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Reuter B, Miano A, Wassermann J, Elsner B. Why does exposure-based therapy fail in some individuals with obsessive-compulsive disorder? Expert Rev Neurother 2024:1-4. [PMID: 38875186 DOI: 10.1080/14737175.2024.2365949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Benedikt Reuter
- MSB Medical School Berlin, Department of Human Medicine, Berlin, Germany
| | - Annemarie Miano
- MSB Medical School Berlin, Department of Human Medicine, Berlin, Germany
| | - Josepha Wassermann
- MSB Medical School Berlin, Department of Human Medicine, Berlin, Germany
| | - Björn Elsner
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany
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Zisler EM, Meule A, Endres D, Schennach R, Jelinek L, Voderholzer U. Effects of inpatient, residential, and day-patient treatment on obsessive-compulsive symptoms in persons with obsessive-compulsive disorder: A systematic review and meta-analysis. J Psychiatr Res 2024; 176:182-197. [PMID: 38875774 DOI: 10.1016/j.jpsychires.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patients with severe or treatment-refractory obsessive-compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive-compulsive symptoms in patients with OCD. METHODS PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. RESULTS We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and-if available-at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive-compulsive symptoms decreased from admission to discharge with large effect sizes (g = -1.59, 95%CI [-1.76; -1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [-0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. CONCLUSIONS Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are-on average-maintained after discharge.
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Affiliation(s)
- Eva M Zisler
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
| | - Adrian Meule
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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3
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Hermida-Barros L, Primé-Tous M, García-Delgar B, Forcadell E, Lera-Miguel S, Fernández de la Cruz L, Vieta E, Radua J, Lázaro L, Fullana MA. Family accommodation in obsessive-compulsive disorder: An updated systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 161:105678. [PMID: 38621516 DOI: 10.1016/j.neubiorev.2024.105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
Family accommodation might play a crucial role in obsessive-compulsive disorder (OCD). Previous systematic reviews on family accommodation in OCD have focused on specific populations or variables or are outdated. We conducted a preregistered systematic review and meta-analysis on family accommodation in adults, children, and adolescents with OCD (CRD42021264461). We searched PubMed, Scopus, and Web of Science using the keywords "family accommodation" and "obsessive-compulsive disorder. One hundred-eight studies involving 8928 individuals with OCD were included. Our results indicate that levels of family accommodation in OCD are moderate, that there is a significant positive correlation between family accommodation and OCD severity (r = 0.42), that baseline family accommodation does not predict pre- to post-treatment change in OCD severity (g = -0.03), and that family accommodation decreases as a result of both individual and family-focused cognitive behavioral therapy for OCD (g = 2.00 and g = 1.17, respectively). Our findings highlight the relevance of family accommodation in OCD and may help guide assessment and treatment.
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Affiliation(s)
- Laura Hermida-Barros
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Mireia Primé-Tous
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Blanca García-Delgar
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Eduard Forcadell
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Sara Lera-Miguel
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm 10431, Sweden
| | - Eduard Vieta
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona 08036, Spain; University of Barcelona, Barcelona 08007, Spain
| | - Joaquim Radua
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 17177, Sweden; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona 08036, Spain.
| | - Luisa Lázaro
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona 08036, Spain; University of Barcelona, Barcelona 08007, Spain
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona 08036, Spain.
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Tjelle K, Opstad HB, Solem S, Kvale G, Wheaton MG, Björgvinsson T, Hansen B, Hagen K. Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder. BMC Psychiatry 2024; 24:327. [PMID: 38689256 PMCID: PMC11059693 DOI: 10.1186/s12888-024-05780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exposure and response prevention (ERP) is considered the first-line psychotherapy for obsessive-compulsive disorder (OCD). Substantial research supports the effectiveness of ERP, yet a notable portion of patients do not fully respond while others experience relapse. Understanding poor outcomes such as these necessitates further research. This study investigated the role of patient adherence to ERP tasks in concentrated exposure treatment (cET) in a sample who had previously not responded to treatment or relapsed. METHOD The present study included 163 adults with difficult-to-treat OCD. All patients received cET delivered during four consecutive days. Patients' treatment adherence was assessed using the Patient EX/RP Adherence Scale (PEAS-P) after the second and third day of treatment. OCD severity was evaluated at post-treatment, 3-month follow-up, and 1-year follow-up by independent evaluators. RESULTS PEAS-P scores during concentrated treatment were associated with OCD-severity at post-treatment, 3-month follow-up, and 1-year follow-up. Moreover, PEAS-P scores predicted 12-month OCD severity adjusting for relevant covariates. Adherence also predicted work- and social functioning at 1-year follow-up. CONCLUSIONS These results indicate that ERP adherence during the brief period of cET robustly relates to improvement in OCD symptoms and functioning in both the short and long term. Assessing adherence might identify patients at risk of poor outcomes, while improving adherence may enhance ERP for treatment resistant patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02656342.
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Affiliation(s)
- Kristian Tjelle
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Berg Opstad
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Thröstur Björgvinsson
- Behavioral Health Partial Hospital Program, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway.
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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Geiger Y, van Oppen P, Visser H, Eikelenboom M, van den Heuvel OA, Anholt GE. Long-term remission rates and trajectory predictors in obsessive-compulsive disorder: Findings from a six-year naturalistic longitudinal cohort study. J Affect Disord 2024; 350:877-886. [PMID: 38266929 DOI: 10.1016/j.jad.2024.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/29/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND This naturalistic study, utilizing data from the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) cohort, investigated the long-term remission rates and predictors of different trajectories of obsessive-compulsive disorder (OCD) within a clinical population. METHODS A sample of 213 participants was classified into three illness trajectories: "Chronic," "Episodic, "and "Remitted-OCD." Long-term remission rates were calculated based on three follow-up measurements over a 6-year period. A multinomial logistic regression model, incorporating five selected predictors with high explanatory power and one covariate, was employed to analyze OCD trajectory outcomes. RESULTS The long-term full remission rates, calculated from all the measurements combined (14%), were significantly lower than what was observed in earlier studies and when compared to assessments at each individual follow-up (∼30%). Moreover, high baseline symptom severity and early age of onset were identified as significant risk factors for a chronic course of OCD, while male sex and younger age predicted a more favorable trajectory. Notably, the likelihood of an episodic course remained high even without identified risk factors. LIMITATIONS The bi-annual data collection process is unable to capture participants' clinical conditions between assessments. Additionally, no data was collected regarding the specific type and duration of psychological treatment received. Regarding the type of treatment participants received. CONCLUSIONS Results suggest that long-term remission rates may be lower than previously reported. Consequently, employing multiple assessment points in longitudinal studies is necessary for valid estimation of long-term full remission rates. The results emphasize the importance of personalized clinical care and ongoing monitoring and maintenance for most OCD cases.
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Affiliation(s)
- Yuval Geiger
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands.
| | - Henny Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, the Netherlands.
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands.
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, the Netherlands.
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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6
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Rickelt J, Viechtbauer W, Marcelis M, van den Heuvel OA, van Oppen P, Eikelenboom M, Schruers K. Anxiety during the long-term course of obsessive-compulsive disorder. J Affect Disord 2024; 345:311-319. [PMID: 37838266 DOI: 10.1016/j.jad.2023.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE The study aimed to investigate anxiety and its relation with obsessive-compulsive symptoms during the long-term course of obsessive-compulsive disorder (OCD). METHODS We used data from the Netherlands OCD Association (NOCDA) study, which included 419 participants with OCD (aged 18-79 years). Severity of obsessive-compulsive symptoms and anxiety at baseline and after two, four, and six years were entered into three models, which were analyzed using structural equation modeling: 1) the cross-lagged model, which assumes that anxiety and obsessive-compulsive symptoms are two distinct groups of symptoms interacting directly on the long-term; 2) the stable traits model, which assumes that anxiety and obsessive-compulsive symptoms result from two distinct latent factors, which are stable over the time and interact with each other; and 3) the common factor model, which assumes that anxiety and obsessive-compulsive symptoms are presentations of the same latent factor. RESULTS The cross-lagged model and the stable traits model both were valid models with a good model fit. The common factor model had a poor model fit and was rejected. LIMITATIONS The duration of OCD varied widely between the participants (0-64 years). The majority experienced obsessive-compulsive symptoms since several years, which may have affected results on the course of anxiety and the interaction between anxiety and obsessive-compulsive symptoms. CONCLUSIONS Anxiety and obsessive-compulsive symptoms in OCD patients do not result from a shared underlying factor but are distinct, interacting symptom groups, probably interacting by distinct latent factors.
