Cognitive control of obsessional thoughts

Estradiol modulates changes in effective connectivity in emotion regulation networks

Hormonal changes in ovarian hormones like estradiol (E2) during the menstrual cycle affect emotional processes, including emotion recognition, memory, and regulation. So far, the neural underpinnings of the effect of E2 on emotional experience have been investigated using task-based functional magnetic resonance imaging (fMRI) and functional connectivity. In the present study, we examined whether the intrinsic network dynamics at rest (i.e., directed effective connectivity) related to emotion regulation are (1) modulated by E2 levels and (2) linked to behavioral emotion regulation ability. Hence, 29 naturally cycling women participated in two resting-state fMRI scans in their early follicular phase after being administered a placebo or an E2 valerate, respectively. Emotion regulation ability was assessed using a standard emotion regulation task in which participants were asked to down-regulate their emotions in response to negative images. The regions of two functionally predefined neural networks related to emotional down-regulation and reactivity were used to investigate effective connectivity at rest using spectral dynamic causal modelling. We found that E2, compared to placebo, resulted in changes in effective connectivity in both networks. In the regulation network, prefrontal regions showed distinct connectivity in the E2 compared to the placebo condition, while mixed results evolved in the emotional reactivity network. Stepwise regressions revealed that in the E2 condition a connection from the parietal to the prefrontal cortex predicted regulation ability. Our results demonstrate that E2 levels influence effective connectivity in networks underlying emotion regulation and emotional reactivity. Thus, E2 and its potential modification via hormonal administration may play a supporting role in the treatment of mental disorders that show a dysregulation of emotions.

The Relationship of Rumination, Worry and OCD Symptoms During Technology Supported Mindfulness Therapy for OCD

BACKGROUND

In this study, we re-examined data from a previous randomized controlled trial investigating 'technology supported mindfulness' (TSM)-an 8-week treatment intervention for individuals experiencing OCD. The current analysis involves an examination of the longitudinal relationships between rumination, worry and OCD symptom changes during mindfulness treatment, in comparison to a waitlist control.

METHODS

Participants experiencing OCD (n = 71) were randomly assigned to 8 weeks of (1) TSM or (2) waitlist control. We tested the extent to which rumination (using the Ruminative Response Scale) and worry (using the Penn State Worry Questionnaire) are associated with OCD symptom changes during the acute phase of treatment, concurrently (i.e., within the same longitudinal model).

RESULTS

Generalized linear model (GLM) results indicated a significant time (week 1 vs. week 8) by condition interaction involving decreased rumination in the TSM condition: F(1, 61) = 13.37, p = 0.001, partial η2 = 0.18 and observed power = 0.94. A second GLM demonstrated decreased worry in the TSM condition: F(1, 69) = 37.34, p = 0.001, partial η2 = 0.35 and observed power = 0.83. Longitudinal 'latent difference' structural equation analyses demonstrated a cross-lagged association between worry (but not rumination) and OCD symptom changes.

CONCLUSIONS

Individuals in the TSM condition experienced greater reductions in rumination and worry during 8 weeks of TSM treatment compared to the waitlist control, and reduced worry predicted subsequent OCD symptom reduction.

Toward personalized circuit-based closed-loop brain-interventions in psychiatry: using symptom provocation to extract EEG-markers of brain circuit activity

