1
|
Duholm CS, Jensen S, Rask CU, Thomsen PH, Ivarsson T, Skarphedinsson G, Torp NC, Weidle B, Nissen JB, Højgaard DRMA. Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD. Child Psychiatry Hum Dev 2024; 55:1135-1145. [PMID: 36510026 DOI: 10.1007/s10578-022-01480-y] [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] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.
Collapse
Affiliation(s)
- Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
- Akershus University Hospital, Oslo, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Pinciotti CM, Van Kirk N, Horvath G, Storch EA, Mancebo MC, Abramowitz JS, Fontenelle LF, Goodman WK, Riemann BC, Cervin M. Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response. J Affect Disord 2024; 353:109-116. [PMID: 38452939 DOI: 10.1016/j.jad.2024.03.004] [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: 12/12/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. METHODS The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs. RESULTS Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. LIMITATIONS Findings are limited by a naturalistic treatment sample with variation in treatment provision. CONCLUSIONS Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.
Collapse
Affiliation(s)
- Caitlin M Pinciotti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Nathaniel Van Kirk
- OCD Institute, Office of Clinical Assessment and Research (OCAR), McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Gregor Horvath
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Mancebo
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leonardo F Fontenelle
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Matti Cervin
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Bramante S, Rigardetto S, Borgogno R, Mehanović E, Pellegrini L, Albert U, Maina G. Episodic obsessive-compulsive disorder and bipolar spectrum disorder: new evidence from a large Italian OCD sample. Int J Psychiatry Clin Pract 2023; 27:330-337. [PMID: 37401917 DOI: 10.1080/13651501.2023.2231040] [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: 08/03/2022] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Obsessive-Compulsive Disorder (OCD) has been considered to be a chronic illness; however, some authors described a subtype of OCD characterised by symptom-free periods of time: Episodic-OCD (E-OCD). Only few studies focussed on this subtype of the disorder. The objectives of this research were to study the association between the episodic course of the disorder and lifetime psychiatric comorbidities and to investigate socio-demographic and other clinical features correlated to the episodic course. METHODS The sample is composed of adult OCD patients. The course was defined episodic when at least one circumscribed symptom-free interval of at least 6 months was present. The sample was divided into two subgroups: Episodic-OCD and Chronic-OCD. Differences between groups were analysed with Student's t-test, χ2 tests, Fisher test and multivariate logistic regression. RESULTS Data regarding 585 individuals were collected. 14.2% (N = 83) of our sample had an episodic course. Bipolar I comorbid disorder, abrupt onset, lower severity of illness and lower rates of repeating compulsions were associated with the likelihood of having an E-OCD. CONCLUSIONS Our findings confirm that a significant proportion of OCD patients have an episodic course and that E-OCD could represent a specific endophenotype.
Collapse
Affiliation(s)
- Stefano Bramante
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
- Psychiatry Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Sylvia Rigardetto
- Psychiatry Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Roberta Borgogno
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
- Psychiatry Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Emina Mehanović
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
- Centre for Psychedelic Research, Imperial College London, London, UK
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano-Isontina - ASUGI, UCO Clinica Psichiatrica, Trieste, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
- Psychiatry Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| |
Collapse
|
6
|
Smárason O, Højgaard DRMA, Jensen S, Storch EA, Arnkelsson GB, Wolters LH, Torp NC, Melin K, Weidle B, Nissen JB, Hybel KA, Thomsen PH, Ivarsson T, Skarphedinsson G. Long-term functional impairment in pediatric OCD after and during treatment: An analysis of distinct trajectories. Psychiatry Res 2023; 324:115223. [PMID: 37119789 DOI: 10.1016/j.psychres.2023.115223] [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: 01/18/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
The present study aimed to: (a) identify latent class trajectories of OCD-related functional impairment, before, during and over three years after stepped-care treatment in children and adolescents with OCD; (b) describe these classes according to pretreatment characteristics; (c) identify predictors of trajectory class membership and (d) examine the relationship of functional impairment trajectory classes with OCD symptom severity trajectory classes. The sample consisted of 266 children and adolescents (aged 7-17 years) with OCD, participating in the Nordic long-term OCD treatment study. Latent class growth analysis was conducted using Child Obsessive-Compulsive Impact Scale-Revised (COIS-R) data from children and parents on seven assessment points over a three-year period. A 3-class solution was identified. The largest class (70.7%) initiated treatment with lower functional impairment and obtained moderate reduction which was maintained over time. The second class (24.4%) initiated with higher functional impairment which rapidly diminished over time. The third and smallest class (4.9%), initiated with moderate functional impairment which remained stable over time. The classes differed on measures of OCD severity and comorbid symptoms. Most participants improved with treatment and maintained low levels of impairment. However, a subgroup distinguished by higher levels of ADHD symptoms, remained at pretreatment levels of impairment throughout.
Collapse
Affiliation(s)
- Orri Smárason
- University of Iceland, Faculty of Psychology, Reykjavik, Iceland.
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Lidewij H Wolters
- Accare Child Study Center, Groningen, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Nor Christian Torp
- Akershus University Hospital, Oslo, Norway; Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Child and Adolescent Psychiatry, Gothenburg, Sweden
| | - Bernhard Weidle
- Regional Center for Child Mental Health and Child Welfare, Norwegian University of Science and Technology and St. Olavs University Hospital, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Katja Anna Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | | | | |
Collapse
|
7
|
Melkonian M, McDonald S, Scott A, Karin E, Dear BF, Wootton BM. Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2022; 318:175-184. [PMID: 36030999 DOI: 10.1016/j.jad.2022.08.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common psychiatric condition that results in significant distress and impairment, and high societal costs. OCD is widely considered to be a chronic condition, however, our understanding of the chronicity of the disorder, and the incidence of spontaneous remission, has largely relied on longitudinal studies of individuals who have received treatment. The aim of the current study is to examine symptom improvement and rate of spontaneous remission in individuals with OCD who were assigned to a no-treatment control group within a randomized controlled trial using a meta-analytic approach. Twelve studies (n = 282; mean age = 35.52; 60.03 % female) were included in the meta-analysis. The pooled within-group effect size was negligible (g = -0.14; 95 % CI [-0.25, -0.04]) and only 4 % of participants demonstrated spontaneous remission across an average of 10.92 weeks (event rate = 0.04; [95 % CI: 0.01, 0.11]). Sample size and duration of OCD symptoms significantly moderated the effect size for symptom change. No moderators were found for symptom remission. The findings add to the small body of literature demonstrating that OCD has a chronic and unremitting course without treatment.
Collapse
Affiliation(s)
- Maral Melkonian
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Amelia Scott
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Eyal Karin
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Blake F Dear
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia; Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, NSW, Australia.
| |
Collapse
|
8
|
Assessing response, remission, and treatment resistance in patients with obsessive-compulsive disorder with and without tic disorders: results from a multicenter study. CNS Spectr 2022; 27:747-753. [PMID: 34528504 DOI: 10.1017/s109285292100081x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Highlighting the relationship between obsessive-compulsive disorder (OCD) and tic disorder (TD), two highly disabling, comorbid, and difficult-to-treat conditions, Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) acknowledged a new "tic-related" specifier for OCD, ie, obsessive-compulsive tic-related disorder (OCTD). As patients with OCTD may frequently show poor treatment response, the aim of this multicenter study was to investigate rates and clinical correlates of response, remission, and treatment resistance in a large multicenter sample of OCD patients with versus without tics. METHODS A sample of 398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from 10 different psychiatric departments across Italy. For the purpose of the study, treatment response profiles in the whole sample were analyzed comparing the rates of response, remission, and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to identify possible factors associated with treatment response. RESULTS The remission group was associated with later ages of onset of TD and OCD. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts emerged in the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement. CONCLUSIONS Although remission was associated with later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response with a significant impairment in quality of life for both patients and their caregivers, suggesting a worse profile of treatment response for patients with OCTD.
Collapse
|
9
|
Cruz S, Gutiérrez-Rojas L, González-Domenech P, Díaz-Atienza F, Martínez-Ortega JM, Jiménez-Fernández S. Deep brain stimulation in obsessive-compulsive disorder: Results from meta-analysis. Psychiatry Res 2022; 317:114869. [PMID: 36240634 DOI: 10.1016/j.psychres.2022.114869] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 01/04/2023]
Abstract
The aim of this work is to investigate the effectiveness of Deep Brain Stimulation (DBS) in patients with severe Obsessive Compulsive Disorder (OCD) who are resistant to pharmacological treatments, focusing on obsessive compulsive, depressive and anxiety symptoms as well as global function. A systematic review and meta-analysis including 25 studies (without language restrictions) from between 2003 and 2020 was performed. A total of 303 patients were evaluated twice (before and after DBS). After DBS treatment OCD patients with resistance to pharmacological treatments showed a significant improvement of obsessive-compulsive symptoms (25 studies; SMD=2.39; 95% CI, 1.91 to 2.87; P<0.0001), depression (9 studies; SMD= 1.19; 95%CI, 0.84 to 1.54; P<0.0001), anxiety (5 studies; SMD=1.00; 95%CI, 0.32 to 1.69; P=0.004) and functionality (7 studies; SMD=-3.51; 95%CI, -5.00 to -2.02; P=0.005) measured by the standardized scales: Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Global Assessment of Function (GAF). Publication bias were discarded by using funnel plot. The main conclusions of this meta-analysis highlight the statistically significant effectiveness of DBS in patients with severe OCD who are resistant to conventional pharmacological treatments, underlying its role in global functioning apart from obsessive-compulsive symptoms.