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Affiliation(s)
- J Rickelt
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands; Institute for Mental Health Eindhoven (GGzE), Dr. Poletlaan 39, 5626ND Eindhoven, the Netherlands.
| | - W Viechtbauer
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands
| | - M Marcelis
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands; Institute for Mental Health Eindhoven (GGzE), Dr. Poletlaan 39, 5626ND Eindhoven, the Netherlands
| | - O A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, de Boelelaan 1117, 1007MB Amsterdam, the Netherlands
| | - P van Oppen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, de Boelelaan 1117, 1007MB Amsterdam, the Netherlands; GGZ inGeest, Research & Innovation, Oldenaller 1, 1081 HL Amsterdam, the Netherlands
| | - M Eikelenboom
- GGZ inGeest, Research & Innovation, Oldenaller 1, 1081 HL Amsterdam, the Netherlands
| | - K Schruers
- Maastricht University, Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Vijverdalseweg 1, 6226NB Maastricht, the Netherlands; Mondriaan Mental Health Center, Vijverdalseweg 1, 6226NB Maastricht, the Netherlands
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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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Tibi L, van Oppen P, van Balkom AJ, Eikelenboom M, Visser H, Anholt GE. Predictors of the 6-year outcome of obsessive-compulsive disorder: Findings from the Netherlands Obsessive-Compulsive Disorder Association study. Aust N Z J Psychiatry 2023; 57:1443-1452. [PMID: 37183408 DOI: 10.1177/00048674231173342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder is characterized by a chronic course that can vary between patients. The knowledge on the naturalistic long-term outcome of obsessive-compulsive disorder and its predictors is surprisingly limited. The present research was designed to identify clinical and psychosocial predictors of the long-term outcome of obsessive-compulsive disorder. METHODS We included 377 individuals with a current diagnosis of obsessive-compulsive disorder, who participated in the Netherlands Obsessive Compulsive Disorder Association study, a multicenter naturalistic cohort study. Predictors were measured at baseline using self-report questionnaires and clinical interviews. Outcome was assessed using the Yale-Brown Obsessive Compulsive Scale at 2-, 4- and 6-year follow-up. RESULTS The overall course of obsessive-compulsive disorder was characterized by two prominent trends: the first reflected an improvement in symptom severity, which was mitigated by the second, worsening trend in the long term. Several determinants affected the course variations of obsessive-compulsive disorder, namely, increased baseline symptom severity, late age of onset, history of childhood trauma and autism traits. CONCLUSION The long-term outcome of obsessive-compulsive disorder in naturalistic settings was characterized by an overall improvement in symptom severity, which was gradually halted to the point of increased worsening. However, after 6 years, the severity of symptoms remained below the baseline level. While certain determinants predicted a more favorable course, their effect diminished over time in correspondence to the general worsening trend. The results highlight the importance of a regular and continuous monitoring for symptom exacerbations as part of the management of the obsessive-compulsive disorder, regardless of the presence of putative predictors.
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Affiliation(s)
- Lee Tibi
- Cognetica: The Israeli Center for Cognitive Behavioral Therapy, Tel-Aviv, Israel
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Anton Jlm van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center/GGZ InGeest, Amsterdam, The Netherlands
| | - Henny Visser
- Mental Health Care Institute GGZ Centraal, Amsterdam, The Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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9
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Wheaton MG, Rosenfield B, Rosenfield D, Marsh R, Foa EB, Simpson HB. Predictors of EX/RP alone versus EX/RP with medication for adults with OCD: does medication status moderate outcomes? J Obsessive Compuls Relat Disord 2023; 39:100850. [PMID: 38054078 PMCID: PMC10695351 DOI: 10.1016/j.jocrd.2023.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Exposure and response prevention (EX/RP) can be delivered as monotherapy or to augment serotonin reuptake inhibitors (SRIs). While both options are considered effective OCD treatments, responses are heterogenous. Substantial work has investigated EX/RP predictors to account for this variability in responses, with mixed findings. Little research has studied whether EX/RP predictors may differ in medicated versus non-medicated samples (i.e., medication status as a moderator). We pooled data from two clinical trials conducted concurrently in the same specialty OCD clinic. One enrolled patients who were on stable SRI doses (EX/RP as SRI augmentation, n=58) while the other enrolled non-medicated patients (EX/RP monotherapy, n=38). Both trials used the same manualized EX/RP protocol and blinded independent evaluators. LASSO regression derived predictors and moderators of outcome. Improvement did not significantly differ between the EX/RP alone group and the SRI+EX/RP group. In both groups, higher baseline OCD severity and worse quality of life predicted poorer outcome. OCPD traits moderated results: Patients with more severe OCPD traits had better outcomes from EX/RP monotherapy than those receiving EX/RP with SRIs. Patient adherence to EX/RP homework mediated the associations between the baseline variables and outcome. The effect of OCPD traits on outcome warrants future study to improve care.
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Affiliation(s)
- Michael G Wheaton
- Barnard College, Columbia University, New York, NY USA
- New York State Psychiatric Institute, New York, NY USA
| | | | | | - Rachel Marsh
- New York State Psychiatric Institute, New York, NY USA
- Columbia Psychiatry, Columbia University Medical Center, New York, NY USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA, USA
| | - H Blair Simpson
- New York State Psychiatric Institute, New York, NY USA
- University of Pennsylvania, Philadelphia, PA, USA
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10
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Franken K, ten Klooster P, Bohlmeijer E, Westerhof G, Kraiss J. Predicting non-improvement of symptoms in daily mental healthcare practice using routinely collected patient-level data: a machine learning approach. Front Psychiatry 2023; 14:1236551. [PMID: 37817829 PMCID: PMC10560743 DOI: 10.3389/fpsyt.2023.1236551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare. Methods In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data. Results ML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models' performance (AUC range: 0.68-0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58-0.62 vs. 0.58-0.63) and models with early change scores (AUC: 0.69-0.73 vs. 0.68-0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement. Conclusion Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.
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Affiliation(s)
- Katinka Franken
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
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11
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Eilertsen SEH, Eilertsen TH. Why is it so hard to identify (consistent) predictors of treatment outcome in psychotherapy? - clinical and research perspectives. BMC Psychol 2023; 11:198. [PMID: 37408027 DOI: 10.1186/s40359-023-01238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Anxiety and depression are two of the most debilitating psychological disorders worldwide today. Fortunately, effective treatments exist. However, a large proportion of patients do not recover from treatment, and many still have symptoms after completing treatment. Numerous studies have tried to identify predictors of treatment outcome. So far, researchers have found few or no consistent predictors applicable to allocate patients to relevant treatment. METHODS We set out to investigate why it is so hard to identify (consistent) predictors of treatment outcome for psychotherapy in anxiety and depression by reviewing relevant literature. RESULTS Four challenges stand out; a) the complexity of human lives, b) sample size and statistical power, c) the complexity of therapist-patient relationships, and d) the lack of consistency in study designs. Together these challenges imply there are a countless number of possible predictors. We also consider ethical implications of predictor research in psychotherapy. Finally, we consider possible solutions, including the use of machine learning, larger samples and more realistic complex predictor models. CONCLUSIONS Our paper sheds light on why it is so hard to identify consistent predictors of treatment outcome in psychotherapy and suggest ethical implications as well as possible solutions to this problem.
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Affiliation(s)
- Silje Elisabeth Hasmo Eilertsen
- Haugaland DPS/Department of Research and Innovation, Helse Fonna HF, Haugaland DPS v/ Silje Eilertsen, Postboks 2052, Haugesund, Norway.
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12
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Kim H, Wheaton MG, Foa EB, Simpson HB. Identifying trajectories of symptom change in adults with obsessive compulsive disorder receiving exposure and response prevention therapy. J Anxiety Disord 2023; 96:102711. [PMID: 37148799 PMCID: PMC10209477 DOI: 10.1016/j.janxdis.2023.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 05/08/2023]
Abstract
Exposure and response prevention (EX/RP) is a recommended psychotherapy for obsessive-compulsive disorder (OCD). Yet, not all patients benefit equally from EX/RP. Prior studies have examined EX/RP predictors by predicting endpoint symptoms and/or pre-post symptom change, rather than accounting for trajectories of symptom change across treatment. We pooled data from four NIMH-funded clinical trials, yielding a large sample (N = 334) of adults who received a standard course of manualized EX/RP. Independent evaluators rated OCD severity using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Data were analyzed using growth mixture modeling (GMM) to detect subgroups of participants with similar trajectories of symptom change followed by multinomial logistic regression to identify baseline variables capable of predicting class membership. GMM revealed three distinct trajectory classes: 22.5% of the sample showed dramatic improvement (dramatic progress class), 52.1% showed moderate improvement (moderate progress class), and 25.4% showed little change (little to no progress class). Membership in the little to no progress class was predicted by baseline avoidance and transdiagnostic internalizing factor levels. These findings suggest that OCD symptom improvement with outpatient EX/RP occurs via distinct trajectories. These findings have implication regarding identifying treatment non-responders and personalizing treatment depending one's baseline characteristics in order to optimize treatment effectiveness.
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Affiliation(s)
| | - Michael G Wheaton
- Barnard College, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA, USA
| | - H Blair Simpson
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA.
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13
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Claus N, Miegel F, Jelinek L, Landmann S, Moritz S, Külz AK, Rubel J, Cludius B. Perfectionism as Possible Predictor for Treatment Success in Mindfulness-Based Cognitive Therapy and Metacognitive Training as Third-Wave Treatments for Obsessive-Compulsive Disorder. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Abstract
Background
Identifying predictors of treatment outcome can guide treatment selection and optimize use of resources. In patients affected by obsessive-compulsive disorder (OCD), perfectionism has emerged as one possible predictor, with some data suggesting that cognitive-behavioral therapy outcomes are poorer for more perfectionistic patients. Findings so far are inconsistent, however, and research has yet to be extended to newer treatment approaches.
Methods
We administered measures of concern over mistakes, clinical perfectionism, as well as OCD and depression symptom severity to a sample of OCD patients in out-patient group treatments (N = 61), namely, metacognitive training (MCT-OCD) or mindfulness-based cognitive therapy (MBCT) for OCD. Hierarchical data over time was submitted to multi-level analysis.
