1
|
Segalàs C, Cernadas E, Puialto M, Fernández-Delgado M, Arrojo M, Bertolin S, Real E, Menchón JM, Carracedo A, Tubío-Fungueiriño M, Alonso P, Fernández-Prieto M. Cognitive and clinical predictors of a long-term course in obsessive compulsive disorder: A machine learning approach in a prospective cohort study. J Affect Disord 2024; 350:648-655. [PMID: 38246282 DOI: 10.1016/j.jad.2024.01.157] [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: 09/15/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a disabling illness with a chronic course, yet data on long-term outcomes are scarce. This study aimed to examine the long-term course of OCD in patients treated with different approaches (drugs, psychotherapy, and psychosurgery) and to identify predictors of clinical outcome by machine learning. METHOD We included outpatients with OCD treated at our referral unit. Demographic and neuropsychological data were collected at baseline using standardized instruments. Clinical data were collected at baseline, 12 weeks after starting pharmacological treatment prescribed at study inclusion, and after follow-up. RESULTS Of the 60 outpatients included, with follow-up data available for 5-17 years (mean = 10.6 years), 40 (67.7 %) were considered non-responders to adequate treatment at the end of the study. The best machine learning model achieved a correlation of 0.63 for predicting the long-term Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score by adding clinical response (to the first pharmacological treatment) to the baseline clinical and neuropsychological characteristics. LIMITATIONS Our main limitations were the sample size, modest in the context of traditional ML studies, and the sample composition, more representative of rather severe OCD cases than of patients from the general community. CONCLUSIONS Many patients with OCD showed persistent and disabling symptoms at the end of follow-up despite comprehensive treatment that could include medication, psychotherapy, and psychosurgery. Machine learning algorithms can predict the long-term course of OCD using clinical and cognitive information to optimize treatment options.
Collapse
Affiliation(s)
- C Segalàs
- OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, 32 Barcelona, Spain
| | - E Cernadas
- Centro Singular de Investigación en Tecnoloxías Intelixentes da USC (CiTIUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - M Puialto
- OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Fernández-Delgado
- Centro Singular de Investigación en Tecnoloxías Intelixentes da USC (CiTIUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - M Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - S Bertolin
- OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
| | - E Real
- OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
| | - J M Menchón
- OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, 32 Barcelona, Spain
| | - A Carracedo
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Genetics Group, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Grupo de Medicina Xenómica, U-711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Servicio Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - M Tubío-Fungueiriño
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Santiago de Compostela, Spain; Genetics Group, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.
| | - P Alonso
- OCD Clinical and Research Unit, Psychiatry Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, 32 Barcelona, Spain
| | - M Fernández-Prieto
- Genomics and Bioinformatics Group, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Santiago de Compostela, Spain; Genetics Group, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Grupo de Medicina Xenómica, U-711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
| |
Collapse
|
2
|
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
|
3
|
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
|
4
|
Piras F, Banaj N, Ciullo V, Piras F, Ducci G, Demaria F, Vicari S, Spalletta G. Dysfunctional Beliefs and Cognitive Performance across Symptom Dimensions in Childhood and Adolescent OCD. J Clin Med 2022; 12:219. [PMID: 36615019 PMCID: PMC9821226 DOI: 10.3390/jcm12010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Although etiological and maintenance cognitive factors have proved effective in predicting the disease course in youths with OCD, their contribution to symptom severity and specific OCD dimensions has been scarcely examined. In a cohort of children and adolescents with OCD (N = 41; mean age = 14; age range = 10-18 yrs.), we investigated whether certain dysfunctional beliefs and cognitive traits could predict symptom severity, and whether they were differentially associated with specific symptom dimensions. We found that self-oriented and socially prescribed perfectionism and intolerance to uncertainty were associated with higher obsession severity, which was not uniquely related to any neuropsychological variable. Greater severity of obsessions and compulsions about harm due to aggression/injury/violence/natural disasters was predicted by excessive concerns with the expectations of other people. Severity in this dimension was additionally predicted by decreasing accuracy in performing a problem-solving, non-verbal reasoning task, which was also a significant predictor of severity of obsessions about symmetry and compulsions to count or order/arrange. Apart from corroborating both the belief-based and neuropsychological models of OCD, our findings substantiate for the first time the specificity of certain dysfunctional beliefs and cognitive traits in two definite symptom dimensions in youth. This bears important clinical implications for developing treatment strategies to deal with unique dysfunctional core beliefs, and possibly for preventing illness chronicity.