Collapse
Affiliation(s)
- Sheila Cruz
- Child and Adolescent Mental Health Service, Jaén University Hospital Complex, Jaén, Spain
| | - Luis Gutiérrez-Rojas
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain; Psychiatry Service, Hospital San Cecilio, Granada, Spain.
| | | | - Francisco Díaz-Atienza
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain; Child and Adolescent Mental Health Service, Granada Virgen de las Nieves University Hospital, Granada, Spain
| | - José M Martínez-Ortega
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain
| | - Sara Jiménez-Fernández
- Child and Adolescent Mental Health Service, Jaén University Hospital Complex, Jaén, Spain; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
| |
Collapse
|
10
|
Tantrarungroj T, Saipanish R, Lotrakul M, Kusalaruk P, Wisajun P. Psychometric Properties and Factor Analysis of Family Accommodation Scale For Obsessive Compulsive Disorder-Interviewer-Rated-Thai Version (FAS-T). Psychol Res Behav Manag 2022; 15:1607-1615. [PMID: 35789732 PMCID: PMC9250339 DOI: 10.2147/prbm.s358251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Obsessive compulsive disorder (OCD) is a longstanding and debilitating psychiatric disorder which is related to a level of distress in family members of patients who suffer from it. The Family Accommodation Scale (FAS) for OCD helps medical personnel have a clearer and deeper understanding of the pattern of family accommodation. This study aimed to translate FAS into Thai and examine its psychometric properties and factor analysis. Patients and Methods There were fifty participants who were relatives of OCD patients. Demographic data were collected along with completion of the FAS-T, the Patient Health Questionnaire (PHQ-9), the Pictorial Thai Quality of Life (PTQL), and the Thai Florida Obsessive Compulsive Inventory (FOCI-T), and then analyzed. The severity scales of FOCI-T from 44 OCD patients who had relatives participating in this study were collected from medical records and examined. Psychometric properties and factor analysis of FAS-T were tested. Results The average total score of FAS-T was 8.36±8.77 ranging between 0 to 25. The mean scores of FOCI-severity scale in relatives, PHQ-9, PTQL, and FOCI-severity scale in OCD patients, were 1.04±1.97, 4.04±3.73, 52.31±13.99, 8.95±4.36, respectively. The Cronbach’s coefficient alpha of FAS-T was 0.84, which demonstrated good internal consistency. The item-level CVI and scale-level CVI were at an excellent level. The Spearman’s rho between the FAS and FOCI symptom checklist, FOCI severity score, and PHQ-9 PTQL, were weakly correlated which implied acceptable discriminant validity. Exploratory Factor Analysis (EFA) suggested a three-factor solution as participation, modification, and facilitation. Conclusion The Family Accommodation Scale for Obsessive–Compulsive Disorder—Interviewer-Rated - Thai version is a psychometrically reliable and valid measure for assessing accommodation in family members of OCD patients.
Collapse
Affiliation(s)
- Thanita Tantrarungroj
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ratana Saipanish
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichaya Kusalaruk
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarabhorn Wisajun
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
11
|
Neural correlates of emotional reactivity predict response to cognitive-behavioral therapy in obsessive-compulsive disorder. J Affect Disord 2022; 308:398-406. [PMID: 35427712 DOI: 10.1016/j.jad.2022.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Examining predictive biomarkers to identify individuals who will likely benefit from a specific treatment is important for the development of targeted interventions. The late positive potential (LPP) is a neural marker of attention and elaborated stimulus processing, and increased LPP responses to negative stimuli are characteristic of pathological anxiety. The present study investigated whether LPP reactivity would prospectively predict response to cognitive-behavioral therapy (CBT), the first-line treatment for obsessive-compulsive disorder (OCD). METHODS To this end, the LPP in response to negative as compared to neutral pictures was examined in 45 patients with OCD, who underwent CBT in a naturalistic outpatient setting. LPP amplitudes were used as predictors of symptom reduction after CBT. RESULTS We found that higher LPP amplitudes to negative relative to neutral stimuli were predictive of lower self-reported OCD symptoms after completion of CBT, controlling for pre-treatment symptoms. Further, LPP reactivity was negatively correlated with self-reported habitual use of suppression in everyday life. LIMITATIONS Some participants had already begun treatment at the time of study participation. Overall, results need further replication in larger samples and standardized therapy settings. CONCLUSIONS The current findings suggest that patients with increased emotional reactivity benefit more from CBT, possibly through less avoidance of anxiety-provoking stimuli during exposure with response prevention, a crucial component in CBT for OCD. Although its clinical utility still needs to be evaluated further, the LPP constitutes a promising candidate as a prognostic marker for CBT response in OCD.
Collapse
|
12
|
Saradhadevi S, Hemavathy V. Effectiveness of sleep hygiene to reduce insomnia among persons with suffering with obsessive compulsive disorder-pilot analysis. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.462466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Obsessive-compulsive disorder frequently have insomnia, and those with acute insomnia who also have mental comorbidities without therapy, they are more likely to develop persistent insomnia. We present a case of OCD with acute insomnia that was successfully treated with early non-pharmacological sleep psychiatry intervention. Sleep is necessary for brain function and the maintenance of cognitive and emotional processes. Insomnia and anxiety problems are common, and they’re linked to a lot of damage and disability. In addition to being strongly comorbid with major depressive illness, there is evidence that sleeplessness and anxiety disorders frequently co-occur. The majority of insomnia psychological therapies include sleep hygiene. In terms of clinical practice, these instructions are a solid place to start. Obsessive-compulsive disorder is associated with sleep difficulties. Sleep difficulties are also common in people with obsessive-compulsive disorder, with up to 48% reporting them. Obsessive compulsive disorder research reveals a link between specific sleep habits and clinical factors such the severity of obsessive-compulsive symptoms, treatment resistance, and the age at which the disorder.
Collapse
|
13
|
Saradhadevi S, Hemavathy V. Effectiveness of sleep hygiene to reduce insomnia among persons with suffering with obsessive compulsive disorderpilot analysis. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.484488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Obsessive-compulsive disorder frequently have insomnia, and those with acute insomnia who also have mental comorbidities without therapy, they are more likely to develop persistent insomnia. We present a case of OCD with acute insomnia that was successfully treated with early non-pharmacological sleep psychiatry intervention. Sleep is necessary for brain function and the maintenance of cognitive and emotional processes. Insomnia and anxiety problems are common, and they’re linked to a lot of damage and disability. In addition to being strongly comorbid with major depressive illness, there is evidence that sleeplessness and anxiety disorders frequently co-occur. The majority of insomnia psychological therapies include sleep hygiene. In terms of clinical practice, these instructions are a solid place to start. Obsessive-compulsive disorder is associated with sleep difficulties. Sleep difficulties are also common in people with obsessive-compulsive disorder, with up to 48% reporting them. Obsessive compulsive disorder research reveals a link between specific sleep habits and clinical factors such the severity of obsessive-compulsive symptoms, treatment resistance, and the age at which the disorder.
Collapse
|
14
|
Alić M, de Leeuw A, Selier J, van Megen H, Visser H. Responsiveness and other psychometric properties of the Y-BOCS Severity Scale-Second Edition (Y-BOCS-II) in a Dutch clinical sample. Clin Psychol Psychother 2022; 29:1355-1363. [PMID: 35080071 DOI: 10.1002/cpp.2715] [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: 10/09/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used clinician-rated interview to assess the presence and severity of obsessive-compulsive disorder (OCD). The scale is revised (Y-BOCS-II) to overcome several psychometric limitations, for example by extending the scoring for better discrimination within higher severity levels. The aim of the present study was to examine the responsiveness and other psychometric properties of the Y-BOCS-II Severity Scale in a Dutch clinical sample. The Y-BOCS-II is translated into Dutch (Y-BOCS-II) and administered to 110 patients seeking therapy for OCD. This was done twice, before and after treatment. The original Y-BOCS was simultaneously rated. Self-report measures regarding depression, symptom severity and OCD symptoms were assessed. The Y-BOCS-II has a good internal consistency (Cronbach's α=0.84), test-retest (ICC=0.89) and inter-rater reliability (ICC=0.98). The construct validity proved to be modest to good. The responsiveness over time was in favour of the Y-BOCS-II, compared with the YBOCS-I, particularly in the moderate-severely affected OCD patients. The Y-BOCS-II severity scale is a reliable and valid instrument for accurately assessing the severity of OCD symptoms and for measuring treatment-induced change. This second version also has clinical and psychometric advantages over the YBOCS-I. When these findings are sufficiently replicated, use of the YBOCS-II as the new common standard seems recommendable.