Results
Neither concern over mistakes nor clinical perfectionism at baseline predicted OCD symptoms across time points. However, concern over mistakes at baseline did significantly predict comorbid depressive symptoms. Furthermore, exploratory analysis revealed change in clinical perfectionism during treatment as a predictor of OCD symptoms at follow-up.
Conclusion
These results suggest that initial concern over mistakes may not prevent patients with OCD from benefitting from third-wave treatments. Change in clinical perfectionism may present a putative process of therapeutic change. Limitations and avenues for future research are discussed.
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14
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Erceg-Hurn DM, Campbell BNC, McEvoy PM. What explains the failure to identify replicable moderators of symptom change in social anxiety disorder? J Anxiety Disord 2023; 94:102676. [PMID: 36758344 DOI: 10.1016/j.janxdis.2023.102676] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
Trials of cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) have struggled to identify replicable moderators of treatment outcome. This could be due to a genuine lack of effects, or a spurious finding caused by methodological factors such as inadequate testing of theory-driven moderators, use of small homogenous samples, failure to model non-linear relationships, and over-reliance on significance testing. We probed explanations for the field's failure to detect moderators by testing whether 15 theory-driven and atheoretical variables moderated treatment outcome in a large heterogeneous sample treated with group CBT for SAD. Moderation was not assessed by only using p-values for linear models, but also by considering effect sizes, plots, and non-linear relationships. Despite using a comprehensive approach to assess moderation, only two variables - the baseline severity of SAD symptoms and fear of negative evaluation (FNE) - were found to moderate social anxiety symptom trajectories. FNE had a non-linear relationship with symptom change that would have been missed using common research methods. Our findings suggest both a genuine lack of effects and limitations of research methods have contributed to the field's inability to identify moderators. We provide suggestions that may increase the likelihood of future researchers detecting genuine effects.
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Affiliation(s)
- David M Erceg-Hurn
- Centre for Clinical Interventions, Perth, Australia; School of Population Health & enAble Institute, Curtin University, Perth, Australia.
| | | | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Population Health & enAble Institute, Curtin University, Perth, Australia
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15
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Leeuwerik T, Caradonna G, Cavanagh K, Forrester E, Jones AM, Lea L, Rosten C, Strauss C. A thematic analysis of barriers and facilitators to participant engagement in group exposure and response prevention therapy for obsessive-compulsive disorder. Psychol Psychother 2023; 96:129-147. [PMID: 36302721 PMCID: PMC10092306 DOI: 10.1111/papt.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/30/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
Exposure and response prevention (ERP) is the gold standard in the treatment of the obsessive-compulsive disorder (OCD). It can be delivered effectively using an individual or group therapy format. Nonetheless, a sizeable proportion of people diagnosed with OCD do not experience OCD symptom remission following ERP. Research suggests that participant engagement with ERP tasks predicts therapy outcomes but there is little consistent evidence across studies on what predicts engagement. A recent meta-analysis of participant engagement in cognitive-behavioral therapy for OCD found that group ERP had a comparatively lower dropout rate than individual ERP. Little is known about participant perceptions of ERP to guide an understanding of how the group therapy format may affect participant engagement. This study conducted a qualitative exploration of what helps or hinders participants' engagement in group ERP. It involved thematic analysis of semi-structured interview data collected at a 6-month follow-up from 15 adults with OCD who took part in group ERP. The study identified five main themes that captured participants' perceived facilitators and barriers to engagement in therapy: 'Group processes', 'Understanding how to overcome OCD', 'Personal relevance', 'Personal circumstances', and 'Attitudes towards ERP', which captured dynamically inter-related barriers and facilitators at the level of the client, therapist, therapy and social environment. Each theme and associated sub-themes are discussed in turn, followed by a consideration of the study's limitations and implications.
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Affiliation(s)
| | | | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | - Laura Lea
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Claire Rosten
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
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16
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Huang FF, Wang PC, Yang XY, Luo J, Yang XJ, Li ZJ. Predicting responses to cognitive behavioral therapy in obsessive-compulsive disorder based on multilevel indices of rs-fMRI. J Affect Disord 2023; 323:345-353. [PMID: 36470552 DOI: 10.1016/j.jad.2022.11.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/28/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to identify neuroimaging predictors to predict the response of cognitive behavioral therapy (CBT) in patients with obsessive-compulsive disorder (OCD) based on indices of resting-state functional magnetic resonance imaging (rs-fMRI). METHODS Fifty patients with OCD were enrolled and allocated to either high or low responder groups after CBT using a 50 % response rate as the delineator. The pre-treatment amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and degree centrality (DC) in each cerebrum region, defined by automated anatomical labeling atlas, were extracted. Least absolute shrinkage and selection operator and logistic regression were used to select features and establish models. RESULTS The combination of multilevel rs-fMRI indices achieved the best performance, with a cross-validation area under the receiver operating characteristic curve (AUC) of 0.900. In this combined model, an increase of interquartile range (IQR) in fALFF of right inferior orbital frontal gyrus (IOFG), and ReHo of left hippocampus and superior occipital gyrus (SOG) corresponded to a 26.52 %, 38.67 % and 24.38 % increase in the possibility to be high responders of CBT, respectively. ALFF of left thalamus and ReHo of left putamen were negatively associated with the response to CBT, with a 14.30 % and 19.91 % decrease per IQR increase of the index value. CONCLUSION The combination of ALFF, fALFF and ReHo achieved a better predictive performance than separate index. Pre-treatment ALFF of the left thalamus, fALFF of the right IOFG, ReHo of the left hippocampus, SOG and putamen can be used as predictors of CBT response.
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Affiliation(s)
- Fang-Fang Huang
- Department of Clinical Psychology, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Department of Preventive Medicine, School of Basic Medical Sciences, Henan University of Science and Technology, Henan, China
| | - Peng-Chong Wang
- Department of Clinical Psychology, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yun Yang
- Department of Clinical Psychology, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jia Luo
- Department of Clinical Psychology, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Jie Yang
- Department of Clinical Psychology, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Zhan-Jiang Li
- Department of Clinical Psychology, The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
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Konkolÿ Thege B, Emmanuel T, Callanan J, Askland KD. Trans-diagnostic determinants of psychotherapeutic treatment response: The pressing need and new opportunities for a more systematic way of selecting psychotherapeutic treatment in the age of virtual service delivery. Front Public Health 2023; 11:1102434. [PMID: 36926171 PMCID: PMC10013819 DOI: 10.3389/fpubh.2023.1102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning - often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and - with the seismic shift toward online service delivery - is more feasible than it used to be. Such a transition toward more client-centered care - systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices - would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.
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Affiliation(s)
- Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Talia Emmanuel
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | | | - Kathleen D Askland
- Askland Medicine Professional Corporation, Midland, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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18
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Treatment of refractory obsessive-compulsive disorder with nutraceuticals (TRON): a 20-week, open label pilot study. CNS Spectr 2022; 27:588-597. [PMID: 34165060 DOI: 10.1017/s1092852921000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is often challenging to treat and resistant to psychological interventions and prescribed medications. The adjunctive use of nutraceuticals with potential neuromodulatory effects on underpinning pathways such as the glutamatergic and serotonergic systems is one novel approach. OBJECTIVE To assess the effectiveness and safety of a purpose-formulated combination of nutraceuticals in treating OCD: N-acetyl cysteine, L-theanine, zinc, magnesium, pyridoxal-5' phosphate, and selenium. METHODS A 20-week open label proof-of-concept study was undertaken involving 28 participants with treatment-resistant DSM-5-diagnosed OCD, during 2017 to 2020. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale (YBOCS), administered every 4 weeks. RESULTS An intention-to-treat analysis revealed an estimated mean reduction across time (baseline to week-20) on the YBOCS total score of -7.13 (95% confidence interval = -9.24, -5.01), with a mean reduction of -1.21 points per post-baseline visit (P ≤ .001). At 20-weeks, 23% of the participants were considered "responders" (YBOCS ≥35% reduction and "very much" or "much improved" on the Clinical Global Impression-Improvement scale). Statistically significant improvements were also revealed on all secondary outcomes (eg, mood, anxiety, and quality of life). Notably, treatment response on OCD outcome scales (eg, YBOCS) was greatest in those with lower baseline symptom levels, while response was limited in those with relatively more severe OCD. CONCLUSIONS While this pilot study lacks placebo-control, the significant time effect in this treatment-resistant OCD population is encouraging and suggests potential utility especially for those with lower symptom levels. Our findings need to be confirmed or refuted via a follow-up placebo-controlled study.
