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Fatori D, Costa DL, Asbahr FR, Ferrão YA, Rosário MC, Miguel EC, Shavitt RG, Batistuzzo MC. Is it time to change the gold standard of obsessive-compulsive disorder severity assessment? Factor structure of the Yale-Brown Obsessive-Compulsive Scale. Aust N Z J Psychiatry 2020; 54:732-742. [PMID: 32475123 DOI: 10.1177/0004867420924113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The Yale-Brown Obsessive-Compulsive Scale has been considered the gold standard scale to assess obsessive-compulsive disorder severity. Previous studies using exploratory factor analysis and confirmatory factor analysis with this scale showed mixed findings in terms of factor structure and fit of models. Therefore, we used confirmatory factor analysis to compare different Yale-Brown Obsessive-Compulsive Scale models in a large sample aiming to identify the best model fit. METHODS We assessed adult obsessive-compulsive disorder patients (n = 955) using three measures: Yale-Brown Obsessive-Compulsive Scale severity ratings, the Dimensional Yale-Brown Obsessive-Compulsive Scale and the clinical global impression scale. We tested all factor structures reported by previous studies to investigate which model best fitted the data: one-factor, two-factor, three-factor and their equivalent high-order solutions. We also investigated Yale-Brown Obsessive-Compulsive Scale items correlations with scores from the other measures of obsessive-compulsive disorder severity. RESULTS Confirmatory factor analysis models presented mediocre to fair goodness-of-fit indexes. Severity items related to resistance to obsessions and compulsions presented low factor loadings. The model with the best fit indexes was a high-order model without obsessive-compulsive disorder resistance items. These items also presented small correlations with other obsessive-compulsive disorder severity measures. CONCLUSION The obsessive-compulsive disorder field needs to discuss further improvements in the Yale-Brown Obsessive-Compulsive Scale and/or continue to search for better measures of obsessive-compulsive disorder severity.
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Affiliation(s)
- Daniel Fatori
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Daniel Lc Costa
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Fernando R Asbahr
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Maria Conceição Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Euripedes C Miguel
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Roseli G Shavitt
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil
| | - Marcelo C Batistuzzo
- Departamento de Psiquiatria (Department of Psychiatry), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (University of Sao Paulo Medical School), São Paulo, Brazil.,Department of Methods and Techniques, Psychology Course, Pontifical Catholic University of São Paulo, São Paulo, Brazil
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Silveira VP, Frydman I, Fontenelle LF, Mattos P, de Oliveira-Souza R, Moll J, Hoexter MQ, Miguel EC, McLaughlin NC, Shephard E, Batistuzzo MC. Exploring response inhibition and error monitoring in obsessive-compulsive disorder. J Psychiatr Res 2020; 126:26-33. [PMID: 32413597 PMCID: PMC7313630 DOI: 10.1016/j.jpsychires.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Behavioral evidence of impaired response inhibition (RI) and hyperactive error monitoring (EM) in obsessive-compulsive disorder (OCD) is inconsistent. Recent neuroimaging work suggests that EM plays a role in RI impairments in OCD, but this has rarely been investigated using behavioral measures. The aims of this study were to (1) compare RI and EM performance between adults with OCD and non-psychiatric controls (NPC) while investigating possible moderators, and (2) assess whether excessive EM influences RI in OCD. We compared RI and EM performance on the Stop-Signal Task (SST) between 92 adults with OCD and 65 NPC from two Brazilian sites. We used linear regression to investigate which variables (group, age, medication use, clinical symptomatology) influenced performance, as well as to examine possible associations between RI and EM. OCD and NPC did not differ in RI and EM. However, age moderated RI performance in OCD with a medium effect size, reflecting differential effects of age on RI between groups: age was positively associated with RI in OCD but not NPC. Further, OCD severity predicted EM with a medium to large effect size, suggesting that more symptomatic patients showed greater monitoring of their mistakes. Finally, group moderated the relationship between RI and EM with a small effect size. Our findings suggest that demographic factors may influence RI, whereas clinical factors may influence EM. Further, we found preliminary behavioral evidence to indicate that impaired RI and excessive EM are related in OCD.