Collapse
Affiliation(s)
- Mediha Alić
- Marina de Wolf centrum, Mental Health Care Institute, GGZ Centraal, Ermelo, the Netherlands
| | - Aart de Leeuw
- Altrecht Academisch Angstcentrum, Mental Health Care Institute, Utrecht, the Netherlands
| | - Jonathan Selier
- Marina de Wolf centrum, Mental Health Care Institute, GGZ Centraal, Ermelo, the Netherlands
| | - Harold van Megen
- Marina de Wolf centrum, Mental Health Care Institute, GGZ Centraal, Ermelo, the Netherlands
| | - Henny Visser
- Marina de Wolf centrum, Mental Health Care Institute, GGZ Centraal, Ermelo, the Netherlands
| |
Collapse
|
15
|
Ziegler S, Bednasch K, Baldofski S, Rummel-Kluge C. Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLoS One 2021; 16:e0261169. [PMID: 34898630 PMCID: PMC8668120 DOI: 10.1371/journal.pone.0261169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/27/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although obsessive-compulsive disorder (OCD) is one of the most common mental disorders, it takes up to 17 years for patients with OCD to receive adequate therapy. According to existing outdated literature, this study aimed to investigate the current duration between symptom onset and diagnosis and between diagnosis and the beginning of therapy separately. METHODS In a cross-sectional study, N = 100 patients diagnosed with OCD undergoing treatment in a psychiatric outpatient department were assessed, using self-report questionnaires on sociodemographic and clinical variables. Based on self-reported information, the durations between age at symptom onset and age at diagnosis, and between age at diagnosis and beginning of therapy were calculated. To investigate associated factors, two subgroups of patients, one with a short duration between symptom onset and diagnosis < 7 years, and another with a long duration between symptom onset and diagnosis ≥ 7 years, respectively, were compared. RESULTS AND CONCLUSION Patients reported first symptoms of OCD at a mean age of 18.72 years. The mean duration between age at symptom onset and age at diagnosis was 12.78 years and the mean duration between age at diagnosis and the beginning of therapy was 1.45 years. Subgroup comparison indicated that patients with a short duration between symptom onset and diagnosis were significantly younger than patients with a long duration. However, patients with a short duration between symptom onset and diagnosis were at an older age when they reported first symptoms of OCD. Further, they showed less severe symptoms of OCD, higher functioning levels, and less self-stigmatization than patients with a long duration. It can be concluded that the duration until patients with OCD are diagnosed correctly and receive adequate treatment is still very long. Therefore, the duration between symptom onset and diagnosis should be shortened. Further, the duration between diagnosis and the beginning of therapy could be a good additional approach to reduce the overall duration of untreated disorder.
Collapse
Affiliation(s)
- Sina Ziegler
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Klara Bednasch
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| |
Collapse
|
16
|
Fletcher TL, Boykin DM, Helm A, Dawson DB, Ecker AH, Freshour J, Teng E, Lindsay J, Hundt NE. A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder in rural Veterans. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1970983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Terri L. Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Derrecka M. Boykin
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Ashley Helm
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Darius B. Dawson
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Anthony H. Ecker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Jessica Freshour
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Ellen Teng
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Jan Lindsay
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| | - Natalie E. Hundt
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas
| |
Collapse
|
17
|
Bürkle JJ, Fendel JC, Schmidt S. Mindfulness-based and acceptance-based programmes in the treatment of obsessive-compulsive disorder: a study protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e050329. [PMID: 34172553 PMCID: PMC8237723 DOI: 10.1136/bmjopen-2021-050329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cognitive-behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive-compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes' effectiveness. METHODS AND ANALYSIS We will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence. ETHICS AND DISSEMINATION Ethical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.
Collapse
Affiliation(s)
| | - Johannes Caspar Fendel
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| |
Collapse
|
18
|
Tibi L, Asher S, van Oppen P, van Balkom AJLM, Eikelenboom M, Visser HA, Penninx BW, Anholt GE. The correlates of social phobia in OCD: Findings from a large clinical sample. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:312-332. [PMID: 33870535 DOI: 10.1111/bjc.12292] [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: 07/14/2020] [Revised: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder, often complicated with comorbidities. Social phobia (SP) is the most frequent co-occurring anxiety disorder in OCD, associated with increased clinical severity. However, no study had examined the relevance of interpersonal processes in this comorbidity, which are at the core of SP. This study characterized the clinical (i.e., symptom profile, age of onset, chronicity, and comorbidity), vulnerability (i.e., childhood trauma, negative life events), and interpersonal (attachment style, expressed emotion, and social support) correlates of comorbid SP in a large sample of OCD patients. METHODS We analysed the data of 382 OCD patients participating in the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. We examined the correlates of SP in OCD using self-report questionnaires and structured clinical interviews. In addition, data of 312 non-OCD SP patients were drawn from the Netherlands Study of Depression and Anxiety (NESDA), to compare the age of onset of SP between groups. Descriptive univariate analyses were followed by backward stepwise logistic regression analyses. RESULTS Social phobia was present among approximately 20% of OCD patients. Social phobia in OCD was associated with increased depression severity and decreased ratings of secure attachment style. Among OCD patients, SP had a significantly earlier age onset as compared to SP in non-OCD patients. CONCLUSION Social phobia in OCD might render a vulnerable clinical picture, characterized with early onset of SP symptoms, insecure attachment style, and increased depressive symptoms. Future studies should use prospective designs to better understand the nature of comorbid SP in OCD. PRACTITIONER POINTS Approximately one fifth of OCD patients were diagnosed with comorbid social phobia in a large representative clinical sample. OCD patients with comorbid social phobia presented with a vulnerable clinical picture, characterized with increased depression severity and decreased ratings of secure attachment style. Social phobia in OCD was associated with an earlier AOO as compared to the AOO of social phobia without OCD. The findings are limited by a cross-sectional design; thus, causality could not be assessed. Research is needed to further examine the mechanisms of comorbid social phobia in OCD.
Collapse
Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sapir Asher
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Patricia van Oppen
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Merijn Eikelenboom
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Henny A Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands
| | - Brenda W Penninx
- Amsterdam UMC, Location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
19
|
Vellozo AP, Fontenelle LF, Torresan RC, Shavitt RG, Ferrão YA, Rosário MC, Miguel EC, Torres AR. Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates. J Clin Med 2021; 10:jcm10020274. [PMID: 33451078 PMCID: PMC7828517 DOI: 10.3390/jcm10020274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
Collapse
Affiliation(s)
- Aline P. Vellozo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
- D’Or Institute for Research and Education & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Correspondence: ; Tel.: +61-3-990-29755
| | - Ricardo C. Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Roseli G. Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Ygor A. Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90570-080, Brazil;
| | - Maria C. Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil;
| | - Euripedes C. Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| |
Collapse
|
20
|
Labad J, Melia CS, Segalàs C, Alonso P, Salvat-Pujol N, Real E, Ferrer Á, Jiménez-Murcia S, Soriano-Mas C, Soria V, Menchón JM. Sex differences in the association between obsessive-compulsive symptom dimensions and diurnal cortisol patterns. J Psychiatr Res 2021; 133:191-196. [PMID: 33352399 DOI: 10.1016/j.jpsychires.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 10/25/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
Previous studies in non-clinical populations suggest that obsessive-compulsive symptoms are associated with hypothalamic-pituitary-adrenal (HPA) axis measures and that there are sex differences in these associations. We aimed to replicate these findings in a sample of 57 patients with obsessive-compulsive disorder (OCD) and 98 healthy subjects. Current and lifetime OCD symptom dimensions were assessed with the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS). Depressive symptoms and state and trait anxiety were also assessed. The following HPA axis measures were analysed in saliva: the diurnal cortisol slope (calculated using two formulas: [1] awakening to 11 p.m. [AWE diurnal slope] and [2] considering fixed time points [FTP diurnal slope] from 10 a.m. to 11 p.m.) and the dexamethasone suppression test ratio (DSTR) after 0.25 mg of dexamethasone. Multiple linear regression analyses were conducted to explore the contribution of OCD symptom dimensions to each HPA axis measure while adjusting for age, sex, BMI, smoking, trait anxiety and depressive symptoms. A sex-specific association between current ordering/symmetry symptoms and AWE diurnal cortisol slope (positive association [flattened slope] in men, inverse association [stepper slope] in women) was found. Two similar sex by OCD dimensions interactions were found for lifetime aggressive and ordering/symmetry symptoms and both (FTP, AWE) diurnal cortisol slopes. Current and lifetime hoarding symptoms were associated to a more flattened FTP diurnal cortisol slope in women. The DSTR was not associated with OCD symptoms. The lifetime interference in functionality was associated with a more flattened AWE diurnal cortisol slope. In conclusion, our study suggests that there are sex differences in the association between OCD subtypes and specific HPA axis measures.
