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Clarke AT, Fineberg NA, Pellegrini L, Laws KR. The relationship between cognitive phenotypes of compulsivity and impulsivity and clinical variables in obsessive-compulsive disorder: A systematic review and Meta-analysis. Compr Psychiatry 2024; 133:152491. [PMID: 38714143 DOI: 10.1016/j.comppsych.2024.152491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND This systematic review and meta-analysis explored the relationship between cognitive phenotypes of compulsivity and impulsivity and clinical variables in obsessive-compulsive disorder (OCD). METHODS We searched Pubmed, Scopus, Cochrane Library and PsychINFO databases until February 2023 for studies comparing patients with OCD and healthy controls on cognitive tests of compulsivity and impulsivity. The study followed PRISMA guidelines and was pre-registered on PROSPERO (CRD42021299017). RESULTS Meta-analyses of 112 studies involving 8313 participants (4289 patients with OCD and 4024 healthy controls) identified significant impairments in compulsivity (g = -0.58, [95%CI -0.68, -0.47]; k = 76) and impulsivity (g = -0.48, [95%CI -0.57, -0.38]; k = 63); no significant difference between impairments. Medication use and comorbid psychiatric disorders were not significantly related to impairments. No associations were revealed with OCD severity, depression/anxiety, or illness duration. CONCLUSION Cognitive phenotypes of compulsivity and impulsivity in patients with OCD appear to be orthogonal to clinical variables, including severity of OCD symptomatology. Their clinical impact is poorly understood and may require different clinical assessment tools and interventions.
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Affiliation(s)
- Aaron T Clarke
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; Centre for Psychedelic Research, Imperial College London, London, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Zisler EM, Meule A, Koch S, Schennach R, Voderholzer U. Duration of daily life activities in persons with and without obsessive-compulsive disorder. J Psychiatr Res 2024; 173:6-13. [PMID: 38460475 DOI: 10.1016/j.jpsychires.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/08/2024] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
Persons with obsessive-compulsive disorder (OCD) are often impaired in their daily level of functioning due to their time-consuming obsessions and/or compulsions. To date, however, studies are lacking that quantify how much time persons with OCD actually spend on activities of daily living. Therefore, the current study assessed 13 daily life activities (in minutes) with a self-report questionnaire in 299 persons with OCD at admission to inpatient treatment and 300 age- and sex-matched persons without OCD. A majority of persons with OCD indicated that they experienced obsessions and/or compulsions when leaving (84%) and cleaning (70%) the apartment, grocery shopping (66%), changing clothes (66%), and showering with (62%) and without (63%) shampooing. Persons with OCD who experienced obsessions and/or compulsions during a given daily life activity-but not those who did not experience obsessions and/or compulsions during these activities-reported longer durations for performing 10 of the 13 activities than persons without OCD. For most activities, longer durations related weakly but significantly to higher OCD symptom severity. Results indicate that the duration of daily life activities seems to depend more on whether persons with OCD experience obsessions and/or compulsions during a specific activity and less on whether a person is diagnosed with OCD in general. Future studies may use other assessment methods that allow for tracking the duration in daily life in real time.
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Affiliation(s)
- Eva M Zisler
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Germany
| | - Stefan Koch
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | | | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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3
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Algin S, Banik D, Rahman SA, Mahmud Tusher S, Tuj Johora F, Akter A, Ahmed T, Biswas MAM, Sinha S, Haque M. Ketamine Infusion in a Resistant Obsessive-Compulsive Disorder Patient in Bangladesh with Severe Suicidal Ideation: A Case Report. Cureus 2024; 16:e57877. [PMID: 38596207 PMCID: PMC11002706 DOI: 10.7759/cureus.57877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
Treatment of resistant obsessive-compulsive disorder (OCD) typically results in insufficient symptom alleviation, and even long-term medication often fails to have the intended effect. Ketamine is a potent non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Studies have shown that low-dose ketamine infusion results in a considerable reduction in obsessive-compulsive symptoms and a rapid resolution of suicidal ideation. This is a case report on the effect of intravenous ketamine infusion on a patient with resistant OCD and severe suicidal ideation. Intravenous (IV) ketamine was given once a week over consecutive three weeks with necessary precautions. Psychometric tools such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impressions Scale (CGI-S), the Beck Scale for Suicidal Ideations (BSSI), and Depression Anxiety and Stress Scale 21 (DASS-21) were applied before and after infusions. Obsessive-compulsive symptoms and suicidal severity started to decrease rapidly after the first infusion. However, after a transient improvement, these symptoms again began to increase after a stressful incident on the second day of the first infusion. All the symptoms measured by validated rating scales showed continued improvement after the following two infusions. The improvement was sustained until discharge (one week after the last infusion) and subsequent follow-up in the sixth and 12th weeks. The role of ketamine in reducing suicidal thoughts and behavior is already established. Very few studies emphasized its effectiveness in improving severe/resistant obsessive-compulsive symptoms. This pioneering work may offer scope for similar research in the relevant field.
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Affiliation(s)
- Sultana Algin
- Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Debasish Banik
- Anesthesia, Analgesia, and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Sm Atikur Rahman
- Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Saiful Mahmud Tusher
- Anesthesia, Analgesia, and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Fatema Tuj Johora
- Child and Adolescent Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Asha Akter
- Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Tanbir Ahmed
- Child and Adolescent Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | | | - Susmita Sinha
- Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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4
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Rickelt J, Viechtbauer W, Marcelis M, van den Heuvel OA, van Oppen P, Eikelenboom M, Schruers K. Anxiety during the long-term course of obsessive-compulsive disorder. J Affect Disord 2024; 345:311-319. [PMID: 37838266 DOI: 10.1016/j.jad.2023.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE The study aimed to investigate anxiety and its relation with obsessive-compulsive symptoms during the long-term course of obsessive-compulsive disorder (OCD). METHODS We used data from the Netherlands OCD Association (NOCDA) study, which included 419 participants with OCD (aged 18-79 years). Severity of obsessive-compulsive symptoms and anxiety at baseline and after two, four, and six years were entered into three models, which were analyzed using structural equation modeling: 1) the cross-lagged model, which assumes that anxiety and obsessive-compulsive symptoms are two distinct groups of symptoms interacting directly on the long-term; 2) the stable traits model, which assumes that anxiety and obsessive-compulsive symptoms result from two distinct latent factors, which are stable over the time and interact with each other; and 3) the common factor model, which assumes that anxiety and obsessive-compulsive symptoms are presentations of the same latent factor. RESULTS The cross-lagged model and the stable traits model both were valid models with a good model fit. The common factor model had a poor model fit and was rejected. LIMITATIONS The duration of OCD varied widely between the participants (0-64 years). The majority experienced obsessive-compulsive symptoms since several years, which may have affected results on the course of anxiety and the interaction between anxiety and obsessive-compulsive symptoms. CONCLUSIONS Anxiety and obsessive-compulsive symptoms in OCD patients do not result from a shared underlying factor but are distinct, interacting symptom groups, probably interacting by distinct latent factors.
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Affiliation(s)
- J Rickelt
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands; Institute for Mental Health Eindhoven (GGzE), Dr. Poletlaan 39, 5626ND Eindhoven, the Netherlands.
| | - W Viechtbauer
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands
| | - M Marcelis
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands; Institute for Mental Health Eindhoven (GGzE), Dr. Poletlaan 39, 5626ND Eindhoven, the Netherlands
| | - O A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, de Boelelaan 1117, 1007MB Amsterdam, the Netherlands
| | - P van Oppen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, de Boelelaan 1117, 1007MB Amsterdam, the Netherlands; GGZ inGeest, Research & Innovation, Oldenaller 1, 1081 HL Amsterdam, the Netherlands
| | - M Eikelenboom
- GGZ inGeest, Research & Innovation, Oldenaller 1, 1081 HL Amsterdam, the Netherlands
| | - K Schruers
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands; Mondriaan Mental Health Center, Vijverdalseweg 1, 6226NB Maastricht, the Netherlands
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5
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Ching THW, Amoroso L, Bohner C, D’Amico E, Eilbott J, Entezar T, Fitzpatrick M, Fram G, Grazioplene R, Hokanson J, Jankovsky A, Kichuk SA, Martins B, Patel P, Schaer H, Shnayder S, Witherow C, Pittenger C, Kelmendi B. Safety, feasibility, tolerability, and clinical effects of repeated psilocybin dosing combined with non-directive support in the treatment of obsessive-compulsive disorder: protocol for a randomized, waitlist-controlled trial with blinded ratings. Front Psychiatry 2024; 14:1278823. [PMID: 38264632 PMCID: PMC10803438 DOI: 10.3389/fpsyt.2023.1278823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Background To date, few randomized controlled trials of psilocybin with non-directive support exist for obsessive-compulsive disorder (OCD). Results and participant feedback from an interim analysis of an ongoing single-dose trial (NCT03356483) converged on the possibility of administering a higher fixed dose and/or more doses of psilocybin in future trials for presumably greater benefits. Objectives This trial aims to evaluate the safety, feasibility, tolerability, and clinical effects of two doses of psilocybin paired with non-directive support in the treatment of OCD. This trial also seeks to examine whether two doses of psilocybin lead to greater OCD symptom reduction than a single dose, and to elucidate psychological mechanisms underlying the effects of psilocybin on OCD. Design A randomized (1:1), waitlist-controlled design with blinded ratings will be used to examine the effects of two doses of oral psilocybin paired with non-directive support vs. waitlist control on OCD symptoms. An adaptive dose selection strategy will be implemented (i.e., first dose: 25 mg; second dose: 25 or 30 mg). Methods and analysis This single-site trial will enroll 30 adult participants with treatment-refractory OCD. Aside from safety, feasibility, and tolerability metrics, primary outcomes include OCD symptoms assessed on the Yale-Brown Obsessive-Compulsive Scale - Second Edition (Y-BOCS-II). A blinded independent rater will assess primary outcomes at baseline and the primary endpoint at the end of the second dosing week. Participants will be followed up to 12 months post-second dosing. Participants randomized to waitlist will be rescreened after 7 weeks post-randomization, and begin their delayed treatment phase thereafter if still eligible. Ethics Written informed consent will be obtained from participants. The institutional review board has approved this trial (protocol v. 1.7; HIC #2000032623). Discussion This study seeks to advance our ability to treat refractory OCD, and catalyze future research seeking to optimize the process of psilocybin treatment for OCD through understanding relevant psychological mechanisms.Clinical trial registration: ClinicalTrials.gov, identifier NCT05370911.