Symptom provocation is a well-established component of psychiatric research and therapy. It is hypothesized that specific activation of those brain circuits involved in the symptomatic expression of a brain pathology makes the relevant neural substrate accessible as a target for therapeutic interventions. For example, in the treatment of obsessive-compulsive disorder (OCD), symptom provocation is an important part of psychotherapy and is also performed prior to therapeutic brain stimulation with transcranial magnetic stimulation (TMS). Here, we discuss the potential of symptom provocation to isolate neurophysiological biomarkers reflecting the fluctuating activity of relevant brain networks with the goal of subsequently using these markers as targets to guide therapy. We put forward a general experimental framework based on the rapid switching between psychiatric symptom states. This enable neurophysiological measures to be derived from EEG and/or TMS-evoked EEG measures of brain activity during both states. By subtracting the data recorded during the baseline state from that recorded during the provoked state, the resulting contrast would ideally isolate the specific neural circuits differentially activated during the expression of symptoms. A similar approach enables the design of effective classifiers of brain activity from EEG data in Brain-Computer Interfaces (BCI). To obtain reliable contrast data, psychiatric state switching needs to be achieved multiple times during a continuous recording so that slow changes of brain activity affect both conditions equally. This is achieved easily for conditions that can be controlled intentionally, such as motor imagery, attention, or memory retention. With regard to psychiatric symptoms, an increase can often be provoked effectively relatively easily, however, it can be difficult to reliably and rapidly return to a baseline state. Here, we review different approaches to return from a provoked state to a baseline state and how these may be applied to different symptoms occurring in different psychiatric disorders.

Validity of the counter-app method in the assessment of intrusions

BACKGROUND AND OBJECTIVES

The counter-app method is often used to assess the frequency of intrusions. The method requires the participants to press a button on a smartphone whenever an intrusion occurs during a predefined time period. We evaluated the convergent, discriminant, and predictive validity of the counter-app method in two studies.

METHODS

In the first study, we assessed the frequency of intrusions with a counter-app method, thought-sampling method, and a retrospective measure in N = 77 students. Additionally, we assessed retrospectively-estimated duration, percentage of time, intensity, and intrusiveness of intrusions. The second study (N = 65) was identical to the first except the thinking-aloud method replaced the thought-sampling method, and additionally we assessed behavioral neutralizing.

RESULTS

The counter-app frequency was positively correlated with the convergent (thought-sampling and thinking-aloud frequencies, and retrospectively-estimated frequencies of intrusions) and predictive (behavioral neutralizing) validity criteria. The correlations between counter-app frequency and discriminant validity criteria (retrospectively-estimated duration, percentage of time, intensity, and intrusiveness of intrusions) were not smaller than the correlations between counter-app frequency and convergent validity criteria.

LIMITATIONS

We evaluated the predictive validity of the counter-app method using a criterion typical of obsessive-compulsive disorder research. Thus, the result for predictive validity might not transfer to other areas.

CONCLUSIONS

Our findings support convergent and predictive, but not discriminant, validity of the counter-app method. The counter-app method can validly assess the frequency of intrusions but is not appropriate if the study requires the differentiation of frequency from other constructs such as duration.

Exam-related unwanted intrusive thoughts and related neutralizing behaviors: Analogues to obsessions and compulsions

Exam-related unwanted intrusive thoughts (UITs) and related neutralizing behaviors are common experiences among students. The present study investigated in what ways these UITs and behaviors are analogues to clinical obsessions and compulsions. Twenty-nine students completed three ecological momentary assessment surveys per day over 7 consecutive days, assessing the severity of exam-related UITs and related neutralizing behaviors, obsessive-compulsive (OC) symptoms, anxiety, distress, urge to neutralize, depressed mood, and stress in the week immediately before an exam period. Multilevel analysis demonstrated that the severity of exam-related UITs and related neutralizing behaviors was positively associated with OC symptoms, anxiety, distress, urge to neutralize, and stress but was not related to depressed mood. During the study period, the exam-related UITs occurred on average 7 times, and the related neutralizing behaviors on average 6 times. Overall, they were experienced with mild severity, low distress, and low urge to neutralize. Findings indicate that some aspects of exam-related UITs and related neutralizing behaviors (e.g., association with distress and urge to neutralize) might be analogous to OC symptoms but not all (e.g., no relation to depressed mood). We discuss how research on obsessive-compulsive disorder could benefit from considering exam-related UITs and related behaviors.

Is a Ruminative Thinking Style Related to Obsessive-Compulsive Symptom Severity Beyond Its Associations with Depressive and Anxiety Symptom Severity?