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Affiliation(s)
- Vitor Portella Silveira
- Departmento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Ilana Frydman
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro - RJ, 22290-140, Brazil
| | - Leonardo F. Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro - RJ, 22290-140, Brazil,Turner Institute for Brain and Mental Health, Monash University, Wellington Rd, Clayton VIC 3800, Australia,D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Paulo Mattos
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Ricardo de Oliveira-Souza
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Jorge Moll
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. Rua Diniz Cordeiro, 30 - Botafogo, Rio de Janeiro - RJ, 22281-100, Brazil
| | - Marcelo Queiroz Hoexter
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil. R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo - SP, 05403-903, Brazil
| | - Eurípedes Constantino Miguel
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil. R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo - SP, 05403-903, Brazil
| | - Nicole C.R. McLaughlin
- Butler Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA. 345 Blackstone Blvd, Providence, RI 02906, USA
| | - Elizabeth Shephard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK. 16 De Crespigny Park, Camberwell, London SE5 8AF, UK
| | - Marcelo Camargo Batistuzzo
- Psychology Department, Health Sciences School, Pontifical Catholic University of São Paulo, São Paulo, SP, Brazil. Rua Monte Alegre 984 - Perdizes, São Paulo - SP, 05014-001, Brazil
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Aspvall K, Lenhard F, Melin K, Krebs G, Norlin L, Näsström K, Jassi A, Turner C, Knoetze E, Serlachius E, Andersson E, Mataix-Cols D. Implementation of internet-delivered cognitive behaviour therapy for pediatric obsessive-compulsive disorder: Lessons from clinics in Sweden, United Kingdom and Australia. Internet Interv 2020; 20:100308. [PMID: 32082991 PMCID: PMC7019117 DOI: 10.1016/j.invent.2020.100308] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) can be successfully treated with cognitive behaviour therapy (CBT). However, as few patients have access to CBT, there is a strong push to develop and evaluate scalable and cost-effective internet-delivered interventions. BIP OCD is a therapist-guided online CBT intervention for pediatric OCD that has shown promise in trials conducted at a single site in Stockholm, Sweden. In this study, we evaluated if BIP OCD is an acceptable, feasible, and effective treatment in other countries and clinical contexts. Thirty-one patients were recruited at three different sites; a specialist OCD clinic in Gothenburg (Sweden), a specialist OCD clinic in London (United Kingdom), and a university-based clinic in Brisbane (Australia). Acceptability and feasibility measures included treatment adherence and feedback from therapists. Clinician assessments were conducted at baseline, post-treatment, and 3-month follow-up. The average module completion for the participants was 8.1/12 (SD = 3.2) and the majority of patients completed the BIP OCD treatment (100% in Gothenburg, and 55.6% in both London and Brisbane). Pooling data from the three sites, the within-group effect sizes from baseline to post-treatment on the Children's Yale-Brown Obsessive-Compulsive Scale were in the expected range (bootstrapped Cohen's d = 1.78; 95% CI 1.18-2.39), with an additional symptom reduction to the 3-month follow-up (bootstrapped Cohen's d = 0.27; 95% CI 0.02-0.51). Participating therapists identified both advantages and difficulties supporting patients in this digital format. The results of this study suggest that the treatment effects obtained in the original BIP OCD trials can be generalized to other clinical contexts nationally and internationally. Lessons learned provide important information for successful implementation of BIP OCD in regular healthcare contexts.
