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Ouellet-Courtois C, Audet JS, Aardema F. The COGINS: A New Measure of Cognitive Insight in Obsessive-Compulsive and Related Disorders. J Cogn Psychother 2024; 38:133-156. [PMID: 38631718 DOI: 10.1891/jcp-2023-0011] [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] [Indexed: 04/19/2024]
Abstract
Research suggests that individuals with obsessive-compulsive and related disorders (OCRDs) with lower insight show a poorer response to cognitive behavioral therapy and might benefit from alternative treatments. However, there are inconsistencies in the literature regarding the definition and measurement of insight. This study endeavored to evaluate the psychometric properties of the Cognitive Obsessional Insight Scale (COGINS), a novel self-report measure of cognitive insight in OCRDs. The sample comprised 166 participants with a diagnosis of obsessive-compulsive disorder or body dysmorphic disorder enrolled in clinical trials. Participants completed the COGINS and a questionnaire battery at baseline and posttreatment. The COGINS demonstrated good internal consistency, test-rest reliability, convergent validity with other OCRD-specific measures of insight, positive associations with OCRD symptomatology, and had a moderating effect on treatment response. The COGINS is a valid and reliable practical tool to measure cognitive insight in OCRDs and might help toward clarifying the role of cognitive insight in this population.
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Affiliation(s)
| | - Jean-Sébastien Audet
- Montreal Mental Health University Institute Research Center, Montreal, QC, Canada
| | - Frederick Aardema
- Montreal Mental Health University Institute Research Center, Montreal, QC, Canada
- Department of Psychiatry and Addiction, University of Montreal, Montreal, QC, Canada
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2
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Huang Y, Weng Y, Lan L, Zhu C, Shen T, Tang W, Lai HY. Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment. PSYCHORADIOLOGY 2023; 3:kkad025. [PMID: 38666121 PMCID: PMC10917385 DOI: 10.1093/psyrad/kkad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 04/28/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic disabling disease with often unsatisfactory therapeutic outcomes. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the diagnostic criteria for OCD, acknowledging that some OCD patients may lack insight into their symptoms. Previous studies have demonstrated that insight can impact therapeutic efficacy and prognosis, underscoring its importance in the treatment of mental disorders, including OCD. In recent years, there has been a growing interest in understanding the influence of insight on mental disorders, leading to advancements in related research. However, to the best of our knowledge, there is dearth of comprehensive reviews on the topic of insight in OCD. In this review article, we aim to fill this gap by providing a concise overview of the concept of insight and its multifaceted role in clinical characteristics, neuroimaging mechanisms, and treatment for OCD.
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Affiliation(s)
- Yueqi Huang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Yazhu Weng
- Fourth Clinical School of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lan Lan
- Department of Psychology and Behavior Science, Zhejiang University, Hangzhou 310058, China
| | - Cheng Zhu
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Ting Shen
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 19104, PA, USA
| | - Wenxin Tang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Hsin-Yi Lai
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310029, China
- MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-machine Intelligence, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou 311121, China
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
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3
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Broekhuizen A, Vriend C, Wolf N, Koenen EH, van Oppen P, van Balkom AJLM, Visser HAD, van den Heuvel OA. Poor Insight in Obsessive-Compulsive Disorder as a Multifaceted Phenomenon: Evidence From Brain Activation During Symptom Provocation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1135-1144. [PMID: 37121397 DOI: 10.1016/j.bpsc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/24/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Poor insight in obsessive-compulsive disorder (OCD) is associated with higher symptom severity, more comorbidities, and worse response to treatment. This study aimed to elucidate underlying mechanisms of poor insight in OCD by exploring its neurobiological correlates. METHODS Using a symptom provocation task during functional magnetic resonance imaging, we compared brain activation of patients with poor insight (n = 19; 14 female, 5 male), good/fair insight (n = 63; 31 female, 32 male), and healthy control participants (n = 42; 22 female, 20 male) using a Bayesian region-of-interest and a general linear model whole-brain approach. Insight was assessed using the Overvalued Ideas Scale. RESULTS Compared with patients with good/fair insight and healthy control participants, patients with OCD and poor insight showed widespread lower task-related activation in frontal areas (subgenual anterior cingulate cortex, ventromedial prefrontal cortex, dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, supplementary motor area, precentral gyrus), parietal areas (posterior parietal cortex, precuneus), and the middle temporal gyrus and insula. Results were not driven by interindividual differences in OCD symptom severity, medication usage, age of disorder onset, or state distress levels. CONCLUSIONS During symptom provocation, patients with OCD and poor insight show altered activation in brain circuits that are involved in emotional processing, sensory processing, and cognitive control. Future research should focus on longitudinal correlates of insight and/or use tasks that probe emotional and sensory processing and cognitive control.