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Affiliation(s)
- Terence H. W. Ching
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Lucia Amoroso
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Calvin Bohner
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elizabeth D’Amico
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jeffrey Eilbott
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Tara Entezar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Madison Fitzpatrick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Geena Fram
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Rachael Grazioplene
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jamila Hokanson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Anastasia Jankovsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Stephen A. Kichuk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Bradford Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Prerana Patel
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Henry Schaer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Sarah Shnayder
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chelsea Witherow
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Psychology, Yale University, New Haven, CT, United States
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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6
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Xu Z, Xie M, Wang Z, Chen H, Zhang X, Li W, Jiang W, Liu N, Zhang N. Altered brain functional network topology in Obsessive-Compulsive Disorder: A comparison of patients with varying severity of depressive symptoms and the impact on psychosocial functioning. Neuroimage Clin 2023; 40:103545. [PMID: 38006651 PMCID: PMC10755823 DOI: 10.1016/j.nicl.2023.103545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is associated with psychosocial impairment, which can be exacerbated by depressive symptoms. In this study, we employed graph theory analysis to investigate the association among neuroimaging, clinical features, and psychosocial functioning in OCD patients, with a specific focus on the differential impact of depressive symptoms. METHODS 216 OCD patients were divided into two subgroups based on depressive symptoms. Resting-state functional MRI data were acquired from a subset of 106 OCD patients along with 77 matched healthy controls (HCs). We analyzed the topological characteristics of the entire brain and the cognition-related subnetworks and performed Pearson correlation analyses to further explore the relationship with psychosocial functioning. RESULTS OCD patients with more severe depressive symptoms exhibited greater impairment across all dimensions of psychosocial functioning. Graph theory analysis revealed more pronounced reductions in network efficiency within the entire brain, the default mode network (DMN), and the cingulo-opercular network (CON) among patients with non or mild depressive symptoms. Lower nodal efficiency and degree centrality of the right superior temporal gyrus (STG) were found in OCD patients and these variables were positively correlated with psychosocial functioning impairment. CONCLUSIONS This study revealed that the presence of depressive symptoms generally exacerbated psychosocial functioning impairment in OCD patients. Abnormalities in the functional integration of the entire brain, the DMN, and the CON in OCD patients may comprise the basis of cognitive deficits, while dysfunction of the right STG may affect the psychosocial functioning through its role in emotion, intention perception, and insight.
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Affiliation(s)
- Zhihan Xu
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Minyao Xie
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Zhongqi Wang
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Haochen Chen
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Xuedi Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Wangyue Li
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Wenjing Jiang
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China
| | - Na Liu
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China.
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China.
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7
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Abrams SK, Rabinovitch BS, Zafar R, Aziz AS, Cherup NP, McMillan DW, Nielson JL, Lewis EC. Persons With Spinal Cord Injury Report Peripherally Dominant Serotonin-Like Syndrome After Use of Serotonergic Psychedelics. Neurotrauma Rep 2023; 4:543-550. [PMID: 37636336 PMCID: PMC10457609 DOI: 10.1089/neur.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Psychedelic-assisted therapy (PAT) may treat various mental health conditions. Despite its promising therapeutic signal across mental health outcomes, less attention is paid on its potential to provide therapeutic benefits across complex medical situations within rehabilitation medicine. Persons with spinal cord injury (SCI) have a high prevalence of treatment-resistant mental health comorbidities that compound the extent of their physical disability. Reports from online discussion forums suggest that those living with SCI are using psychedelics, though the motivation for their use is unknown. These anecdotal reports describe a consistent phenomenon of neuromuscular and autonomic hypersensitivity to classical serotonergic psychedelics, such as psilocybin and lysergic acid diethylamide (LSD). Persons describe intense muscle spasms, sweating, and tremors, with an eventual return to baseline and no reports of worsening of their baseline neurological deficits. The discomfort experienced interferes with the subjective beneficial effects self-reported. This phenomenon has not been described previously in the academic literature. We aim to provide a descriptive review and explanatory theoretical framework hypothesizing this phenomenon as a peripherally dominant serotonin syndrome-like clinical picture-that should be considered as such when persons with SCI are exposed to classical psychedelics. Raising awareness of this syndrome may help our mechanistic understanding of serotonergic psychedelics and stimulate development of treatment protocols permitting persons with SCI to safely tolerate their adverse effects. As PAT transitions from research trials into accepted clinical and decriminalized use, efforts must be made from a harm reduction perspective to understand these adverse events, while also serving as an informed consent process aid if such therapeutic approaches are to be considered for use in persons living with SCI.
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Affiliation(s)
| | - Brenden Samuel Rabinovitch
- Numinus Toronto, Toronto, Ontario, Canada
- Division of Fundamental Neurobiology, Krembil Research Institute, Toronto, Ontario, Canada
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rayyan Zafar
- Centre for Psychedelic Research and Neuropsychopharmacology, Imperial College, London, United Kingdom
| | - Aly Shah Aziz
- Pediatric Neurology Clinic, Oakville, Ontario, Canada
| | - Nicholas Paul Cherup
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - David W. McMillan
- The Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Jessica L. Nielson
- Department of Psychiatry and Behavioral Sciences; Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Evan Cole Lewis
- Numinus Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ching THW, Grazioplene R, Bohner C, Kichuk SA, DePalmer G, D’Amico E, Eilbott J, Jankovsky A, Burke M, Hokanson J, Martins B, Witherow C, Patel P, Amoroso L, Schaer H, Pittenger C, Kelmendi B. Safety, tolerability, and clinical and neural effects of single-dose psilocybin in obsessive-compulsive disorder: protocol for a randomized, double-blind, placebo-controlled, non-crossover trial. Front Psychiatry 2023; 14:1178529. [PMID: 37181888 PMCID: PMC10166878 DOI: 10.3389/fpsyt.2023.1178529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Background Psilocybin may help treat obsessive-compulsive disorder (OCD). To date, only one open-label study of psilocybin for OCD exists, necessitating further investigation with a randomized controlled design. The neural correlates of psilocybin's effects on OCD have also not been studied. Objectives This first-of-its-kind trial aims to evaluate the feasibility, safety, and tolerability of psilocybin in the treatment of OCD, provide preliminary evidence on the effects of psilocybin on OCD symptoms, and elucidate neural mechanisms that may mediate psilocybin's effects on OCD. Design We use a randomized (1:1), double-blind, placebo-controlled, non-crossover design to examine the clinical and neural effects of either a single dose of oral psilocybin (0.25 mg/kg) or active placebo-control agent (250 mg of niacin) on OCD symptoms. Methods and analysis We are enrolling 30 adult participants at a single site in Connecticut, USA who have failed at least one trial of standard care treatment (medication/psychotherapy) for OCD. All participants will also receive unstructured, non-directive psychological support during visits. Aside from safety, primary outcomes include OCD symptoms over the past 24 h, assessed by the Acute Yale-Brown Obsessive-Compulsive Scale and Visual Analog Scale ratings. These are collected by blinded, independent raters at baseline and the primary endpoint of 48 h post-dosing. Total follow-up is 12 weeks post-dosing. Resting state neuroimaging data will be collected at baseline and primary endpoint. Participants randomized to placebo will be offered the chance to return for an open-label dose of 0.25 mg/kg. Ethics statement All participants will be required to provide written informed consent. The trial (protocol v. 5.2) was approved by the institutional review board (HIC #2000020355) and registered with ClinicalTrials.gov (NCT03356483). Discussion This study may represent an advance in our ability to treat refractory OCD, and pave the way for future studies of neurobiological mechanisms of OCD that may respond to psilocybin.
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Affiliation(s)
- Terence H. W. Ching
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Rachael Grazioplene
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Calvin Bohner
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Stephen A. Kichuk
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Giuliana DePalmer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elizabeth D’Amico
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jeffrey Eilbott
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Anastasia Jankovsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Michelle Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Jamila Hokanson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brad Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chelsea Witherow
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Prerana Patel
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Lucia Amoroso
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Henry Schaer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
- Department of Psychology, Yale University, New Haven, CT, United States
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, United States
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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9
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Gajadien PT, Postma TS, van Oostrom I, Scheepstra KW, van Dijk H, Sack AT, van den Heuvel OA, Arns M. Sleep predicts the response to rTMS and CBT in patients with OCD: an open label effectiveness study. Int J Clin Health Psychol 2023; 23:100353. [DOI: 10.1016/j.ijchp.2022.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
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10
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Runge K, Reisert M, Feige B, Nickel K, Urbach H, Venhoff N, Tzschach A, Schiele MA, Hannibal L, Prüss H, Domschke K, Tebartz van Elst L, Endres D. Deep clinical phenotyping of patients with obsessive-compulsive disorder: an approach towards detection of organic causes and first results. Transl Psychiatry 2023; 13:83. [PMID: 36882422 PMCID: PMC9992508 DOI: 10.1038/s41398-023-02368-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
In the revised diagnostic classification systems ICD-11 and DSM-5, secondary, organic forms of obsessive-compulsive disorder (OCD) are implemented as specific nosological entities. Therefore, the aim of this study was to clarify whether a comprehensive screening approach, such as the Freiburg-Diagnostic-Protocol for patients with OCD (FDP-OCD), is beneficial for detecting organic OCD forms. The FDP-OCD includes advanced laboratory tests, an expanded magnetic resonance imaging (MRI) protocol, and electroencephalography (EEG) investigations as well as automated MRI and EEG analyses. Cerebrospinal fluid (CSF), [18F]fluorodeoxyglucose positron emission tomography, and genetic analysis were added for patients with suspected organic OCD. The diagnostic findings of the first 61 consecutive OCD inpatients (32 female and 29 male; mean age: 32.7 ± 12.05 years) analyzed using our protocol were investigated. A probable organic cause was assumed in five patients (8%), which included three patients with autoimmune OCD (one patient with neurolupus and two with specific novel neuronal antibodies in CSF) and two patients with newly diagnosed genetic syndromes (both with matching MRI alterations). In another five patients (8%), possible organic OCD was detected (three autoimmune cases and two genetic cases). Immunological serum abnormalities were identified in the entire patient group, particularly with high rates of decreased "neurovitamin" levels (suboptimal vitamin D in 75% and folic acid in 21%) and increased streptococcal (in 46%) and antinuclear antibodies (ANAs; in 36%). In summary, the FDP-OCD screening led to the detection of probable or possible organic OCD forms in 16% of the patients with mostly autoimmune forms of OCD. The frequent presence of systemic autoantibodies such as ANAs further support the possible influence of autoimmune processes in subgroups of patients with OCD. Further research is needed to identify the prevalence of organic OCD forms and its treatment options.
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Affiliation(s)
- Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Tzschach
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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11
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Nagata JM, Chu J, Zamora G, Ganson KT, Testa A, Jackson DB, Costello CR, Murray SB, Baker FC. Screen Time and Obsessive-Compulsive Disorder Among Children 9-10 Years Old: A Prospective Cohort Study. J Adolesc Health 2023; 72:390-396. [PMID: 36517380 PMCID: PMC9975071 DOI: 10.1016/j.jadohealth.2022.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study is to determine the prospective associations between baseline screen time and obsessive-compulsive disorder (OCD) at 2-year follow-up in a national (United States) cohort of 9- to 10-year-old children. METHODS We analyzed prospective cohort data from the Adolescent Brain Cognitive Development study (n = 9,208). Logistic regression analyses were used to determine the associations between baseline self-reported screen time (exposure) and OCD, based on the Kiddie Schedule for Affective Disorders and Schizophrenia (outcome), at 2-year-follow-up, adjusting for race/ethnicity, sex, household income, parent education, family history of psychopathology, and study site, excluding participants with baseline OCD. RESULTS The sample was 48.9% female and racially and ethnically diverse (43.5% non-White). Each additional hour of total screen time was prospectively associated with 1.05 higher odds of OCD at 2-year follow-up (95% confidence interval [CI] 1.01-1.09). For specific screen time modalities, each additional hour of playing video games (adjusted odds ratio 1.15, 95% CI 1.03-1.28) and watching videos (adjusted odds ratio 1.11, 95% CI 1.01-1.23) was associated with a subsequent OCD diagnosis. CONCLUSION Video games and watching videos are prospectively associated with new-onset OCD in early adolescents. Future research should examine mechanisms linking these specific screen modalities to OCD development to inform future prevention and intervention efforts.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Jonathan Chu
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Gabriel Zamora
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Caitlin R Costello
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, California
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, California; School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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12
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Najera RA, Gregory ST, Shofty B, Anand A, Gadot R, Youngerman BE, Storch EA, Goodman WK, Sheth SA. Cost-effectiveness analysis of radiosurgical capsulotomy versus treatment as usual for treatment-resistant obsessive-compulsive disorder. J Neurosurg 2023; 138:347-357. [PMID: 35907186 DOI: 10.3171/2022.5.jns22474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Stereotactic radiosurgical capsulotomy (SRS-C) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (TROCD). Unlike other procedures such as deep brain stimulation and radiofrequency ablation, the cost-effectiveness of SRS-C for TROCD has not been investigated. The authors herein report the first cost-effectiveness analysis of SRS-C for TROCD. METHODS Using a decision analytic model, the authors compared the cost-effectiveness of SRS-C to treatment as usual (TAU) for TROCD. Treatment response and complication rates were derived from a review of relevant clinical trials. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn from Medicare reimbursement rates and available healthcare economics data. A Monte Carlo simulation and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio. RESULTS One hundred fifty-eight TROCD patients across 9 studies who had undergone SRS-C and had at least 36 months of follow-up were included in the model. Compared to TAU, SRS-C was more cost-effective, with an estimated incremental cost-effectiveness ratio of $28,960 per quality-adjusted life year (QALY) gained. Within the 3-year time horizon, net QALYs gained were greater in the SRS-C group than the TAU group by 0.27 (95% CI 0.2698-0.2702, p < 0.0001). At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the Monte Carlo simulation revealed that SRS-C was more cost-effective than TAU in 83% and 100% of iterations, respectively. CONCLUSIONS Compared to TAU, SRS-C for TROCD is more cost-effective under a range of possible cost and effectiveness values.