Collapse
Affiliation(s)
- Javier Labad
- Consorci Sanitari del Maresme, Mataró, Spain; Institut d'Investigació Sanitària Parc Taulí (I3PT), Sabadell, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristian Sebastian Melia
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain
| | - Cinto Segalàs
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain
| | - Pino Alonso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain
| | - Neus Salvat-Pujol
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Spain
| | - Eva Real
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain
| | - Álex Ferrer
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, I3PT, Sabadell, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain; Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Carles Soriano-Mas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain.
| | - José Manuel Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group-Psychiatry and Mental Health, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Spain.
| |
Collapse
|
21
|
van Geijtenbeek-de Vos van Steenwijk M, de Leeuw A, van Megen H, Selier J, Visser H. Proof of Principle: Is a Pre-treatment Behavior Approach Test a Potential Predictor for Response to Intensive Residential Treatment in Patients With Treatment Refractory Obsessive Compulsive Disorder? Front Psychiatry 2021; 12:662069. [PMID: 34366912 PMCID: PMC8333859 DOI: 10.3389/fpsyt.2021.662069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with severe and treatment refractory obsessive compulsive disorder (OCD) are usually referred to a specialized center for intensive residential treatment (IRT), consisting of exposure and response prevention (EX/RP), pharmacotherapy and additional therapies. About 50% of the patients does not respond to IRT. Currently we are not able to predict treatment response. If we were to have predictive tools, we could personify treatment at an earlier stage. Recent studies show that early adherence and willingness to EX/RP and low avoidance during EX/RP measured during treatment were associated with treatment response. In this observational study willingness and ability of patients with severe and treatment refractory OCD (N = 58) is conceptualized by a behavioral measurement, measured before the start of 12 weeks of IRT, using a Behavior Approach Test (BAT), as opposed to relying on self-report measurements. A medium or strong association between pre-treatment performance on the BAT and treatment response would justify next steps to test the BAT as a predictive tool for IRT. Results of regression analyses showed that there is a significant association between the performance on the BAT and change in OCD symptom severity after IRT. However, the effect-size is too small to use the BAT in its current form as predictor in clinical practice. The principle of the association between pre-treatment behaviorally measured willingness and ability to fully engage in EX/RP, and treatment response has now been proven. To ultimately design a predictive tool, future research is needed to refine a behavioral measurement of pre-treatment willingness and ability.
Collapse
Affiliation(s)
| | - Aart de Leeuw
- Academisch Angstcentrum, Altrecht, Utrecht, Netherlands
| | - Harold van Megen
- Marina de Wolfcentrum, Centrum Voor Psychotherapie, GGZ Centraal, Ermelo, Netherlands
| | - Jonathan Selier
- Marina de Wolfcentrum, Centrum Voor Psychotherapie, GGZ Centraal, Ermelo, Netherlands
| | - Henny Visser
- Marina de Wolfcentrum, Centrum Voor Psychotherapie, GGZ Centraal, Ermelo, Netherlands
| |
Collapse
|
22
|
Jensen S, Højgaard DRMA, Hybel KA, Mortensen EL, Skarphedinsson G, Melin K, Ivarsson T, Nissen JB, Weidle B, Valderhaug R, Torp NC, Dahl K, Compton S, Thomsen PH. Distinct trajectories of long-term symptom severity in pediatric obsessive-compulsive disorder during and after stepped-care treatment. J Child Psychol Psychiatry 2020; 61:969-978. [PMID: 31736082 DOI: 10.1111/jcpp.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/02/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND First-line treatments for pediatric obsessive-compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). No studies have thus far identified distinct classes and associated predictors of long-term symptom severity during and after treatment. Yet, these could form the basis for more personalized treatment in pediatric OCD. METHOD The study included 269 OCD patients aged 7-17 years from the Nordic Long-term OCD Treatment Study (NordLOTS). All participants received stepped-care treatment starting with 14 weekly sessions of manualized CBT. Nonresponders were randomized to either prolonged CBT or SSRIs. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale at seven time points from pre- to post-treatment and over a three-year follow-up. Latent class growth analysis (LCGA) was performed to identify latent classes of symptom severity trajectories. Univariate and multivariate analyses were used to detect differences between classes and identify predictors of trajectory class membership including several clinical and demographic variables. TRIAL REGISTRY Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. RESULTS Three LCGA classes were identified: (a) acute, sustained responders (54.6%); (b) slow, continued responders (23.4%); and (c) limited long-term responders (21.9%). Class membership was predicted by distinct baseline characteristics pertaining to age, symptom severity, contamination/cleaning and anxiety symptoms. CONCLUSIONS The LCGA suggests three distinct trajectory classes of long-term symptom severity during and after treatment in pediatric OCD with different clinical profiles at pretreatment. The results point to required clinical attention for adolescent patients with contamination/cleaning and anxiety symptoms who do not show convincing responses to first-line treatment even though they may have reached the established cutoff for treatment response.
Collapse
Affiliation(s)
- Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Katja A Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Robert Valderhaug
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Kitty Dahl
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| |
Collapse
|
23
|
Boger S, Ehring T, Berberich G, Werner GG. Impact of childhood maltreatment on obsessive-compulsive disorder symptom severity and treatment outcome. Eur J Psychotraumatol 2020; 11:1753942. [PMID: 33488994 PMCID: PMC7803079 DOI: 10.1080/20008198.2020.1753942] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Preliminary evidence suggests childhood maltreatment to play a causal role in the development and maintenance of obsessive-compulsive disorder (OCD). However, both the effect of childhood maltreatment on the course of OCD treatment and the role of specific subtypes of maltreatment remain largely unknown. Objective: This study aimed to investigate the relationship between childhood maltreatment and the severity and time course of OCD symptoms within a clinical sample of OCD patients (N = 68). We hypothesized that higher levels of childhood maltreatment in OCD patients would be associated with higher symptom severity and worse treatment outcomes. Method: Assessments of childhood maltreatment, OCD symptomatology, and related variables were completed in a sample of OCD patients before and after inpatient treatment as well as at 6 month follow-up. Results: Emotional abuse, sexual abuse and neglect were highly prevalent in our sample. Additionally, the severity of experienced childhood maltreatment was associated with higher OCD symptom severity, with the strongest association found for emotional abuse. Hierarchical linear models indicated that patients with childhood maltreatment showed higher OCD symptom severity at pre-treatment, post-treatment, and follow-up compared to patients without these experiences. However, childhood maltreatment did not moderate symptom improvement during treatment. Conclusion: Thus, although childhood maltreatment is not related to treatment outcome, it is highly prevalent among OCD patients and childhood trauma survivors still show higher OCD symptom severity after treatment. Therefore, childhood maltreatment should be considered in psychological interventions in individuals with OCD.
Collapse
Affiliation(s)
- Sabrina Boger
- Department of Psychology, LMU Munich, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Götz Berberich
- Psychosomatic Clinic Windach, Academic Teaching Hospital of LMU Munich, Windach, Germany
| | | |
Collapse
|
24
|
Taylor S, Asmundson GJG. Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment. J Anxiety Disord 2020; 72:102231. [PMID: 32447204 PMCID: PMC7252157 DOI: 10.1016/j.janxdis.2020.102231] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Steven Taylor
- Department of Psychiatry, University of British Columbia, Canada.
| | | |
Collapse
|
25
|
The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample. Eur Psychiatry 2020; 44:76-82. [DOI: 10.1016/j.eurpsy.2017.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 11/23/2022] Open
Abstract
AbstractBackground:Depression is the most common comorbidity in obsessive-compulsive disorder (OCD). However, the mechanisms of depressive comorbidity in OCD are poorly understood. We assessed the directionality and moderators of the OCD-depression association over time in a large, prospective clinical sample of OCD patients.Methods:Data were drawn from 382 OCD patients participating at the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study. Cross-lagged, structural equation modeling analyses were used to assess the temporal association between OCD and depressive symptoms. Assessments were conducted at baseline, two-year and four-year follow up. Cognitive and interpersonal moderators of the prospective association between OCD and depressive symptoms were tested.Results:Cross-lagged analyses demonstrated that OCD predicts depressive symptoms at two-year follow up and not vice a versa. This relationship disappeared at four-year follow up. Secure attachment style moderated the prospective association between OCD and depression.Conclusions:Depressive comorbidity in OCD might constitute a functional consequence of the incapacitating OCD symptoms. Both OCD and depression symptoms demonstrated strong stability effects between two-year and four-year follow up, which may explain the lack of association between them in that period. Among OCD patients, secure attachment represents a buffer against future depressive symptoms.
Collapse
|
26
|
Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Hendriks GJ, Anholt GE. Childhood trauma and attachment style predict the four-year course of obsessive compulsive disorder: Findings from the Netherlands obsessive compulsive disorder study. J Affect Disord 2020; 264:206-214. [PMID: 32056752 DOI: 10.1016/j.jad.2019.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/08/2019] [Accepted: 12/19/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients' care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators. METHODS We used the baseline, two and four-year data of 382 adult OCD patients participating in the naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Remission was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Predictors of outcome were assessed at baseline, via clinician-rated and self-report instruments. RESULTS Remission at two and at four-year follow-up ranged from 11% to 26%. Early age of onset and the presence of childhood trauma predicted a worse four-year course. Secure attachment style emerged as a protective predictor of improved outcome. LIMITATIONS The naturalistic design of our study did not enable a systematic estimation the effect of treatments received during the follow-up period. Furthermore, age of onset and childhood trauma were assessed retrospectively, which may contribute to recall bias. CONCLUSION Results coincide with previous prediction research and stress the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed.