Previous studies suggest that a ruminative thinking style (RTS) is positively associated with the severity of obsessive-compulsive symptoms and might be involved in the maintenance of obsessive-compulsive disorder (OCD). We sought to replicate this association in a sample of individuals with OCD, controlling for depressive and anxiety symptom severity, and to extend previous studies by including an interview measure of obsessive-compulsive symptom severity. A sample of 140 individuals diagnosed with OCD participated in a cross-sectional observational study. Participants completed questionnaire measures of an RTS as well as obsessive-compulsive, depressive, and anxiety symptom severity. Obsessive-compulsive symptom severity was additionally assessed with an interview. When statistically controlling for depressive and anxiety symptom severity, an RTS continued to predict the questionnaire, but not the interview measure of obsessive-compulsive symptom severity. We discuss possible explanations for these mixed findings, emphasizing the unique aspects of each measure, and consider implications for further research on OCD.

Gender Matters: Nonlinear Relationships Between Heart Rate Variability and Depression and Positive Affect

Vagally mediated heart rate variability (vmHRV), a measure of the parasympathetic nervous system's control over the heart, is often negatively related to maladaptive emotional outcomes. Recent work suggests that quadratic relationships involving these factors may be present; however, research has not investigated gender differences in these nonlinear functions. To address this gap, the current study tested for quadratic relationships between resting vmHRV and depression and positive affect while investigating gender differences in these relationships. Significant quadratic effects were found between resting vmHRV and reports of both depression symptoms and positive affect in women but not men. Specifically, the lowest levels of depression and the highest levels of positive affect were found at moderate vmHRV in women. These results suggest that examinations of vmHRV's nonlinear associations require the consideration of gender. Our findings are interpreted based on proposed differential neuropsychological mechanisms of vmHRV in men versus women.

The role of perceived thought control ability in the psychological functioning of Black American mothers

OBJECTIVES

The purpose of the study was to investigate the extent to which perceived thought control ability (PTCA) promotes the psychological functioning of Black American mothers, as well as moderates the negative effects of key stressors faced by this population, including discrimination experiences, financial strain, and parenting stress.

METHODS

An online survey was administered to 305 Black American mothers across the U.S. Participants completed measures of PTCA, psychological well-being (life satisfaction and emotional well-being), psychological distress (depressive and anxiety symptoms), and stressors (discrimination experiences, financial strain, and parenting stress).

RESULTS

Discrimination experiences, financial strain, and parenting stress were related to higher anxiety and depressive symptoms. Financial strain and parenting stress were also related to lower life satisfaction and emotional well-being. PTCA protected against the link between discrimination experiences and depressive symptoms (β = -.15, p < .001), discrimination experiences and anxiety (β = -.15, p < .001), and parenting stress on anxiety (β = .08, p = .04). PTCA also was associated with higher life satisfaction (β =.19, p = .001) and emotional well-being (β =.42, p < .001).

CONCLUSIONS

This study provides evidence that PTCA is a culturally relevant and practical psychological resource for psychological functioning among Black American mothers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): a retrospective study

BACKGROUND

Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far.

METHODS

In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response.

RESULTS

Patients' scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors "obsession severity", "resistance" and "disturbance" and the "interference due to obsessions" and "resistance against compulsions" items of the Y-BOCS significantly predicted response to rTMS.

CONCLUSIONS

In patients with less intrusive/interfering thoughts, and low scores in the "obsession severity", "disturbance", and "resistance" factors, rTMS might have superior effects. Identifying clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.

Is repetitive negative thinking a transdiagnostic process? A comparison of key processes of RNT in depression, generalized anxiety disorder, obsessive-compulsive disorder, and community controls

BACKGROUND AND OBJECTIVES

The transdiagnostic view of repetitive negative thinking (RNT) claims that different forms of RNT are characterized by identical processes that are applied to disorder-specific content. The purpose of the study was to test whether the processes of RNT differ across major depression disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD).