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Affiliation(s)
- Ricardo A Najera
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Ben Shofty
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Adrish Anand
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Ron Gadot
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Brett E Youngerman
- 3Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York; and
| | - Eric A Storch
- 4Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Wayne K Goodman
- 4Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Sameer A Sheth
- 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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13
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Kaur R, Garg R, Raj R. Quality of life among patients with obsessive compulsive disorder: Impact of stigma, severity of illness, insight, and beliefs. Ind Psychiatry J 2023; 32:130-135. [PMID: 37274563 PMCID: PMC10236666 DOI: 10.4103/ipj.ipj_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 02/19/2023] Open
Abstract
Background No Indian studies have evaluated the impact of stigma, severity, and insight on the quality of life in obsessive compulsive disorder. Methods A hospital-based, cross-sectional, descriptive study on 100 patients of obsessive-compulsive disorder (OCD) as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was conducted. Data were collected using socio-demographic performa, Yale-Brown obsessive-compulsive scale (Y-BOCS), WHOQoL-Bref hindi, hindi stigma scale, and Brown Assessment of Beliefs Scale (BABS) from March to June 2021. Appropriate statistical analyses were used. Results A majority of patients were males (58%), married (65%), above matric pass (89%), and belonged to rural areas (62%). The total stigma score showed a significant negative correlation with overall QoL (P < 0.01**), overall health (P < 0.002**), satisfaction with physical health (P 0.006**), psychological health (P < 0.01**), and social relations (P < 0.01**) on WHOQoL-Bref. Discrimination, disclosure, and positive aspect domains of the stigma scale also showed a significant negative correlation with many domains of QoL. Severity of illness showed a significant negative correlation with overall QoL (P 0.045*), satisfaction with physical health (P < 0.01**), psychological health (P 0.01**), social relations (P 0.004**), and environment (P 0.007**). Poorer insight on BABS was associated with poorer overall health (P 0.04*), satisfaction with physical health (P 0.001**), social relations (P 0.03**), and environment (P 0.009**). Stigma was significantly increased by higher severity of obsessions (P 0.04*), compulsions (P 0.007**), and total Y-BOCS score (P 0.007**). Conclusion Stigma and severity of OCD have a significant negative impact on quality of life. Stigma reduction and appropriate management of severity should be an integral part of management for patients with OCD.
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Affiliation(s)
- Ramandeep Kaur
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Rohit Garg
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Rajnish Raj
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
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14
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Sandoval-Lentisco A, López-Nicolás R, López-López JA, Sánchez-Meca J. Florida Obsessive-Compulsive Inventory and Children's Florida Obsessive Compulsive Inventory: A reliability generalization meta-analysis. J Clin Psychol 2023; 79:28-42. [PMID: 35849418 PMCID: PMC10084361 DOI: 10.1002/jclp.23416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/13/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Florida Obsessive Compulsive Inventory (FOCI) and its pediatric version, the Children's Florida Obsessive Compulsive Inventory (C-FOCI), are instruments for evaluating obsessive-compulsive symptomatology. METHOD A reliability generalization meta-analysis was conducted to estimate an average reliability of the scores and to identify study characteristics that explained the heterogeneity among scores. Using Kuder-Richardson 20 (KR-20) and Cronbach's α, a total of 23 and 20 independent samples were included in the meta-analysis for the FOCI and C-FOCI. RESULTS We found an average KR-20 of 0.826 for the FOCI's Symptom Checklist and an α of 0.882 FOCI's Symptom Severity. An average KR-20 of 0.740 was found for the C-FOCI's Symptom Checklist, while an average α of 0.794 was found for the C-FOCI's Symptom Severity. Moderator analyses showed that the source of the coefficients (i.e., whether they were reported by the authors of the primary study or estimated by the meta-analysts) was an important variable for the FOCI Symptom Severity, and that the focus of the study (i.e., whether it was psychometric or applied) and the sample size were relevant for the C-FOCI Symptom Checklist. CONCLUSIONS Considering that the FOCI and C-FOCI are scales characterized by their brevity and ease of use, and the reliabilities obtained here, both scales are well suited for screening purposes.
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Affiliation(s)
| | - Rubén López-Nicolás
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
| | | | - Julio Sánchez-Meca
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
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15
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Huang Y, Yang H, Zhu C, Jiang X, Zhu W, Liang Y, Ma L, Wang Y, Tang W. An Exploratory Study of a Novel Combined Therapeutic Modality for Obsessive-Compulsive Disorder. Brain Sci 2022; 12:brainsci12101309. [PMID: 36291243 PMCID: PMC9599080 DOI: 10.3390/brainsci12101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore whether a systematic combined therapeutic modality (CTM) could quickly and effectively improve the severity of obsessive–compulsive disorder (OCD) and the insight of OCD patients. Methods: Included in this study were 100 patients with OCD according to the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for a 2-week short-term treatment. They were assigned to a drug-alone group (n = 57), and a CTM group (n = 43) using drug treatment in combination with cognitive behavioral treatment (CBT) and repetitive transcranial magnetic stimulation (rTMS). The therapeutic outcome was assessed by the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Brown Assessment of Beliefs Scale (BABS), 24-item Hamilton Depression Scale (HAMD-24) and Hamilton Anxiety Scale (HAMA) before and after treatment. All data were treated with SPSS25.0 Software. Results: After the 2-week treatment, the success rate in the CTM group was significantly higher than that in the drug-alone group. Y-BOCS overall and factor scores were decreased as compared with those before treatment in both groups. HAMD, HAMA and BABS overall scores were all decreased after treatment in the CTM group. In addition, compared with the drug-alone group, the Y-BOCS overall score and factor score, HAMD overall score and HAMA overall score were all decreased significantly in CTM group, while the Y-BOCS score reduction rate was increased significantly. Insight was improved in eight cases (57.14%) in the CTM group containing 14 cases with poor insight. Multinomial logistic regression analysis showed that CTM was beneficial for the insight improvement of OCD patients (OR = 91.04–139.68); this improvement was more pronounced in patients with low baseline BABS overall scores (OR = 0.07). Conclusion: CTM may be an effective short-term strategy to improve the severity of OCD and insight of OCD patients and, therefore, is worthy of clinical promotion and application.
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Affiliation(s)
- Yueqi Huang
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Hangyi Yang
- Fourth Clinical School, Zhejiang Chinese Medical University, Hangzhou 310013, China
| | - Cheng Zhu
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Xiaoying Jiang
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Wenjing Zhu
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Yan Liang
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Lisha Ma
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Yunzan Wang
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
| | - Wenxin Tang
- Department of Psychiatry, Affiliated Mental Health Centre and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310013, China
- Correspondence:
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16
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Pankratz B, von Zedtwitz K, Runge K, Denzel D, Nickel K, Schlump A, Pitsch K, Maier S, Dersch R, Voderholzer U, Domschke K, Tebartz van Elst L, Schiele MA, Prüss H, Endres D. Cerebrospinal fluid findings in adult patients with obsessive-compulsive disorder: A retrospective analysis of 54 samples. World J Biol Psychiatry 2022; 24:292-302. [PMID: 35904379 DOI: 10.1080/15622975.2022.2104457] [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] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) can rarely be associated with immunological aetiologies, most notably in Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections and possibly in autoimmune encephalitis. As cerebrospinal fluid (CSF) analysis is a sensitive method for assessing neuroinflammation, this retrospective study analysed basic CSF parameters and well-characterised as well as novel neuronal autoantibodies in OCD to screen for signs of autoimmunity. METHODS Basic CSF findings of 54 adult OCD patients suspected of an organic aetiology were retrospectively compared to a control group of mentally healthy patients (N = 39) with idiopathic intracranial hypertension. Further subgroup analysis included testing for well-characterised neuronal IgG autoantibodies and tissue-based assays using indirect immunofluorescence to screen for novel brain autoantibodies. RESULTS Elevated protein in the CSF of OCD patients compared to the control group (p = 0.043) was identified. Inflammatory markers (pleocytosis/oligoclonal bands/increased IgG-index) were detected in 7% of all patients with OCD. Well-characterised neuronal autoantibodies were not found in any OCD patient, whereas 6/18 (33%) CSF samples showed binding on mouse brain sections in tissue-based assays (binding to neuropil in the basal ganglia/brainstem, cilia of granule cells, blood vessels, nuclear/perinuclear structures). CONCLUSIONS While elevated CSF protein is merely a weak indicator of blood CSF barrier dysfunction, the presence of inflammatory CSF changes and novel brain autoantibodies in CSF may indicate OCD subtypes with inflammatory pathomechanism and supports the hypothesis of a rare "autoimmune OCD" subtype.
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Affiliation(s)
- Benjamin Pankratz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina von Zedtwitz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Denzel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Schlump
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karoline Pitsch
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Prien am Chiemsee, Schoen Clinic Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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17
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Health-related quality of life in hoarding: A comparison to chronic conditions with high disease burden. J Psychiatr Res 2022; 149:68-75. [PMID: 35255385 DOI: 10.1016/j.jpsychires.2022.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022]
Abstract
Hoarding disorder often results in debilitating functional impairment and may also compromise health-related quality of life (QoL). This study investigated the association between hoarding behavior and QoL relative to six highly impairing medical and psychiatric disorders in a sample of 20,722 participants enrolled in the internet-based Brain Health Registry. Nearly 1 in 8 participants (12.2%) endorsed clinically relevant hoarding symptoms (CHS). In separate multivariable linear regression models, hoarding was more strongly associated with mental QoL than diabetes (Standardizedβ = -0.21, 95% CI: [-0.22, -0.20] vs. -0.01 [-0.02, 0.0]), heart disease (-0.22 [-0.23, -0.20] vs. 0.00 [-0.02, 0.01]), chronic pain (-0.18 [-0.19, -0.16] vs. -0.12 [-0.13, -0.10]), post-traumatic stress disorder (PTSD; -0.20 [-0.22, -0.19] vs. -0.07 [-0.09, -0.06]), and substance use disorder (SUD; -0.21 [-0.23, -0.20] vs. -0.04 [-0.05, -0.03]). Similarly, CHS was more strongly negatively associated with physical QoL than diabetes (-0.11 [-0.10, -0.12] vs. -0.08 [-0.06, -0.09]), major depressive disorder (-0.09 [-0.10, -0.08] vs. -0.05 [-0.06, 0.03]), PTSD (-0.11 [-0.12, -0.10] vs. -0.08 [-0.09, -0.07]), and SUD (-0.12 [-0.13, -0.09] vs. -0.01 [-0.02, 0.00]). Higher hoarding severity was associated with reductions in both mental (Standardizedβ = -0.28, ΔR2 = 0.08, p < 0.0001) and physical (β = -0.12, ΔR2 = 0.02, p < 0.0001) QoL, though the strength of the relationship between hoarding symptoms and QoL varied with depression severity. Efforts to improve the overall QoL and well-being of those with CHS are needed.