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19
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Pampaloni I, Marriott S, Pessina E, Fisher C, Govender A, Mohamed H, Chandler A, Tyagi H, Morris L, Pallanti S. The global assessment of OCD. Compr Psychiatry 2022; 118:152342. [PMID: 36007341 DOI: 10.1016/j.comppsych.2022.152342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
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Affiliation(s)
- Ilenia Pampaloni
- South West London and St Georges Mental Health Trust, London, UK.
| | - Sabina Marriott
- South West London and St Georges Mental Health Trust, London, UK
| | | | - Claire Fisher
- South West London and St Georges Mental Health Trust, London, UK
| | - Anusha Govender
- South West London and St Georges Mental Health Trust, London, UK
| | - Heba Mohamed
- South West London and St Georges Mental Health Trust, London, UK
| | - Augusta Chandler
- South West London and St Georges Mental Health Trust, London, UK
| | - Himanshu Tyagi
- University College London Hospital NHS foundation Trust, London, UK
| | - Lucy Morris
- South West London and St Georges Mental Health Trust, London, UK
| | - Stefano Pallanti
- Albert Einstein Institute, New York, USA; Istututo di Neuroscienze, Firenze, Italy
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20
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Grützmann R, Klawohn J, Elsner B, Reuter B, Kaufmann C, Riesel A, Bey K, Heinzel S, Kathmann N. Error-related activity of the sensorimotor network contributes to the prediction of response to cognitive-behavioral therapy in obsessive-compulsive disorder. Neuroimage Clin 2022; 36:103216. [PMID: 36208547 PMCID: PMC9668595 DOI: 10.1016/j.nicl.2022.103216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cognitive behavioral therapy is a highly effective treatment for obsessive-compulsive disorder (OCD), yielding large symptom reductions on the group level, individual treatment response varies considerably. Identification of treatment response predictors may provide important information for maximizing individual treatment response and thus achieving efficient treatment resource allocation. Here, we investigated the predictive value of previously identified biomarkers of OCD, namely the error-related activity of the supplementary motor area (SMA) and the sensorimotor network (SMN, postcentral gyrus/precuneus). METHODS Seventy-two participants with a primary diagnosis of OCD underwent functional magnetic resonance imaging (fMRI) scanning while performing a flanker task prior to receiving routine-care CBT. RESULTS Error-related BOLD response of the SMN significantly contributed to the prediction of treatment response beyond the variance accounted for by clinical and sociodemographic variables. Stronger error-related SMN activity at baseline was associated with a higher likelihood of treatment response. CONCLUSIONS The present results illustrate that the inclusion of error-related SMN activity can significantly increase treatment response prediction quality in OCD. Stronger error-related activity of the SMN may reflect the ability to activate symptom-relevant processing networks and may thus facilitate response to exposure-based CBT interventions.
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Affiliation(s)
- Rosa Grützmann
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; MSB Medical School Berlin, Department of Psychology, Germany.
| | - Julia Klawohn
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; MSB Medical School Berlin, Department of Medicine, Germany
| | - Björn Elsner
- Humboldt-Universität zu Berlin, Department of Psychology, Germany
| | - Benedikt Reuter
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; MSB Medical School Berlin, Department of Medicine, Germany
| | | | - Anja Riesel
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; Universität Hamburg, Department of Psychology, Germany
| | - Katharina Bey
- University Hospital Bonn, Department of Psychiatry and Psychotherapy, Germany
| | - Stephan Heinzel
- Humboldt-Universität zu Berlin, Department of Psychology, Germany; Freie Universität Berlin, Department of Education and Psychology, Germany
| | - Norbert Kathmann
- Humboldt-Universität zu Berlin, Department of Psychology, Germany
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21
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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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22
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Yan H, Shan X, Li H, Liu F, Guo W. Abnormal spontaneous neural activity in hippocampal-cortical system of patients with obsessive-compulsive disorder and its potential for diagnosis and prediction of early treatment response. Front Cell Neurosci 2022; 16:906534. [PMID: 35910254 PMCID: PMC9334680 DOI: 10.3389/fncel.2022.906534] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Early brain functional changes induced by pharmacotherapy in patients with obsessive-compulsive disorder (OCD) in relation to drugs per se or because of the impact of such drugs on the improvement of OCD remain unclear. Moreover, no neuroimaging biomarkers are available for diagnosis of OCD and prediction of early treatment response. We performed a longitudinal study involving 34 patients with OCD and 36 healthy controls (HCs). Patients with OCD received 5-week treatment with paroxetine (40 mg/d). Resting-state functional magnetic resonance imaging (fMRI), regional homogeneity (ReHo), support vector machine (SVM), and support vector regression (SVR) were applied to acquire and analyze the imaging data. Compared with HCs, patients with OCD had higher ReHo values in the right superior temporal gyrus and bilateral hippocampus/parahippocampus/fusiform gyrus/cerebellum at baseline. ReHo values in the left hippocampus and parahippocampus decreased significantly after treatment. The reduction rate (RR) of ReHo values was positively correlated with the RRs of the scores of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and obsession. Abnormal ReHo values at baseline could serve as potential neuroimaging biomarkers for OCD diagnosis and prediction of early therapeutic response. This study highlighted the important role of the hippocampal-cortical system in the neuropsychological mechanism underlying OCD, pharmacological mechanism underlying OCD treatment, and the possibility of building models for diagnosis and prediction of early treatment response based on spontaneous activity in the hippocampal-cortical system.
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Affiliation(s)
- Haohao Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoxiao Shan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Psychiatry, The Third People’s Hospital of Foshan, Foshan, China
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, China
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Canavan R. Recognition rates, treatment recommendations and stigma attributions for clients presenting with taboo intrusive thoughts: A vignette‐based survey of psychotherapists. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Réamonn Canavan
- Dublin Business School Dublin 2 Ireland
- Mind and Body Works Galway Ireland
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Kathmann N, Jacobi T, Elsner B, Reuter B. Effectiveness of Individual Cognitive-Behavioral Therapy and Predictors of Outcome in Adult Patients with Obsessive-Compulsive Disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:123-135. [PMID: 35034016 DOI: 10.1159/000520454] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) has proven its efficacy in randomized controlled trials (RCTs). OBJECTIVE To test generalizability to routine care settings, we conducted an effectiveness study to provide naturalistic outcome data and their predictors. METHODS Pre-post changes in symptoms and impairment as well as response rates were determined in a naturalistic OCD sample (intention-to-treat, ITT, n = 393). Patients received individual CBT for OCD adopting an exposure-based, non-manualized treatment format. Linear and logistic regression analyses were applied to identify associations of sociodemographic and clinical variables with symptom change. RESULTS Effect size in ITT patients amounted to d = 1.47 in primary outcome (Yale-Brown Obsessive-Compulsive Scale, Y-BOCS). Remission rates were 46.3% (ITT), 52.0% (completers), and 18.2% (non-completers). The rates of treatment response without remission, no change, and deterioration in the ITT sample were 13.2, 38, and 3%, respectively. Initial symptom severity, comorbid personality disorder, and unemployment were associated with a poorer outcome, and previous medication with a better outcome. Comorbid depressive and anxiety disorders as well as other clinical or sociodemographic variables showed no effects on symptom change. CONCLUSIONS Outcomes in this large observational trial in a naturalistic setting correspond to available RCT findings suggesting that CBT for OCD should be strongly recommended for dissemination in routine care. Targets for further research include early prediction of non-response and development of alternative treatment strategies for patients who respond insufficiently.
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Affiliation(s)
- Norbert Kathmann
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Jacobi
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Elsner
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology and Outpatient Clinical Care Unit, Humboldt-Universität zu Berlin, Berlin, Germany
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25
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What the future holds: Machine learning to predict successful psychotherapy. Behav Res Ther 2022; 156:104116. [DOI: 10.1016/j.brat.2022.104116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 12/14/2022]
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Jalal B, Chamberlain SR, Robbins TW, Sahakian BJ. Obsessive-compulsive disorder-contamination fears, features, and treatment: novel smartphone therapies in light of global mental health and pandemics (COVID-19). CNS Spectr 2022; 27:136-144. [PMID: 33081864 PMCID: PMC7691644 DOI: 10.1017/s1092852920001947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
This review aims to shed light on the symptoms of obsessive-compulsive disorder (OCD) with a focus on contamination fears. In addition, we will briefly review the current therapies for OCD and detail what their limitations are. A key focus will be on discussing how smartphone solutions may provide approaches to novel treatments, especially when considering global mental health and the challenges imposed by rural environments and limited resources; as well as restrictions imposed by world-wide pandemics such as COVID-19. In brief, research that questions this review will seek to address include: (1) What are the symptoms of contamination-related OCD? (2) How effective are current OCD therapies and what are their limitations? (3) How can novel technologies help mitigate challenges imposed by global mental health and pandemics/COVID-19.
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Affiliation(s)
- Baland Jalal
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Department of Psychiatry, Faculty of Medicine, University of Southampton; and Southern Health NHS Foundation Trust, Cambridgeshire & Peterborough NHS Foundation Trust, United Kingdom
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B. Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy. BMC Psychiatry 2022; 22:66. [PMID: 35086513 PMCID: PMC8793233 DOI: 10.1186/s12888-022-03701-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Its mechanisms of action are rarely studied, but two major theories make distinct assumptions: while the emotional processing theory assumes that treatment effects are associated with habituation within and between exposure sessions, the inhibitory learning approach highlights the acquisition of additional associations, implying alternative mechanisms like expectancy violation. The present study aimed to investigate whether process variables derived from both theories predict short-term outcome. METHOD In a university outpatient unit, 110 patients (63 female) with OCD received manual-based cognitive-behavioral therapy with high standardization of the first two exposure sessions. Specifically, therapists repeated the first exposure session identically and assessed subjective units of distress as well as expectancy ratings in the course of exposure sessions. Based on these data, individual scores for habituation and distress-related expectancy violation were calculated and used for prediction of both percentage change on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and remission status after 20 therapy sessions. RESULTS In a multiple regression model for percentage change, within-session habituation during the first exposure was a significant predictor, while in a logistic regression predicting remission status, distress-related expectancy violation during the first exposure revealed significance. A path model further supported these findings. CONCLUSIONS The results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent.