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Affiliation(s)
- Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Child and Adolescent Psychiatry, CAP Specialized unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Georgina Krebs
- Institute of Psychiatry, Psychology & Neuroscience, MRC Social, Genetic and Developmental Psychiatry Centre King's College, London, United Kingdom
- National Specialist OCD, BDD and related disorders clinic, Maudsley Hospital, London, United Kingdom
| | - Lisa Norlin
- Department of Child and Adolescent Psychiatry, CAP Specialized unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Näsström
- Department of Child and Adolescent Psychiatry, CAP Specialized unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amita Jassi
- National Specialist OCD, BDD and related disorders clinic, Maudsley Hospital, London, United Kingdom
| | - Cynthia Turner
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elizabeth Knoetze
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
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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: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [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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Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS. J Am Acad Child Adolesc Psychiatry 2020; 59:244-253. [PMID: 30768383 DOI: 10.1016/j.jaac.2019.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/15/2019] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. METHOD This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. RESULTS Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. CONCLUSION The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. CLINICAL TRIAL REGISTRATION INFORMATION Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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Mataix-Cols D, Fernández de la Cruz L, Rück C. When Improving Symptoms Is Not Enough-Is It Time for Next-Generation Interventions for Obsessive-Compulsive Disorder? JAMA Psychiatry 2020; 77:9-10. [PMID: 31509171 DOI: 10.1001/jamapsychiatry.2019.2335] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Pérez-Vigil A, Fernández de la Cruz L, Brander G, Isomura K, Jangmo A, Kuja-Halkola R, Hesselmark E, D'Onofrio BM, Larsson H, Mataix-Cols D. Association of Tourette Syndrome and Chronic Tic Disorders With Objective Indicators of Educational Attainment: A Population-Based Sibling Comparison Study. JAMA Neurol 2019; 75:1098-1105. [PMID: 29813161 DOI: 10.1001/jamaneurol.2018.1194] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The influence of Tourette syndrome and chronic tic disorders on academic performance has not been objectively quantified. Objective To investigate the association of Tourette syndrome and chronic tic disorders with objectively measured educational outcomes, adjusting for measured covariates and unmeasured factors shared between siblings and taking common psychiatric comorbidities into account. Design, Setting, and Participants A population-based birth cohort consisting of all individuals born in Sweden from 1976 to 1998 was followed up until December 2013. Individuals with organic brain disorders, mental retardation, and 2 foreign-born parents were excluded. We further identified families with at least 2 singleton full siblings and families with siblings discordant for Tourette syndrome or chronic tic disorders. Exposures Previously validated International Classification of Diseases diagnoses of Tourette syndrome or chronic tic disorders in the Swedish National Patient Register. Main Outcomes and Measures Eligibility to access upper secondary school after compulsory education, finishing upper secondary school, starting a university degree, and finishing a university degree. Results Of the 2 115 554 individuals in the cohort, 3590 had registered a diagnosis of Tourette syndrome or a chronic tic disorder in specialist care (of whom 2822 [78.6%] were male; median [interquartile] age at first diagnosis, 14.0 [11-18] years). Of 726 198 families with at least 2 singleton full siblings, 2697 included siblings discordant for these disorders. Compared with unexposed individuals, people with Tourette syndrome or chronic tic disorders were significantly less likely to pass all core and additional courses at the end of compulsory school (odds ratios ranging from 0.23 [95% CI, 0.20-0.26] for the handcraft textile/wood course to 0.36 [95% CI, 0.31-0.41] for the English language course) and to access a vocational program (adjusted OR [aOR], 0.31; 95% CI, 0.28-0.34) or academic program (aOR, 0.43; 95% CI, 0.39-0.47) in upper secondary education. Individuals with the disorders were also less likely to finish upper secondary education (aOR, 0.35; 95% CI, 0.32-0.37), start a university degree (aOR, 0.41; 95% CI, 0.37-0.46), and finish a university degree (aOR, 0.39; 95% CI, 0.32-0.48). The results were only marginally attenuated in the fully adjusted sibling comparison models. Exclusion of patients with neuropsychiatric comorbidities, particularly attention-deficit/hyperactivity disorder and pervasive developmental disorders, resulted in attenuated estimates, but patients with Tourette syndrome or chronic tic disorders were still significantly impaired across all outcomes. Conclusions and Relevance Help-seeking individuals with Tourette syndrome or chronic tic disorders seen in specialist settings experience substantial academic underachievement across all educational levels, spanning from compulsory school to university, even after accounting for multiple confounding factors and psychiatric comorbidities.