METHODS

Forty-two individuals diagnosed with MDD, 35 individuals with GAD, 41 individuals with OCD, and 35 community controls were asked to think of a typical RNT episode and to rate its processes (core processes; use of mental capacity, unproductivity, abstractness, verbal quality, duration). Ratings were compared across groups using planned contrasts and analysis of variance.

RESULTS

All individuals with a clinical diagnosis rated the key processes of RNT and avoidance function of RNT as higher than healthy controls. There were no differences between individuals diagnosed with MDD, GAD or OCD on key processes and avoidance function of RNT.

LIMITATIONS

Results are based on retrospective self-reports, which might restrict validity of the measurements.

CONCLUSIONS

Data support the transdiagnostic hypothesis of RNT. Transdiagnostic prevention and intervention techniques seem highly recommendable given these findings.

Fifteen Years Controlling Unwanted Thoughts: A Systematic Review of the Thought Control Ability Questionnaire (TCAQ)

Thought control ability is a vulnerability factor implicated in the etiology and maintenance of emotional disorders. This manuscript aims to systematically review the use and psychometric performance of the Thought Control Ability Questionnaire (TCAQ), designed to assess people's ability to control unwanted thoughts. Three electronic databases were searched for papers administering the TCAQ published in indexed peer-reviewed journals. Data (participants characteristics, country, study design, etc.) were extracted from the results for qualitative synthesis. The TCAQ's content validity, dimensionality, internal consistency, test-retest reliability, convergent/divergent validity, floor/ceiling effects, and interpretability were summarized. Two reviewers independently screened articles and assessed quality taking COSMIN criteria into account. Finally, the review included 17 papers. The TCAQ has been administered to healthy individuals, students, and adult patients, in six languages from nine countries. We found that the TCAQ, and its shorter versions, demonstrate robust reliability and adequate content validity. Of interest is the TCAQ's capacity to predict performance in diverse experimental tasks focused on thought control. The TCAQ unidimensionality has been supported in exploratory and confirmatory factor analyses. Regarding construct validity, the TCAQ is significantly related to a wide range of psychopathological measures of anxiety, worry, depression, obsessive-compulsive symptoms, etc. However, as only a few of the included studies had a longitudinal design, we are unable to draw firm conclusions about the measure's temporal stability. Moreover, psychometric aspects such as factorial invariance across different samples have not been analyzed. Despite these limitations, based on available psychometric evidence we can recommend using the TCAQ for measuring perceived control of unwanted thoughts.

The Normative Nature of Aggressive Intrusive Thinking Among an Underserved Incarcerated Population Compared With a Student Sample

Aggressive intrusive thoughts (AITs) are unwanted and repetitive thoughts, impulses, or desires that enter into consciousness involuntarily. The current study compared the frequency of and distress from AITs in a sample of inmates jailed for violent crimes ( n = 78) versus college students ( n = 103; that is, participant status). The relationship between psychopathic traits and AITs was also explored. Results indicated that, although there were no differences between students and inmates, AIT frequency was positively associated with Primary Psychopathy. However, there was no significant interaction between participant status (i.e., inmate vs. student) and psychopathy. Finally, there were no significant main or interactions effects in the model predicting AIT distress. These findings demonstrate that AIT frequency is a normative cognitive experience that occurs in both nonviolent and violent individuals, and provides further evidence for an association between psychopathic traits and unwanted aggressive cognition.

Cognitive Profile of Individuals With Obsessive-Compulsive Tendencies

The aim of this study is to compare working memory capacity (WMC), short-term memory (STM), and attention mechanisms of executive function (including inhibition, shifting, and updating) between people with obsessive-compulsive tendencies (OCT) and controls without OCT. For this purpose, 164 undergraduate students (90 women and 74 men) were selected using the stratified random method, and they individually responded to the Maudsley Obsessional-Compulsive Inventory to measure OCT and to executive function tests including Forward Digit Span, Backward Digit Span, Stroop, Set Shifting, and Keep Track tasks. These tasks assessed STM, WMC, and inhibition of prepotent responses, mental set shifting, and information updating and monitoring, respectively. In this study, the cutoff point of the Maudsley Obsessional-Compulsive Inventory was considered to be 11. With regard to this cutoff point, 44 people in the group had OCT and 120 did not. The obtained results from the Pearson correlation coefficient and analysis of variance showed that students with OCT had significantly limited STM and WMC compared with those in the control group. Furthermore, their executive function abilities including shifting, updating, and inhibition were significantly weaker than those in the control group.

