in these disorders.
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Bruin WB, Taylor L, Thomas RM, Shock JP, Zhutovsky P, Abe Y, Alonso P, Ameis SH, Anticevic A, Arnold PD, Assogna F, Benedetti F, Beucke JC, Boedhoe PSW, Bollettini I, Bose A, Brem S, Brennan BP, Buitelaar JK, Calvo R, Cheng Y, Cho KIK, Dallaspezia S, Denys D, Ely BA, Feusner JD, Fitzgerald KD, Fouche JP, Fridgeirsson EA, Gruner P, Gürsel DA, Hauser TU, Hirano Y, Hoexter MQ, Hu H, Huyser C, Ivanov I, James A, Jaspers-Fayer F, Kathmann N, Kaufmann C, Koch K, Kuno M, Kvale G, Kwon JS, Liu Y, Lochner C, Lázaro L, Marques P, Marsh R, Martínez-Zalacaín I, Mataix-Cols D, Menchón JM, Minuzzi L, Moreira PS, Morer A, Morgado P, Nakagawa A, Nakamae T, Nakao T, Narayanaswamy JC, Nurmi EL, O'Neill J, Pariente JC, Perriello C, Piacentini J, Piras F, Piras F, Reddy YCJ, Rus-Oswald OG, Sakai Y, Sato JR, Schmaal L, Shimizu E, Simpson HB, Soreni N, Soriano-Mas C, Spalletta G, Stern ER, Stevens MC, Stewart SE, Szeszko PR, Tolin DF, Venkatasubramanian G, Wang Z, Yun JY, van Rooij D, Thompson PM, van den Heuvel OA, Stein DJ, van Wingen GA. Structural neuroimaging biomarkers for obsessive-compulsive disorder in the ENIGMA-OCD consortium: medication matters. Transl Psychiatry 2020; 10:342. [PMID: 33033241 PMCID: PMC7598942 DOI: 10.1038/s41398-020-01013-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 11/08/2022] Open
Abstract
No diagnostic biomarkers are available for obsessive-compulsive disorder (OCD). Here, we aimed to identify magnetic resonance imaging (MRI) biomarkers for OCD, using 46 data sets with 2304 OCD patients and 2068 healthy controls from the ENIGMA consortium. We performed machine learning analysis of regional measures of cortical thickness, surface area and subcortical volume and tested classification performance using cross-validation. Classification performance for OCD vs. controls using the complete sample with different classifiers and cross-validation strategies was poor. When models were validated on data from other sites, model performance did not exceed chance-level. In contrast, fair classification performance was achieved when patients were grouped according to their medication status. These results indicate that medication use is associated with substantial differences in brain anatomy that are widely distributed, and indicate that clinical heterogeneity contributes to the poor performance of structural MRI as a disease marker.
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Boedhoe PSW, van Rooij D, Hoogman M, Twisk JWR, Schmaal L, Abe Y, Alonso P, Ameis SH, Anikin A, Anticevic A, Arango C, Arnold PD, Asherson P, Assogna F, Auzias G, Banaschewski T, Baranov A, Batistuzzo MC, Baumeister S, Baur-Streubel R, Behrmann M, Bellgrove MA, Benedetti F, Beucke JC, Biederman J, Bollettini I, Bose A, Bralten J, Bramati IE, Brandeis D, Brem S, Brennan BP, Busatto GF, Calderoni S, Calvo A, Calvo R, Castellanos FX, Cercignani M, Chaim-Avancini TM, Chantiluke KC, Cheng Y, Cho KIK, Christakou A, Coghill D, Conzelmann A, Cubillo AI, Dale AM, Dallaspezia S, Daly E, Denys D, Deruelle C, Di Martino A, Dinstein I, Doyle AE, Durston S, Earl EA, Ecker C, Ehrlich S, Ely BA, Epstein JN, Ethofer T, Fair DA, Fallgatter AJ, Faraone SV, Fedor J, Feng X, Feusner JD, Fitzgerald J, Fitzgerald KD, Fouche JP, Freitag CM, Fridgeirsson EA, Frodl T, Gabel MC, Gallagher L, Gogberashvili T, Gori I, Gruner P, Gürsel DA, Haar S, Haavik J, Hall GB, Harrison NA, Hartman CA, Heslenfeld DJ, Hirano Y, Hoekstra PJ, Hoexter MQ, Hohmann S, Høvik MF, Hu H, Huyser C, Jahanshad N, Jalbrzikowski M, James A, Janssen J, Jaspers-Fayer F, Jernigan TL, Kapilushniy D, Kardatzki B, Karkashadze G, Kathmann N, Kaufmann C, Kelly C, Khadka S, King JA, Koch K, Kohls G, Konrad K, Kuno M, Kuntsi J, Kvale G, Kwon JS, Lázaro L, Lera-Miguel S, Lesch KP, Hoekstra L, Liu Y, Lochner C, Louza MR, Luna B, Lundervold AJ, Malpas CB, Marques P, Marsh R, Martínez-Zalacaín I, Mataix-Cols D, Mattos P, McCarthy H, McGrath J, Mehta MA, Menchón JM, Mennes M, Martinho MM, Moreira PS, Morer A, Morgado P, Muratori F, Murphy CM, Murphy DGM, Nakagawa A, Nakamae T, Nakao T, Namazova-Baranova L, Narayanaswamy JC, Nicolau R, Nigg JT, Novotny SE, Nurmi EL, Weiss EO, O'Gorman Tuura RL, O'Hearn K, O'Neill J, Oosterlaan J, Oranje B, Paloyelis Y, Parellada M, Pauli P, Perriello C, Piacentini J, Piras F, Piras F, Plessen KJ, Puig O, Ramos-Quiroga JA, Reddy YCJ, Reif A, Reneman L, Retico A, Rosa PGP, Rubia K, Rus OG, Sakai Y, Schrantee A, Schwarz L, Schweren LJS, Seitz J, Shaw P, Shook D, Silk TJ, Simpson HB, Skokauskas N, Soliva Vila JC, Solovieva A, Soreni N, Soriano-Mas C, Spalletta G, Stern ER, Stevens MC, Stewart SE, Sudre G, Szeszko PR, Tamm L, Taylor MJ, Tolin DF, Tosetti M, Tovar-Moll F, Tsuchiyagaito A, van Erp TGM, van Wingen GA, Vance A, Venkatasubramanian G, Vilarroya O, Vives-Gilabert Y, von Polier GG, Walitza S, Wallace