Collapse
Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Merijn Eikelenboom
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Gert-Jan Hendriks
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, the Netherlands; Institute of Integrated Mental Health Care "Pro Persona," "Overwaal" Centre of Expertise for Anxiety Disorders OCD and PTSD Nijmegen, the Netherlands; Radboud University Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
27
|
Effects of Bergen 4-Day Treatment on Resting-State Graph Features in Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:973-982. [PMID: 32299791 DOI: 10.1016/j.bpsc.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Exposure and response prevention is an effective treatment for obsessive-compulsive disorder (OCD), but it is unclear how symptom reduction is related to changes in the brain. We aimed to determine the effects of a 4-day concentrated exposure and response prevention program (Bergen 4-day treatment) on the static and dynamic functional connectome in patients with OCD. METHODS Thirty-four patients with OCD (25 unmedicated) underwent resting-state functional magnetic resonance imaging the day before the Bergen 4-day treatment, and 28 (21 unmedicated) were rescanned after 1 week. Twenty-eight healthy control subjects were also scanned for baseline comparisons and 19 of them were rescanned after 1 week. Static and dynamic graph measures were quantified to determine network topology at the global, subnetwork, and regional levels (including efficiency, clustering, between-subnetwork connectivity, and node flexibility in module allegiance). The Yale-Brown Obsessive Compulsive Scale was used to measure symptom severity. RESULTS Twenty-four patients (86%) responded to treatment. We found significant group × time effects in frontoparietal-limbic connectivity (ηp2 = 0.19, p = .03) and flexibility of the right subgenual anterior cingulate cortex (ηp2 = 0.18, p = .03), where, in both cases, unmedicated patients showed significant decreases while healthy control subjects showed no significant changes. Healthy control subjects showed increases in global and subnetwork efficiency and clustering coefficient, particularly in the somatomotor subnetwork. CONCLUSIONS Concentrated exposure and response prevention in unmedicated patients with OCD leads to decreased connectivity between the frontoparietal and limbic subnetworks and less flexibility of the connectivity of the subgenual anterior cingulate cortex, suggesting a more independent and stable network topology. This may represent less limbic interference on cognitive control subnetworks after treatment.
Collapse
|
28
|
|
29
|
Boerema YE, de Boer MM, van Balkom AJLM, Eikelenboom M, Visser HA, van Oppen P. Obsessive compulsive disorder with and without hoarding symptoms: Characterizing differences. J Affect Disord 2019; 246:652-658. [PMID: 30611063 DOI: 10.1016/j.jad.2018.12.115] [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: 08/10/2018] [Revised: 12/07/2018] [Accepted: 12/24/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In recent years there has been some ambiguity about the way hoarding and OCD are related to each other. The present study examines the differences between persons with OCD/hoarding and OCD/non-hoarding and examines which characteristics are associated with the OCD/hoarding group. Information is established about prevalences, socio-demographical characteristics, OCD and related characteristics, OCD subtypes, comorbidity (depression, anxiety disorders and PTSD) and personality traits. METHODS Data from baseline assessment of The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study are used. The NOCDA sample consists of 419 participants between 18 and 79 years of age, including participants with current or remitted full DSM-IV-TR criteria for OCD. RESULTS Results show that 58 persons (14.3%) are classified as persons with OCD/hoarding and 349 persons (85,7%) are classified as persons with OCD/non-hoarding. OCD/hoarding is independently associated with severity of autism symptoms (p<.001), living without a partner (p<.05) and being less conscientious (p<.05). Persons with OCD/hoarding are not associated with childhood trauma (p=.31), PTSD (p=.91) and AD(H)D, inattentive type (p=.22) and hyperactive type (p=.57). LIMITATIONS Causal interferences about associations between the risk indicators and hoarding symptoms were precluded since results were based on cross-sectional data. CONCLUSION This study confirmed differences between persons with OCD/hoarding and persons with OCD/non-hoarding. The most relevant outcome of this study was the association between persons with OCD/hoarding and the increased severity of autism symptoms. These results provide a better understanding of persons with OCD/hoarding and have the potential to improve treatment.
Collapse
Affiliation(s)
- Yentl E Boerema
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, The Netherlands.
| | - Mijke M de Boer
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, The Netherlands
| | - Henny A Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, The Netherlands
| |
Collapse
|
30
|
McIngvale E, Van Kirk N, Amspoker AB, Stanley MA, Fletcher TL. Prevalence and Treatment of Obsessive-Compulsive Disorder in Veterans and Active-Duty Service Members: A Systematic Review. J Cogn Psychother 2019; 33:11-22. [PMID: 32746418 DOI: 10.1891/0889-8391.33.1.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The prevalence and treatment of obsessive-compulsive disorder (OCD) in veterans and active-duty military remains unclear. We systematically reviewed literature on OCD diagnosis and treatment in U.S. Veterans and active-duty military to obtain a prevalence estimate, describe treatment approaches for OCD in veterans, and evaluate use of Exposure and Response Prevention (ERP). Eight terms were used to identify studies in PubMed, PsychINFO and SCOPUS up to March 13, 2018; additional articles were identified from reference lists of 19 included studies, 16 addressing prevalence, and 3 addressing treatment. OCD prevalence is lower in studies employing electronic medical records databases than in studies using OCD assessments, suggesting underrecognition of OCD in clinical settings. Higher prevalence was seen with OCD screening tools than with diagnostic interviews. Lower OCD prevalence was seen in active-duty individuals than in veterans. Two case studies showed a decrease in OCD symptoms following ERP. Additional studies with larger samples and controlled designs examining ERP are needed.
Collapse
Affiliation(s)
- Elizabeth McIngvale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Nathaniel Van Kirk
- OCD Institute, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Amber B Amspoker
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Melinda A Stanley
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Terri L Fletcher
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
31
|
van Oudheusden LJB, Eikelenboom M, van Megen HJGM, Visser HAD, Schruers K, Hendriks GJ, van der Wee N, Hoogendoorn AW, van Oppen P, van Balkom AJLM. Chronic obsessive-compulsive disorder: prognostic factors. Psychol Med 2018; 48:2213-2222. [PMID: 29310732 DOI: 10.1017/s0033291717003701] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The course of illness in obsessive-compulsive disorder (OCD) varies significantly between patients. Little is known about factors predicting a chronic course of illness. The aim of this study is to identify factors involved in inducing and in maintaining chronicity in OCD. METHODS The present study is embedded within the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, an ongoing multicenter naturalistic cohort study designed to identify predictors of long-term course and outcome in OCD. For this study, 270 subjects with a current diagnosis of OCD were included. Chronicity status at 2-year follow-up was regressed on a selection of baseline predictors related to OCD, to comorbidity and to stress and support. RESULTS Psychotrauma [odds ratio (OR) 1.98, confidence interval (CI) 1.22-3.22, p = 0.006], recent negative life events (OR 1.42, CI 1.01-2.01, p = 0.043), and presence of a partner (OR 0.28, CI 0.09-0.85, p = 0.025) influenced the risk of becoming chronic. Longer illness duration (OR 1.46, CI 1.08-1.96, p = 0.013) and higher illness severity (OR 1.09, CI 1.03-1.16, p = 0.003) increased the risk of remaining chronic. CONCLUSIONS External influences increase the risk of becoming chronic, whereas the factors involved in maintaining chronicity are illness-related. As the latter are potentially difficult to modify, treatment should be devoted to prevent chronicity from occurring in the first place. Therapeutic strategies aimed at alleviating stress and at boosting social support might aid in achieving this goal.
Collapse
Affiliation(s)
- Lucas J B van Oudheusden
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Harold J G M van Megen
- Innova Research Centre, Mental Health Care Institute GGZ Centraal,Ermelo,The Netherlands
| | - Henny A D Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal,Ermelo,The Netherlands
| | - Koen Schruers
- Research School for Mental Health and Neuroscience, Maastricht University and Mondriaan Academic Anxiety Center,Maastricht,The Netherlands
| | - Gert-Jan Hendriks
- Department of Psychiatry,Center for Anxiety Disorders 'Overwaal', Institute for Integrated Mental Health Care Pro Persona, Behavioural Science Institute, Radboud University, Radboud University Medical Center,Nijmegen,the Netherlands
| | - Nic van der Wee
- Department of Psychiatry,Leiden Center for Brain and Cognition and Leiden Center for Translational Neuroscience, Leiden University Medical Center,Leiden,the Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGOInstitute,VU-University Medical Center, Academic Outpatient Clinic for Anxiety Disorders, GGZinGeest,Amsterdam,The Netherlands
| |
Collapse
|
32
|
Abstract
OBJECTIVE We aimed to determine whether individuals with obsessive-compulsive disorder (OCD) and demographically matched healthy individuals can be clustered into distinct clinical subtypes based on dimensional measures of their self-reported compulsivity (OBQ-44 and IUS-12) and impulsivity (UPPS-P). METHODS Participants (n=217) were 103 patients with a clinical diagnosis of OCD; 79 individuals from the community who were "OCD-likely" according to self-report (Obsessive-Compulsive Inventory-Revised scores equal or greater than 21); and 35 healthy controls. All data were collected between 2013 and 2015 using self-report measures that assessed different aspects of compulsivity and impulsivity. Principal component analysis revealed two components broadly representing an individual's level of compulsivity and impulsivity. Unsupervised clustering grouped participants into four subgroups, each representing one part of an orthogonal compulsive-impulsive phenotype. RESULTS Clustering converged to yield four subgroups: one group low on both compulsivity and impulsivity, comprised mostly of healthy controls and demonstrating the lowest OCD symptom severity; two groups showing roughly equal clinical severity, but with opposing drivers (i.e., high compulsivity and low impulsivity, and vice versa); and a final group high on both compulsivity and impulsivity and recording the highest clinical severity. Notably, the largest cluster of individuals with OCD was characterized by high impulsivity and low compulsivity. Our results suggest that both impulsivity and compulsivity mediate obsessive-compulsive symptomatology. CONCLUSIONS Individuals with OCD can be clustered into distinct subtypes based on measures of compulsivity and impulsivity, with the latter being found to be one of the more defining characteristics of the disorder. These dimensions may serve as viable and novel treatment targets.