Which Facets of Mindfulness Protect Individuals from the Negative Experiences of Obsessive Intrusive Thoughts?

Obsessive intrusive thoughts (OITs) are experienced by the majority of the general population, and in their more extreme forms are characteristic of obsessive–compulsive disorder (OCD). These cognitions are said to exist on a continuum that includes differences in their frequency and associated distress. The key factors that contribute to an increased frequency and distress are how the individual appraises and responds to the OIT. Facets of mindfulness, such as nonjudgment and nonreactivity, offer an alternative approach to OITs than the negative appraisals and commonly utilised control strategies that often contribute to distress. Clarifying the role of facets of mindfulness in relation to these cognitions offers a means to elucidate individual characteristics that may offer protection from distress associated with OITs. A sample of nonclinical individuals (n = 583) completed an online survey that assessed their experiences of OITs, including frequency, emotional reaction and appraisals, and trait mindfulness. The findings from a series of multiple regression analyses confirmed that specific facets of mindfulness relating to acting with awareness and acceptance (nonjudgment and nonreactivity) consistently predicted less frequent and distressing experiences of OITs. In contrast, the observe facet emerged as a consistent predictor of negative experiences of OITs. These findings suggest that acting with awareness and acceptance may confer protective characteristics in relation to OITs, but that the observe facet may reflect a hypervigilance to OITs. Mindfulness-based prevention and intervention for OCD should be tailored to take account of the potential differential effects of increasing specific facets of mindfulness.

Discovering what is hidden: The role of non-ritualized covert neutralizing strategies in Obsessive-Compulsive Disorder

BACKGROUND AND OBJECTIVES

Neutralizing strategies are secondary to obsessions and an additional cause of distress and interference, but they have received little attention in theories and research, especially the non-ritualized covert strategies. This study focuses on the comparative impact of non-ritualized covert and compulsive-overt strategies in the course of OCD.

METHODS

Eighty-two OCD adult patients completed measures assessing distress, interference, appraisals and overt and covert neutralizing strategies to control obsessions. Thirty-eight patients who had completed cognitive therapy were assessed again after treatment.

RESULTS

Only overt compulsions are associated with OCD severity. Nonetheless, considering the main symptom dimension, covert strategies are also associated with severity in patients with moral-based obsessions. Patients who used covert strategies more frequently, compared to those who use them less, reported more sadness, guilt, control importance, interference, and dysfunctional appraisals. Regarding the overt strategies, patients who used them more reported more anxiety and ascribed more personal meaning to their obsessions than the patients who used them less. After treatment, recovered patients decreased their use of both covert and overt strategies, while non-recovered patients did not. There was a higher rate of non-recovered patients among those who used more non-ritualized covert strategies before treatment.

LIMITATIONS

Emotions and appraisals were assessed with a single item. OCD symptom dimensions were only assessed by the Obsessive-Compulsive Inventory.

CONCLUSIONS

In addition to studying overt compulsions, the impact of covert neutralizing strategies on the OCD course and severity warrants more in-depth study.

Why Can’t I Stop Thinking About It?