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18
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Feusner JD, Farrell NR, Kreyling J, McGrath PB, Rhode A, Faneuff T, Lonsway S, Mohideen R, Jurich JE, Trusky L, Smith SM. Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes from a Retrospective Longitudinal Observational Study (Preprint). J Med Internet Res 2022; 24:e36431. [PMID: 35587365 PMCID: PMC9164091 DOI: 10.2196/36431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 12/22/2022] Open
Abstract
Background Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. Objective We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. Methods The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. Results Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. Conclusions In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD.
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Affiliation(s)
- Jamie D Feusner
- NOCD Inc, Chicago, IL, United States
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- General Adult Psychiatry & Health Systems Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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19
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Efe A, Açıkel SB, Uygun SD, Canlı M, Temeltürk RD, Gürel Y, Çetinkaya M, Çakmak FH. A Retrospective Evaluation on Demographic, Phenomenological, and Comorbidity Features of Pediatric Obsessive-Compulsive Disorder. J Nerv Ment Dis 2022; 210:6-25. [PMID: 34417423 DOI: 10.1097/nmd.0000000000001402] [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] [Indexed: 11/25/2022]
Abstract
ABSTRACT The impacts of sex, age of onset, phenotype, and comorbidity on clinical features were explored in a large clinical sample with pediatric obsessive-compulsive disorder (p-OCD) (n = 457), along with concomitant specific features in the framework of different symptom dimensions/phenotypes, by a retrospective cross-sectional evaluation design. The most prevalent phenotype was obsession/checking (almost half), and the clinical features belonging to different phenotypes varied among sexes, age of onset, severity, and comorbidities. The contamination and aggressive obsessions, along with the compulsions such as cleaning and repeating routine activities, were the most prevalent symptoms, which were prevalently accompanied by generalized anxiety disorder, attention deficit hyperactivity disorder, and depression. Females with OCD were likely prone to exhibit comorbid internalizing disorders, whereas males were prone to externalizing. This recent study on a large Turkish clinical sample of p-OCD followed up within 5 years, highlighting separate evidence on subtyping of p-OCD in phenotype and comorbidity frame.
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Affiliation(s)
- Ayşegül Efe
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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20
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Mahjani B, Bey K, Boberg J, Burton C. Genetics of obsessive-compulsive disorder. Psychol Med 2021; 51:2247-2259. [PMID: 34030745 PMCID: PMC8477226 DOI: 10.1017/s0033291721001744] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a psychiatric disorder with multiple symptom dimensions (e.g. contamination, symmetry). OCD clusters in families and decades of twin studies clearly demonstrate an important role for genetics in the etiology of the disorder. METHODS In this review, we summarize the genetic epidemiology and molecular genetic studies of OCD and obsessive-compulsive symptoms. RESULTS OCD is a heritable, polygenic disorder with contributions from both common and rare variants, including de novo deleterious variations. Multiple studies have provided reliable support for a large additive genetic contribution to liability to OCD, with discrete OCD symptom dimensions having both shared and unique genetic risks. Genome-wide association studies have not produced significant results yet, likely because of small sample sizes, but larger meta-analyses are forthcoming. Both twin and genome-wide studies show that OCD shares genetic risk with its comorbid conditions (e.g. Tourette syndrome and anorexia nervosa). CONCLUSIONS Despite significant efforts to uncover the genetic basis of OCD, the mechanistic understanding of how genetic and environmental risk factors interact and converge at the molecular level to result in OCD's heterogeneous phenotype is still mostly unknown. Future investigations should increase ancestral genetic diversity, explore age and/or sex differences in genetic risk for OCD and expand the study of pharmacogenetics, gene expression, gene × environment interactions and epigenetic mechanisms for OCD.
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Affiliation(s)
- Behrang Mahjani
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Tics, Obsessive-Compulsive Disorder (OCD) and Related Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julia Boberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christie Burton
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada
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21
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Davis RA, Giordano J, Hufford DB, Sheth SA, Warnke P, Widge AS, Richardson RM, Rosenow JM, Rossi PJ, Storch EA, Winston H, Zboyan J, Dougherty DD, Foote KD, Goodman WK, McLaughlin NCR, Ojemann S, Rasmussen S, Abosch A, Okun MS. Restriction of Access to Deep Brain Stimulation for Refractory OCD: Failure to Apply the Federal Parity Act. Front Psychiatry 2021; 12:706181. [PMID: 34456762 PMCID: PMC8387630 DOI: 10.3389/fpsyt.2021.706181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachel A. Davis
- Department of Psychiatry, University of Colorado Anschutz, Aurora, CO, United States
| | - James Giordano
- Neuroethics Studies Program, Department of Neurology, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, United States
| | | | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Peter Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, United States
| | - Alik S. Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurosurgery, Harvard Medical School, Boston, MA, United States
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University, Chicago, IL, United States
| | - Peter Justin Rossi
- University of California San Francisco Department of Psychiatry, San Francisco, CA, United States
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Helena Winston
- Department of Psychiatry, University of Colorado Anschutz, Aurora, CO, United States
- Denver Health Hospital Authority, Denver, CO, United States
| | - JoAnne Zboyan
- Springer and Steinberg, PC, Denver, CO, United States
| | - Darin D. Dougherty
- Department of Neurosurgery, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kelly D. Foote
- Departments of Neurosurgery and Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nicole C. R. McLaughlin
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz, Aurora, CO, United States
| | - Steven Rasmussen
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, United States
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
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22
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Doi S, Kobayashi Y, Takebayashi Y, Mizokawa E, Nakagawa A, Mimura M, Horikoshi M. Associations of Autism Traits With Obsessive Compulsive Symptoms and Well-Being in Patients With Obsessive Compulsive Disorder: A Cross-Sectional Study. Front Psychol 2021; 12:697717. [PMID: 34393929 PMCID: PMC8360877 DOI: 10.3389/fpsyg.2021.697717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to examine the association of autism traits with long-term obsessive compulsive disorder (OCD) symptoms and well-being levels in patient with OCD. Participants comprised 18 outpatients from a tertiary hospital and 100 adults who were registered in a large Japanese internet marketing research company and met OCD criteria by the Mini-International Neuropsychiatric Interview and were between the ages of 20 and 65 years. Clinical characteristics, autism trait assessed using the Autism Spectrum Quotient (AQ), OCD symptoms assessed using Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and well-being assessed using the Flourishing Scale were assessed. Multiple regression analyses showed that a greater total score of AQ, a greater subscale score "imagination" was associated with a greater score of Y-BOCS. Greater total score of AQ, a greater subscale score "social skill," and "imagination" were associated with lower well-being score. Autism traits, especially lack of imagination, were associated with more severe OCD symptoms. Further, autism traits, especially social skill problems and lack of imagination, were associated with lower levels of well-being. Assessment of autism traits before treatment and a strategy designed for OCD patients with autism traits may be warranted.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yuki Kobayashi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | | | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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23
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Freedman DE, Richter MA. A narrative review of exercise and obsessive-compulsive disorder. Gen Hosp Psychiatry 2021; 71:1-10. [PMID: 33887525 DOI: 10.1016/j.genhosppsych.2021.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Individuals with obsessive-compulsive disorder (OCD) suffer significant distress due to their condition; however, there can be multiple barriers to treatment. Even following OCD-tailored treatment, symptoms often remain. Exercise may be an effective and available approach to managing OCD, and yet, there are no specifically dedicated reviews, limiting integration into clinical practice. This study aimed to provide an overview of the literature on exercise and OCD. METHOD Four databases, the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and EMBASE, were systematically searched. 1534 records were screened and the reference lists of eligible articles were examined. For this review, 11 extracted studies were narratively explored. RESULTS Two observational and nine interventional studies were included, of which one article focused on youth and ten studies focused on adults. Physical activity likely reduces the risk of metabolic syndrome or general health conditions. Several pre-post studies demonstrated exercise's benefits for OCD symptoms, while the only randomized controlled trial showed negative findings for its efficacy in reducing obsessions and compulsions. CONCLUSIONS The evidence for aerobic exercise's long-term benefits for the symptoms of OCD is mixed, but remains promising. Potential mechanisms of exercise's effects and future directions for research are explored.
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Affiliation(s)
- David E Freedman
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada.
| | - Margaret A Richter
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada
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24
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Mantovani A, Neri F, D'Urso G, Mencarelli L, Tatti E, Momi D, Menardi A, Sprugnoli G, Santarnecchi E, Rossi S. Functional connectivity changes and symptoms improvement after personalized, double-daily dosing, repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: A pilot study. J Psychiatr Res 2021; 136:560-570. [PMID: 33158554 DOI: 10.1016/j.jpsychires.2020.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND intrusive thoughts and compulsive behaviors that characterize obsessive compulsive disorder (OCD) are associated to aberrant resting state functional connectivity (rsFC) patterns within the cortico-striatal-thalamo-cortical (CSTC) circuits. A high percentage of OCD patients do not respond to conventional pharmacological treatments or psychotherapy. In these patients, inhibitory repetitive transcranial magnetic stimulation (rTMS) of the Supplementary Motor Area (SMA) resulted in a significant clinical benefit. METHODS In the current study, we applied a novel protocol of 1-week MRI-guided individualized double-daily sessions of rTMS treatment (1-Hz; 110% of resting Motor Threshold/7200 pulses/day), to bilateral SMA in 9 OCD patients. We tested its (i) feasibility-safety, (ii) clinical efficacy and (iii) rsFC related changes. RESULTS Patients reported no side effects during and after rTMS. Personalized rTMS treatment led to a significant improvement of OCD symptoms (average 25%; p = .005) and persistence of benefit up to 3-month follow-up. rsFC analysis revealed a significant reduction of connectivity patterns between bilateral SMA and subcortical regions, specifically in the basal ganglia and thalamus. Additional analysis showed that OCD symptoms severity correlates with a higher connectivity pattern between bilateral SMA and subcortical regions. CONCLUSIONS rTMS double-daily sessions are safe, feasible and effective in OCD. The clinical outcomes, that are consistent with those found in our previous RCT, are linked to a decreased connectivity between SMA and subcortical brain areas implicated in control over obsessions and maladaptive compulsive behavior.
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Affiliation(s)
- Antonio Mantovani
- Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA
| | - Francesco Neri
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy.
| | - Giordano D'Urso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Lucia Mencarelli
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY, School of Medicine, New York, USA
| | - Davide Momi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arianna Menardi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulia Sprugnoli
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Emiliano Santarnecchi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Department of Medicine, Surgery and Neuroscience, University of Siena School of Medicine, Siena, Italy
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25
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Luo L, Feng B, Yang S, Zhang N, Qiu S. Clinical characteristics of moderate-severe obsessive-compulsive disorder in children and adolescents in China. J Int Med Res 2021; 48:300060520922679. [PMID: 32458715 PMCID: PMC7273799 DOI: 10.1177/0300060520922679] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study reports clinical characteristic of moderate–severe
obsessive–compulsive disorder (OCD) among school students in China. Methods We examined 153 patients for the distribution of OCD symptoms using the
Yale-Brown Obsessive Compulsive Scale Symptoms Checklist, the severity of
anxiety and depression symptoms using the Hamilton Anxiety Scale and the
Hamilton Depression Scale-24, respectively, and impairment in learning,
family and social functions using the Pediatric Quality of Life Enjoyment
and Satisfaction Questionnaire. Results The number of total OCD, obsession and compulsion symptoms was 6.71 (standard
deviation [SD] = 2.25), 3.77 (SD = 1.32) and 2.94 (SD = 1.59), respectively.