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Affiliation(s)
- Ana Pérez-Vigil
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Brander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Eva Hesselmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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58
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Flygare O, Andersson E, Ringberg H, Hellstadius AC, Edbacken J, Enander J, Dahl M, Aspvall K, Windh I, Russell A, Mataix-Cols D, Rück C. Adapted cognitive behavior therapy for obsessive-compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:190-199. [PMID: 31187645 DOI: 10.1177/1362361319856974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obsessive-compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive-compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale-Brown Obsessive-Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive-compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive-compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
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Affiliation(s)
- Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council and M46, Karolinska University Hospital, Huddinge, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Helene Ringberg
- Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Stockholm, Sweden
| | | | | | - Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Matti Dahl
- Stockholm Health Care Services, Stockholm County Council and M46, Karolinska University Hospital, Huddinge, Sweden
| | - Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Stockholm, Sweden
| | - Indra Windh
- Stockholm Health Care Services, Stockholm County Council and M46, Karolinska University Hospital, Huddinge, Sweden
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council and M46, Karolinska University Hospital, Huddinge, Sweden
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59
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Blanco-Vieira T, Santos M, Ferrão YA, Torres AR, Miguel EC, Bloch MH, Leckman JF, do Rosario MC. The impact of attention deficit hyperactivity disorder in obsessive-compulsive disorder subjects. Depress Anxiety 2019; 36:533-542. [PMID: 30990937 DOI: 10.1002/da.22898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients. METHODS A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinical characteristics in adult OCD patients with and without comorbid ADHD were compared using Fisher's exact test, t-tests or Mann-Whitney tests. Bivariate analyses were followed by logistic regression analysis to identify clinical characteristics independently associated with ADHD comorbidity. RESULTS The lifetime prevalence of ADHD in adult OCD patients was 13.7%. The current results indicate that OCD + ADHD patients were more severe, had an earlier onset of the obsessive-compulsive symptoms, a higher history of rheumatic fever, with higher frequencies of sensory phenomena and comorbidity with Tourette syndrome. They also had an increased risk for academic impairment and suicide attempts. CONCLUSION Adult OCD patients with ADHD present some specific clinical features and may represent a special subgroup of adult OCD. Future studies should focus on the development of interventions more tailored to the phenotype of this subgroup of patients.
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Affiliation(s)
- Thiago Blanco-Vieira
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Matheus Santos
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ygor A Ferrão
- Department od Psychiatry, Porto Alegre Health Science Federal University, Porto Alegre, Brazil.,Brazilian OCD Research Consortium (CTOC), Brazil
| | - Albina R Torres
- Brazilian OCD Research Consortium (CTOC), Brazil.,Department of Psychiatry, Faculty of Medicine of Botucatu, State University of São Paulo, São Paulo, Brazil
| | - Eurípedes C Miguel
- Brazilian OCD Research Consortium (CTOC), Brazil.,Psychiatry Institute, Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Maria C do Rosario
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian OCD Research Consortium (CTOC), Brazil.,Child Study Center, Yale University, New Haven, Connecticut
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60
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Pérez-Vigil A, Mittendorfer-Rutz E, Helgesson M, Fernández de la Cruz L, Mataix-Cols D. Labour market marginalisation in obsessive-compulsive disorder: a nationwide register-based sibling control study. Psychol Med 2019; 49:1015-1024. [PMID: 29950186 DOI: 10.1017/s0033291718001691] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The impact of obsessive-compulsive disorder (OCD) on objective indicators of labour market marginalisation has not been quantified. METHODS Linking various Swedish national registers, we estimated the risk of three labour market marginalisation outcomes (receipt of newly granted disability pension, long-term sickness absence and long-term unemployment) in individuals diagnosed with OCD between 2001 and 2013 who were between 16 and 64 years old at the date of the first OCD diagnosis (n = 16 267), compared with matched general population controls (n = 157 176). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression models, adjusting for a number of covariates (e.g. somatic disorders) and stratifying by sex. To adjust for potential familial confounders, we further analysed data from 7905 families that included full siblings discordant for OCD. RESULTS Patients were more likely to receive at least one outcome of interest [adjusted HR = 3.63 (95% CI 3.53-3.74)], including disability pension [adjusted HR = 16.36 (95% CI 15.34-17.45)], being on long-term sickness absence [adjusted HR = 3.07 (95% CI 2.95-3.19)] and being on long-term unemployment [adjusted HR = 1.72 (95% CI 1.63-1.82)]. Results remained similar in the adjusted sibling comparison models. Exclusion of comorbid psychiatric disorders had a minimal impact on the results. CONCLUSIONS Help-seeking individuals with OCD diagnosed in specialist care experience marked difficulties to participate in the labour market. The findings emphasise the need for cooperation between policy-makers, vocational rehabilitation and mental health services in order to design and implement specific strategies aimed at improving the patients' participation in the labour market.
