1
|
Suzuki T, Gu P, Grove TB, Hammond T, Collins KM, Pamidighantam P, Arnold PD, Taylor SF, Liu Y, Gehring WJ, Hanna GL, Tso IF. Abnormally Enhanced Midfrontal Theta Activity During Response Monitoring in Youths With Obsessive-Compulsive Disorder. Biol Psychiatry 2023; 93:1031-1040. [PMID: 36822934 PMCID: PMC10182182 DOI: 10.1016/j.biopsych.2022.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/03/2022] [Accepted: 10/29/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Response monitoring, as reflected in electroencephalogram recordings after commission of errors, has been consistently shown to be abnormally enhanced in individuals with obsessive-compulsive disorder (OCD). This has traditionally been quantified as error-related negativity (ERN) and may reflect abnormal neurophysiological mechanisms underlying OCD. However, the ERN reflects the increase in phase-locked activities, particularly in the theta-band (4-8 Hz), and does not reflect non-phase-locked activities. To more broadly investigate midfrontal theta activity in a brain region that is essential for complex cognition, this study investigated theta abnormalities during response monitoring in participants with OCD to acheive a better understanding of the mechanism underlying the ERN. METHODS Electroencephalogram data were recorded from 99 participants with pediatric OCD and 99 sex- and age-matched healthy control participants while they completed the arrow flanker task. Effects of group (OCD, healthy control) and response type (error, correct) on postresponse theta total power and intertrial phase coherence (ITPC) were examined using mixed analysis of covariance and Bayesian analyses controlling for sex and accuracy. RESULTS Theta total power was larger on error than on correct trials and larger in OCD than healthy control participants, but there was no effect of response type between groups. Theta ITPC was larger on error than correct trials, but there was no group difference or response type difference between the groups. Correlations of theta total power and ITPC with clinical measures were overall small. CONCLUSIONS Abnormally enhanced midfrontal theta total power, but not ITPC, may reflect ineffective heightened response monitoring or compensatory activity in pediatric OCD.
Collapse
Affiliation(s)
- Takakuni Suzuki
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Department of Psychology, University of Michigan, Ann Arbor, Michigan.
| | - Pan Gu
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Tyler B Grove
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Taeah Hammond
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Kelsey M Collins
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Paul D Arnold
- Department of Psychiatry, The Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Yanni Liu
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - William J Gehring
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Gregory L Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Department of Psychology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
2
|
Tzirini M, Roth Y, Harmelech T, Zibman S, Pell GS, Kimiskidis VK, Tendler A, Zangen A, Samaras T. Detailed measurements and simulations of electric field distribution of two TMS coils cleared for obsessive compulsive disorder in the brain and in specific regions associated with OCD. PLoS One 2022; 17:e0263145. [PMID: 36040972 PMCID: PMC9426893 DOI: 10.1371/journal.pone.0263145] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The FDA cleared deep transcranial magnetic stimulation (Deep TMS) with the H7 coil for obsessive-compulsive disorder (OCD) treatment, following a double-blinded placebo-controlled multicenter trial. Two years later the FDA cleared TMS with the D-B80 coil on the basis of substantial equivalence. In order to investigate the induced electric field characteristics of the two coils, these were placed at the treatment position for OCD over the prefrontal cortex of a head phantom, and the field distribution was measured. Additionally, numerical simulations were performed in eight Population Head Model repository models with two sets of conductivity values and three Virtual Population anatomical head models and their homogeneous versions. The H7 was found to induce significantly higher maximal electric fields (p<0.0001, t = 11.08) and to stimulate two to five times larger volumes in the brain (p<0.0001, t = 6.71). The rate of decay of electric field with distance is significantly slower for the H7 coil (p < 0.0001, Wilcoxon matched-pairs test). The field at the scalp is 306% of the field at a 3 cm depth with the D-B80, and 155% with the H7 coil. The H7 induces significantly higher intensities in broader volumes within the brain and in specific brain regions known to be implicated in OCD (dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), inferior frontal gyrus (IFG), orbitofrontal cortex (OFC) and pre-supplementary motor area (pre-SMA)) compared to the D-B80. Significant field ≥ 80 V/m is induced by the H7 (D-B80) in 15% (1%) of the dACC, 78% (29%) of the pre-SMA, 50% (20%) of the dlPFC, 30% (12%) of the OFC and 15% (1%) of the IFG. Considering the substantial differences between the two coils, the clinical efficacy in OCD should be tested and verified separately for each coil.