The incidence of moderate and severe depressive symptoms for junior high
school students was significantly higher than for primary and high school
students. The number of children and adolescents with OCD increased with
age, reaching a peak in the senior high school stage. Conclusion The most common symptoms in children and adolescent OCD patients are
miscellaneous obsessions, aggressiveness, religiousness, checking,
miscellaneous compulsions, cleaning-washing and repeating. These patients
show a relatively high co-occurrence rate of anxiety symptoms and depressive
symptoms, which impairs their learning, as well as their family and social
functions.
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Affiliation(s)
- Liyuan Luo
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, P.R. China
| | - Bin Feng
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, P.R. China
| | - Senjun Yang
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, P.R. China
| | - Ning Zhang
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, P.R. China
| | - Shengliang Qiu
- Department of Internal Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, P.R. China
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26
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Dominke C, Graham-Schmidt K, Gentsch A, Schütz-Bosbach S. Action inhibition in individuals with high obsessive-compulsive trait of incompleteness: An ERP study. Biol Psychol 2021; 159:108019. [PMID: 33460785 DOI: 10.1016/j.biopsycho.2021.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/01/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Missing action completion signals are assumed to trigger repetitive behavior and feelings of the action "not being right". This proposal is based mostly on individual's self-reports. Here, we investigated the influence of experimentally manipulated action completion experience and the obsessive-compulsive (OC) trait of incompleteness on behavioral and neurophysiological measures of action inhibition. METHODS Action completion was manipulated in an adapted Go/NoGo task, and OC trait incompleteness was assessed in healthy participants. More commission errors and faster responses were expected after missing action completion, especially for individuals with high OC trait incompleteness. The inhibition-related event-related potentials (ERPs) N200 and P300 were also measured. RESULTS High OC trait incompleteness led to more errors following omitted- and faster responses during commission errors following incongruent outcomes. Furthermore, lower N200 was associated with worse response inhibition, and high OC trait incompleteness was associated with reduced N200, but not reduced P300 amplitude. These findings provide evidence that trait-like feelings of incompleteness may underlie maladaptive action repetition and impaired inhibitory control as observed in OCD.
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Affiliation(s)
- Clara Dominke
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany.
| | - Kyran Graham-Schmidt
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany
| | - Antje Gentsch
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany
| | - Simone Schütz-Bosbach
- General and Experimental Psychology, Ludwig-Maximilians-University, Munich, Leopoldstr. 13, München, 80802, Germany
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27
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Chang KW, Jung HH, Chang JW. Magnetic Resonance-Guided Focused Ultrasound Surgery for Obsessive-Compulsive Disorders: Potential for use as a Novel Ablative Surgical Technique. Front Psychiatry 2021; 12:640832. [PMID: 33889100 PMCID: PMC8057302 DOI: 10.3389/fpsyt.2021.640832] [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: 12/12/2020] [Accepted: 03/11/2021] [Indexed: 12/24/2022] Open
Abstract
Surgical treatment for psychiatric disorders, such as obsessive-compulsive disorder (OCD) and depression, using ablative techniques, such as cingulotomy and capsulotomy, have historically been controversial for a number of scientific, social, and ethical reasons. Recently, with the elucidation of anatomical and neurochemical substrates of brain function in healthy controls and patients with such disorders using various functional neuroimaging techniques, these criticisms are becoming less valid. Furthermore, by using new techniques, such as deep brain stimulation (DBS), and identifying more precise targets, beneficial effects and the lack of serious complications have been demonstrated in patients with psychiatric disorders. However, DBS also has many disadvantages. Currently, magnetic resonance-guided focused ultrasound surgery (MRgFUS) is used as a minimal-invasive surgical method for generating precisely placed focal thermal lesions in the brain. Here, we review surgical techniques and their potential complications, along with anterior limb of the internal capsule (ALIC) capsulotomy by radiofrequency lesioning and gamma knife radiosurgery, for the treatment of OCD and depression. We also discuss the limitations and technical issues related to ALIC capsulotomy with MRgFUS for medically refractory OCD and depression. Through this review we hope MRgFUS could be considered as a new treatment choice for refractory OCD.
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Affiliation(s)
- Kyung Won Chang
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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28
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Macul Ferreira de Barros P, do Rosário MC, Szejko N, Polga N, Requena GDL, Ravagnani B, Fatori D, Batistuzzo MC, Hoexter MQ, Rohde LA, Polanczyk GV, Leckman JF, Miguel EC, de Alvarenga PG. Risk factors for obsessive-compulsive symptoms. Follow-up of a community-based youth cohort. Eur Child Adolesc Psychiatry 2021; 30:89-104. [PMID: 32076869 DOI: 10.1007/s00787-020-01495-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
Environmental factors are at least as important as genetic factors for the development of obsessive-compulsive symptoms (OCS), but the identification of such factors remain a research priority. Our study aimed to investigate the association between a broad scope of potential risk factors and OCS in a large community cohort of children and adolescents. We evaluated 1877 participants and their caregivers at baseline and after 3 years to assess various demographic, prenatal, perinatal, childhood adversity, and psychopathological factors. Mean age at baseline was 10.2 years (SD 1.9) and mean age at follow-up was 13.4 years (SD 1.9). Reports of OCS at baseline and follow-up were analyzed using latent variable models. At preliminary regression analysis, 15 parameters were significantly associated with higher OCS scores at follow-up. At subsequent regression analysis, we found that eight of these parameters remained significantly associated with higher follow-up OCS scores while being controlled by each other and by baseline OCS scores. The significant predictors of follow-up OCS were: lower socioeconomic status (p = 0.033); lower intelligence quotient (p = 0.013); lower age (p < 0.001); higher maternal stress level during pregnancy (p = 0.028); absence of breastfeeding (p = 0.017); parental baseline OCS (p = 0.038); youth baseline anxiety disorder (p = 0.023); and youth baseline OCS scores (p < 0.001). These findings may better inform clinicians and policymakers engaged in the mental health assessment and prevention in children and adolescents.
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Affiliation(s)
| | - Maria Conceição do Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Natália Polga
- Graduate Program in Psychology, Federal University of São Paulo, Santos, Brazil
| | - Guaraci de Lima Requena
- Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Beatriz Ravagnani
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
| | - Daniel Fatori
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
| | - Marcelo Camargo Batistuzzo
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
| | - Marcelo Queiroz Hoexter
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
| | - Luis Augusto Rohde
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Guilherme Vanoni Polanczyk
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
| | | | - Eurípedes Constantino Miguel
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
| | - Pedro Gomes de Alvarenga
- Institute of Psychiatry, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, São Paulo, 05403-903, Brazil
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Saraiva LC, Cappi C, Simpson HB, Stein DJ, Viswanath B, van den Heuvel OA, Reddy YCJ, Miguel EC, Shavitt RG. Cutting-edge genetics in obsessive-compulsive disorder. Fac Rev 2020; 9:30. [PMID: 33659962 PMCID: PMC7886082 DOI: 10.12703/r/9-30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This article reviews recent advances in the genetics of obsessive-compulsive disorder (OCD). We cover work on the following: genome-wide association studies, whole-exome sequencing studies, copy number variation studies, gene expression, polygenic risk scores, gene–environment interaction, experimental animal systems, human cell models, imaging genetics, pharmacogenetics, and studies of endophenotypes. Findings from this work underscore the notion that the genetic architecture of OCD is highly complex and shared with other neuropsychiatric disorders. Also, the latest evidence points to the participation of gene networks involved in synaptic transmission, neurodevelopment, and the immune and inflammatory systems in this disorder. We conclude by highlighting that further study of the genetic architecture of OCD, a great part of which remains to be elucidated, could benefit the development of diagnostic and therapeutic approaches based on the biological basis of the disorder. Studies to date revealed that OCD is not a simple homogeneous entity, but rather that the underlying biological pathways are variable and heterogenous. We can expect that translation from bench to bedside, through continuous effort and collaborative work, will ultimately transform our understanding of what causes OCD and thus how best to treat it.
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Affiliation(s)
- Leonardo Cardoso Saraiva
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carolina Cappi
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Helen Blair Simpson
- Columbia University Irving Medical Center, Columbia University, New York, NY, 10032, USA
- The New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Biju Viswanath
- Molecular Genetics Laboratory, National Institute of Mental Health & Neurosciences (NIMHANS); Accelerator Program for Discovery in Brain disorders using Stem cells (ADBS) Laboratory, NIMHANS, Bangalore, India
| | - Odile A van den Heuvel
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neuroscience, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - YC Janardhan Reddy
- Obsessive-Compulsive Disorder (OCD) Clinic, Department of Psychiatry, NIMHANS, Bangalore, India
| | - Euripedes C Miguel
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roseli G Shavitt
- Department & Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Williams MT, Taylor RJ, George JR, Schlaudt VA, Ifatunji MA, Chatters LM. Correlates of Obsessive-Compulsive Symptoms Among Black Caribbean Americans. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020; 50:53-77. [PMID: 33840831 PMCID: PMC8034584 DOI: 10.1080/00207411.2020.1826261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite the rapid growth of the Black Caribbean population in the United States, we know little about the presentation and prevalence of obsessive-compulsive disorder (OCD) among these groups. This study examines the demographic correlates and the effect of racial discrimination on OCD symptoms among a nationally-representative sample of Black Caribbean and African American adults (n = 5,191). Drawing on the Composite International Diagnostic Interview Short Form (CIDI-SF) for OCD, we examine two types of obsessions (harm and contamination) and four types of compulsions (repeating, washing, ordering, and counting). There we no significant differences between Black Caribbeans and African Americans in obsessions and compulsions. Analysis among Black Caribbeans found that compared with Jamaican and Trinidadian Americans, Haitian American individuals reported the fewest number of obsessions and compulsions. We show that Black Caribbean Americans with lower income, lower self-rated physical and mental health, and more experiences with racial discrimination report higher levels of OCD. More specifically, racial discrimination was associated with contamination and harm obsessions, as well as washing and repeating compulsions. Our findings highlight the need to consider specific domains of OCD relative to Black Caribbeans, and the relationship between social and demographic variables on symptomology.