Obsessive-compulsive disorder (OCD) is a severe anxiety disorder characterized by frequent obsessive thoughts and repetitive behaviors. Neuroticism is a vulnerability factor for OCD, yet the mechanisms by which this general vulnerability factor affects the development of OCD-related symptoms are unknown. The present study assessed a hierarchical model of the development of obsessive thoughts that includes neuroticism as a general, higher-order factor, and specific, potentially maladaptive thought processes (thought suppression, worry, and brooding) as second-order factors manifesting in the tendency toward obsessing. A total of 238 participants completed questionnaires assessing the examined constructs. The results of mediator analyses demonstrated the hypothesized relationships: A positive association between neuroticism and obsessing was mediated by thought suppression, worry, and brooding. Independent of the participant’s sex, all three mediators contributed equally and substantially to the association between neuroticism and obsessing. These findings extend earlier research on hierarchical models of anxiety and provide a basis for further refinement of models of the development of obsessive thoughts.

Cognitive Bias Modification (CBM) of obsessive compulsive beliefs

BACKGROUND

Cognitive bias modification (CBM) protocols have been developed to help establish the causal role of biased cognitive processing in maintaining psychopathology and have demonstrated therapeutic benefits in a range of disorders. The current study evaluated a cognitive bias modification training paradigm designed to target interpretation biases (CBM-I) associated with obsessive compulsive disorder (OCD).

METHODS

We evaluated the impact of CBM-I on measures of interpretation bias, distress, and on responses to three OC stressor tasks designed to tap the core belief domains of Importance of Thoughts/Control, Perfectionism/Intolerance of Uncertainty, and Contamination/Estimation of Threat in a selected sample of community members reporting obsessive compulsive (OC) symptoms (N = 89).

RESULTS

Participants randomly assigned to the Positive condition evidenced a change in interpretation bias towards more positive and less negative OC-relevant interpretations following CBM-I compared to participants assigned to the Control condition. Importantly, a positivity bias was not observed for foil scenarios unrelated to the core OC belief domains. Further, participants in the Positive condition reported less distress and urge to neutralize following an OC stressor task designed to tap Importance of Thoughts/Control. No significant difference emerged on the indices of behavioural response to the OC stressor tasks. Severity of OC symptoms did not moderate the effects of positive CBM-I training.

CONCLUSIONS

CBM-I appears effective in selectively targeting OC beliefs. Results need to be replicated in clinical samples in order for potential therapeutic benefit to be demonstrated.

Responding to intrusions in obsessive-compulsive disorder: the roles of neuropsychological functioning and beliefs about thoughts

BACKGROUND AND OBJECTIVES

The aim of the current study was to examine cognitive and psychological factors hypothesized to affect responding to intrusions in obsessive-compulsive disorder (OCD).

METHODS

A group of individuals diagnosed with OCD (N = 22) was compared to a social phobia (SP) group (N = 25) and a nonclinical control group (N = 24). Participants performed a battery of neuropsychological tasks, completed self-report measures, and engaged in a self-relevant thought suppression task.

RESULTS

Participants in the OCD group demonstrated worse working memory and response inhibition on the neuropsychological tasks and had increased intrusions during the suppression task relative to comparison groups. They also reported more distress during the task relative to the nonclinical group, but not the SP group. Regression analyses revealed that beliefs about thought control failures, but not working memory or response inhibition, was associated with increased frequency of intrusions and greater distress during suppression.

LIMITATIONS

Future studies may include a more comprehensive battery of cognitive tests and have a larger sample size.

CONCLUSIONS

Findings support cognitive-behavioural models of OCD that emphasize the role of meta-beliefs in explaining the struggle with obsessional thoughts.

Gender differences in rumination: A meta-analysis

Starting in adolescence and continuing through adulthood, women are twice as likely as men to experience depression. According to the response styles theory (RST), gender differences in depression result, in part, from women's tendency to ruminate more than men. A meta-analysis was performed to evaluate gender differences in rumination in adults (k = 59; N = 14,321); additionally, an analysis of subtypes of rumination - brooding and reflection - was conducted (k = 23). Fixed effects analyses indicated that women scored higher than men in rumination (d = .24, p < .01, SEd = .02), brooding (d = .19, p < .01, SEd = .03) and reflection (d = .17, p < .01, SEd = .03); there was no evidence of heterogeneity or publication bias across studies for these effect sizes. Although statistically significant, the effect sizes for gender differences in rumination were small in magnitude. Results are discussed with respect to the RST and gender differences in depression.