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Affiliation(s)
- Aniek Broekhuizen
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands; Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Anatomy & Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Amsterdam, the Netherlands.
| | - Chris Vriend
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Anatomy & Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Amsterdam, the Netherlands
| | - Nadja Wolf
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands
| | - Emma H Koenen
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Geestelijke Gezondheidszorg (GGZ) in Geest Specialized Mental Healthcare, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Geestelijke Gezondheidszorg (GGZ) in Geest Specialized Mental Healthcare, Amsterdam, the Netherlands
| | - Henny A D Visser
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Anatomy & Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Amsterdam, the Netherlands
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4
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Steinberg JS, Morris SH, Jaffee SR. 'Excessive and Unreasonable': The Relation Between Clinical Insight and Clinical Correlates and Treatment Outcomes in Obsessive-Compulsive Disorder Across the Life Course. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01548-3. [PMID: 37268797 DOI: 10.1007/s10578-023-01548-3] [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] [Accepted: 05/19/2023] [Indexed: 06/04/2023]
Abstract
Individuals with mental disorders possess varying levels of clinical insight-the degree to which one understands that they are afflicted with a mental disorder and that their symptoms are manifestations of this psychopathology. Although clinical insight in OCD is thought to play an especially important role in determining various clinical characteristics and treatment outcomes, insight has not been sufficiently addressed developmentally, the importance of which this review will elucidate. Findings from this review suggest that clinical insight is typically associated with more complex cases and worse treatment outcomes across the life course, and also reveal nuances between pediatric and adult OCD cases with low insight. Implications of these findings, future research directions, and recommendations for the field are discussed.
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Affiliation(s)
- Joshua S Steinberg
- Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA.
| | - Sarah H Morris
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Obsessive-compulsive disorder (OCD) is characterized by time-consuming, distressing, or impairing obsessions and compulsions. Obsessions are recurrent, persistent, and intrusive thoughts, urges, or images. Compulsions are repetitive and often ritualized behaviors or mental acts performed to manage obsession-related distress or prevent harm. OCD affects 1% to 3% of the population, typically begins during adolescence or early adulthood, and can have a chronic or deteriorating course in the absence of effective treatment.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences, Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, Lund SE-22241, Sweden.
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6
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Şenay O, Tükel R. Comparison of Obsessive-Compulsive Disorder and Schizophrenia With Comorbid Obsessive-Compulsive Disorder in Terms of Insight, Metacognitive Beliefs, and Clinical Features. J Nerv Ment Dis 2022; 211:266-272. [PMID: 36315973 DOI: 10.1097/nmd.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The aim was to compare insight levels into obsessive-compulsive symptoms (OCS), and metacognitions of patients with obsessive-compulsive disorder (OCD) and with schizophrenia with comorbid OCD (SZ-OCD). Thirty OCD patients and 30 SZ-OCD patients were evaluated; no significant difference was found between the groups in the Brown Assessment of Beliefs Scale (BABS) and the Metacognition Questionnaire-30 (MCQ-30). When all patients were divided into two groups regardless of the presence or absence of schizophrenia as "good insight" and "poor or no insight," the MCQ-30 total score was found to be higher in the "poor or no insight" group and showed a significant but moderate positive correlation with the BABS score. This study supports that the level of insight into OCS in SZ-OCD is not significantly different from patients with OCD. Metacognitions differ not according to the distinction between OCD and SZ-OCD but according to the level of insight in whole OCD sample.
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Affiliation(s)
- Olcay Şenay
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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7
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Gan J, He J, Fu H, Zhu X. Association between obsession, compulsion, depression and insight in obsessive-compulsive disorder: a meta-analysis. Nord J Psychiatry 2022; 76:489-496. [PMID: 34895018 DOI: 10.1080/08039488.2021.2013532] [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: 12/11/2022]
Abstract
BACKGROUND Previous studies examining potential relationships of impaired insight with severity obsessive-compulsive (O-C) symptoms and depressive symptoms in patients diagnosed with obsessive-compulsive disorder (OCD) have produced mixed results. Here, we examined differences in these clinical characteristics and their changes after treatment in adult patients with OCD who have poor insight (OCD-PI) versus in those who have good insight (OCD-GI). METHODS Fifty-nine full-text articles were screened for eligibility with 20 studies ultimately being included in the present meta-analysis. RESULTS The OCD-PI and OCD-GI groups differed from each other with respect to O-C symptom (p < 0.001, g > 0.7) and depressive symptom (p < 0.001, g = 0.614) severity. Significant and moderate correlations were observed between insight and treatment outcomes (O-C symptoms, r = 0.33; depressive symptoms, r = 0.47). Exploratory meta-regression showed that methodological factors influenced the magnitudes of inter-group O-C symptom differences. CONCLUSIONS The current meta-analysis indicates that poorer insight is associated with more severe O-C and depression, and less improvement of symptoms in patients with OCD. Insight impairment may be a critical and core OCD-related deficit.