Collapse
|
33
|
Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Hendriks GJ, Anholt GE. The relationship between cognitions and symptoms in obsessive-compulsive disorder. J Affect Disord 2018; 225:495-502. [PMID: 28865371 DOI: 10.1016/j.jad.2017.08.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 08/18/2017] [Accepted: 08/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The cognitive theory of obsessive-compulsive disorder (OCD) ascertains that catastrophic (mis)interpretations of normally occurring intrusive thoughts are related to the maintenance of OCD. Nonetheless, findings supporting the relationship between cognitive biases and OCD symptoms are largely inconsistent. In the present study we examined the relationship between OCD cognitions and symptoms among 382 OCD patients participating in the longitudinal Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. METHODS OCD cognitions and OC, anxiety and depressive symptoms were assessed using self-report questionnaires at baseline and at two-year follow-up. Baseline multiple regression analyses assessed the specificity of OC cognitions to OCD symptoms. Cross-lagged analyses examined whether cognitions predict OCD symptoms at two-year follow up. RESULTS Baseline analyses demonstrated significant relationships between comorbid anxiety, depressive severity and OC cognitions, adjusted for OCD symptoms (β = .283, p < .001 and β = .246, p < .001, respectively). OCD severity adjusted for comorbid symptoms was unrelated to cognitions at baseline (β = .040, p = n.s). Unique associations were found between cognitions and two OCD symptom subtypes (Impulses: β = .215, p < .001; Rumination/doubting: β = .205, p < .001). Longitudinal analyses yielded non-significant associations between OCD cognitions and symptom severity. Prospective analyses of cognitions and OCD symptom subtypes yielded significant effects for both bidirectional and unidirectional associations (β = .11-.16, p < .05). LIMITATIONS Given the naturalistic design of the study, we did not assess therapeutic interventions between baseline and follow-up. CONCLUSIONS Results only partially concord with the predictions of the cognitive theory of OCD. Future studies should focus on mechanisms alternative to cognitions when investigating the course of OCD.
Collapse
Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands
| | - Gert-Jan Hendriks
- Institute of Integrated Mental Health Care "Pro Persona", Centre for Anxiety Disorders "Overwaal", Lent, The Netherlands; University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychiatry, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
34
|
Rochat L, Manolov R, Billieux J. Efficacy of metacognitive therapy in improving mental health: A meta-analysis of single-case studies. J Clin Psychol 2017; 74:896-915. [DOI: 10.1002/jclp.22567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/11/2017] [Accepted: 11/13/2017] [Indexed: 01/24/2023]
|
35
|
Dell'Osso B, Benatti B, Rodriguez CI, Arici C, Palazzo C, Altamura AC, Hollander E, Fineberg N, Stein DJ, Nicolini H, Lanzagorta N, Marazziti D, Pallanti S, Van Ameringen M, Lochner C, Karamustafalioglu O, Hranov L, Figee M, Drummond L, Grant J, Denys D, Cath D, Menchon JM, Zohar J. Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Eur Psychiatry 2017; 45:36-40. [PMID: 28728093 DOI: 10.1016/j.eurpsy.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. METHODS Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age<vs≥65years, and then divided on the basis of the median age of the sample (age<vs≥42years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests). RESULTS G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P<.001), showing a significantly later age at onset (29.4±15.1 vs 18.7±9.2years, P<.001), a more frequent adult onset (75% vs 41.1%, P<.001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P<.05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P=.07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P<.05). CONCLUSIONS G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.
Collapse
Affiliation(s)
- B Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, 94305 Stanford, CA, USA
| | - B Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
| | - C I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, 94305 Stanford, CA, USA
| | - C Arici
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - C Palazzo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - A C Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - E Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, 10467 New York, USA
| | - N Fineberg
- Mental Health Unit, Hertfordshire Partnership Foundation Trust, Queen Elizabeth II Hospital, AL7 4HQ Welwyn Garden City, UK
| | - D J Stein
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, 7935 Cape Town, South Africa
| | - H Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), 03100 Mexico City, Mexico; Carracci Medical Group, 03100 Mexico City, Mexico
| | - N Lanzagorta
- Carracci Medical Group, 03100 Mexico City, Mexico
| | - D Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria, Università di Pisa, 56126 Pisa, Italy
| | - S Pallanti
- Department of Psychiatry, University of Florence, and Institute of Neurosciences, 50121 Florence, Italy
| | - M Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, ON L8S 4L8 Hamilton, Canada
| | - C Lochner
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, 7599 Stellenbosch, South Africa
| | - O Karamustafalioglu
- Department of Psychiatry, Sisli Eftal Teaching and Research Hospital, 34371 Istanbul, Turkey
| | - L Hranov
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum, 1797 Sofia, Bulgaria
| | - M Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, Netherlands
| | - L Drummond
- National and Trustwide Services for OCD/BDD, SW London and St George's NHS Trust, SW17 7DJ London, UK
| | - J Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 60607 Chicago, USA
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, Netherlands
| | - D Cath
- Department of Clinical and Health Psychology, Utrecht University, 3512 Utrecht, The Netherlands
| | - J M Menchon
- Psychiatry Unit at Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - J Zohar
- Department of Psychiatry, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel
| |
Collapse
|
36
|
Dell'Osso B, Benatti B, Hollander E, Altamura AC. Clinical features associated with increased severity of illness in tertiary clinic referred patients with obsessive compulsive disorder. Int J Psychiatry Clin Pract 2017; 21:131-136. [PMID: 27809644 DOI: 10.1080/13651501.2016.1249891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition. Specific patterns of psychiatric comorbidity, early age at onset, long duration of illness (DI) and untreated illness (DUI) have been associated with poor outcome in OCD. The present study was aimed to explore sociodemographic and clinical characteristics associated with increased severity of illness in a sample of OCD patients. METHODS A total of 124 OCD outpatients were recruited and divided into two groups on the basis of their severity of illness, as assessed through the Yale-Brown Obsessive Compulsive Scale (>24). Chi-squared test and t-test for independent samples were performed to compare sociodemographic and clinical variables between the two groups. RESULTS The group with increased severity of illness had a younger age, an earlier age at onset and age at first pharmacological treatment (p < .05). In addition, the same group showed a longer DI but a shorter DUI (p < .01). Moreover, significantly higher rates of psychiatric comorbidities (p < .01) were observed in the higher severity group. CONCLUSIONS Earlier age, age at onset and age at first pharmacological treatment, longer DI, shorter DUI and higher rate of psychiatric comorbidities were associated with increased severity of OCD. Further studies on larger samples are warranted to confirm the reported results.
Collapse
Affiliation(s)
- Bernardo Dell'Osso
- a Dipartimento di Neuroscienze , Università degli Studi di Milano , Dipartimento di Salute Mentale , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy.,b Department of Psychiatry and Behavioral Sciences , Stanford University , CA , USA
| | - Beatrice Benatti
- a Dipartimento di Neuroscienze , Università degli Studi di Milano , Dipartimento di Salute Mentale , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy
| | - Eric Hollander
- c Albert Einstein College of Medicine , Montefiore Medical Center, and Spectrum Neuroscience and Treatment Institute , New York , NY , USA
| | - A Carlo Altamura
- a Dipartimento di Neuroscienze , Università degli Studi di Milano , Dipartimento di Salute Mentale , Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico , Milano , Italy
| |
Collapse
|
37
|
Miller ML, Brock RL. The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: A meta-analysis. J Anxiety Disord 2017; 47:29-44. [PMID: 28242410 DOI: 10.1016/j.janxdis.2017.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
It is important to consider trauma-related sequelae in the etiology and maintenance of psychopathology, namely understudied disorders such as those belonging to the Obsessive-Compulsive Spectrum (OCS). This meta-analysis examined the association between past trauma exposure and current severity of OCS disorder symptoms. A systematic literature search was conducted with 24 (N=4557) articles meeting inclusion criteria. A significant overall effect size was obtained (r=0.20), indicating that exposure to past trauma is associated with a higher severity of OCS symptoms, with a stronger association for females (β=0.01, p<.001) but not varying as a function of relationship status. Four types of interpersonal trauma (violence, emotional abuse, sexual abuse, and neglect) were associated with OCS symptom severity (r=0.19 -0.24) and past trauma was significantly associated with more severe compulsions (r=0.17), but not obsessions. Results suggest an important link between multiple types of past trauma exposure and OCS symptoms.