Collapse
Affiliation(s)
- Federica Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Ciullo
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Giuseppe Ducci
- Mental Health Department, ASL Roma 1, Piazza Santa Maria della Pietà 5–Pad. 26, 00193 Rome, Italy
| | - Francesco Demaria
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
| |
Collapse
|
5
|
Ruan H, Wang Y, Li Z, Tong G, Wang Z. A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder. Brain Sci 2022; 12:brainsci12070936. [PMID: 35884742 PMCID: PMC9316868 DOI: 10.3390/brainsci12070936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 12/04/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental disorder. Deep brain stimulation (DBS) is a promising approach for refractory OCD patients. Research aiming at treatment outcome prediction is vital to provide optimized treatments for different patients. The primary purpose of this systematic review was to collect and synthesize studies on outcome prediction of OCD patients with DBS implantations in recent years. This systematic review (PROSPERO registration number: CRD42022335585) followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. The search was conducted using three different databases with the following search terms related to OCD and DBS. We identified a total of 3814 articles, and 17 studies were included in our review. A specific tract confirmed by magnetic resonance imaging (MRI) was predictable for DBS outcome regardless of implant targets, but inconsistencies still exist. Current studies showed various ways of successful treatment prediction. However, considering the heterogeneous results, we hope that future studies will use larger cohorts and more precise approaches for predictors and establish more personalized ways of DBS surgeries.
Collapse
Affiliation(s)
- Hanyang Ruan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Yang Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Zheqin Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Geya Tong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China; (H.R.); (Y.W.); (Z.L.); (G.T.)
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, China
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai 200030, China
- Correspondence: ; Tel.: +86-180-1731-1286
| |
Collapse
|
6
|
Grassi M, Rickelt J, Caldirola D, Eikelenboom M, van Oppen P, Dumontier M, Perna G, Schruers K. Prediction of illness remission in patients with Obsessive-Compulsive Disorder with supervised machine learning. J Affect Disord 2022; 296:117-125. [PMID: 34600172 DOI: 10.1016/j.jad.2021.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/30/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The course of OCD differs widely among OCD patients, varying from chronic symptoms to full remission. No tools for individual prediction of OCD remission are currently available. This study aimed to develop a machine learning algorithm to predict OCD remission after two years, using solely predictors easily accessible in the daily clinical routine. METHODS Subjects were recruited in a longitudinal multi-center study (NOCDA). Gradient boosted decision trees were used as supervised machine learning technique. The training of the algorithm was performed with 227 predictors and 213 observations collected in a single clinical center. Hyper-parameter optimization was performed with cross-validation and a Bayesian optimization strategy. The predictive performance of the algorithm was subsequently tested in an independent sample of 215 observations collected in five different centers. Between-center differences were investigated with a bootstrap resampling approach. RESULTS The average predictive performance of the algorithm in the test centers resulted in an AUROC of 0.7820, a sensitivity of 73.42%, and a specificity of 71.45%. Results also showed a significant between-center variation in the predictive performance. The most important predictors resulted related to OCD severity, OCD chronic course, use of psychotropic medications, and better global functioning. LIMITATIONS All recruiting centers followed the same assessment protocol and are in The Netherlands. Moreover, the sample of the data recruited in some of the test centers was limited in size. DISCUSSION The algorithm demonstrated a moderate average predictive performance, and future studies will focus on increasing the stability of the predictive performance across clinical settings.