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Affiliation(s)
- Jun Gan
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Jing He
- Department of Psychology, Hunan First Normal University, Changsha, China.,Hunan Key Laboratory of Children's Psychological Development and Brain Cognitive Science, Hunan the First Normal University, Changsha, China
| | - Hong Fu
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Xiongzhao Zhu
- Medical Psychological center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medial Psychological Institute of Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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8
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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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9
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Provider perceptions of telehealth and in-person exposure and response prevention for obsessive-compulsive disorder. Psychiatry Res 2022; 313:114610. [PMID: 35567851 PMCID: PMC9910090 DOI: 10.1016/j.psychres.2022.114610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/27/2023]
Abstract
Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery.
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10
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Steglich-Petersen A, Varga S. Obsessive-compulsive disorder and recalcitrant emotion: relocating the seat of irrationality. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2066514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Somogy Varga
- Department of Philosophy and Intellectual History, Aarhus University Jens Chr, Aarhus, Denmark
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11
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Tonna M, Ottoni R, Pellegrini C, Mora L, Gambolo L, Di Donna A, Parmigiani S, Marchesi C. The motor profile of obsessive-compulsive rituals: psychopathological and evolutionary implications. CNS Spectr 2022; 28:1-9. [PMID: 35184763 DOI: 10.1017/s1092852922000165] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies investigating obsessive-compulsive disorder from an ethological approach have highlighted a specific motor pattern of compulsive rituals with respect to corresponding ordinary behaviors. Particularly, compulsive motor profile is built through the repetition of acts, with prevalence of nonfunctional ones and redirection of attention to its basic structural units. These formal features would characterize ritual behavior throughout evolution, from nonhuman animals to human cultures. However, no study to date has investigated a possible relationship between such motor profile and underlying psychopathology. Therefore, the first objective of the study was to confirm previous findings on a larger sample size of obsessive patients; the second objective was to elucidate whether motor profile might be associated with obsessive-compulsive psychopathology and/or prepsychotic symptoms of schizophrenia. METHODS Twenty-one obsessive-compulsive outpatients provided a videotape of their rituals. An equal number of healthy controls, matched for sex and age, were registered for corresponding ordinary acts. Obsessive patients were administered the Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Hamilton Rating Scale for Depression, and the Frankfurt Complaint Questionnaire. RESULTS The results of the present study confirm that ritual compulsions present a specific motor structure characterized by repetition of both functional and nonfunctional acts and their longer duration. Such a motor pattern is independent from obsessive-compulsive psychopathology, whereas it results specifically associated with prepsychotic symptoms of schizophrenia. CONCLUSIONS We argue that this association may reflect the adaptive significance of ritual behavior across evolution, that is, its homeostatic function in conditions of unpredictability.
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Affiliation(s)
- Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Rebecca Ottoni
- Department of Mental Health, Local Health Service, Parma, Italy
| | | | - Lorenzo Mora
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Luca Gambolo
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Anna Di Donna
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Stefano Parmigiani
- Department of Chemistry, Life Sciences and Environmental Sustainability, Unit of Behavioral Biology, University of Parma, Parma, Italy
| | - Carlo Marchesi
- Department of Mental Health, Local Health Service, Parma, Italy
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
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12
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Ottoni R, Pellegrini C, Mora L, Marchesi C, Tonna M. Psychopathology of insight in obsessive–compulsive disorder. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Guillén-Font MA, Cervera M, Puigoriol E, FOGUET-BOREU QUINTÍ, Arrufat FX, Serra-Millàs M. Insight in Obsessive-Compulsive Disorder: Relationship With Sociodemographic and Clinical Characteristics. J Psychiatr Pract 2021; 27:427-438. [PMID: 34768265 PMCID: PMC8575164 DOI: 10.1097/pra.0000000000000580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Insight is considered a multidimensional concept and, in the context of obsessive-compulsive disorder (OCD), impairment in insight has been widely reported to be associated with severity and other clinical and sociodemographic variables. However, the studies concerning insight in OCD have produced heterogenous data as a result of the scales used to measure insight. To overcome this heterogeneity, the study presented here used 4 different widely used and validated insight scales. The objective was to evaluate various aspects of insight using these scales to identify the relationships between different aspects of insight and clinical and sociodemographic variables to assess which scale or scales might possess greater efficiency in clinical practice. For this purpose, a descriptive, observational, and cross-sectional study of 81 patients in treatment in a mental health center was conducted. Patients were evaluated using the Brown Assessment of Beliefs Scale, the Overvalued Ideas Scale, the Scale of Unawareness of Mental Disorders, the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impressions Scale, the Global Assessment of Functioning Scale, and the Rey-Osterrieth Complex Figure Test. The results reported significant relationships between insight and scores on the Yale-Brown Obsessive Compulsive Scale (Thoughts, Compulsions, and Total scales), Clinical Global Impressions Scale, and the Global Assessment of Functioning Scale, and significant differences with regard to sex, level of education, working status, and course of the disorder. A correlation analysis was conducted to assess the relationships among the 4 insight scales. The results of this analysis suggest that the scales that measure insight in a multidimensional way (Brown Assessment of Beliefs Scale and Overvalued Ideas Scale) provide more information about the severity of the disorder in patients with OCD.