GL, Wang Z, Wolfers T, Yoncheva YN, Yun JY, Zanetti MV, Zhou F, Ziegler GC, Zierhut KC, Zwiers MP, Thompson PM, Stein DJ, Buitelaar J, Franke B, van den Heuvel OA. Subcortical Brain Volume, Regional Cortical Thickness, and Cortical Surface Area Across Disorders: Findings From the ENIGMA ADHD, ASD, and OCD Working Groups. Am J Psychiatry 2020; 177:834-843. [PMID: 32539527 PMCID: PMC8296070 DOI: 10.1176/appi.ajp.2020.19030331] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. The authors sought to directly compare these disorders using structural brain imaging data from ENIGMA consortium data. METHODS Structural T1-weighted whole-brain MRI data from healthy control subjects (N=5,827) and from patients with ADHD (N=2,271), ASD (N=1,777), and OCD (N=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. The authors examined subcortical volume, cortical thickness, and cortical surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults, using linear mixed-effects models adjusting for age, sex, and site (and intracranial volume for subcortical and surface area measures). RESULTS No shared differences were found among all three disorders, and shared differences between any two disorders did not survive correction for multiple comparisons. Children with ADHD compared with those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller intracranial volume than control subjects and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared with adult control subjects and other clinical groups. No OCD-specific differences were observed across different age groups and surface area differences among all disorders in childhood and adulthood. CONCLUSIONS The study findings suggest robust but subtle differences across different age groups among ADHD, ASD, and OCD. ADHD-specific intracranial volume and hippocampal differences in children and adolescents, and ASD-specific cortical thickness differences in the frontal cortex in adults, support previous work emphasizing structural brain differences in these disorders.
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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] [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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Stewart SE. Editorial: Expanding Notions of Networks Within Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 2020; 59:805-807. [PMID: 31972263 DOI: 10.1016/j.jaac.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/03/2020] [Indexed: 11/17/2022]
Abstract
Child and adolescent psychiatry trainees are traditionally offered "pearls of wisdom" emphasizing, among other things, the value of collegial peer networks such as that found within the American Academy of Child and Adolescent Psychiatry (AACAP). The article in this issue by Cervin et al.1 demonstrates the value of an admittedly different type of network. They report on the application of Network Theory and related analytic methods to examine for "universal" obsessive-compulsive symptomatology (OCS) patterns, as expressed within normative and pathological samples. Specifically, they use Obsessive-Compulsive Inventory-Child Version (OCI-CV)2 data from an impressive sample of 6,991 unselected school children and 704 obsessive-compulsive disorder (OCD)-affected children, collected across 18 international sites. OCD is one of the most debilitating and heterogeneous childhood-onset psychiatric illnesses with notable treatment potential.3 Yet, it remains unclear whether the OCD phenotype represents: (1) an "extreme end" of human cognition and behavior within a normative continuum, or (2) a distinct symptom pattern that is a harbinger of significant dysfunction and distress.4 This question has historically been difficult to address, given limited available samples and analytic strategies. Although the pediatric OCD phenotype was traditionally described according to symptom categories5 and dimensions,6 their interrelationships were not fully examined. Nor was the individual symptom of "doubt" within or across dimensions. The networking analyses of Cervin et al. highlights the doubt/checking OCS dimension as a central node, especially within clinical populations. This supports a long-standing lay definition of OCD as the "doubting disease." The study also demonstrates observable cross-population differences-with less robust interconnections ("edges") between nodes among OCD-affected children versus unselected students-raising the question of whether this paucity contributes to the dysfunction and distress characterizing this illness. Akin to peer networks, which are optimally dense with close, strong interconnections, it would appear that the presence of fewer connections within pediatric OCS networks may contribute to poorer function. Longitudinal studies examining OCS networks in unaffected, at-risk siblings both pre- and post-OCD onset would help to substantiate this.