Collapse
Affiliation(s)
- Marietta Tzirini
- School of Physics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- THESS, Thessaloniki Software Solution S.A., Thessaloniki, Greece
- * E-mail:
| | - Yiftach Roth
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
| | | | | | - Gaby S. Pell
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
| | - Vasilios K. Kimiskidis
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aron Tendler
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
- Advanced Mental Health Care Inc., United States of America
| | - Abraham Zangen
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Theodoros Samaras
- School of Physics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physics, University of Malta, Msida, Malta
| |
Collapse
|
3
|
Thomas KS, Birch RE, Jones CRG, Vanderwert RE. Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder. Front Hum Neurosci 2022; 16:841633. [PMID: 35693540 PMCID: PMC9179647 DOI: 10.3389/fnhum.2022.841633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.
Collapse
Affiliation(s)
- Kai S. Thomas
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | | | - Catherine R. G. Jones
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Ross E. Vanderwert
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
4
|
Harmelech T, Roth Y, Tendler A. Deep TMS H7 Coil: Features, Applications & Future. Expert Rev Med Devices 2021; 18:1133-1144. [PMID: 34878347 DOI: 10.1080/17434440.2021.2013803] [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: 10/19/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) uses magnetic pulses to induce electrical current in the underlying neuronal tissue. A variety of TMS coils exist on the market, differing primarily in configuration, orientation, and flexibility of the wire windings of the coil. Deep TMSTM utilizes H-Coils, flexible coils with different configurations for stimulating different brain regions implicated in different neuropsychiatric disorders. The H7 Coil, designed to target primarily the medial prefrontal cortex and the anterior cingulate cortex, is FDA-cleared for obsessive-compulsive disorder (OCD). It was chosen as the focus of this review since it recently showed promise in various neuropsychiatric populations in addition to growing understanding of its mechanism of action (MOA). AREAS COVERED Here we assembled all peer-reviewed publications on the H7 Coil to showcase its efficacy in: (a) various OCD patient populations (e.g., different degrees of symptom severity, treatment resistance, comorbidities) (b) other neuropsychiatric populations (e.g., addiction, major depressive disorder and autism spectrum disorder). EXPERT OPINION While substantial evidence pertaining to the H7 Coil's efficacy as well as its MOA has accumulated, much work remains. In the final section of this review, we highlight areas of ongoing and future research that will further elucidate the coil's MOA as well as its full efficacy potential.
Collapse
Affiliation(s)
| | - Yiftach Roth
- BrainsWay Ltd.,Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aron Tendler
- BrainsWay Ltd.,Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Advanced Mental Health Care Inc, FL, USA
| |
Collapse
|
5
|
Bellato A, Norman L, Idrees I, Ogawa CY, Waitt A, Zuccolo PF, Tye C, Radua J, Groom MJ, Shephard E. A systematic review and meta-analysis of altered electrophysiological markers of performance monitoring in Obsessive-Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (GTS), Attention-Deficit/Hyperactivity disorder (ADHD) and Autism. Neurosci Biobehav Rev 2021; 131:964-987. [PMID: 34687698 DOI: 10.1016/j.neubiorev.2021.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
Altered performance monitoring is implicated in obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome (GTS), attention-deficit/hyperactivity disorder (ADHD) and autism. We conducted a systematic review and meta-analysis of electrophysiological correlates of performance monitoring (error-related negativity, ERN; error positivity, Pe; feedback-related negativity, FRN; feedback-P3) in individuals with OCD, GTS, ADHD or autism compared to control participants, or associations between correlates and symptoms/traits of these conditions. Meta-analyses on 97 studies (5890 participants) showed increased ERN in OCD (Hedge's g = 0.54[CIs:0.44,0.65]) and GTS (g = 0.99[CIs:0.05,1.93]). OCD also showed increased Pe (g = 0.51[CIs:0.21,0.81]) and FRN (g = 0.50[CIs:0.26,0.73]). ADHD and autism showed reduced ERN (ADHD: g=-0.47[CIs:-0.67,-0.26]; autism: g=-0.61[CIs:-1.10,-0.13]). ADHD also showed reduced Pe (g=-0.50[CIs:-0.69,-0.32]). These findings suggest overlap in electrophysiological markers of performance monitoring alterations in four common neurodevelopmental conditions, with increased amplitudes of the markers in OCD and GTS and decreased amplitudes in ADHD and autism. Implications of these findings in terms of shared and distinct performance monitoring alterations across these neurodevelopmental conditions are discussed. PROSPERO pre-registration code: CRD42019134612.