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14
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Manarte L, Andrade AR, do Rosário L, Sampaio D, Figueira ML, Langley C, Morgado P, Sahakian BJ. Poor insight in obsessive compulsive disorder (OCD): Associations with empathic concern and emotion recognition. Psychiatry Res 2021; 304:114129. [PMID: 34311099 DOI: 10.1016/j.psychres.2021.114129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Insight is currently considered to be responsible for 20% to 40% of the cases of ineffective obsessive-compulsive disorder (OCD) treatment. As 15% to 36% of patients with OCD have reduced insight, we aimed to identify some of the clinical determinants of insight in OCD. RESULTS Our sample consisted of 57 OCD patients, of which 34 men (59%) and 23 women (41%). All individuals completed a two-phase interview consisting of a clinical assessment, emotional awareness evaluation and insight measurement, using the Brown Assessment of Beliefs Scale (BABS). The insight score correlated significantly with negative emotion recognition (p < 0.0001) and empathic concern (p = 0.003). MAJOR CONCLUSIONS Our results support the hypothesis that insight in OCD is related to emotional awareness, specifically emotion recognition and empathic concern. Future research should investigate the extent to which poor insight and impaired emotional awareness can be modified by psychological or pharmacological therapies and whether this will enhance treatment response.
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Affiliation(s)
- Lucas Manarte
- Psychiatry and Mental Health Department, Faculty of Medicine of the University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
| | - António R Andrade
- IDMEC. Instituto Superior Técnico. University of Lisbon, Av. Rovisco Pais 1, 1649-001 Lisboa, Portugal
| | - Linete do Rosário
- Psychiatry and Mental Health Department, Faculty of Medicine of the University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Daniel Sampaio
- Psychiatry and Mental Health Department, Faculty of Medicine of the University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Luísa Figueira
- Psychiatry and Mental Health Department, Faculty of Medicine of the University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Christelle Langley
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way. Cambridge CB2 0SZ, UK
| | - Pedro Morgado
- Life and Health Sciences Research Institute, School of Medicine, University of Minho. R. da Universidade, 4710-057. Braga, Portugal
| | - Barbara J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way. Cambridge CB2 0SZ, UK
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15
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Geller DA, Homayoun S, Johnson G. Developmental Considerations in Obsessive Compulsive Disorder: Comparing Pediatric and Adult-Onset Cases. Front Psychiatry 2021; 12:678538. [PMID: 34248714 PMCID: PMC8269156 DOI: 10.3389/fpsyt.2021.678538] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
There appear to be two peaks of incidence of Obsessive Compulsive Disorder (OCD), one with a pre-adolescent onset and another in early adulthood. As new cases are added, the cumulative prevalence of OCD increases, but the great majority of cases have an onset in youth. The notion that early onset OCD represents a unique developmental subtype of the disorder has been considered by many researchers based on several specific age-related factors. Ascertainment and early intervention in affected youth is critical to abbreviate the functional impairments associated with untreated illness. In this paper we review the clinical, familial and translational biomarker correlates seen in early onset OCD that support the notion of a developmental subtype and discuss implications for research and treatment aimed at this cohort. The importance of cognitive, academic and social development tasks of childhood and adolescence, illness-specific and familial factors, and immune-mediated inflammatory factors are discussed, with their implications for management.
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Affiliation(s)
- Daniel A. Geller
- Pediatric OCD and Tic Disorder Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Saffron Homayoun
- Harvard Medical School, Boston, MA, United States
- Psychiatry and Neuroimmunology Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Gabrielle Johnson
- Pediatric OCD and Tic Disorder Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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16
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Manarte L, Andrade AR, do Rosário L, Sampaio D, Figueira ML, Morgado P, Sahakian BJ. Executive functions and insight in OCD: a comparative study. BMC Psychiatry 2021; 21:216. [PMID: 33926404 PMCID: PMC8082868 DOI: 10.1186/s12888-021-03227-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Around 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients. METHODS To help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions-through a Rey's figure test, a California verbal learning test, a Toulouse-Piéron test and a Wisconsin Card Sorting Test (WCST)-and compared the results with those of a paired control group. RESULTS The statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002). CONCLUSIONS These differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.