Collapse
|
38
|
Alam Dianati F, Moheb N, Amiri S. Is mindfulness a mediator factor in obsessive compulsive disorder? JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2016. [DOI: 10.15171/jarcm.2016.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
39
|
Sica C, Bottesi G, Caudek C, Orsucci A, Ghisi M. "Not Just Right Experiences" as a psychological endophenotype for obsessive-compulsive disorder: Evidence from an Italian family study. Psychiatry Res 2016; 245:27-35. [PMID: 27526314 DOI: 10.1016/j.psychres.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 01/01/2023]
Abstract
The heart of the obsessional process may be considered the subject's underlying impression that "something is wrong" or "that something is not just as it should be". This phenomenon, labeled "not just right experiences" (NJREs), has increasingly been receiving attention as a possible marker of obsessive-compulsive disorder (OCD). The present study sought to add to the evidence that NJREs may be a putative endophenotype of obsessional symptoms. To this aim, measures of NJREs, obsessive-compulsive (OC) symptoms and psychological distress were compared in offspring of parents with and without OC symptoms. The offspring of parents with OC symptoms (N=120) reported higher frequency and severity of NJREs compared to offspring of parents without OC symptoms (N=106). Such differences remained significant for NJREs frequency and close to significance for NJREs severity, when general distress (i.e., anxiety and depression) was controlled. The possible role of NJREs as an endophenotype for OCD is discussed in reference to Gottesman and Gould criteria and the National Institute of Mental Health RDoC initiative.
Collapse
Affiliation(s)
- Claudio Sica
- Department of Health Sciences, University of Firenze, Italy.
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Italy
| | - Corrado Caudek
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Firenze, Italy
| | | | - Marta Ghisi
- Department of General Psychology, University of Padova, Italy
| |
Collapse
|
40
|
d-cycloserine addition to exposure sessions in the treatment of patients with obsessive-compulsive disorder. Eur Psychiatry 2016; 40:38-44. [PMID: 27837671 DOI: 10.1016/j.eurpsy.2016.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preliminary studies have shown that the addition of the partial NMDA-agonist d-cycloserine (DCS) might be promising in enhancing the results of exposure therapy in obsessive-compulsive disorder (OCD). We examined the effect of DCS addition to exposure therapy in a somewhat larger sample of OCD patients with special attention to subgroups, because of the heterogeneity of OCD. METHODS A randomized, double-blind, placebo controlled trial was conducted in 39 patients with OCD. Patients received 6 guided exposure sessions, once a week. One hour before each session 125mg DCS or placebo was administered. RESULTS Scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) declined more in the DCS group than in the placebo group, but the difference did not reach statistical significance (P=0.076, partial η2=0.13). Response percentages also did not differ between the DCS and the placebo group (37% and 15% respectively). In the 'cleaning/contamination' subgroup a significant effect was found in favour of DCS (P=0.033, partial η2=0.297). CONCLUSIONS The results of this study did not support the application of DCS to exposure therapy in OCD. Some specific aspects need further investigation: efficacy of DCS in a larger 'cleaning/contamination' (sub-)group, DCS addition only after successful sessions, interaction with antidepressants.
Collapse
|
41
|
Abstract
AbstractWhile there is considerable evidence that the factors involved in hoarding typically begin to manifest early in life (mostly in adolescence), the majority of those sampled in research studies are in their later years. As so much of our understanding of the psychological factors involved in hoarding is derived from those who are older and more chronically affected, the core hoarding psychopathology may have been masked, overlaid or even disregarded in previous research and in our approaches to clinical intervention. That is, factors relating primarily to chronicity of the problem and feelings of demoralization, hopelessness, loss and the extent of the damage caused to the person's life may swamp the processes which led to and maintain the problem. The present review examines the extent to which this is so and considers theoretical and clinical implications. The literature relevant to hoarding in later life was reviewed evaluatively in relation to a number of questions placing hoarding in a lifespan developmental context. Many studies relied on purely descriptive methodologies, meaning that typical case presentations and case histories are well documented, with less attention paid to underlying causal and maintaining mechanisms. Efforts to identify and control for factors relating to age or problem chronicity were minimal. A key future direction is the identification of younger samples of people who hoard in order to identify more clearly the processes which drive acquisition and retention of excessive amounts of material.
Collapse
|
42
|
Zoun MHH, Koekkoek B, Sinnema H, Muntingh ADT, van Balkom AJLM, Schene AH, Smit F, Spijker J. Effectiveness and cost-effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders: design of a multicenter randomized controlled trial. BMC Psychiatry 2016; 16:216. [PMID: 27388878 PMCID: PMC4936240 DOI: 10.1186/s12888-016-0927-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients with anxiety or depressive disorders achieve no remission of their symptoms after evidence-based treatment algorithms. They develop a chronic course of the disorder. Current care for these patients usually consists of long-term supportive contacts with a community psychiatric nurse and pharmacological management by a psychiatrist. Data on the effectiveness of these treatments is lacking. A psychosocial rehabilitation approach, where self-management is an increasingly important part, could be more suitable. It focuses on the restoration of functioning and enhancement of patients' autonomy and responsibility. Treatment with this focus, followed by referral to primary care, may be more (cost-)effective. METHODS A multicenter randomized controlled trial is designed for twelve participating specialized outpatient mental health services in the Netherlands. Patients with chronic and treatment resistant anxiety or depressive disorders, currently receiving supportive care in specialized outpatient mental health care, are asked to participate. After inclusion, patients receive the baseline questionnaire and are randomized to the intervention group or the usual care control group. The intervention focuses on rehabilitation and self-management and is provided by a trained community psychiatric nurse, followed by referral to primary care. Measurements take place at 6, 12, and 18 months after baseline. This study evaluates both the effectiveness (on quality of life, symptom severity, and empowerment), and cost-effectiveness of the intervention compared to usual care. In addition, a questionnaire is designed to get insight in which self-management strategies patients use to manage their disorder, and in the experiences of patients with the change of care setting. DISCUSSION In this study we evaluate the effectiveness and cost-effectiveness of a self-management intervention for patients with chronic and treatment resistant anxiety or depressive disorders in specialized outpatient mental health care. The results of this study may provide a first 'proof-of-concept' in this under-researched but important field, and might be relevant for a large group of patients in the context of a transition of the Dutch health care system. TRIAL REGISTRATION Netherlands Trial Register: NTR3335 , registered 7 March 2012.
Collapse
Affiliation(s)
- Maringa H. H. Zoun
- />Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- />Pro Persona Mental Health Care, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
| | - Bauke Koekkoek
- />Pro Persona Mental Health Care, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
- />Research Group for Social Psychiatry & Mental Health Nursing, HAN University of Applied Science, PO Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Henny Sinnema
- />Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Anna D. T. Muntingh
- />Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- />Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Aart H. Schene
- />Department of Psychiatry, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Filip Smit
- />Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
- />Department of Clinical, Neuro and Developmental Psychology, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
- />Department of Epidemiology and Biostatistics, VU University Medical Centre, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jan Spijker
- />Behavioural Science Institute, Radboud University Medical Center, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- />Pro Persona Mental Health Care, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
- />Trimbos Institute (Netherlands Institute of Mental Health and Addiction), PO Box 725, 3500 AS Utrecht, The Netherlands
| |
Collapse
|
43
|
The cost and impact of compulsivity: A research perspective. Eur Neuropsychopharmacol 2016; 26:800-9. [PMID: 27235690 DOI: 10.1016/j.euroneuro.2016.02.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 12/13/2015] [Accepted: 02/05/2016] [Indexed: 11/20/2022]
Abstract
Compulsivity is the defining feature of various psychiatric disorders including Obsessive Compulsive Related Disorders (OCRDs), and other compulsive, impulsive, and addictive disorders. These disorders are disabling, chronic conditions with an early onset and high rates of comorbidity, misdiagnoses, and delay in treatment onset. Disorders of compulsivity are responsible for considerable socioeconomic burden to society. We review the costs and impacts of compulsivity. In order to facilitate earlier diagnosis and targeted treatments, we examine the overlapping mechanisms that underlie compulsivity. We reconceptualize psychiatric disorders based on core features of compulsivity, highlight challenges in harmonizing research in children and adults, describe newer research methodologies, and point to future directions that can impact the costs and impact of disorders of compulsivity.