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Affiliation(s)
- Ana Pérez-Vigil
- Department of Clinical Neuroscience, Centre forPsychiatry Research,Karolinska Institutet,Stockholm,Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine,Department of Clinical Neuroscience,Karolinska Institutet,Stockholm,Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine,Department of Clinical Neuroscience,Karolinska Institutet,Stockholm,Sweden
| | | | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre forPsychiatry Research,Karolinska Institutet,Stockholm,Sweden
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61
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Brown LA, Wakschal E, Russman-Block S, Boisseau CL, Mancebo MC, Eisen JL, Rasmussen SA. Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample ✰. J Affect Disord 2019; 245:841-847. [PMID: 30699868 PMCID: PMC6361538 DOI: 10.1016/j.jad.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/17/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study. METHODS Participants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported. RESULTS The best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts. LIMITATIONS The study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study. DISCUSSION OCD symptom severity predicted next year suicidal ideation severity. In contrast, suicidal ideation severity in a given year did not predict next-year OCD symptom severity in this OCD sample. Thus, rather than waiting for suicidal ideation to resolve, clinicians should consider providing empirically supported treatments for OCD.
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Affiliation(s)
- Lily A. Brown
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA,Corresponding author information: Lily A. Brown, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North Philadelphia, PA 19104; 215-746-3346; Fax: 215-746-3311;
| | - Emily Wakschal
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Stefanie Russman-Block
- Warren Alpert Medical School of Brown University, Providence RI, USA,Michigan State University, East Lansing, MI, USA
| | - Christina L. Boisseau
- Warren Alpert Medical School of Brown University, Providence RI, USA,Butler Hospital, Providence RI, USA
| | - Maria C. Mancebo
- Warren Alpert Medical School of Brown University, Providence RI, USA,Butler Hospital, Providence RI, USA
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62
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Melin K, Skarphedinsson G, Skärsäter I, Haugland BSM, Ivarsson T. A solid majority remit following evidence-based OCD treatments: a 3-year naturalistic outcome study in pediatric OCD. Eur Child Adolesc Psychiatry 2018; 27:1373-1381. [PMID: 29502315 DOI: 10.1007/s00787-018-1137-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/23/2018] [Indexed: 11/30/2022]
Abstract
This study reports follow-up 2 and 3 years after the initial assessment of a sample of youth with a primary diagnosis of OCD. Participants were 109 children and adolescents, aged 5-17 years, recruited from a specialized, outpatient OCD clinic in Sweden. Patients were treated with cognitive behavioral therapy (CBT), augmented when indicated by selective serotonin reuptake inhibitor (SSRI). In cases where SSRIs were insufficient, augmentation with a second-generation antipsychotic (SGA) was applied. Participants were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), Children's OCD Impact Scale (COIS), and Children's Depressive Inventory (CDI) at follow-ups 2 and 3 years after baseline assessment. Treatment response was defined as CY-BOCS total score ≤ 15, and remission was defined as CY-BOCS total score ≤ 10. Analyzing the outcomes with linear mixed-effects models (LME) showed a decrease in OCD symptom load from 23 to 6.9 at the 3-year follow-up. Moreover, two of three (66.1%) participants were in remission, and another 19.2% had responded to treatment at the 3-year follow-up. Thus, 85.3% of participants responded to treatment. Moreover, during the follow-up period, participants' psychosocial functioning had significantly improved, and depressive symptoms had significantly decreased. The results suggest that evidence-based treatment for pediatric OCD, following expert consensus guidelines, has long-term positive effects for most children and adolescents diagnosed with OCD. The results also indicate that improvements are maintained over a 3-year period, at least, and that improvement is also found with regard to psychosocial functioning and depressive symptoms.