Principal domains of quantitative anxiety trait in subjects with lifetime history of mania

BACKGROUND

High comorbidity rates for anxiety have been documented in subjects with history of mania or hypomania. We explored the presence of latent constructs of quantitative anxiety in subjects who have a history of mania or hypomania.

METHODS

We conducted an exploratory factor analysis of anxiety trait in 212 subjects who have a lifetime history of at least one manic/hypomanic syndrome. Participants were originally recruited for a Costa Rican sibling pair genetic study of Bipolar Disorder. We used principal factors extraction method with squared multiple correlations (SAS/SAT Professional software) of the STAI (trait subscale).

RESULTS

A three-factor solution with a good simple structure and statistical adequacy was obtained with a KMO of 0.84 (>0.6) and Bartlett's Test of Sphericity of 2.4668E-162 (p<0.05). Items were grouped into anxiety-absent factor and the anxiety-present symptoms in two additional factors based on the nature of the symptoms, worry and rumination.

LIMITATIONS

Comorbid disorders could affect the interaction of anxiety score with manic/hypomanic symptoms. Some statistical parameters (mood status independence, score distribution and correlation between trait score and quantitative mania/hypomania) were not taken into consideration to extract the factors. Because anxiety dimensions were explored on individuals with history of mania or hypomania and not in healthy subjects, comparison of our results with other studies can draw confusing conclusions.

CONCLUSIONS

Two underlying constructs, worry and rumination may explain anxiety sub-syndromic symptoms in Costa Rican patients with history of mania or hypomania.

[Obsessive-compulsive disorder: psychosocial consequences and quality of life: a review]

The considerable restrictions and psychosocial consequences associated with obsessive-compulsive disorder (OCD) are often multiform and expansive. The subjective distress perceived by individuals with OCD is influenced by multidimensional and interindividually varying factors beyond symptom severity. Therefore, besides symptom scales, generic (general) and illness-specific measures of quality of life (QoL) represent important markers of well-being. The repeatedly described serious consequences of OCD in social, functional, and emotional fields, which often persist even after treatment, refer to the necessity to increasingly address these aspects in treatment planning. Interventions would be desirable which directly involve the patient's social environment and more specifically target those problems which are associated with the present symptom dimension (e.g., contamination/washing).

Generic and Illness-Specific Quality of Life in Obsessive-Compulsive Disorder

Background: Obsessive compulsive disorder (OCD) is a chronic and disabling disorder. It profoundly compromises various aspects of patients’ everyday life, thus affecting their quality of life (QoL). Using generic instruments, several studies have confirmed severely impaired health-related QoL in patients diagnosed with OCD. However, there has been a dearth of research on illness-specific QoL. Aims: The present study aimed to further investigate subjective QoL in individuals with OCD with a focus on illness-specific aspects. Method: To assess subjective QoL in a broad OCD sample, an internet survey was conducted with 123 participants with obsessive-compulsive symptoms. The survey comprised both a generic (WHOQOL-BREF) and a novel self-developed OCD-specific QoL measure (QoLOC). Psychopathology was determined with diagnostic standard instruments (self-report forms of: Y-BOCS, OCI-R, BDI-SF). Results: Regression analyses confirmed depression as the best predictor for decreased QoL. In addition, participants reported high despair resulting from OCD-related problems that differed across symptom subtypes. An exploratory factor analysis suggested four domains of OCD-specific problems tapped by the QoLOC: (1) depressiveness in association with OCD; (2) constraints in activities due to OCD symptoms or avoidance; (3) problems with partner and/or family due to OCD symptoms or avoidance; (4) self-concept/coping of own illness. Conclusions: Results produced a comprehensive picture of QoL impairments and their relation to psychopathology in a representative OCD sample. Illness-specific concerns should be further addressed in QoL research in OCD because such problems are not sufficiently mirrored in generic QoL measures.