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Kong XZ, Boedhoe PS, Abe Y, Alonso P, Ameis SH, Arnold PD, Assogna F, Baker JT, Batistuzzo MC, Benedetti F, Beucke JC, Bollettini I, Bose A, Brem S, Brennan BP, Buitelaar J, Calvo R, Cheng Y, Cho KIK, Dallaspezia S, Denys D, Ely BA, Feusner J, Fitzgerald KD, Fouche JP, Fridgeirsson EA, Glahn DC, Gruner P, Gürsel DA, Hauser TU, Hirano Y, Hoexter MQ, Hu H, Huyser C, James A, Jaspers-Fayer F, Kathmann N, Kaufmann C, Koch K, Kuno M, Kvale G, Kwon JS, Lazaro L, Liu Y, Lochner C, Marques P, Marsh R, Martínez-Zalacaín I, Mataix-Cols D, Medland SE, Menchón JM, Minuzzi L, Moreira PS, Morer A, Morgado P, Nakagawa A, Nakamae T, Nakao T, Narayanaswamy JC, Nurmi EL, O’Neil J, Pariente JC, Perriello C, Piacentini J, Piras F, Piras F, Pittenger C, Reddy YJ, Rus-Oswald OG, Sakai Y, Sato JR, Schmaal L, Simpson HB, Soreni N, Soriano-Mas C, Spalletta G, Stern ER, Stevens MC, Stewart SE, Szeszko PR, Tolin DF, Tsuchiyagaito A, van Rooij D, van Wingen GA, Venkatasubramanian G, Wang Z, Yun JY, Thompson PM, Stein DJ, van den Heuvel OA, Francks C. Mapping Cortical and Subcortical Asymmetry in Obsessive-Compulsive Disorder: Findings From the ENIGMA Consortium. Biol Psychiatry 2020; 87:1022-1034. [PMID: 31178097 PMCID: PMC7094802 DOI: 10.1016/j.biopsych.2019.04.022] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lateralized dysfunction has been suggested in obsessive-compulsive disorder (OCD). However, it is currently unclear whether OCD is characterized by abnormal patterns of brain structural asymmetry. Here we carried out what is by far the largest study of brain structural asymmetry in OCD. METHODS We studied a collection of 16 pediatric datasets (501 patients with OCD and 439 healthy control subjects), as well as 30 adult datasets (1777 patients and 1654 control subjects) from the OCD Working Group within the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium. Asymmetries of the volumes of subcortical structures, and of measures of regional cortical thickness and surface areas, were assessed based on T1-weighted magnetic resonance imaging scans, using harmonized image analysis and quality control protocols. We investigated possible alterations of brain asymmetry in patients with OCD. We also explored potential associations of asymmetry with specific aspects of the disorder and medication status. RESULTS In the pediatric datasets, the largest case-control differences were observed for volume asymmetry of the thalamus (more leftward; Cohen's d = 0.19) and the pallidum (less leftward; d = -0.21). Additional analyses suggested putative links between these asymmetry patterns and medication status, OCD severity, or anxiety and depression comorbidities. No significant case-control differences were found in the adult datasets. CONCLUSIONS The results suggest subtle changes of the average asymmetry of subcortical structures in pediatric OCD, which are not detectable in adults with the disorder. These findings may reflect altered neurodevelopmental processes in OCD.