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Affiliation(s)
- Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Child and Adolescent Psychiatry, CAP Specialized unit, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.
| | | | - Ingela Skärsäter
- School of Social and Health and Sciences, Halmstad University, Box 823, 301 18, Halmstad, Sweden
| | - Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Postboks 7810, 5008, Bergen, Norway
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Postboks 4623, Nydalen, 0405, Oslo, Norway
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63
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Osland S, Arnold PD, Pringsheim T. The prevalence of diagnosed obsessive compulsive disorder and associated comorbidities: A population-based Canadian study. Psychiatry Res 2018; 268:137-142. [PMID: 30025284 DOI: 10.1016/j.psychres.2018.07.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/08/2018] [Accepted: 07/08/2018] [Indexed: 02/05/2023]
Abstract
The objective of this study was to provide epidemiological data regarding obsessive compulsive disorder (OCD) in Canada, and examine related conditions, childhood experiences and healthcare utilization. A Statistics Canada population-based health survey was utilized (N = 25,097). The prevalence of diagnosed OCD in Canada was 0.93% (95% CI 0.75-1.11). People with OCD were younger and more likely to have lower incomes. They were more likely to have mood disorders including depression and bipolar disorder (both diagnosed conditions and by screening), and generalized anxiety disorder. The diagnosis of OCD was also associated with alcohol dependence and substance abuse and dependence. Negative childhood experiences were more common in people with OCD, with 72.33%(95% CI 62.25%-82.41%) of people with OCD having experienced some form of childhood maltreatment. Healthcare utilization was more frequent in people with OCD, but they were also more likely to desire help but feel as if they did not receive it. The higher proportion of people with OCD reporting not receiving the care they needed may reveal a crucial gap in treatment and available resources.
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Affiliation(s)
- Sydney Osland
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Canada
| | - Paul D Arnold
- Departments of Psychiatry & Medical Genetics, Cumming School of Medicine, University of Calgary, Canada; Division of Child Psychiatry, Faculty of Medicine, University of Toronto, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Canada.
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64
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Manning EE, Ahmari SE. How can preclinical mouse models be used to gain insight into prefrontal cortex dysfunction in obsessive-compulsive disorder? Brain Neurosci Adv 2018; 2:2398212818783896. [PMID: 32166143 PMCID: PMC7058260 DOI: 10.1177/2398212818783896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023] Open
Abstract
Obsessive-compulsive disorder is a debilitating psychiatric disorder that is characterised by perseverative thoughts and behaviours. Cognitive and affective disturbances play a central role in this illness, and it is therefore not surprising that clinical neuroimaging studies have demonstrated widespread alterations in prefrontal cortex functioning in patients. Preclinical mouse experimental systems provide the opportunity to gain mechanistic insight into the neurobiological changes underlying prefrontal cortex dysfunction through new technologies that allow measurement and manipulation of activity in discrete neural populations in awake, behaving mice. However, recent preclinical research has focused on striatal dysfunction, and has therefore provided relatively little insight regarding the role of the prefrontal cortex in obsessive-compulsive disorder-relevant behaviours. Here, we will discuss a number of translational prefrontal cortex-dependent paradigms, including obsessive-compulsive disorder-relevant tasks that produce compulsive responding, and how they can be leveraged in this context. Drawing on recent examples that have led to mechanistic insight about specific genes, cell types and circuits that mediate prefrontal cortex contributions to distinct aspects of cognition, we will provide a framework for applying similar strategies to identify neural mechanisms underlying obsessive-compulsive disorder-relevant behavioural domains. We propose that research using clinically relevant paradigms will accelerate translation of findings from preclinical mouse models, thus supporting the development of novel therapeutics targeted to specific pathophysiological mechanisms.
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Affiliation(s)
| | - Susanne E. Ahmari
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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