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Affiliation(s)
- Björn Elsner
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Tanja Jacobi
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Eva Kischkel
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Daniel Schulze
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
- Department of Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
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28
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Grassi M, Rickelt J, Caldirola D, Eikelenboom M, van Oppen P, Dumontier M, Perna G, Schruers K. Prediction of illness remission in patients with Obsessive-Compulsive Disorder with supervised machine learning. J Affect Disord 2022; 296:117-125. [PMID: 34600172 DOI: 10.1016/j.jad.2021.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/30/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The course of OCD differs widely among OCD patients, varying from chronic symptoms to full remission. No tools for individual prediction of OCD remission are currently available. This study aimed to develop a machine learning algorithm to predict OCD remission after two years, using solely predictors easily accessible in the daily clinical routine. METHODS Subjects were recruited in a longitudinal multi-center study (NOCDA). Gradient boosted decision trees were used as supervised machine learning technique. The training of the algorithm was performed with 227 predictors and 213 observations collected in a single clinical center. Hyper-parameter optimization was performed with cross-validation and a Bayesian optimization strategy. The predictive performance of the algorithm was subsequently tested in an independent sample of 215 observations collected in five different centers. Between-center differences were investigated with a bootstrap resampling approach. RESULTS The average predictive performance of the algorithm in the test centers resulted in an AUROC of 0.7820, a sensitivity of 73.42%, and a specificity of 71.45%. Results also showed a significant between-center variation in the predictive performance. The most important predictors resulted related to OCD severity, OCD chronic course, use of psychotropic medications, and better global functioning. LIMITATIONS All recruiting centers followed the same assessment protocol and are in The Netherlands. Moreover, the sample of the data recruited in some of the test centers was limited in size. DISCUSSION The algorithm demonstrated a moderate average predictive performance, and future studies will focus on increasing the stability of the predictive performance across clinical settings.
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Affiliation(s)
- Massimiliano Grassi
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
| | - Judith Rickelt
- Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Merijn Eikelenboom
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Michel Dumontier
- Institute of Data Science, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Koen Schruers
- Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Herzog P, Osen B, Stierle C, Middendorf T, Voderholzer U, Koch S, Feldmann M, Rief W, Brakemeier EL. Determining prognostic variables of treatment outcome in obsessive-compulsive disorder: effectiveness and its predictors in routine clinical care. Eur Arch Psychiatry Clin Neurosci 2022; 272:313-326. [PMID: 34218306 PMCID: PMC8866294 DOI: 10.1007/s00406-021-01284-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/14/2021] [Indexed: 01/07/2023]
Abstract
The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive-behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.
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Affiliation(s)
- Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Bernhard Osen
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Christian Stierle
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Thomas Middendorf
- Schön-Klinik Bad Arolsen, Psychosomatic Clinic, Hofgarten 10, 34454 Bad Arolsen, Germany
| | - Ulrich Voderholzer
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Stefan Koch
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Matthias Feldmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Metacognitions and Obsessive Beliefs in Obsessive–Compulsive Disorder: A Study of Within- and Between-Person Effects on Long-Term Outcome. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Vousoura E, Gergov V, Tulbure BT, Camilleri N, Saliba A, Garcia-Lopez L, Podina IR, Prevendar T, Löffler-Stastka H, Chiarenza GA, Debbané M, Markovska-Simoska S, Milic B, Torres S, Ulberg R, Poulsen S. Predictors and moderators of outcome of psychotherapeutic interventions for mental disorders in adolescents and young adults: protocol for systematic reviews. Syst Rev 2021; 10:239. [PMID: 34462006 PMCID: PMC8404358 DOI: 10.1186/s13643-021-01788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. METHODS The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. DISCUSSION This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166756 .
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Affiliation(s)
- Eleni Vousoura
- Department of Psychology, American College of Greece - Deree, 6 Gravias Street GR-153 42 Aghia Paraskevi, Athens, Greece.
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Nigel Camilleri
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | - Andrea Saliba
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | | | - Ioana R Podina
- Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, Bucharest, Romania
| | | | | | | | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | - Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Novara C, Lebrun C, Macgregor A, Vivet B, Thérouanne P, Capdevielle D, Raffard S. Acquisition and maintenance of disgust reactions in an OCD analogue sample: Efficiency of extinction strategies through a counter-conditioning procedure. PLoS One 2021; 16:e0254592. [PMID: 34260646 PMCID: PMC8279387 DOI: 10.1371/journal.pone.0254592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has long been considered as an anxiety disorder, disgust is the dominant emotion in contamination-based OCD. However, disgust seems resistant to exposure with response prevention partly due to the fact that disgust is acquired through evaluative conditioning. AIMS The present research investigates a counter-conditioning intervention in treating disgust-related emotional responses in two groups of individuals with high (High contamination concerns, HCC, n = 24) and low (Low contamination concerns LCC, n = 23) contamination concerns. METHODS The two groups completed a differential associative learning task in which neutral images were followed by disgusting images (conditioned stimulus; CS+), or not (CS-). Following this acquisition phase, there was a counter-conditioning procedure in which CS+ was followed by a very pleasant unconditional stimulus while CS- remained unreinforced. RESULTS Following counter-conditioning, both groups reported significant reduction in their expectancy of US occurrence and reported less disgust with CS+. For both expectancy and disgust, reduction was lower in the HCC group than in the LCC group. Disgust sensitivity was highly correlated with both acquisition and maintenance of the response acquired, while US expectation was predicted by anxiety. CONCLUSION Counter-conditioning procedure reduces both expectations and conditioned disgust.
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Affiliation(s)
- Caroline Novara
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, Montpellier, France
- Groupe Ramsay Gds, Clinique RECH, Montpellier, France
| | - Cindy Lebrun
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Alexandra Macgregor
- Service Universitaire de Psychiatrie Adulte, CHU Montpellier, Montpellier, France
| | - Bruno Vivet
- Groupe Ramsay Gds, Clinique RECH, Montpellier, France
| | | | - Delphine Capdevielle
- Service Universitaire de Psychiatrie Adulte, CHU Montpellier, Montpellier, France
| | - Stephane Raffard
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, Montpellier, France
- Service Universitaire de Psychiatrie Adulte, CHU Montpellier, Montpellier, France
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Simpson HB, Foa EB, Wheaton MG, Gallagher T, Gershkovich M, Schmidt AB, Huppert JD, Campeas RB, Imms PA, Cahill SP, DiChiara C, Tsao SD, Puliafico AC, Chazin D, Asnaani A, Moore K, Tyler J, Steinman SA, Sanchez-LaCay A, Capaldi S, Snorrason I, Turk-Karan E, Vermes D, Kalanthroff E, Pinto A, Hahn CG, Xu B, Van Meter PE, Katechis M, Scodes J, Wang Y. Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder. Behav Res Ther 2021; 143:103890. [PMID: 34089924 DOI: 10.1016/j.brat.2021.103890] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/31/2021] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.
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Affiliation(s)
- Helen B Simpson
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael G Wheaton
- New York State Psychiatric Institute, New York, NY, 10032, USA; Barnard College, Columbia University, New York, NY, 10027, USA
| | - Thea Gallagher
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Marina Gershkovich
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Andrew B Schmidt
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Raphael B Campeas
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Patricia A Imms
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shawn P Cahill
- University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA
| | - Christina DiChiara
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA
| | - Steven D Tsao
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA
| | - Anthony C Puliafico
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Daniel Chazin
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Anu Asnaani
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Kelly Moore
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Rutgers University/Biomedical Health Sciences New Brunswick, NJ, 08854, USA
| | - Jeremy Tyler
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shari A Steinman
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychology, WVU, Morgantown, WV, 26506, USA
| | - Arturo Sanchez-LaCay
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Sandy Capaldi
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ivar Snorrason
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA
| | - Elizabeth Turk-Karan
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donna Vermes
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Anthony Pinto
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, 11004, USA
| | - Chang-Gyu Hahn
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bin Xu
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - Page E Van Meter
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Martha Katechis
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
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Storch EA, Tendler A, Schneider SC, Guzick AG, La Buissonniere-Ariza V, Goodman WK. Moderators and predictors of response to deep transcranial magnetic stimulation for obsessive-compulsive disorder. J Psychiatr Res 2021; 136:508-514. [PMID: 33218749 DOI: 10.1016/j.jpsychires.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/16/2020] [Indexed: 02/08/2023]
Abstract
Deep transcranial magnetic stimulation (dTMS) has emerged as a treatment option for adults with obsessive-compulsive disorder (OCD) who continue to exhibit impairing symptoms following an adequate response to first line interventions. Currently, little is known about the predictors or moderators of dTMS outcome for OCD. This paper examined if several theoretically relevant variables may predict and moderate treatment effects including OCD symptom severity, functional impairment, co-occurring depressive symptoms, age, gender, age of OCD onset, and family history of OCD. As part of a previously reported study, 100 patients received 29 dTMS or sham stimulation treatments over 6 weeks. dTMS was administered using a Magstim Rapid2 TMS (The Magstim Co. Ltd., Whitland, Carmarthenshire, United Kingdom) stimulator equipped with a H shaped coil design, which was specifically designed to stimulate the dorsal mPFC-ACC bilaterally. Findings suggest older participants and those with lower OCD severity and disability respond faster to both dTMS and sham stimulation. dTMS of the dorsal mPFC/ACC appeared to have larger benefits for individuals with greater OCD severity, whereas the difference between treatment arms was minimal in those with lower severity. Implications of these findings for treatment of OCD are discussed.