Collapse
Affiliation(s)
- Alessio Bellato
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Luke Norman
- Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Iman Idrees
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Carolina Y Ogawa
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Alice Waitt
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Pedro F Zuccolo
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Charlotte Tye
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Joaquim Radua
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Elizabeth Shephard
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK; Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
6
|
Carruthers S, Michelini G, Kitsune V, Hosang GM, Brandeis D, Asherson P, Kuntsi J. Early neurophysiological stimulus processing during a performance-monitoring task differentiates women with bipolar disorder from women with ADHD. Psychiatry Res 2021; 303:114088. [PMID: 34252636 DOI: 10.1016/j.psychres.2021.114088] [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: 03/17/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/21/2022]
Abstract
Adults with attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder (BD) may display similar cognitive impairments and clinical symptoms, which might reflect shared mechanisms. Initial evidence indicates disorder-specific and overlapping neurophysiological alterations using event-related potentials (ERPs) in individuals with BD or ADHD during attentional tasks, but it is unknown whether impairments generalize across other processes and tasks. We conduct the first comparison between women with ADHD (n = 20), women with BD (n = 20) and control women (n = 20) on ERPs from a performance-monitoring flanker task. The BD group showed a significantly attenuated frontal ERP of conflict monitoring (N2) compared to the ADHD group across both low-conflict (congruent) and high-conflict (incongruent) task conditions, and compared to controls in the high-conflict condition. However, when controlling for an earlier attentional ERP (frontal N1), which was significantly reduced in participants with BD compared to participants with ADHD and controls, N2 group differences were no longer significant. These results indicate that ERP differences in conflict monitoring may be attributable to differences in earlier attentional processes. These findings identify neural differences in early attention between BD and ADHD which precede conflict monitoring processes, potentially pointing to distinct neural mechanisms implicated in the two disorders.
Collapse
Affiliation(s)
- Sophie Carruthers
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Giorgia Michelini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK; Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Viryanaga Kitsune
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Georgina M Hosang
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London, London, UK
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.
| |
Collapse
|
7
|
Michael JA, Wang M, Kaur M, Fitzgerald PB, Fitzgibbon BM, Hoy KE. EEG correlates of attentional control in anxiety disorders: A systematic review of error-related negativity and correct-response negativity findings. J Affect Disord 2021; 291:140-153. [PMID: 34038831 DOI: 10.1016/j.jad.2021.04.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause substantial personal, social and economic burden. Altered attentional control has been shown to be present across anxiety disorders and is associated with specific changes in brain activity which can be recorded by electroencephalogram (EEG). These include changes in the EEG markers of error-related negativity (ERN) and correct-response negativity (CRN), both believed to reflect response monitoring and attentional control pathophysiology in anxiety. The aim of this review was to systematically assess the research on ERN and CRN in attentional control in individuals with clinical anxiety and healthy controls, across emotional and non-emotional attentional control. METHODS A comprehensive literature search was conducted for studies published prior to October 22nd, 2020. Details of the protocol for this systematic review were registered on PROSPERO (CRD42019144885). RESULTS 66 studies had their data extracted. All 66 studies measured ERN, with 85% finding significantly increased ERN amplitudes associated with clinical anxiety. Only 44 of the extracted studies analysed CRN and only ~20% of these found significant changes in CRN amplitude associated with individuals with clinical anxiety. LIMITATIONS There were several anxiety disorders that had either limited literature (i.e. specific phobia, separation anxiety disorder or agoraphobia) or nil literature (i.e. selective mutism) available. No extracted studies included samples of older adults (i.e. aged 60+ years), and only six extracted studies included measures of emotional attentional control. CONCLUSIONS Findings indicate the promising utility of ERN of attentional control as a robust, transdiagnostic trait marker of clinical anxiety.