Collapse
Affiliation(s)
- Massimiliano Grassi
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
| | - Judith Rickelt
- Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Merijn Eikelenboom
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health research institute and GGZ inGeest Specialized Mental Health Care, the Netherlands
| | - Michel Dumontier
- Institute of Data Science, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy; Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Koen Schruers
- Research Institute of Mental Health and Neuroscience and Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
7
|
Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
Collapse
Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
| |
Collapse
|
8
|
Thamby A, Balachander S, Ali SF, Arumugham SS, Ts J, Narayanaswamy JC, Janardhan Reddy YC. Naturalistic outcome of medication-naïve obsessive compulsive disorder treated with serotonin reuptake inhibitors. Asian J Psychiatr 2021; 60:102642. [PMID: 33930709 DOI: 10.1016/j.ajp.2021.102642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/08/2021] [Accepted: 04/05/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The data on the course of obsessive compulsive disorder (OCD) is mostly derived from studying chronic, severely ill patients with varying degree of treatment resistance. We studied the course and outcome of OCD patients who were medication-naïve at initial assessment compared to those who were medicated. MATERIAL AND METHODS We analyzed the clinical chart data of all patients with a primary diagnosis of OCD attending a speciality OCD clinic in India during a specified period and compared outcome between medication-naïve (n = 75) and medicated (n = 117) patients. RESULTS The mean time to remission was shorter in the medication-naïve [18.99 months (95 % CI: 14.61-23.37)] compared to medicated [33.91 months (95 % CI: 27.55-40.28)] patients. The survival distribution of the two groups was significantly different as per the log-rank test (χ2 = 5.76, p = 0.02). In the Cox proportional hazards regression, medication-naïve status predicted time to remission. Overall, the rate of remission was the same in both groups (57 %). CONCLUSIONS Medication-naïve OCD patients seem to remit faster than the previously treated patients. Future prospective naturalistic studies can compare the outcome of medication naïve OCD patients treated with medications and CBT.
Collapse
Affiliation(s)
- Abel Thamby
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Srinivas Balachander
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Syed Farooq Ali
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jaisoorya Ts
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | - Y C Janardhan Reddy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| |
Collapse
|
9
|
Reddy YCJ, Arumugham SS. Are current pharmacotherapeutic strategies effective in treating OCD? Expert Opin Pharmacother 2020; 21:853-856. [PMID: 32124656 DOI: 10.1080/14656566.2020.1735355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS) , Bangalore, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences (NIMHANS) , Bangalore, India
| |
Collapse
|
10
|
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
|
11
|
Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Emmelkamp PMG, Anholt GE. Predictors of treatment outcome in OCD: An interpersonal perspective. J Anxiety Disord 2019; 68:102153. [PMID: 31704634 DOI: 10.1016/j.janxdis.2019.102153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.
Collapse
Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, GGZ InGeest, Amsterdam, the Netherlands
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
12
|
Abstract
Obsessive-compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak - in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long-term outcomes in OCD are not necessarily bleak and that at least half the treatment-seeking patients with OCD show symptomatic remission over long term. A short duration illness, of low severity that is treated early and intensively, with continued maintenance treatment over long term possibly has a good outcome. Recent studies have also identified neuroimaging and neuropsychological correlates of good outcome, but these need further replication. This paper presents an overview of conceptual issues and studies on long-term outcome of OCD and predictors of outcome.
Collapse
Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
13
|
Kapur V, Nadella RK, Sathur Raghuraman B, Saraf G, Mishra S, Srinivasmurthy N, Jain S, Del Zompo M, Viswanath B. Clinical factors associated with lithium treatment response in bipolar disorder patients from India. Asian J Psychiatr 2019; 39:165-168. [PMID: 29636228 DOI: 10.1016/j.ajp.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/24/2018] [Accepted: 04/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Bipolar Disorder (BD) is a chronic and disabling psychiatric illness with waxing and waning course. Lithium is the mainstay of treatment for Bipolar disorder (BD). There is limited literature on the clinical markers of Lithium treatment response from south Asia. METHODS Two hundred and ten individuals with BD I and a history of at least 6 months of treatment with Lithium were recruited from the outpatient services of the National Institute of Mental Health and Neurosciences (NIMHANS) after obtaining informed consent. A diagnosis of BD I was made according to the DSM-IV criteria. The characterization of response to lithium prophylaxis was done using NIMH Retrospective Life Chart and "Retrospective Criteria of Long Term Treatment Response in Research Subjects with Bipolar Disorder" scale. RESULTS There were 132 (62.86%) good responders and 78 (37.14%) non-responders. Good responders were noted to have less number of hospitalizations and more onset episode of depression than non-responders. Using continuous phenotype, Lithium response was inversely correlated with total number of episodes, number of episodes of mania/ depression, number of hospitalisations and presence of suicide attempt. Multivariate analysis only revealed number of episodes and hospitalization to be associated with Lithium response. CONCLUSION Our Lithium response rates were higher than what have been reported in the few previous studies. Illness severity was the only factor associated with Lithium response. There is a need to examine this question in larger prospective samples and to focus on biological/ molecular markers of treatment response.