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Affiliation(s)
- Lucas Manarte
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
| | - António R Andrade
- IDMEC. Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal
| | - Linete do Rosário
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Daniel Sampaio
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Maria Luísa Figueira
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, R. da Universidade, 4710-057, Braga, Portugal
| | - Barbara J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
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17
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Tonna M, Trinchieri M, Lucarini V, Ferrari M, Ballerini M, Ossola P, De Panfilis C, Marchesi C. Pattern of occurrence of obsessive-compulsive symptoms in bipolar disorder. Psychiatry Res 2021; 297:113715. [PMID: 33535087 DOI: 10.1016/j.psychres.2021.113715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/09/2021] [Indexed: 01/22/2023]
Abstract
Apparent comorbidity between Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) is a common condition, but its meaning has not been clarified yet. The present study aimed to evaluate the pattern of occurrence of obsessive-compulsive symptoms (OCS) in the different phases of BD. One hundred and sixty-five BD patients, 62 (37.5%) euthymic, 34 (20.6%) in hypomanic/manic phase, 43 (26%) in depressive phase and 26 (15.7%) in mixed state, were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Ruminative Response Scale (RRS). In the whole sample, the severity of OCS was associated to the severity of depressive symptoms. The highest severity of OCS (YBOCS total score) was observed in the mixed group and the lowest scores in the hypomanic/manic group. Our findings suggest that OCS in BD patients appear as a state-dependent phenomenon cycling with the mood phases, particularly exacerbating in the context of depressive and mixed states.
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Affiliation(s)
- Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy; Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy.
| | | | - Valeria Lucarini
- Department of Mental Health, Local Health Service, Parma, Italy.
| | - Martina Ferrari
- Department of Mental Health, Local Health Service, Parma, Italy.
| | | | - Paolo Ossola
- Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy.
| | - Chiara De Panfilis
- Department of Mental Health, Local Health Service, Parma, Italy; Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy.
| | - Carlo Marchesi
- Department of Mental Health, Local Health Service, Parma, Italy; Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy.
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18
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du Mortier JAM, Remmerswaal KCP, Batelaan NM, Visser HAD, Twisk JWR, van Oppen P, van Balkom AJLM. Predictors of Intensive Treatment in Patients With Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:659401. [PMID: 33912087 PMCID: PMC8072047 DOI: 10.3389/fpsyt.2021.659401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Few studies have investigated which patients with obsessive-compulsive disorder (OCD) do not recover through regular cognitive behavior therapy or pharmacotherapy and subsequently end up in intensive treatment like day treatment or inpatient treatment. Knowing the predictors of intensive treatment in these patients is significant because it could prevent intensive treatment. This study has identified predictors of intensive treatment in patients with OCD. Methods: Using 6-year longitudinal data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA), potential predictors of intensive treatment were assessed in patients with OCD (n = 419). Intensive treatment was assessed using the Treatment Inventory Costs in Patients with Psychiatric Disorders (TIC-P). Examined potential predictors were: sociodemographics, and clinical and psychosocial characteristics. Logistic Generalized Estimating Equations was used to estimate to what extent the various characteristics (at baseline, 2- and 4-year assessment) predicted intensive treatment in the following 2 years, averaged over the three assessment periods. Results: Being single, more severe comorbid depression, use of psychotropic medication, and a low quality of life predicted intensive treatment in the following 2 years. Conclusions: Therapists should be aware that patients with OCD who are single, who have more severe comorbid depression, who use psychotropic medication, and who have a low quality of life or a drop in quality of life are at risk for intensive treatment. Intensive treatment might be prevented by focusing regular treatment not only on OCD symptoms but also on comorbid depression and on quality of life. Intensive treatment might be improved by providing extra support in treatment or by adjusting treatment to impairments due to comorbid depressive symptoms or a low quality of life.
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Affiliation(s)
| | - Karin C P Remmerswaal
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Neeltje M Batelaan
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | | | - Jos W R Twisk
- Amsterdam UMC, Vrije Universiteit, Epidemiology and Biostatistics, Amsterdam, Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
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19
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Szalisznyó K, Silverstein DN. Computational Predictions for OCD Pathophysiology and Treatment: A Review. Front Psychiatry 2021; 12:687062. [PMID: 34658945 PMCID: PMC8517225 DOI: 10.3389/fpsyt.2021.687062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/01/2021] [Indexed: 01/29/2023] Open
Abstract
Obsessive compulsive disorder (OCD) can manifest as a debilitating disease with high degrees of co-morbidity as well as clinical and etiological heterogenity. However, the underlying pathophysiology is not clearly understood. Computational psychiatry is an emerging field in which behavior and its neural correlates are quantitatively analyzed and computational models are developed to improve understanding of disorders by comparing model predictions to observations. The aim is to more precisely understand psychiatric illnesses. Such computational and theoretical approaches may also enable more personalized treatments. Yet, these methodological approaches are not self-evident for clinicians with a traditional medical background. In this mini-review, we summarize a selection of computational OCD models and computational analysis frameworks, while also considering the model predictions from a perspective of possible personalized treatment. The reviewed computational approaches used dynamical systems frameworks or machine learning methods for modeling, analyzing and classifying patient data. Bayesian interpretations of probability for model selection were also included. The computational dissection of the underlying pathology is expected to narrow the explanatory gap between the phenomenological nosology and the neuropathophysiological background of this heterogeneous disorder. It may also contribute to develop biologically grounded and more informed dimensional taxonomies of psychopathology.