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Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA.
| | | | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
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Berman NC, Hezel DM, Wilhelm S. Is my patient too sad to approach their fear? Depression severity and imaginal exposure outcomes for patients with OCD. J Behav Ther Exp Psychiatry 2021; 70:101615. [PMID: 32937237 DOI: 10.1016/j.jbtep.2020.101615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES There is conflicting research on how comorbid depression impacts the treatment of obsessive compulsive disorder (OCD) with exposure with response prevention. To better understand this relationship, the current study tests theoretical claims that greater depression limits motivation to engage in exposures, restricts habituation, and interferes with adaptive learning. METHODS Fifty-one individuals with OCD completed a diagnostic interview and self-report questionnaires assessing depression symptom severity and then participated in a standardized imaginal exposure protocol, in which they repeatedly approached an idiosyncratic fear deemed "moderately anxiety-provoking." RESULTS Contrary to expectations, linear regression models indicated that depression symptom severity was not independently associated with motivation, subjective or objective within-session habituation or adaptive learning outcomes. However, the perceived likelihood of the best-case scenario occurring as a result of the exposure moderated the relationship between depression severity and motivation to engage in the exposure exercise. LIMITATIONS Use of a one-session exposure protocol precludes conclusions regarding how depression is associated with outcomes in a full ERP treatment. CONCLUSIONS Depression symptom severity was not independently associated with motivation, habituation, or adaptive learning. The observed non-significant effects suggest that degree of depression, on its own, is not a meaningful indicator of how patients with OCD will fare an exposure intervention.
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Affiliation(s)
- Noah Chase Berman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, OCD and Related Disorders, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA; Psychology Department, College of the Holy Cross, 1 College St., Beaven Hall, PO Box 38A, Worcester, MA, 01610, USA.
| | - Dianne M Hezel
- Center for Obsessive-Compulsive Treatment and Related Disorders, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit #69, New York, NY, 10032, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, OCD and Related Disorders, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
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Ociskova M, Prasko J, Vanek J, Holubova M, Hodny F, Latalova K, Kantor K, Nesnidal V. Self-Stigma and Treatment Effectiveness in Patients with SSRI Non-Responsive Obsessive-Compulsive Disorder. Psychol Res Behav Manag 2021; 14:85-97. [PMID: 33574718 PMCID: PMC7873032 DOI: 10.2147/prbm.s287419] [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] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Obsessive compulsive disorder (OCD) is a debilitating mental disorder that often takes a chronic course. One of the factors influencing the treatment effectiveness in anxiety and depressive disorders is the self-stigma. This study focused on the relationship between the self-stigma, symptomatology, and therapeutic outcomes in patients with OCD. Patients and Methods Ninety-four inpatients with OCD, who did not sufficiently respond to at least one selective serotonin reuptake inhibitor trial, participated in the study. They attended a six-week therapeutic program consisting of exposure and response prevention, transdiagnostic group cognitive behavioral therapy, individual sessions, mental imagery, relaxation, sport, and ergotherapy. The participants completed several scales: the Internalized Stigma of Mental Illness Scale (ISMI), the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR), Beck Anxiety Scale (BAI), Beck Depression Scale-II (BDI-II), and Dissociative Experiences Scale (DES). A senior psychiatrist filled in the Clinical Global Impression (CGI-S). Results The average scales' scores considerably declined in all measurements except for DES. The self-stigma positively correlated with all psychopathology scales. It was also higher in patients with a comorbid personality disorder (PD). The higher self-stigma predicted a lower change in compulsion, anxiety, and depressive symptoms but not the change of obsessions or the overall psychopathology. Conclusion The self-stigma presents an important factor connected to higher severity of OCD. It is also a minor predictor of a lower change in symptomatology after combined treatment.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Prague, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic
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Wheaton MG, Patel SR, Andersson E, Rück C, Simpson HB. Predicting Treatment Outcomes From Internet-Based Cognitive Behavior Therapy for Obsessive-Compulsive Disorder. Behav Ther 2021; 52:77-85. [PMID: 33483126 PMCID: PMC7826445 DOI: 10.1016/j.beth.2020.02.003] [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: 11/13/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 11/29/2022]
Abstract
Internet-based cognitive-behavioral therapy (ICBT) with therapist support shows promise as a treatment for obsessive-compulsive disorder (OCD). Yet, not all patients respond to ICBT. It is therefore important to identify predictors of ICBT outcomes to determine who is likely to benefit. Relative to the large literature on predictors of outcomes for in-person CBT for OCD, very few studies have investigated ICBT predictors. Therefore, we analyzed predictors of outcome in an open trial (n=30) of ICBT for OCD using the OCD-NET platform, which consists of 10 online modules delivered with therapist support. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was administered by independent raters as the primary outcome measure at baseline and posttreatment. In this sample, greater baseline OCD severity and OCD-related avoidance behaviors were associated with higher end-state OCD symptoms (i.e., poorer outcome). Patients with a past history of face-to-face CBT for OCD also had worse outcomes. Although these results require replication, these factors may identify individuals at risk for poor ICBT outcomes.
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Affiliation(s)
- Michael G. Wheaton
- Department of Psychology, Barnard College, Columbia University, New York, NY, USA,New York State Psychiatric Institute/Columbia Psychiatry,corresponding author Michael G. Wheaton, PhD, Assistant Professor of Psychology, Department of Psychology, Barnard College, Columbia University, (212) 853-1692,
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Zaccari V, Gragnani A, Pellegrini V, Caiazzo T, D'Arienzo MC, Magno A, Femia G, Mancini F. An Observational Study of OCD Patients Treated With Cognitive Behavioral Therapy During the COVID-19 Pandemic. Front Psychiatry 2021; 12:755744. [PMID: 34744841 PMCID: PMC8569247 DOI: 10.3389/fpsyt.2021.755744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Objectives: While the consequences of the COVID-19 pandemic for general mental health and the increase in anxiety and depression are clear, less is known about the potential effect of the pandemic on OCD. The purpose of this study is to collect new data to monitor the symptomatic status of patients with OCD during the period of emergency due to COVID-19 and to make a comparison between two psychodiagnostic evaluations. Methods: Eleven OCD patients and their psychotherapists were recruited. All patients had a specific psychodiagnostic assessment for OCD (SCL-90; OCI-R; Y-BOCS self-report) performed between December 2019 and January 2020 (t0), and undertook cognitive behavioral therapy (CBT) and exposure and prevention of response protocol (ERP) before the lockdown. The psychodiagnostic assessment carried out at t0 was re-administered (t1) to all patients, together with a set of qualitative questions collected through an online survey. The respective therapists were asked to document the status of the therapy and the monitoring of symptoms through use of a semi-structured interview (Y-BOCS) and a qualitative interview. Non-parametric analyses were conducted. Results: Patients reported a significant decrease in OCD symptoms. Data analysis showed a decrease in the scores across t0 and at t1 on the Y-BOCS (SR) total self-report, and on OCD symptoms' severity assessed by means of the OCI-r and SCL-90 r OC subscale, for 11 participants. Relating to the measures detected by psychotherapists, marginally significant improvements and lower scores were found in the Y-BOCS (I). An improvement in symptoms was noticed by 90.9% of the clinical sample; this was confirmed by 45.4% of the therapists, who claimed moderate progress in their patients. Conclusions: The data collected through standardized measurements at two different times, albeit relative to a small sample, assume relevance from a clinical point of view. In the literature, some studies document the worsening of OCD. However, in many studies, the type of treatment, the detection time, and the intervention period are not well-specified. These results confirm the effectiveness of CBT/ERP as an elective treatment for OCD through a specific intervention procedure.
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Affiliation(s)
- Vittoria Zaccari
- Associazione Scuola di Psicoterapia Cognitiva (APC-SPC), Rome, Italy.,Department of Human Sciences, Marconi University, Rome, Italy
| | - Andrea Gragnani
- Associazione Scuola di Psicoterapia Cognitiva (APC-SPC), Rome, Italy
| | - Valerio Pellegrini
- Department of Social and Developmental Psychology Sapienza, University of Rome, Rome, Italy
| | - Tecla Caiazzo
- Associazione Scuola di Psicoterapia Cognitiva (APC-SPC), Rome, Italy
| | | | - Antonella Magno
- Associazione Scuola di Psicoterapia Cognitiva (APC-SPC), Rome, Italy
| | - Giuseppe Femia
- Associazione Scuola di Psicoterapia Cognitiva (APC-SPC), Rome, Italy
| | - Francesco Mancini
- Associazione Scuola di Psicoterapia Cognitiva (APC-SPC), Rome, Italy.,Department of Human Sciences, Marconi University, Rome, Italy
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Innovations in the Delivery of Exposure and Response Prevention for Obsessive-Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:301-329. [PMID: 33590457 DOI: 10.1007/7854_2020_202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obsessive-Compulsive Disorder is an important cause of global health-related disability. In the last several decades, exposure and response prevention (EX/RP) has emerged as one of the most evidence-based treatments for adult and pediatric OCD. Recommended as a first-line treatment in practice guidelines for OCD, EX/RP, when expertly delivered, can be superior to serotonin reuptake inhibitor (SRI) medications alone and superior to adding antipsychotic medication to augment SRI treatment response. Despite a robust evidence base, EX/RP is not widely available. Moreover, although effective, only about half of patients who receive a standard course of EX/RP will achieve remission.This chapter will review innovations in delivering EX/RP, focusing on technology-based methods designed to increase access to EX/RP and translational neuroscience approaches to personalizing and optimizing EX/RP. Technology-based innovations to deliver EX/RP include video conferencing, internet-based treatment, and smartphone apps. Of these, internet-based, clinician-supported treatment has the most evidence base to date. Relevant to all technology-based innovations are the need for advances in the ethical, regulatory and financial aspects of understanding how access to EX/RP may be delivered to individuals of diverse socioeconomic backgrounds in accordance with professional standards and regulations and covered by healthcare.Advances in our understanding of the neural processes underlying learning and memory have led to new ways to combine EX/RP with medications, behavioral interventions, or neuromodulatory methods, with the goal of enhancing the functioning of brain circuits that subserve fear processing and cognitive control. Among the pharmacological approaches to enhancing EX/RP outcome, both ketamine and cannabinoids show promise in small open trials but are in need of further study. Studies to train cognitive control are at an early stage of development yet provide preliminary evidence that training neural processes may be a new path to personalize treatment. How best to combine EX/RP with different types of neuromodulation is being actively studied.Together these innovations in the delivery of EX/RP for OCD hold great promise for improving outcomes of care for individuals with OCD by increasing the availability and the individual treatment effects of this already effective treatment.