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Affiliation(s)
| | | | - Jamilah R. George
- University of Connecticut, Department of Psychological Sciences, Storrs, CT
| | | | - Mosi Adesina Ifatunji
- University of Wisconsin at Madison, Department of Afro American Studies, Madison, WI
| | - Linda M. Chatters
- University of Michigan, School of Social Work, Ann Arbor, MI
- University of Michigan, School of Public Health, Ann Arbor, MI
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Zhang L, Hu X, Lu L, Li B, Hu X, Bu X, Li H, Tang S, Gao Y, Yang Y, Sweeney JA, Gong Q, Huang X. Anatomic alterations across amygdala subnuclei in medication-free patients with obsessive-compulsive disorder. J Psychiatry Neurosci 2020; 45:334-343. [PMID: 32293840 PMCID: PMC7850150 DOI: 10.1503/jpn.190114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The amygdala has been implicated in obsessive-compulsive disorder (OCD), a common, disabling illness. However, the regional distribution of anatomic alterations in this structure and their association with the symptoms of OCD remains to be established. METHODS We collected high-resolution 3D T1-weighted images from 81 untreated patients with OCD and no lifetime history of comorbid psychotic, affective or anxiety disorders, and from 95 age- and sex-matched healthy controls. We extracted the volume of the central nucleus of the amygdala (CeA) and the basolateral complex of the amygdala (BLA) and compared them across groups using FreeSurfer 6.0. In exploratory analyses, we evaluated other subnuclei, including the cortical medial nuclei, the anterior amygdaloid area, and the corticoamygdaloid transition area. RESULTS Patients with OCD had reduced amygdala volume bilaterally compared with healthy controls (left, p = 0.034; right, p = 0.002). Volume reductions were greater in the CeA (left: -11.9%, p = 0.002; right: -13.3%, p < 0.001) than in the BLA (left lateral nucleus: -3.3%, p = 0.029; right lateral nucleus: -3.9%, p = 0.018; right basal nucleus: -4.1%, p = 0.017; left accessory basal nucleus: -6.5%, p = 0.001; right accessory basal nucleus: -9.3%, p < 0.001). Volume reductions in the CeA were associated with illness duration. Exploratory analysis revealed smaller medial (left: -15.4%, p < 0.001, η2 = 0.101) and cortical (left: -9.1%, p = 0.001, η2 = 0.058; right: -15.4%, p < 0.001, η2 = 0.175) nuclei in patients with OCD compared with healthy controls. LIMITATIONS Although the strict exclusion criteria used in the study helped us to identify OCD-specific alterations, they may have limited generalizability to the broader OCD population. CONCLUSION Our results provide a comprehensive anatomic profile of alterations in the amygdala subnuclei in untreated patients with OCD and highlight a distinctive pattern of volume reductions across subnuclei in OCD. Based on the functional properties of the amygdala subnuclei established from preclinical research, CeA impairment may contribute to behavioural inflexibility, and BLA disruption may be responsible for altered fear conditioning and the affective components of OCD.
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Affiliation(s)
- Lianqing Zhang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xinyu Hu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Lu Lu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Bin Li
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xiaoxiao Hu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xuan Bu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Hailong Li
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Shi Tang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Yingxue Gao
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Yanchun Yang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - John A Sweeney
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Qiyong Gong
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
| | - Xiaoqi Huang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Sweeney, Gong, Huang); the Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, PR China (Li, Yang); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, USA (Sweeney); and the Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China (Zhang, Xinyu Hu, Lu, Xiaoxiao Hu, Bu, Li, Tang, Gao, Gong, Huang)
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Mierau JO, Kann-Weedage D, Hoekstra PJ, Spiegelaar L, Jansen DEMC, Vermeulen KM, Reijneveld SA, van den Hoofdakker BJ, Buskens E, van den Akker-van Marle ME, Dirksen CD, Groenman AP. Assessing quality of life in psychosocial and mental health disorders in children: a comprehensive overview and appraisal of generic health related quality of life measures. BMC Pediatr 2020; 20:329. [PMID: 32620157 PMCID: PMC7333319 DOI: 10.1186/s12887-020-02220-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Mental health problems often arise in childhood and adolescence and can have detrimental effects on people's quality of life (QoL). Therefore, it is of great importance for clinicians, policymakers and researchers to adequately measure QoL in children. With this review, we aim to provide an overview of existing generic measures of QoL suitable for economic evaluations in children with mental health problems. METHODS First, we undertook a meta-review of QoL instruments in which we identified all relevant instruments. Next, we performed a systematic review of the psychometric properties of the identified instruments. Lastly, the results were summarized in a decision tree. RESULTS This review provides an overview of these 22 generic instruments available to measure QoL in children with psychosocial and or mental health problems and their psychometric properties. A systematic search into the psychometric quality of these instruments found 195 suitable papers, of which 30 assessed psychometric quality in child and adolescent mental health. CONCLUSIONS We found that none of the instruments was perfect for use in economic evaluation of child and adolescent mental health care as all instruments had disadvantages, ranging from lack of psychometric research, no proxy version, not being suitable for young children, no age-specific value set for children under 18, to insufficient focus on relevant domains (e.g. social and emotional domains).
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Affiliation(s)
- Jochen O Mierau
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Aletta Jacobs School of Public Health, Groningen, The Netherlands
| | | | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisan Spiegelaar
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Danielle E M C Jansen
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Buskens
- University Medical Center Groningen and Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - M Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Annabeth P Groenman
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, freepostnumber 176, 9700VB, Groningen, The Netherlands.
- Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
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Dadashi M, Yousefi Asl V, Morsali Y. Cognitive-Behavioral Therapy Versus Transcranial Direct Current Stimulation for Augmenting Selective Serotonin Reuptake Inhibitors in Obsessive-Compulsive Disorder Patients. Basic Clin Neurosci 2020; 11:111-120. [PMID: 32483481 PMCID: PMC7253812 DOI: 10.32598/bcn.11.1.13333.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/10/2018] [Accepted: 02/13/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction: Obsessive-Compulsive Disorder (OCD) belongs to the categories of psychiatric disorders with the potential to turn into a chronic condition without receiving the necessary treatments. The main feature of OCD is the frequent or intense obsession and compulsion that might induce great pain and suffering in patients. Moreover, as one of the most prevalent abnormalities, depression usually follows OCD. The present study aimed to compare the effects of Exposure and Response Prevention (ERP) and Transcranial Direct Current Stimulation (tDCS) treatments adjunct to pharmacotherapy on decreasing the severity of obsession-depression symptoms and improving the quality of life in OCD patients. Methods: This was a quasi-experimental study with a pre-test, post-test design and a follow-up stage. The statistical population comprised all the patients diagnosed with OCD in Zanjan Province, Iran. Besides, 26 OCD patients referring to Shahid Beheshti Medical Center in Zanjan were selected using a purposive sampling method. Then, they were randomly assigned to two treatment groups. The study subjects completed the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI 2), and the Quality of Life Questionnaire at the pre-treatment, post-treatment, and follow-up stages (1 month and 2 months after the treatment). Analysis of Covariance (ANCOVA) and Reliable Change Index (RCI) methods were used to measure statistical and clinical significances, respectively. The collected data were analyzed using SPSS. Results: The obtained data suggested no significant difference between the ERP and tDCS groups concerning the symptoms of OCD and depression at the post-test stage (P>0.05). Conversely, in terms of life quality, there was a significant difference between the ERP and tDCS groups at the post-test phase (P<0.05). Conclusion: Although the present findings revealed no statistically significant difference between the ERP and tDCS groups (except for the quality of life variable), the pharmacotherapy-ERP combination proved to be more effective than pharmaco therapy-tDCS in treating OCD patients.
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Affiliation(s)
- Mohsen Dadashi
- Department of Clinical Psychology, Social Determinants of Health Research Center, University of Medical Sciences, Zanjan, Iran
| | - Vida Yousefi Asl
- Department of Psychology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Yousef Morsali
- Department of Psychology, Zanjan University of Medical Sciences, Zanjan, Iran
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Velloso P, Piccinato C, Ferrão Y, Aliende Perin E, Cesar R, Fontenelle L, Hounie A, do Rosário M. The suicidality continuum in a large sample of obsessive–compulsive disorder (OCD) patients. Eur Psychiatry 2020; 38:1-7. [DOI: 10.1016/j.eurpsy.2016.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 01/24/2023] Open
Abstract
AbstractBackgroundObsessive–compulsive disorder (OCD) has a chronic course leading to huge impact in the patient’s functioning. Suicidal thoughts and attempts are much more frequent in OCD subjects than once thought before.AimTo empirically investigate whether the suicidal phenomena could be analyzed as a suicidality severity continuum and its association with obsessive–compulsive (OC) symptom dimensions and quality of life (QoL), in a large OCD sample.MethodsCross-sectional study with 548 patients diagnosed with OCD according to the DSM-IV criteria, interviewed in the Brazilian OCD Consortium (C-TOC) sites. Patients were evaluated by OCD experts using standardized instruments including: Yale-Brown Obsessive–Compulsive Scale (YBOCS); Dimensional Yale-Brown Obsessive–Compulsive Scale (DYBOCS); Beck Depression and Anxiety Inventories; Structured Clinical Interview for DSM-IV (SCID); and the SF-36 QoL Health Survey.ResultsThere were extremely high correlations between all the suicidal phenomena. OCD patients with suicidality had significantly lower QoL, higher severity in the “sexual/religious”, “aggression” and “symmetry/ordering” OC symptom dimensions, higher BDI and BA scores and a higher frequency of suicide attempts in a family member. In the regression analysis, the factors that most impacted suicidality were the sexual dimension severity, the SF-36 QoL Mental Health domain, the severity of depressive symptoms and a relative with an attempted suicide history.ConclusionsSuicidality could be analyzed as a severity continuum and patients should be carefully monitored since they present with suicidal ideation. Lower QoL scores, higher scores on the sexual dimension and a family history of suicide attempts should be considered as risk factors for suicidality among OCD patients.
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The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample. Eur Psychiatry 2020; 44:76-82. [DOI: 10.1016/j.eurpsy.2017.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 11/23/2022] Open
Abstract
AbstractBackground:Depression is the most common comorbidity in obsessive-compulsive disorder (OCD). However, the mechanisms of depressive comorbidity in OCD are poorly understood. We assessed the directionality and moderators of the OCD-depression association over time in a large, prospective clinical sample of OCD patients.Methods:Data were drawn from 382 OCD patients participating at the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study. Cross-lagged, structural equation modeling analyses were used to assess the temporal association between OCD and depressive symptoms. Assessments were conducted at baseline, two-year and four-year follow up. Cognitive and interpersonal moderators of the prospective association between OCD and depressive symptoms were tested.Results:Cross-lagged analyses demonstrated that OCD predicts depressive symptoms at two-year follow up and not vice a versa. This relationship disappeared at four-year follow up. Secure attachment style moderated the prospective association between OCD and depression.Conclusions:Depressive comorbidity in OCD might constitute a functional consequence of the incapacitating OCD symptoms. Both OCD and depression symptoms demonstrated strong stability effects between two-year and four-year follow up, which may explain the lack of association between them in that period. Among OCD patients, secure attachment represents a buffer against future depressive symptoms.
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Rahmat R. Urinary frequency: going beyond the tract. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:58-60. [PMID: 32284808 PMCID: PMC7136674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a common anxiety disorder which can be chronic and sustained. An OCD sufferer experiences intrusive and repetitive thoughts, impulses, and behaviors, which ultimately cause extreme discomfort. We report a case of a patient that primarily presented with lower urinary tract symptoms who was subsequently treated with antibiotics. Nonetheless, the symptoms persisted. In subsequent consultations, the patient clarified the compulsive nature of his symptoms and was treated as a case of OCD. Therefore, it is crucial for physicians to correctly identify the nature of the symptoms to manage the disorder properly and to avoid unnecessary consultation and treatment. To the best of our knowledge, this is the first report of other presentations of OCD.