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Affiliation(s)
- Krisztina Szalisznyó
- Department of Neuroscience and Psychiatry, Uppsala University Hospital, Uppsala, Sweden.,Theoretical Neuroscience Group, Wigner Research Centre for Physics, Hungarian Academy of Sciences, Budapest, Hungary
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20
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Gillan CM. Recent Developments in the Habit Hypothesis of OCD and Compulsive Disorders. Curr Top Behav Neurosci 2021; 49:147-167. [PMID: 33547600 DOI: 10.1007/7854_2020_199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This chapter aims to familiarise the reader with a diverse and fast-growing literature concerning the role that habits play in obsessive-compulsive disorder (OCD). Core concepts will be introduced, including how the balance between habits and a more deliberate form of action selection (goal-directed control) has traditionally been measured and how cross-species translation, neuroscience tools, and computational modelling have been used to build on these basic principles and reveal core mechanisms under study today. Next, the application of these methods to the study of OCD and related disorders will be detailed, converging on a theory that enhanced habit expression, and indeed compulsions in OCD, might arise from deficits in goal-directed control systems. These basic findings will be contextualised in terms of major tide changes in the field, including the shift from categorical disease frameworks to dimensional ones. Mechanistically, recent research concerning how goal-directed deficits arise, perhaps through failures in the construction of a mental model, are discussed along with studies critically evaluating our ability to measure habits in humans, in a laboratory setting. The chapter ends with a nod to the future, focusing on the need for clinically oriented, longitudinal, and intervention-based research that aim to translate what is now a wealth of cross-sectional mechanistic insights to the clinic.
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Affiliation(s)
- Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland.
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21
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Parent-led Behavioral Intervention for a Treatment-refusing Adult With Obsessive-Compulsive Disorder With Poor Insight and Extreme Family Accommodation. J Psychiatr Pract 2020; 26:149-152. [PMID: 32134889 PMCID: PMC7197436 DOI: 10.1097/pra.0000000000000449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obsessive-compulsive disorder (OCD) with poor insight can contribute to the refusal to receive treatment, leaving the burden of care on parents or other caregivers. The case presented here involved a young adult with OCD with delusional levels of insight paired with extreme family-accommodating behaviors that had resulted in impaired quality of life and functioning for the young adult and his parents. A parent-led behavioral intervention [The Supportive Parenting for Anxious Childhood Emotions (SPACE)] that was developed for children with anxiety was adapted and utilized for a young adult with severe OCD. The case presents a treatment option for parents and caregivers of individuals with OCD who refuse treatment.
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22
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Landmann S, Cludius B, Tuschen-Caffier B, Moritz S, Külz AK. Mindfulness predicts insight in obsessive-compulsive disorder over and above OC symptoms: An experience-sampling study. Behav Res Ther 2019; 121:103449. [PMID: 31437777 DOI: 10.1016/j.brat.2019.103449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/10/2019] [Accepted: 07/26/2019] [Indexed: 12/28/2022]
Abstract
Insight in obsessive-compulsive disorder (OCD) is assumed to fluctuate over time. However, temporal variations of insight and its correlates in OCD have never been empirically studied. We used ecological momentary assessment (EMA) to analyze the temporal variation of insight into the unreasonableness of the threat-related core belief (1), into the senselessness of compulsions to prevent this belief from occurring (2), and into the belief, itself, as being due to OCD (3). Furthermore, we analyzed whether worry, self-punishment and mindfulness are associated with these aspects of insight. A total of 50 OCD patients underwent EMA 10 times a day over 6 consecutive days. Data were analyzed using multilevel modelling. Results revealed that multiple time-points within individuals accounted for up to 51.4% of insight variance, indicating a substantial fluctuation of insight over time. Root mean square successive difference (rMSSD) scores indicated significantly higher fluctuation patterns in the doubt/checking dimension as compared to taboo thoughts throughout all aspects of insight. As hypothesized, self-punishment and mindfulness significantly predicted insight into the unreasonableness of the threat-related belief and the senselessness of compulsions to prevent this belief from occurring. Mindfulness demonstrated the greatest predictive value and remained significant after controlling for OC symptoms. Contrary to expectation, worry, as it was measured in our study, was not associated with insight. Besides providing evidence for insight fluctuation, our results indicate that mindfulness-based strategies might be beneficial for increasing insight in OCD.