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Belschner L, Lin SY, Yamin DF, Best JR, Edalati K, McDermid J, Stewart SE. Mindfulness-based skills training group for parents of obsessive-compulsive disorder-affected children: A caregiver-focused intervention. Complement Ther Clin Pract 2020; 39:101098. [PMID: 32379640 DOI: 10.1016/j.ctcp.2020.101098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Parents of children with obsessive-compulsive disorder (OCD) report significant emotional and socio-occupational impacts. There is, however, currently insufficient support for these parents. This study examined a mindfulness-based intervention for parents of OCD-affected children, investigating its feasibility and impact on parental ability to tolerate their child's OCD-related distress, in addition to exploring potential indirect effects. MATERIALS AND METHODS Parents of OCD-affected children (n = 39) completed an eight-week baseline observation period followed by eight, weekly manualized mindfulness-based intervention group sessions. Measures of parental tolerance of child distress, dispositional mindfulness, family accommodation, family functioning, and OCD symptom severity were collected. RESULTS In comparison to the baseline observation period, parental tolerance of child distress and dispositional mindfulness significantly improved following mindfulness training. No other temporal differences were observed. Parents reported high satisfaction. CONCLUSION Mindfulness-based skills training for parents of OCD-affected youth appears to be feasible and to significantly increase tolerance related to the child's distress. CLINICAL TRIAL REGISTRATION NUMBER NCT03212703.
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Negreiros J, Belschner L, Best JR, Lin S, Franco Yamin D, Joffres Y, Selles RR, Jaspers-Fayer F, Miller LD, Woodward TS, Honer WG, Stewart SE. Neurocognitive risk markers in pediatric obsessive-compulsive disorder. J Child Psychol Psychiatry 2020; 61:605-613. [PMID: 31749150 DOI: 10.1111/jcpp.13153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has complex genetic underpinnings, particularly in its early-onset form, which places siblings at a 10-fold increased risk of developing the disorder. Examination for neurocognitive markers preceding pediatric OCD onset has not been conducted, although markers have been identified in adult OCD. This study compared neurocognition across groups of OCD-affected youth (n = 87), unaffected siblings of those with early-onset OCD (n = 67), and healthy controls (HC; n = 79). METHODS A total of 233 participants aged 6-18 years old completed standardized neurocognitive tests of cognitive flexibility, decision making, planning, response inhibition, spatial working memory, attention, recognition nonverbal memory, and intelligence. They were administered the Anxiety Disorders Interview Schedule-Parent version (ADIS-P) and completed self-report anxiety and OCD questionnaires. Linear mixed-effects models tested for differences between groups, adjusting for age, gender, IQ, state anxiety, and ethnicity, and accounting for random effects of family membership. RESULTS OCD-affected youth and unaffected siblings performed significantly worse on planning in comparison to HCs (Cohen's d = 0.74; 95% CI = [0.11, 1.36]; Cohen's d = 0.75; 95% CI = [0.12, 1.38], respectively; omnibus group effect p = .007). No other significant between-group differences were identified. CONCLUSIONS Neurocognitive performance differences between groups identified planning as a preexisting trait marker of pediatric OCD, while no other domain presented as a marker of pediatric OCD. This differs from adult OCD, which is associated with broader cognitive impairments. Investigating longitudinal trajectories and predictive significance of neurocognition in those affected by, and at risk for, early-onset OCD is warranted. Ideally, this will enhance individualized risk stratification and inform future prevention and early intervention strategies.
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Selles RR, Højgaard DRMA, Ivarsson T, Thomsen PH, McBride NM, Storch EA, Geller D, Wilhelm S, Farrell LJ, Waters AM, Mathieu S, Stewart SE. Avoidance, Insight, Impairment Recognition Concordance, and Cognitive-Behavioral Therapy Outcomes in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:650-659.e2. [PMID: 31228561 PMCID: PMC7179819 DOI: 10.1016/j.jaac.2019.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/10/2019] [Accepted: 06/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Insight and avoidance are commonly discussed factors in obsessive-compulsive disorder (OCD) that have demonstrated associations with increased severity as well as reduced treatment response in adults, but these factors have not been sufficiently examined in pediatric OCD. This study examined the impacts of avoidance, insight, and impairment recognition concordance on cognitive-behavioral therapy (CBT) outcomes as well as impacts of CBT on insight and avoidance in a large sample of youths affected by OCD. METHOD Data from 573 OCD-affected youths enrolled in CBT trials were aggregated. Children's Yale-Brown Obsessive-Compulsive Scale items measured treatment response, insight, and avoidance. Standardized differences between child and parent ratings of impairment were used to calculate impairment recognition concordance. Binary logistic regression was used to identify variables associated with treatment response. RESULTS Greater avoidance, limited child recognition of impairment, older age, and lower baseline severity predicted reduced likelihood of treatment response, but insight did not. Both insight and avoidance improved significantly following CBT. Response rates were lower when posttreatment insight and avoidance were worse. CONCLUSION Contrasting with prevailing belief, poor insight does not appear to limit CBT response potential in pediatric OCD. Avoidance and impairment recognition are understudied CBT response predictors and warrant further consideration in pediatric OCD. Clinicians should attend to these factors to optimize outcomes for children affected by this common, debilitating illness.
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