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Affiliation(s)
- R Rahmat
- MD (UKM), MMED Family Medicine (USM) Klinik Kesihatan Taiping, Perak Malaysia
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Subramaniam M, Abdin E, Vaingankar J, Shafie S, Chang S, Seow E, Chua BY, Jeyagurunathan A, Heng D, Kwok KW, Chong SA. Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2019185] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Using data from Singapore Mental Health Study 2016 (SMHS 2016), we
examined the prevalence of lifetime and 12-month obsessive-compulsive disorder (OCD),its sociodemographics correlates and association with comorbid psychiatric disorders and physical conditions, perceived social support and quality of life. Materials and Methods: The World Mental Health Composite International Diagnostic Interview (version 3.0) was administered by trained interviewers to 6126 residents aged ≥18 years old to assess OCD prevalence and that of other select psychiatric disorders. Details on sociodemographics, perceived social support and health-related quality of life were obtained. Results: Lifetimeand 12-month prevalence of OCD was 3.6% and 2.9%, respectively. Adjusted regression analysis showed that those with OCD had significantly higher odds of major depressive disorder (odds ratio [OR], 5.4), bipolar disorder (OR, 8.9), generalised anxiety disorder (OR, 7.3) and alcohol abuse (OR, 2.7). OCD was significantly associated with suicidal ideation and suicidality (OR, 5.1). OCD subjects also had higher odds of chronic pain (OR, 2.4) and diabetes (OR, 3.1). Finally, OCD subjects had lower mean mental composite summary scores than controls (respondents without any of the psychiatric disorders and physical conditions included in SMHS 2016) and those with other lifetime psychiatric disorders and physical conditions. Conclusion: OCD prevalence in Singapore is high. Most people with OCD do not seek treatment despite experiencing significant comorbidity and loss of quality of life.
Key words: Composite International Diagnostic Interview, Epidemiology, Multi-ethnic,
Psychiatric disorder, Survey
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Affiliation(s)
- Mythily Subramaniam
- Institute of Mental Health, Singapore, Nanyang Technological University, Singapore
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Zheng Y, Xiao L, Xie Y, Wang H, Wang G. Prevalence and Characteristics of Obsessive-Compulsive Disorder Among Urban Residents in Wuhan During the Stage of Regular Control of Coronavirus Disease-19 Epidemic. Front Psychiatry 2020; 11:594167. [PMID: 33391055 PMCID: PMC7772465 DOI: 10.3389/fpsyt.2020.594167] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/17/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Coronavirus disease-19 (Covid-19) is one of the most devastating epidemics in the 21st century, which has caused considerable damage to the physical and mental health of human beings. Despite a few regions like China having controlled the epidemic trends, most countries are still under siege of COVID-19. As the emphasis on cleaning and hygiene has been increasing, the problems related to obsessive-compulsive disorder (OCD) may appear. Objective: This study was designed to investigate the prevalence of OCD in the urban population in Wuhan during the stage of regular epidemic control and prevention. Meanwhile, characteristics and risk factors for OCD were also explored. Method: Five-hundred and seventy residents in urban areas of Wuhan were recruited using the snowball sampling method to complete questionnaires and an online interview from July 9 to July 19, 2020. Collected information encompassed socio-demographics, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, Social Support Rating Scale (SSRS) scores and Pittsburgh Sleep Quality Index(PSQI) values. Results: Three months after lifting the quarantine in Wuhan, the prevalence of OCD was 17.93%. About 89% of OCD patients had both obsessions and compulsions, while 8% had only obsessions and 3% had only compulsions. Top 3 common dimensions of obsessions were miscellaneous (84.0%), aggressive (76.6%), and contamination (48.9%), and of compulsions were miscellaneous (64%), checking (51.7%), and cleaning/washing/repeating (31.5%). The unmarried were more vulnerable to OCD than the married (p < 0.05, odds ration = 1.836). Students had 2.103 times the risk of developing OCD than health care workers (p < 0.05). Those with positive family history of OCD and other mental disorders (p < 0.05, odds ration = 2.497) and presence of psychiatric comorbidity (p < 0.05, odds ration = 4.213) were also at higher risk. Each level increase in sleep latency increased the risk of OCD to 1.646 times (p < 0.05). Conclusion: In the background of regular epidemic control, the prevalence of OCD was high, and the symptoms were widely distributed. Obsessions often accompanied compulsions. Being single and a student, positive family history of OCD and other mental disorders, presence of psychiatric comorbidity, and longer sleep latency were predictors of OCD. Early recognition and detection of these issues may help to intervene in OCD.
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Affiliation(s)
- Yage Zheng
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yinping Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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39
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Four-year course of quality of life and obsessive-compulsive disorder. Soc Psychiatry Psychiatr Epidemiol 2020; 55:989-1000. [PMID: 31541270 PMCID: PMC7395050 DOI: 10.1007/s00127-019-01779-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/10/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Patients with obsessive compulsive disorder (OCD) have high disease burden. It is important to restore quality of life (QoL) in treatment, so that patients become able to live a fulfilling life. Little is known about the longitudinal course of QoL in patients with OCD, its association with remission from OCD, and about factors that contribute to an unfavourable course of QoL in remitting patients. METHODS Study on the 4-year course of QoL of patients with chronic (n = 144), intermittent (n = 22), and remitting OCD (n = 73) using longitudinal data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA; complete data: n = 239; imputed data n = 382). The EuroQol five-dimensional questionnaire (EQ-5D) utility score was used to assess QoL. In patients with remitting OCD, we examined patient characteristics that contributed to an unfavourable course of QoL, including sociodemographics, OCD characteristics, psychiatric comorbidity, and personality traits. RESULTS Course of QoL was associated with course of OCD. QoL improved in those who remitted from OCD; however, even in these patients, QoL remained significantly below the population norms. The correlation between QoL and severity of OCD was only moderate: r = - 0.40 indicating that other factors besides OCD severity contribute to QoL. In remitters, more severe anxiety and depression symptoms were related to a lower QoL. Results were similar in complete and imputed data sets. CONCLUSIONS Remission from OCD is associated with improvement of QoL, but comorbid anxiety and depression symptoms hamper the improvement of QoL. QoL could be improved by reducing OCD symptoms in patients with OCD and by treating comorbid anxiety and depression symptoms in remitting patients.
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40
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Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Emmelkamp PMG, Anholt GE. Predictors of treatment outcome in OCD: An interpersonal perspective. J Anxiety Disord 2019; 68:102153. [PMID: 31704634 DOI: 10.1016/j.janxdis.2019.102153] [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: 06/07/2019] [Revised: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.
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Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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41
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Van Wilder L, Rammant E, Clays E, Devleesschauwer B, Pauwels N, De Smedt D. A comprehensive catalogue of EQ-5D scores in chronic disease: results of a systematic review. Qual Life Res 2019; 28:3153-3161. [PMID: 31531840 DOI: 10.1007/s11136-019-02300-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Chronic diseases are associated with impaired health-related quality of life (HRQoL) outcomes. Comparison of HRQoL outcomes between different diseases and with the general population is of major importance to health economists, epidemiologists, clinicians, and policy makers. The aim of this systematic literature review was to develop a catalogue with EQ-5D scores in chronic non-communicable diseases, and to compare these scores with reference values from the general population. METHODS MEDLINE, Embase, and Web of Science were systematically searched independently by two reviewers. Studies were included if they reported mean EQ-5D index values for the adult population and if these scores were compared with the general population. The QualSyst tool for quantitative research was used for quality appraisal. RESULTS Two hundred and seven articles met the inclusion criteria. An extensive catalogue summarizes the EQ-5D scores in a wide variety of chronic diseases. Mean EQ-5D index values ranged between - 0.20 and 1. Lower EQ-5D scores are reported in chronic diseases compared to the general population, specifically in neurological disorders. Most of the diseases demonstrate a substantial disutility, although a minority of diseases have equal or even higher index scores than the general population. CONCLUSION A comprehensive, international catalogue has been developed to provide EQ-5D index scores for diverse chronic diseases compared with reference values based on the available literature. The catalogue gives a clear overview of the existing EQ-5D scores and can be rapidly accessed by researchers worldwide for different applications such as health economic evaluations, decision making, resource allocation, and other policy objectives. Future studies should focus on unexamined diseases and specific patient groups to expand the evidence base on HRQoL in chronic diseases.
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Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, University Hospital, Ghent University, Ghent, Belgium.
| | - Elke Rammant
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, University Hospital, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Nele Pauwels
- The Knowledge Center for Health Ghent, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, University Hospital, Ghent University, Ghent, Belgium
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Skapinakis P, Politis S, Karampas A, Petrikis P, Mavreas V. Prevalence, comorbidity, quality of life and use of services of obsessive-compulsive disorder and subthreshold obsessive-compulsive symptoms in the general adult population of Greece. Int J Psychiatry Clin Pract 2019; 23:215-224. [PMID: 30987479 DOI: 10.1080/13651501.2019.1588327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: We aimed to describe the epidemiology of obsessive-compulsive disorder (OCD) and related subthreshold symptoms in the general population of Greece and to assess the comorbidity, use of health services and impact on quality of life of these syndromes in the general population. Methods: This was a secondary analysis of the 2009-2010 general population Greek psychiatric morbidity survey (4902 participants living in private households, response rate 54%). Psychiatric disorders were assessed with the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D. Results: 1.69% of the participants (95% confidence interval [CI]: 1.33%-2.05%) met criteria for current OCD while 2.79% met criteria for subthreshold obsessive-compulsive symptoms (95%CI: 2.33%-3.26%). In the adjusted analysis few sociodemographic associations remained statistically significant. Although the full-blown syndrome was more severe in terms of comorbidity and quality of life our results showed that even subthreshold obsessive-compulsive symptoms were associated with significant comorbidity and reductions in quality of life. Use of mental health services was small. Conclusions: OCD is an under-treated public health problem that needs more attention in Greece and elsewhere. Provision of specialised mental health services should be a priority for publicly funded national health systems. Keypoints OCD is common in the general population of Greece with few sociodemographic associations apart from subjective financial difficulties. The comorbidity pattern of the full-blown syndrome versus the subthreshold obsessive-compulsive symptoms is similar and differs in magnitude in the expected way. Quality of life in OCD is greatly reduced especially when there is chronicity and/or comorbidity with depression. Use of services is limited but comorbidity with depression may increase the chances of consultation with a mental health professional.
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Affiliation(s)
- Petros Skapinakis
- Department of Psychiatry, School of Medicine, University of Ioannina , Ioannina , Greece
| | - Spyridon Politis
- Department of Psychiatry, School of Medicine, University of Ioannina , Ioannina , Greece
| | - Andreas Karampas
- Department of Psychiatry, School of Medicine, University of Ioannina , Ioannina , Greece
| | - Petros Petrikis
- Department of Psychiatry, School of Medicine, University of Ioannina , Ioannina , Greece
| | - Venetsanos Mavreas
- Department of Psychiatry, School of Medicine, University of Ioannina , Ioannina , Greece
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Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5:52. [PMID: 31371720 PMCID: PMC7370844 DOI: 10.1038/s41572-019-0102-3] [Citation(s) in RCA: 298] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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Affiliation(s)
- Dan J. Stein
- Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - Daniel L. C. Costa
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christine Lochner
- Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa
| | - Euripedes C. Miguel
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Y. C. Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Roseli G. Shavitt
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A. van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - H. Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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44
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Pedley R, Berry K, Bee P, Gellatly J, Wearden A. Testing the psychometric properties of the illness perceptions questionnaire for OCD (IPQ-O). BMC Psychiatry 2019; 19:217. [PMID: 31291916 PMCID: PMC6617616 DOI: 10.1186/s12888-019-2195-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown that our perceptions about illness are important determinants of how we respond and adjust to health threats. To examine whether illness perceptions affect illness responses in OCD (e.g. help-seeking), this study aimed to develop and test the psychometric properties of a new OCD-specific tool to assess illness perceptions, the illness perceptions questionnaire for OCD (IPQ-O). METHODS A cross-sectional questionnaire-based design was used. Following adaptation of the IPQ-R based on qualitative interviews with people with OCD, adults (age ≥ 16) with OCD completed the IPQ-O (online or postal), alongside measures of depression, anxiety, OCD severity, attitudes to seeking mental health services and behaviours (e.g. treatment seeking intentions). A sub-sample re-completed the IPQ-O after two-weeks to obtain test-retest reliability. Factor analysis was used to derive the IPQ-O factor structure; internal consistency of subscales was calculated. Convergent validity was explored. RESULTS Three hundred forty-eight people with OCD completed the IPQ-O. After factor analysis, seven main sub-scales and four cause sub-scales were identified, explaining 45.5 and 41.6% of the variance after extraction and rotation respectively. Three sub-scales from the original IPQ-R were validated; other dimensions differed from original IPQ-R sub-scales. The new 'spectrum' sub-scale measures the strength of the view that OCD is a trait that presents to varying extents within the general population. The IPQ-O demonstrated internal consistency, test re-test reliability (Kendall's tau = .51-.75) and convergent validity. Illness perceptions were associated with important aspects of adjustment (depression, anxiety) and condition management (receipt of treatment, plans to seek help). In particular, emerging data showed that those who had not received medication for OCD endorsed stronger spectrum beliefs. Though longitudinal study is needed to verify the direction of this association, this raises the question of whether spectrum beliefs deter people with OCD from using pharmacological treatments. CONCLUSIONS The IPQ-O provides a valuable tool for subsequent testing of whether illness perceptions drive outcomes as proposed by the CSM. If perceptions are found to drive adjustment and behaviour, therapists could elicit and subsequently challenge perceptions that have negative effects on adjustment and coping, as part of psychological therapy.