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Affiliation(s)
- Sarah Landmann
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Germany.
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University Freiburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Anne Katrin Külz
- Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Germany
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23
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Abstract
PURPOSE OF REVIEW This review will aim to summarize the current body of epidemiological, clinical and therapeutic knowledge concerning specific co-occurrence of obsessive-compulsive symptoms (OCSs) and schizophrenia spectrum disorder. RECENT FINDINGS Almost 30% of the patients with schizophrenia display OCS, and three main contexts of emergence are identified: prodromal symptoms of schizophrenia, co-occurrence of OCS and schizophrenia and antipsychotics-induced OCS. Recent clinical studies show that patients with SZ and OCS have more severe psychotic and depressive symptoms, higher suicidality and lower social functioning. A recent cognitive investigation found that OCS and delusions share specific metacognitive profiles, particularly through a heightened need to control thoughts. Finally, a recent cross-sectional study of clozapine-induced OCS found a dose-response relationship between clozapine and OCS. OCS appeared reliably as linked to poorer outcomes among patients with schizophrenia. However, the specific clinical value of OCS among other prodromal symptoms of schizophrenia remains unknown.
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24
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Mısır E, Bora E, Akdede BB. Relationship between social-cognitive and social-perceptual aspects of theory of mind and neurocognitive deficits, insight level and schizotypal traits in obsessive-compulsive disorder. Compr Psychiatry 2018; 83:1-6. [PMID: 29499413 DOI: 10.1016/j.comppsych.2018.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The primary aim of the current study was to investigate different aspects of theory of mind (ToM), including social-cognitive (ToM-reasoning) and social-perceptual (ToM-decoding) in obsessive-compulsive disorder (OCD). We also aimed to investigate the relationship between ToM, neurocognition and a number of clinical variables including overvalued ideas, schizotypal personality traits, level of insight, and disease severity. METHOD Thirty-four patients who have been diagnosed with OCD according to DSM-IV and 30 healthy controls were included in the study. All participants were given a neuropsychological battery including tasks measuring ToM-reasoning, ToM-decoding and other neurocognitive functions. Schizotypal Personality Questionnaire (SPQ), Yale Brown Obsession and Compulsion Scale (YBOC-S) and Overvalued Ideas Scale (OVIS) were also administered to the participants. RESULTS Patients with OCD showed significant deficits in both aspects of ToM. ToM performances of patients showed a significant positive correlation with neurocognitive functions. When controlled for general cognition factor, patient-control difference for ToM-reasoning (F = 3,917; p = 0,05), but not ToM-decoding, remained statistically significant. ToM-reasoning impairment of patients was significantly related to the severity of OCD symptoms and poor insight (p = 0,026 and p = 0,045, respectively). On the other hand, general cognitive factor (β = 0,778; t = 3,146; p = 0,04) was found to be the only significant predictor of ToM-reasoning in OCD patients in the multiple linear regression model. CONCLUSION OCD is associated with ToM impairment, which is related to schizotypal traits, disease severity and poor insight, yet neurocognitive deficits also significantly contribute to this finding. However, ToM-reasoning impairment could be considered as a relatively distinct feature of OCD, which is partly separate from general cognitive deficits.
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Affiliation(s)
- Emre Mısır
- Dokuz Eylül Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı, Turkey.
| | - Emre Bora
- Dokuz Eylül Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Vic, Australia
| | - Berna Binnur Akdede
- Dokuz Eylül Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı, Turkey
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25
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Deepthi K, Sagar Kommu JV, Smitha M, Reddy YCJ. Clinical profile and outcome in a large sample of children and adolescents with obsessive-compulsive disorder: A chart review from a tertiary care center in India. Indian J Psychiatry 2018; 60:205-212. [PMID: 30166677 PMCID: PMC6102964 DOI: 10.4103/psychiatry.indianjpsychiatry_342_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Till date, the sample sizes in the Indian studies have been relatively small. METHODOLOGY The present study is a retrospective chart review of a large sample of children and adolescents diagnosed with OCD in a tertiary care center. OBJECTIVES The objectives of this study were to characterize the clinical profile and to evaluate outcome of OCD in children and adolescents. RESULTS Fear of contamination and washing/cleaning compulsions were the most common presenting symptoms. Most of the patients were male with two-thirds having a comorbid disorder. Major depressive disorder was the most common comorbid disorder. The rates of attention deficit hyperactivity disorder, disruptive behavioral disorders, and tic disorders were low when compared to Western studies. One-third of the patients received adequate trial of serotonin reuptake inhibitors and 36% received cognitive behavior therapy. Fifty-four percent of patients had a poor outcome with hospitalization, longer duration of illness, earlier onset of OC symptoms, and family history of OCD being the predictors of poor outcome. CONCLUSION The present study of a large sample of patients with juvenile OCD highlights the low rate of comorbid disruptive behavior disorders as reported in the earlier Indian studies and a favorable short-term outcome in approximately 56% of the patients.