Collapse
Affiliation(s)
- Jessica A Michael
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia.
| | - Michael Wang
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| | - Manreena Kaur
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| | - Kate E Hoy
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, 888 Toorak Rd, Camberwell, Victoria, Australia
| |
Collapse
|
8
|
Roth Y, Tendler A, Arikan MK, Vidrine R, Kent D, Muir O, MacMillan C, Casuto L, Grammer G, Sauve W, Tolin K, Harvey S, Borst M, Rifkin R, Sheth M, Cornejo B, Rodriguez R, Shakir S, Porter T, Kim D, Peterson B, Swofford J, Roe B, Sinclair R, Harmelech T, Zangen A. Real-world efficacy of deep TMS for obsessive-compulsive disorder: Post-marketing data collected from twenty-two clinical sites. J Psychiatr Res 2021; 137:667-672. [PMID: 33183769 DOI: 10.1016/j.jpsychires.2020.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Deep transcranial magnetic stimulation (dTMS) with the H7-coil was FDA cleared for obsessive-compulsive disorder (OCD) in August 2018 based on multicenter sham-controlled studies. Here we look at the efficacy of dTMS for OCD in real world practices. METHODS All dTMS clinics were asked to supply their data on treatment details and outcome measures. The primary outcome measure was response, defined by at least a 30% reduction in the Yale Brown Obsessive Compulsive Scale (YBOCS) score from baseline to endpoint. Secondary outcome measures included first response, defined as the first time the YBOCS score has met response criteria, and at least one-month sustained response. Analyses included response rate at the endpoint (after 29 dTMS sessions), number of sessions and days required to reach first response and sustained response. RESULTS Twenty-two clinical sites with H7-coils provided data on details of treatment and outcome (YBOCS) measures from a total of 219 patients. One-hundred-sixty-seven patients who had at least one post-baseline YBOCS measure were included in the main analyses. Overall first and sustained response rates were 72.6% and 52.4%, respectively. The response rate was 57.9% in patients who had YBOCS scores after 29 dTMS sessions. First response was achieved in average after 18.5 sessions (SD = 9.4) or 31.6 days (SD = 25.2). Onset of sustained one-month response was achieved in average after 20 sessions (SD = 9.8) or 32.1 days (SD = 20.5). Average YBOCS scores demonstrated continuous reduction with increasing numbers of dTMS sessions. CONCLUSIONS In real-world clinical practice, the majority of OCD patients benefitted from dTMS, and the onset of improvement usually occurs within 20 sessions. Extending the treatment course beyond 29 sessions results in continued reduction of OCD symptoms, raising the prospect of value for extended treatment protocols in non-responders.
Collapse
Affiliation(s)
- Yiftach Roth
- The Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; BrainsWay Ltd, Israel.