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Affiliation(s)
- Rebecca Pedley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK. .,Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Katherine Berry
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Penny Bee
- 0000000121662407grid.5379.8Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Judith Gellatly
- 0000000121662407grid.5379.8Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Alison Wearden
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, School of Health Sciences & Manchester Centre for Health Psychology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Zhang L, Hu X, Lu L, Li B, Hu X, Bu X, Li H, Tang S, Yang Y, Roberts N, Sweeney JA, Gong Q, Huang X. Abnormalities of hippocampal shape and subfield volumes in medication-free patients with obsessive-compulsive disorder. Hum Brain Mapp 2019; 40:4105-4113. [PMID: 31188536 DOI: 10.1002/hbm.24688] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/06/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
In this study, we sought to identify alterations of hippocampal shape and subfield volumes in a relatively large sample of medication-free obsessive-compulsive disorder (OCD) patients without comorbid depression. 3D T1-weighted Magnetic Resonance Imaging scans were collected from 81 medication-free OCD patients and 95 age- and sex-matched healthy controls (HC). Total hippocampal volume and volume of eight bilateral subfields were measured using FreeSurfer software. Subregional shape deformity was examined via FSL software. Volumetric and shape differences between groups and correlations with OCD symptoms were examined. The volume of right hippocampus was significantly reduced in OCD patients (p = .001, η2 = 0.065). Follow-up analysis of right hemisphere subfields showed reduced volume in right subiculum (p < .001, η2 = 0.081), presubiculum (p < .001, η2 = 0.125), CA2/3 (p = .001, η2 = 0.06), and hippocampal tail (p < 0.001, η2 = 0.105), while the volume of right fimbria was increased (p = .001, η2 = 0.058). Shape analysis revealed a bilateral outward bending in the hippocampal body related to a lateral displacement of hippocampus from the body to the tail. Symptom severity was correlated with volumes of presubiculum (with compulsions, r = -0.25, p = .024) and fimbria (with obsessions, r = -0.28, p = .012), and with the lateral shift of middle and posterior hippocampus (with obsessions). Alterations across hippocampal subfields and overall shape may contribute to the distinctive cognitive and affective abnormalities associated with OCD.
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Affiliation(s)
- Lianqing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xinyu Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lu Lu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Li
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoxiao Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xuan Bu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hailong Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shi Tang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yanchun Yang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Neil Roberts
- Clinical Research Imaging Centre (CRIC), The Queen's Medical Research Institute (QMRI), University of Edinburgh, Edinburgh, UK
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.,Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Early intervention for obsessive compulsive disorder: An expert consensus statement. Eur Neuropsychopharmacol 2019; 29:549-565. [PMID: 30773387 DOI: 10.1016/j.euroneuro.2019.02.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/04/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.
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Illness perceptions in people with obsessive-compulsive disorder; A qualitative study. PLoS One 2019; 14:e0213495. [PMID: 30893331 PMCID: PMC6426201 DOI: 10.1371/journal.pone.0213495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a serious mental health problem that causes significant impairment and reduced quality of life. Though some substantially benefit from psychological therapies, a substantial proportion of people with OCD disengage from treatment or fail to benefit. Theoretical models such as the Common-Sense Model posit that our management of physical illness depends on our perceptions about the condition. Identifying how people with OCD perceive their condition could lead to important insight that would improve treatment of OCD. OBJECTIVES To identify and characterise the illness perceptions of people with OCD. METHOD Transcribed semi-structured interviews exploring the illness perceptions of 16 people with OCD were analysed using thematic analysis. RESULTS In some cases, identification of symptoms was hindered by a failure to interpret experiences as 'symptoms'. Instead, these individuals interpreted symptoms as a personality quirk, or as evidence that they had become deviant. Perceptions of the condition as 'part' of the self contributed to views of OCD as permanent. Individuals were concerned about the impact of OCD on friends and family and attempted to minimise its consequences, for example by concealing symptoms from their children, who they feared could acquire OCD. CONCLUSION Applying a theoretical model of physical health understanding to OCD yielded novel insights, with important implications for support and treatment. To enable early help-seeking and rapid diagnosis, public and professional knowledge about OCD should be extended beyond 'washing and checking' to the less widely known OCD-subtypes, such as fear of causing harm. It may be important to identify and challenge views of OCD as permanent early in the course of treatment to maximise engagement. Management of OCD should also address the burden of living with OCD in a family context. Further research to test whether these perceptions lead to coping responses and outcomes in OCD is now needed.
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Aldea MA, Michael K, Alexander K, Kison S. Obsessive-Compulsive Tendencies in a Sample of Veterans With Posttraumatic Stress Disorder. J Cogn Psychother 2019; 33:33-45. [PMID: 32746420 DOI: 10.1891/0889-8391.33.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) is considered one of the most debilitating disorders worldwide. Data suggests that trauma may be a significant source of not only posttraumatic stress disorder (PTSD), but also OCD. An epidemiologic study of the general population found the risk for OCD to be increased 10-fold in persons with PTSD. The National Vietnam Veterans Readjustment Study found the prevalence of OCD to be 5.2% in war-zone veterans and other studies highlighted PTSD-OCD comorbidity rates ranging from 41% to 70%. However, the frequency of diagnosed OCD is low among veterans (0.6%), and veterans with OCD receive little mental healthcare after diagnosis (mean: 3.8 sessions). The present study examined obsessive-compulsive (OC) tendencies in a sample of veterans with PTSD seeking treatment in a Veterans Affairs (VA) PTSD program between 2011 and 2013. Of the 318 veterans with PTSD included in the current study, 125 (36%) also reported OC tendencies. Data analyses revealed that participants with PTSD who showed evidence of OC tendencies demonstrated more severe PTSD symptoms, higher anxiety sensitivity, and lower cognitive flexibility than participants with PTSD without comorbid OC tendencies; no differences regarding posttraumatic growth were found between the two groups. This is a preliminary study aiming to assess OC tendencies in a sample of veterans with PTSD and expand on the limited existing literature on OCD-PTSD comorbid presentation among veterans.
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van Oudheusden LJB, Draisma S, van der Salm S, Cath D, van Oppen P, van Balkom AJLM, Meynen G. Perceptions of free will in obsessive-compulsive disorder: a quantitative analysis. BMC Psychiatry 2018; 18:400. [PMID: 30587170 PMCID: PMC6307295 DOI: 10.1186/s12888-018-1985-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study was to explore perceptions of free will in the repetitive behaviors of patients with obsessive-compulsive disorder (OCD) and to explore their relation with core clinical characteristics. METHODS Experiences of free will were assessed with the Symptomatology And Perceived Free will rating scale (SAPF) in 295 subjects with a lifetime diagnosis of OCD. Patients' scores on the SAPF were subjected to an explorative principal axis factor analysis (PAF). Factor scores were regressed on five OCD symptom dimensions and on seven clinical variables: illness duration, severity of OCD, insight, anxiety and depression, suicidal ideation and quality of life. RESULTS The PAF revealed three factors: the perceived ability to control and change one's course of action when faced with an obsession or compulsion (the "alternative possibilities" factor); the experience of obsessions or compulsions as intentional (the "intentionality" factor); and the experience of being the source or owner of the obsessions or compulsions (the "ownership" factor). Lower scores on the "alternative possibilities" factor were associated with lower scores on the washing dimension (β = 0.237, p = 0.004) and higher scores on the precision dimension (β = - 0.190, p = 0.025) and independently associated with longer illness duration (β = - 0.134, p = 0.039), higher illness severity (β = - 0.298, p < 0.001) and lower quality of life (β = 0.172, p = 0.046). Lower scores on the "intentionality" factor were independently associated with lower quality of life (β = 0.233, p = 0.027). Higher scores on the "ownership" factor were associated with higher scores on the precision dimension (β = 0.207, p = 0.023) and independently associated with poorer insight (β = 0.170, p = 0.045). CONCLUSIONS The most notable finding of this study is that a diminished experience of free will in OCD is associated with core clinical characteristics: illness duration and severity, insight and quality of life.
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Affiliation(s)
- Lucas J. B. van Oudheusden
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Stasja Draisma
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Sandra van der Salm
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - Danielle Cath
- Department of Clinical and Health psychology, Altrecht Academic Anxiety Centre, Utrecht University, Utrecht, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Gerben Meynen
- Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest, Amsterdam, The Netherlands
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, The Netherlands
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Akinsulore A, Opakunle T, Aloba O, Suleiman B, Ibigbami O. The relationship between obsessive compulsive symptoms and quality of life in Nigerian patients with schizophrenia. Gen Hosp Psychiatry 2018; 55:72-76. [PMID: 30445337 DOI: 10.1016/j.genhosppsych.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obsessive compulsive symptoms (OCS) are relatively common in schizophrenia. Their presence and severity can affect the quality of life (QoL) of schizophrenia patients. OBJECTIVE This study aimed to determine the effect of OCS on the subjective QoL of the Nigerian outpatients with schizophrenia. It also determines the sociodemographic and clinical factors associated with OCS. METHOD A cross-sectional study involving 232 patients with schizophrenia completed socio-demographic and clinical characteristics questionnaire. OCS was examined with Obsessive Compulsive Inventory (OCI) and QoL was assessed using the brief version of the World Health Organisation Quality of Life questionnaire. RESULT Most of the schizophrenia patients with OCS were unmarried, unemployed, had an earlier onset, longer duration of illness, and were on higher doses of antipsychotics. They reported lower QoL and more severity of symptoms of schizophrenia when compared to those without OCS. The OCI total and it's subscales had negative weak to moderate relationship with all the domains of the WHOQoL Bref. Being unemployed, dosage of antipsychotic medication, negative symptoms and OCI total were the predictors of the total quality of life among Nigerian schizophrenia patients. CONCLUSION OCS are very common and reduce QoL of schizophrenia patients. Hence, there is a need to routinely screen patients with schizophrenia for OCS and manage them appropriately.
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Affiliation(s)
- A Akinsulore
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
| | - T Opakunle
- Department of Mental Health, State Specialist Hospital, Osogbo, Osun State, Nigeria
| | - O Aloba
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - B Suleiman
- Department of Psychiatry, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - O Ibigbami
- Department of Mental Health, State Specialist Hospital, Osogbo, Osun State, Nigeria
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