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Affiliation(s)
- K Deepthi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - M Smitha
- Department of Psychiatry, ESI Hospital, Bengaluru, Karnataka, India
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26
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Jiujias M, Kelley E, Hall L. Restricted, Repetitive Behaviors in Autism Spectrum Disorder and Obsessive-Compulsive Disorder: A Comparative Review. Child Psychiatry Hum Dev 2017; 48:944-959. [PMID: 28281020 DOI: 10.1007/s10578-017-0717-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This review paper critically examines literature regarding restricted and repetitive behaviors (RRBs) in Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD). The similar behavioral profiles of these disorders presents the potential for confusion regarding diagnoses and intervention efforts. As such, this review highlights the similarities and differences between RRBs in ASD and OCD. The developmental trajectories of RRBs are presented, followed by an exploration of three constructs implicated in RRB manifestation: anxiety, executive functioning, and sensory phenomena. While RRBs tend to develop with some similarity in both disorders, the differing role of anxiety highlights important distinctions between ASD and OCD. We urge researchers and clinicians to think critically about the dimensions that affect RRB presentation. Future research should use this review as a starting point to further elucidate the differences between RRBs in these two populations.
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Affiliation(s)
- Marina Jiujias
- Psychology Department, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Elizabeth Kelley
- Psychology Department, Queen's University, Kingston, ON, K7L 3N6, Canada. .,Queen's University, Humphrey Hall Room 351, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
| | - Layla Hall
- Psychology Department, Queen's University, Kingston, ON, K7L 3N6, Canada
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27
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Gillan CM, Fineberg NA, Robbins TW. A trans-diagnostic perspective on obsessive-compulsive disorder. Psychol Med 2017; 47:1528-1548. [PMID: 28343453 PMCID: PMC5964477 DOI: 10.1017/s0033291716002786] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/01/2022]
Abstract
Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.
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Affiliation(s)
- C. M. Gillan
- Department of Psychology,
New York University, New York, NY,
USA
- Department of Psychology,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neuroscience Institute,
University of Cambridge, Cambridge,
UK
| | - N. A. Fineberg
- National Obsessive Compulsive Disorders Specialist
Service, Hertfordshire Partnership NHS University Foundation
Trust, UK
- Department of Postgraduate Medicine,
University of Hertfordshire, Hatfield,
UK
| | - T. W. Robbins
- Department of Psychology,
University of Cambridge, Cambridge,
UK
- Behavioural and Clinical Neuroscience Institute,
University of Cambridge, Cambridge,
UK
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28
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Abstract
The presence of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorders (OCD) in schizophrenia is frequent, and a new clinical entity has been proposed for those who show the dual diagnosis: the schizo-obsessive disorder. This review scrutinizes the literature across the main academic databases, and provides an update on different aspects of schizo-obsessive spectrum disorders, which include schizophrenia, schizotypal personality disorder (SPD) with OCD, OCD with poor insight, schizophrenia with OCS, and schizophrenia with OCD (schizo-obsessive disorder). An epidemiological discussion on the discrepancies observed in the prevalence of OCS and OCD in schizophrenia across time is provided, followed by an overview of the main clinical and phenomenological features of the disorder in comparison to the primary conditions under a spectral perspective. An updated and comparative analysis of the main genetic, neurobiological, neurocognitive, and pharmacological treatment aspects for the schizo-obsessive spectrum is provided, and a discussion on endophenotypic markers is introduced in order to better understand its substrate. There is sufficient evidence in the literature to demonstrate the clinical relevance of the schizo-obsessive spectrum, although little is known about the neurobiology, genetics, and neurocognitive aspects of these groups. The pharmacological treatment of these patients is still challenging, and efforts to search for possible specific endophenotypic markers would open new avenues in the knowledge of schizo-obsessive spectrum.
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29
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Torres AR. The road to improvement in obsessive-compulsive disorder. Lancet Psychiatry 2016; 3:695-697. [PMID: 27318811 DOI: 10.1016/s2215-0366(16)30118-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Albina R Torres
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil.
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30
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31
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Abstract
A 19-year-old man is brought to his primary physician by his father, who explains that his son washes his hands a hundred times a day, will not touch anything that has been touched by someone else without scrubbing it first, and has a fear of germs that has left him isolated in his bedroom, unable to eat, and wishing he were dead. Although the father reports that his son has always been finicky, this problem started approximately 2 years ago and has gradually become completely disabling. How should this patient be evaluated and treated?
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