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Hilbert K, Jacobi T, Kunas SL, Elsner B, Reuter B, Lueken U, Kathmann N. Identifying CBT non-response among OCD outpatients: A machine-learning approach. Psychother Res 2020; 31:52-62. [DOI: 10.1080/10503307.2020.1839140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Kevin Hilbert
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Jacobi
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie L. Kunas
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Elsner
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedikt Reuter
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Lueken
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Norbert Kathmann
- Faculty of Life Sciences, Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Kwak S, Kim M, Kim T, Kwak Y, Oh S, Lho SK, Moon SY, Lee TY, Kwon JS. Defining data-driven subgroups of obsessive-compulsive disorder with different treatment responses based on resting-state functional connectivity. Transl Psychiatry 2020; 10:359. [PMID: 33106472 PMCID: PMC7589530 DOI: 10.1038/s41398-020-01045-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
Characterization of obsessive-compulsive disorder (OCD), like other psychiatric disorders, suffers from heterogeneities in its symptoms and therapeutic responses, and identification of more homogeneous subgroups may help to resolve the heterogeneity. We aimed to identify the OCD subgroups based on resting-state functional connectivity (rsFC) and to explore their differences in treatment responses via a multivariate approach. From the resting-state functional MRI data of 107 medication-free OCD patients and 110 healthy controls (HCs), we selected rsFC features, which discriminated OCD patients from HCs via support vector machine (SVM) analyses. With the selected brain features, we subdivided OCD patients into subgroups using hierarchical clustering analyses. We identified 35 rsFC features that achieved a high sensitivity (82.74%) and specificity (76.29%) in SVM analyses. The OCD patients were subdivided into two subgroups, which did not show significant differences in their demographic and clinical backgrounds. However, one of the OCD subgroups demonstrated more impaired rsFC that was involved either within the default mode network (DMN) or between DMN brain regions and other network regions. This subgroup also showed both lower improvements in symptom severity in the 16-week follow-up visit and lower responder percentage than the other subgroup. Our results highlight that not only abnormalities within the DMN but also aberrant rsFC between the DMN and other networks may contribute to the treatment response and support the importance of these neurobiological alterations in OCD patients. We suggest that abnormalities in these connectivity may play predictive biomarkers of treatment response, and aid to build more optimal treatment strategies.
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Affiliation(s)
- Seoyeon Kwak
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Yoobin Kwak
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
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Rech M, Weinzimmer S, Geller D, McGuire JF, Schneider SC, Patyk KC, De Nadai AS, Cepeda SC, Small BJ, Murphy TK, Wilhelm S, Storch EA. Symptom Trajectories of Early Responders and Remitters among Youth with OCD. J Obsessive Compuls Relat Disord 2020; 27:100580. [PMID: 35990243 PMCID: PMC9390966 DOI: 10.1016/j.jocrd.2020.100580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT). METHODS One hundred and thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT augmented by either placebo or d-cycloserine (DCS) as part of a randomized double-blind multi-site clinical trial. Early response and remission status were determined by clinician-rated global symptom improvement (CGI-I) and severity (CGI-S), respectively. RESULTS At the mid-treatment assessment, 45.3% of youth were early responders, and 28.1% were early remitters. At post-treatment assessment, 79.1% of youth were responders and 67.6% were remitters. Early response predicted a higher likelihood of post-treatment response and remission; early remission significantly predicted a higher likelihood of post-treatment remission. Bivariate logistic regressions showed that early response was predicted by lower baseline clinician-rated global severity (CGI-S) and lower depression severity; however, only depression severity remained a significant predictor in the multivariable logistic regression model. Furthermore, bivariate logistic regressions showed that early remission was predicted by lower baseline clinician-rated global severity (CGI-S), lower depression severity, and lower obsessive-compulsive symptom severity (CY-BOCS); however, only global severity remained a significant predictor in the multivariable logistic regression model. CONCLUSIONS Lower OCD and depression symptom severity predicted a greater likelihood of early treatment response and remission to CBT. Findings suggest that low OCD and depression symptom severity could serve as baseline characteristics to identify potential candidates for lower-intensity initial interventions in a stepped care approach. The modest predictive value of the variables examined suggests that additional factors could add to prediction of treatment response and remission.
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Affiliation(s)
- Megan Rech
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Saira Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Kevin C Patyk
- Department of Psychology, Texas State University, San Marcos, Texas
| | | | - Sandra C Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Brent J Small
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- University of South Florida School of Aging Studies, Tampa, Florida
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Hamatani S, Tsuchiyagaito A, Nihei M, Hayashi Y, Yoshida T, Takahashi J, Okawa S, Arai H, Nagaoka M, Matsumoto K, Shimizu E, Hirano Y. Predictors of response to exposure and response prevention-based cognitive behavioral therapy for obsessive-compulsive disorder. BMC Psychiatry 2020; 20:433. [PMID: 32887553 PMCID: PMC7473813 DOI: 10.1186/s12888-020-02841-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT), which includes exposure and response prevention (ERP), is effective in improving symptoms of obsessive-compulsive disorder (OCD). However, whether poor cognitive functions and autism spectrum disorder (ASD) traits affect the therapeutic response of patients with OCD to ERP-based CBT remains unclear. This study aimed to identify factors predictive of the therapeutic response of Japanese patients with OCD to ERP-based CBT. METHODS Forty-two Japanese outpatients with OCD were assessed using the Wechsler Adult Intelligence Scale-III (WAIS-III), Yale-Brown Obsessive-Compulsive Scale, Patient Health Questionnaire 9-item scale, and Autism Spectrum Quotient (AQ) at pre- and post-treatment. We used multiple regression analyses to estimate the effect on therapeutic response change. The treatment response change was set as a dependent variable in multiple regression analyses. RESULTS Multiple regression analyses showed that among independent variables, communication as an AQ sub-scale and Letter Number Sequencing as a WAIS-III sub-test predict the therapeutic response to ERP-based CBT . CONCLUSIONS Our results suggest that diminished working memory (Letter Number Sequencing), poor communication skill (AQ sub-scale) may undermine responsiveness to ERP-based CBT among patients with OCD. TRIAL REGISTRATION UMIN, UMIN00024087 . Registered 20 September 2016 - Retrospectively registered (including retrospective data).
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Affiliation(s)
- Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Aki Tsuchiyagaito
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Masato Nihei
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
| | - Yuta Hayashi
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tokiko Yoshida
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
| | - Jumpei Takahashi
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
| | - Sho Okawa
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
- United Graduate School of Child Development, Osaka University Research Center of Child Mental Development, Chiba University, Chiba, Japan
| | - Honami Arai
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
| | - Maki Nagaoka
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
| | - Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Cognitive Behavioral Therapy Center, Chiba University Hospital, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Inohana, Chuo-ku, Chiba, 2608670, Japan.
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McCathern AG, Mathai DS, Cho RY, Goodman WK, Storch EA. Deep transcranial magnetic stimulation for obsessive compulsive disorder. Expert Rev Neurother 2020; 20:1029-1036. [PMID: 32684005 DOI: 10.1080/14737175.2020.1798232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a common psychiatric disorder that can be chronic and debilitating if not properly treated. Current first-line treatments for OCD include cognitive-behavioral therapy with exposure and response prevention and serotonin uptake inhibitor medications; however, these therapies are not effective for all individuals. AREAS COVERED Deep transcranial magnetic stimulation (dTMS) has been hypothesized to be an effective alternative for individuals with treatment-resistant OCD. dTMS has thought to be favorable due to its low side effect profile and its minimally invasive nature. EXPERT OPINION This review evaluates the current research on effectiveness of dTMS therapy for individuals with treatment-resistant OCD. This review also investigates shortcomings in current dTMS research and the hypothesized future of dTMS therapy.