| | - Aron Tendler
- The Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; BrainsWay Ltd, Israel; Advanced Mental Health Care, 11903 Southern Blvd. Royal Palm Beach, FL 33411, USA
| | - Mehmet Kemal Arikan
- AKADEMIK Psychiatry& Psychotherapy Center Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B 34371 Osmanbey - Istanbul, Turkey
| | - Ryan Vidrine
- TMS Health Solutions, 3300 WEBSTER STREET, SUITE #402 OAKLAND, CA, 94609, USA
| | - David Kent
- NuMe TMS, 2375 S Cobalt Point Way #102, Meridian, ID, 83642, USA
| | - Owen Muir
- Brooklyn Minds, 347 Grand St, Brooklyn, NY, 11211, USA
| | - Carlene MacMillan
- Brooklyn Minds, 10 W 37th Street, 5th Floor, New York, NY, 10018, USA
| | - Leah Casuto
- Lindner Center of Hope, 4075 Old Western Row Rd, Mason, OH, 45040, USA
| | - Geoffrey Grammer
- Greenbrook TMS, 8405 Greensboro Drive, Suite 120 McLean, VA 22102, USA
| | - William Sauve
- Greenbrook TMS, 8405 Greensboro Drive, Suite 120 McLean, VA 22102, USA
| | - Kellie Tolin
- Greenbrook TMS, 1500 Sunday Dr #200, Raleigh, NC, 27607, USA
| | - Steven Harvey
- Greenbrook TMS, 11477, Olde Cabin Rd, Suite 210 St. Louis MO 63141, USA
| | - Misty Borst
- Greenbrook TMS, 8850, Stanford Boulevard, Suite 3300Columbia, MD 21045, USA
| | - Robert Rifkin
- Greenbrook TMS, 11477, Olde Cabin Rd, Suite 210 St. Louis MO 63141, USA
| | - Manish Sheth
- Achieve TMS, 5060 Shoreham Place Suite 100 San Diego, CA, 92122, USA
| | - Brandon Cornejo
- Achieve TMS, 516 SE Morrison St. Suite #309 Portland, OR, 97214, USA
| | - Raul Rodriguez
- Delray Center for Healing, 403 SE 1st St, Delray Beach, FL, 33483, USA
| | - Saad Shakir
- Silicon Valley TMS, 2039 Forest Ave Esthetician Freshman Classroom, San Jose, CA, 95128, USA
| | - Taylor Porter
- Prime TMS, 1811 Wakarusa Dr #102, Lawrence, KS, 66047, USA
| | - Deborah Kim
- 3535 Market St, Philadelphia, PA, 19104, USA
| | - Brent Peterson
- The family Living Institute, 1307 Jamestown Rd STE 202, Williamsburg, VA 23185, USA
| | - Julia Swofford
- TMS NW, 5512 NE 109th Ct ste n, Vancouver, WA, 98662, USA
| | - Brendan Roe
- TMS NW, 5512 NE 109th Ct ste n, Vancouver, WA, 98662, USA
| | | | | | - Abraham Zangen
- The Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
9
|
Kashyap H, Abramovitch A. Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions. Front Psychiatry 2021; 12:721601. [PMID: 34790136 PMCID: PMC8591286 DOI: 10.3389/fpsyt.2021.721601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neuropsychological functions in obsessive-compulsive disorder (OCD) have been extensively investigated. Despite some common findings across studies indicating deficient test performance across cognitive domains with small to medium effect sizes, results remain inconsistent and heterogeneous. However, multiple past attempts to identify moderators that may account for such variability have been unrewarding. Typical moderators including symptom severity, age at onset, medication status, and comorbid conditions failed to provide sufficient explanatory power. It has then been posited that these inconsistencies may be attributed to the inherent heterogeneous nature of the disorder (i.e., symptom dimensions), or to the natural fluctuation in symptom severity. However, recent meta-analyses suggest that these factors may not account for the persistent unexplained variability. Other potential factors-some of which are unique to neuropsychological testing-received scarce research attention, including definition of cognitive impairments, specificity and selection of test and outcome measures, and their limited ecological validity. Other moderators, particularly motivational aspects, and metacognitive factors (e.g., self-efficacy) were not previously addressed despite their potential association to OCD, and their documented impact on cognitive function. The aim of the present mini-review is to provide an updated succinct overview of the current status of the neuropsychological literature in OCD and expanding upon oft-neglected potential moderators and their putative impact on neuropsychological findings in OCD. Our goal is to highlight important avenues for further research and provide a road map for investigators in order to advance our understanding of cognitive functions in OCD that has been stagnant in the past decade.
Collapse
Affiliation(s)
- Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, United States
| |
Collapse
|