Collapse
|
44
|
Vyskocilova J, Prasko J, Sipek J. Cognitive behavioral therapy in pharmacoresistant obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2016; 12:625-39. [PMID: 27042074 PMCID: PMC4798215 DOI: 10.2147/ndt.s101721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study was to determine whether patients with obsessive-compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioral therapy (CBT) lasting for 6 weeks, and whether it is possible to predict the therapeutic effect using demographic, clinical, and selected psychological characteristics at baseline. METHODS Sixty-six OCD patients were included in the study, of which 57 completed the program. The diagnosis was confirmed using the structured Mini International Neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale-Brown Obsessive Compulsive Scale, objective and subjective forms of the Clinical Global Impression, Beck Anxiety Inventory, Beck Depression Inventory, Dissociative Experiences Scale, 20-item Somatoform Dissociation Questionnaire, and the Sheehan Disability Scale before their treatment, and with subjective Yale-Brown Obsessive Compulsive Scale, objective and subjective Clinical Global Impression, Beck Anxiety Inventory, and Beck Depression Inventory at the end of the treatment. Patients were treated with antidepressants and daily intensive group CBT for the 6-week period. RESULTS During the 6-week intensive CBT program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decrease in the scores assessing the severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who 1) showed fewer OCD themes in symptomatology, 2) showed a higher level of somatoform dissociation, 3) had poor insight, and 4) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who had 1) good insight, 2) a lower initial level of anxiety, and 3) no comorbid depressive disorder.
Collapse
Affiliation(s)
- Jana Vyskocilova
- Faculty of Humanities, Charles University in Prague, Prague, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Sipek
- Department of Psychology, Faculty of Arts, Charles University in Prague, Prague, Czech Republic
| |
Collapse
|
45
|
Comparing two basic subtypes in OCD across three large community samples: a pure compulsive versus a mixed obsessive-compulsive subtype. Eur Arch Psychiatry Clin Neurosci 2015; 265:719-34. [PMID: 25827623 DOI: 10.1007/s00406-015-0594-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/15/2015] [Indexed: 01/26/2023]
Abstract
Due to its heterogeneous phenomenology, obsessive-compulsive disorder (OCD) has been subtyped. However, these subtypes are not mutually exclusive. This study presents an alternative subtyping approach by deriving non-overlapping OCD subtypes. A pure compulsive and a mixed obsessive-compulsive subtype (including subjects manifesting obsessions with/without compulsions) were analyzed with respect to a broad pattern of psychosocial risk factors and comorbid syndromes/diagnoses in three representative Swiss community samples: the Zurich Study (n = 591), the ZInEP sample (n = 1500), and the PsyCoLaus sample (n = 3720). A selection of comorbidities was examined in a pooled database. Odds ratios were derived from logistic regressions and, in the analysis of pooled data, multilevel models. The pure compulsive subtype showed a lower age of onset and was characterized by few associations with psychosocial risk factors. The higher social popularity of the pure compulsive subjects and their families was remarkable. Comorbidities within the pure compulsive subtype were mainly restricted to phobias. In contrast, the mixed obsessive-compulsive subtype had a higher prevalence and was associated with various childhood adversities, more familial burden, and numerous comorbid disorders, including disorders characterized by high impulsivity. The current comparison study across three representative community surveys presented two basic, distinct OCD subtypes associated with differing psychosocial impairment. Such highly specific subtypes offer the opportunity to learn about pathophysiological mechanisms specifically involved in OCD.
Collapse
|
46
|
Goldberg X, Soriano-Mas C, Alonso P, Segalàs C, Real E, López-Solà C, Subirà M, Via E, Jiménez-Murcia S, Menchón JM, Cardoner N. Predictive value of familiality, stressful life events and gender on the course of obsessive-compulsive disorder. J Affect Disord 2015; 185:129-34. [PMID: 26172984 DOI: 10.1016/j.jad.2015.06.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Familiality, stressful life events (SLE) and gender significantly affect the onset of obsessive-compulsive disorder (OCD). However, their combined impact on the probability of OCD chronicity is largely unknown. With the objective of clarifying their predictive value, we tested a model of interaction effects between these influences. METHODS A sample of 449 patients with OCD was systematically assessed for familial loading, exposure to stressful life events, gender and course of the disease at the OCD referral unit at Bellvitge University Hospital. Multiple ordinal logistic regression was used to test interaction models. RESULTS Familiality presented a main negative association with chronicity (OR=0.83, CI97.5%=0.70-0.98). This association was additively moderated by both exposure to SLE before onset and gender, and showed a positive slope among female patients not exposed to SLE before onset (Familiality*SLEbo: OR=0.69, CI97.5%=0.47-1; Familiality*gender: OR=1.30, CI97.5%=0.91-1.84). LIMITATIONS The findings are based on cross-sectional data. Assessment of course is based on a retrospective measure, which may imply the possibility of overestimation of chronicity. CONCLUSIONS The predictive value of familiality on the course of OCD is only partially informative as both SLEbo and gender modify the association. When other risk factors are included in the model, familiality may predict decreased chances of chronicity. The mediation effects identified could explain the discrepancies found in previous research on this topic. Increased chances of presenting a chronic course of OCD may be found in association with familial vulnerability among female patients not exposed to SLEbo.
Collapse
Affiliation(s)
- Ximena Goldberg
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain.
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain.
| | - Pino Alonso
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Cinto Segalàs
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain
| | - Eva Real
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain
| | - Clara López-Solà
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Marta Subirà
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Esther Via
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain; Physiopathology, Obesity and Nutrition CIBER (CIBERobn), Carlos III Health Institute, Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Narcís Cardoner
- Department of Psychiatry, Bellvitge University Hospital - Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Mental Health CIBER (CIBERSAM), Carlos III Health Institute, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| |
Collapse
|
47
|
Cengiz M, Okutan SN, Bayoglu B, Sakalli Kani A, Bayar R, Kocabasoglu N. Genetic Polymorphism of the Serotonin Transporter Gene, SLC6A4 rs16965628, Is Associated with Obsessive Compulsive Disorder. Genet Test Mol Biomarkers 2015; 19:228-34. [DOI: 10.1089/gtmb.2014.0319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mujgan Cengiz
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Saide Nur Okutan
- Department of Science, Institute of Forensic Science, Istanbul University, Istanbul, Turkey
| | - Burcu Bayoglu
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ayse Sakalli Kani
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Reha Bayar
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nese Kocabasoglu
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| |
Collapse
|
48
|
Külz AK, Landmann S, Cludius B, Hottenrott B, Rose N, Heidenreich T, Hertenstein E, Voderholzer U, Moritz S. Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial. BMC Psychiatry 2014; 14:314. [PMID: 25403813 PMCID: PMC4239327 DOI: 10.1186/s12888-014-0314-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/24/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges. METHODS/DESIGN This study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task. DISCUSSION The results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD. TRIAL REGISTRATION German Clinical Trials Register DRKS00004525 . Registered 19 March 2013.
Collapse
Affiliation(s)
- Anne Katrin Külz
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Sarah Landmann
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Nina Rose
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | | | - Elisabeth Hertenstein
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | | | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
49
|
Lenhard F, Vigerland S, Andersson E, Rück C, Mataix-Cols D, Thulin U, Ljótsson B, Serlachius E. Internet-delivered cognitive behavior therapy for adolescents with obsessive-compulsive disorder: an open trial. PLoS One 2014; 9:e100773. [PMID: 24949622 PMCID: PMC4065049 DOI: 10.1371/journal.pone.0100773] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/25/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND International guidelines recommend Cognitive Behavior Therapy (CBT) as the first line treatment for pediatric obsessive-compulsive disorder (OCD). However, a substantial proportion of patients do not have access to such treatment. We developed and tested the feasibility, efficacy and acceptability of a novel therapist-guided, Internet-delivered CBT (ICBT) platform for adolescents with OCD. METHODS An interactive, age-appropriate ICBT platform ("BiP OCD") was developed. Twenty-one adolescents (12-17 years) with a DSM-IV diagnosis of OCD and their parents were enrolled in the study. All participants received 12 weeks of ICBT with therapist support. The primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Acceptability was assessed at post-treatment. RESULTS Participants completed on average 8.29 (SD = 3.0) of the 12 treatment chapters. Treatment yielded significant improvements on all clinician-, parent- and most self-administered outcome measures, with a large effect size of d = 2.29 (95% CI 1.5-3.07) on the CY-BOCS. Patients continued to improve at follow-up. At 6-month follow-up, 71% were classified as responders (≥35% decrease on the CY-BOCS) and 76% as being in remission (CY-BOCS score ≤12). Average clinician support time was less than 20 minutes per patient per week. The majority of participants felt that BiP OCD was age-appropriate and rated the treatment as good or very good. CONCLUSIONS ICBT could be efficacious, acceptable, and cost-effective for adolescents with OCD. More rigorously controlled studies are needed to further evaluate the treatment. TRIAL REGISTRATION ClinicalTrials.gov; NCT01809990.
Collapse
Affiliation(s)
- Fabian Lenhard
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Vigerland
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Thulin
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
50
|
Abstract
Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder (OCD), and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient's autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient's and the therapist's perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist's approach, who used motivational interventions with a view to appealing to the patient's responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions.
Collapse
|