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Affiliation(s)
- Alexis G McCathern
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - David S Mathai
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Raymond Y Cho
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
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Heslin M, Gellatly J, Pedley R, Knopp-Hoffer J, Hardy G, Arundel C, Bee P, McMillan D, Peckham E, Gega L, Barkham M, Bower P, Gilbody S, Lovell K, Byford S. Out of pocket expenses in obsessive compulsive disorder. J Ment Health 2020; 31:607-612. [PMID: 32357807 DOI: 10.1080/09638237.2020.1755028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Despite anecdotal evidence that the out of pocket costs of OCD can be substantial in some cases, there is no evidence on how many people they affect, or the magnitude of these costs.Aims: This paper explores the type and quantity of out of pocket expenses reported by a large sample of adults with OCD.Methods: Data on out of pocket expenses were collected from participants taking part in the OCTET multi-centre randomised controlled trial. Participants were aged 18+, meeting DSM-IV criteria for OCD, and scoring 16+ on the Yale Brown Obsessive Compulsive Scale. Individual-level resource use data including a description and estimated cost of out of pocket expenses were measured using an adapted version of the Adult Service Use Schedule (AD-SUS): a questionnaire used to collect data on resource use.Results: Forty-five percent (208/465) reported out of pocket expenses due to their OCD. The mean cost of out of pocket expenses was £19.19 per week (SD £27.56 SD), range £0.06-£224.00.Conclusions: Future economic evaluations involving participants with OCD should include out of pocket expenses, but careful consideration of alternative approaches to the collection and costing of this data is needed.
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Affiliation(s)
- Margaret Heslin
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Judith Gellatly
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jasmin Knopp-Hoffer
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Gillian Hardy
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Dean McMillan
- Hull York Medical School & Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | - Lina Gega
- Hull York Medical School & Department of Health Sciences, University of York, York, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Hull York Medical School & Department of Health Sciences, University of York, York, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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Garey L, Kauffman BY, Manning KF, Taha SA, Schmidt NB, Neighbors C, Zvolensky MJ. The Effect of Positive and Negative Affect on Early Treatment Milestones in the Context of Integrated Smoking Treatment. J Addict Med 2020; 13:47-54. [PMID: 30067553 PMCID: PMC6349496 DOI: 10.1097/adm.0000000000000445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: Smoking is the leading cause of preventable death in the United States. Efforts have been made to develop effective, integrated smoking-cessation treatments for individuals with greater difficulty quitting, including individuals with elevated anxiety sensitivity (AS). Despite initial evidence for the efficacy of these treatments, little is understood about pretreatment predictors of early treatment milestones, including treatment initiation and response. Positive affectivity (PA) and negative affectivity (NA) are unique mood traits that may be related to early treatment milestones. Indeed, PA and NA are related to smoking and mood outcomes generally. Yet, it is presently unknown if pretreatment PA or NA predict early treatment milestones within the context of an integrated smoking-cessation treatment. The current study sought to evaluate the independent effect of PA and NA on early treatment milestones within the context of an integrated smoking-AS treatment protocol. Smoking and AS outcomes were evaluated independently. Participants included 288 (50% female; Mage = 38.66, SD = 13.67) treatment-seeking adult daily cigarette users. Results indicated that higher pretreatment NA was associated with an increased likelihood of early dropout versus responding to treatment across both outcomes (smoking: odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88-0.99; AS: OR 0.92, 95% CI 0.88-0.98). Pretreatment PA did not significantly differentiate any of the groups. Overall, the present study serves as an initial investigation of the role of pretreatment NA in identifying those at greatest risk for dropping out of treatment (cf. responding to treatment).
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, United States
| | | | - Kara F. Manning
- Department of Psychology, University of Houston, Houston, United States
| | - Samar A. Taha
- Department of Psychology, University of Houston, Houston, United States
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, United States
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, United States
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Altuğlu TB, Metin B, Tülay EE, Tan O, Sayar GH, Taş C, Arikan K, Tarhan N. Prediction of treatment resistance in obsessive compulsive disorder patients based on EEG complexity as a biomarker. Clin Neurophysiol 2020; 131:716-724. [PMID: 32000072 DOI: 10.1016/j.clinph.2019.11.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to identify an Electroencephalography (EEG) complexity biomarker that could predict treatment resistance in Obsessive compulsive disorder (OCD) patients. Additionally, the statistical differences between EEG complexity values in treatment-resistant and treatment-responsive patients were determined. Moreover, the existence of correlations between EEG complexity and Yale-Brown Obsessive Compulsive Scale (YBOCS) score were evaluated. METHODS EEG data for 29 treatment-resistant and 28 treatment-responsive OCD patients were retrospectively evaluated. Approximate entropy (ApEn) method was used to extract the EEG complexity from both whole EEG data and filtered EEG data, according to 4 common frequency bands, namely delta, theta, alpha, and beta. The random forests method was used to classify ApEn complexity. RESULTS ApEn complexity extracted from beta band EEG segments discriminated treatment-responsive and treatment-resistant OCD patients with an accuracy of 89.66% (sensitivity: 89.44%; specificity: 90.64%). Beta band EEG complexity was lower in the treatment-resistant patients and the severity of OCD, as measured by YBOCS score, was inversely correlated with complexity values. CONCLUSIONS The results indicate that, EEG complexity could be considered a biomarker for predicting treatment response in OCD patients. SIGNIFICANCE The prediction of treatment response in OCD patients might help clinicians devise and administer individualized treatment plans.
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Affiliation(s)
- Tuğçe Ballı Altuğlu
- Uskudar University, Faculty of Engineering and Natural Sciences, Istanbul, Turkey.
| | - Barış Metin
- Uskudar University, Faculty of Humanities and Social Sciences, Department of Psychology, Istanbul, Turkey
| | - Emine Elif Tülay
- Uskudar University, Faculty of Engineering and Natural Sciences, Istanbul, Turkey
| | - Oğuz Tan
- Uskudar University, Faculty of Humanities and Social Sciences, Department of Psychology, Istanbul, Turkey; NPIstanbul Brain Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Gökben Hızlı Sayar
- Uskudar University, Faculty of Humanities and Social Sciences, Department of Psychology, Istanbul, Turkey; NPIstanbul Brain Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Cumhur Taş
- Uskudar University, Faculty of Humanities and Social Sciences, Department of Psychology, Istanbul, Turkey
| | - Kemal Arikan
- Uskudar University, Faculty of Humanities and Social Sciences, Department of Psychology, Istanbul, Turkey
| | - Nevzat Tarhan
- Uskudar University, Faculty of Humanities and Social Sciences, Department of Psychology, Istanbul, Turkey; NPIstanbul Brain Hospital, Department of Psychiatry, Istanbul, Turkey
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Predicting cognitive behavioral therapy outcome in the outpatient sector based on clinical routine data: A machine learning approach. Behav Res Ther 2020; 124:103530. [DOI: 10.1016/j.brat.2019.103530] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/14/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
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Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Emmelkamp PMG, Anholt GE. Predictors of treatment outcome in OCD: An interpersonal perspective. J Anxiety Disord 2019; 68:102153. [PMID: 31704634 DOI: 10.1016/j.janxdis.2019.102153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.
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Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kim M, Kwak S, Yoon YB, Kwak YB, Kim T, Cho KIK, Lee TY, Kwon JS. Functional connectivity of the raphe nucleus as a predictor of the response to selective serotonin reuptake inhibitors in obsessive-compulsive disorder. Neuropsychopharmacology 2019; 44:2073-2081. [PMID: 31189178 PMCID: PMC6898154 DOI: 10.1038/s41386-019-0436-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 11/10/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacological agents for treating obsessive-compulsive disorder (OCD). However, because nearly half of patients show insufficient SSRI responses, serotonergic dysfunction in heterogeneous OCD patients should be investigated for precision medicine. We aimed to determine whether functional connectivity (FC) of the raphe nucleus (RN), the major source of most serotonergic neurons, was altered in OCD patients and could predict the SSRI response. A total of 102 medication-free OCD patients and 101 matched healthy control (HC) subjects participated in resting-state functional magnetic resonance imaging. Among them, 54 OCD patients were treated with SSRIs for 16 weeks, resulting in 26 responders and 28 nonresponders. Seed-based whole brain FC with the RN as a seed region was compared between the OCD and HC groups, as well as between SSRI responders and nonresponders. FC cluster values showing significant group differences were used to investigate factors correlated with symptomatic severity before treatment and predictive of SSRI response. Compared to HCs, OCD patients exhibited significantly larger FC between the RN and temporal cortices including the middle temporal gyrus (MTG), paracingulate gyrus, amygdala, hippocampus, putamen, thalamus, and brain stem. Greater RN-left MTG FC was positively correlated with OC symptom severity at baseline. In addition, larger FC of the RN-left MTG was also found in SSRI nonresponders compared to responders, which was a significant predictor of SSRI response after 16 weeks. The FC of RN may reflect the neurobiological underpinning of OCD and could aid future precision medicine as a differential brain-based biomarker.
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Affiliation(s)
- Minah Kim
- 0000 0001 0302 820Xgrid.412484.fDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea ,0000 0004 0470 5905grid.31501.36Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, 03080 Republic of Korea
| | - Seoyeon Kwak
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Youngwoo Bryan Yoon
- 0000 0001 2355 7002grid.4367.6Department of Psychiatry, Washington University in St. Louis, St. Louis, MO USA
| | - Yoo Bin Kwak
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Taekwan Kim
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Kang Ik K. Cho
- 0000 0004 0470 5905grid.31501.36Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Tae Young Lee
- 0000 0001 0302 820Xgrid.412484.fDepartment of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-no, Chongno-gu, Seoul, 03080, Republic of Korea. .,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea. .,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
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