Collapse
Affiliation(s)
- Vaisnvy Kapur
- Department of Clinical Psychology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | | | - Gayatri Saraf
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shree Mishra
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Nithyananda Srinivasmurthy
- Department of Psychiatric Social Work, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Maria Del Zompo
- Laboratory of Pharmacogenomics, Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Unit of Clinical Pharmacology, Teaching Hospital, Cagliari, Italy
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| |
Collapse
|
14
|
Tripathi A, Avasthi A, Grover S, Sharma E, Lakdawala BM, Thirunavukarasu M, Dan A, Sinha V, Sareen H, Mishra KK, Rastogi P, Srivastava S, Dhingra I, Behere PB, Solanki RK, Sinha VK, Desai M, Reddy YCJ. Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India. Asian J Psychiatr 2018; 37:3-9. [PMID: 30086467 DOI: 10.1016/j.ajp.2018.07.022] [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: 02/26/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Abstract
Obsessive-compulsive disorder (OCD) is phenotypically heterogeneous. Gender is an important factor mediating this heterogeneity. We examined gender differences in a large sample (n = 945) of OCD patients under a multi-centric study in India. Cross-sectional assessments were done on consecutive adult (>18 years) treatment-seeking patients with a DSM-5 diagnosis of OCD. Subjects were assessed on Structured Clinical Interview for DSM-5-Research Version for comorbid psychiatric illnesses, Yale Brown Obsessive Compulsive Scale for OCD phenomenology and symptom severity, Brown Assessment of Beliefs Scale for insight, Beck's Depression Inventory for severity of depressive symptoms, and the Obsessive Beliefs Questionnaire. On multivariate backward Wald logistic regression analysis, males (59.7%) had more years of education, had a higher rate of checking compulsions and comorbid substance use disorders. Women were more likely to be married, more commonly reported precipitating factors, had a higher rate of hoarding compulsions and comorbid agoraphobia. Findings from this large study validate gender as an important mediator of phenotypic heterogeneity in OCD. The mechanistic basis for these differences might involve complex interactions between biological, cultural and environmental factors.
Collapse
Affiliation(s)
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Eesha Sharma
- National Institute of Mental Health and Neurosciences, Bangalore, India.
| | | | - M Thirunavukarasu
- SRM Medical College Hospital & Research Center, Kattankulathur, Kanchipuram District, 603203, India
| | | | | | | | | | - Pali Rastogi
- MGM Medical College & MYH Hospital, Indore, India
| | - Shruti Srivastava
- University College of Medical Sciences and GTBH, Dilshad Garden, Delhi, India
| | | | - Prakash B Behere
- Dr D.Y. Patil University Kasba Bawda, Kolhapur 416006, Maharashtra, India
| | | | - Vinod K Sinha
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Mahesh Desai
- Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka India
| | | |
Collapse
|
15
|
Nakajima A, Matsuura N, Mukai K, Yamanishi K, Yamada H, Maebayashi K, Hayashida K, Matsunaga H. Ten-year follow-up study of Japanese patients with obsessive-compulsive disorder. Psychiatry Clin Neurosci 2018; 72:502-512. [PMID: 29652103 DOI: 10.1111/pcn.12661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/09/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Abstract
AIM Obsessive-compulsive disorder (OCD) is a well-known chronic illness. This study retrospectively investigated 10-year outcomes and associated clinical factors in Japanese OCD patients. We focused on the impact of several sociocultural factors, including medical expenses and insurance systems specific to each country, on the differences or biases in follow-up procedures of OCD. METHODS Seventy-nine patients diagnosed with OCD who received a standardized combination of treatments for 10 continuous years were divided into three groups according to their improvement rates on the Yale-Brown Obsessive-Compulsive Scale after 10 years of treatment. RESULTS A survival analysis revealed that the rate of patients achieving full remission increased every year. Following 10 years of treatment, 56% of OCD patients experienced 'full remission' for at least 1 year. Consequently, 48% exhibited full remission, and 37% exhibited partial remission at the end-point of this study. We identified several factors that were predictive of poorer outcomes, including lower Global Assessment of Functioning Scale scores and the presence of hoarding symptoms or involvement behaviors. In addition, improvement rates after 1 year significantly predicted better 10-year outcomes. CONCLUSION Our findings highlight the transcultural nature of long-term outcomes of OCD treatment, which appear to be independent of sociocultural differences.
Collapse
Affiliation(s)
- Akihiro Nakajima
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Naomi Matsuura
- Special Education Course, Faculty of Education, Mie University, Tsu, Japan
| | - Keiichiro Mukai
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Kyosuke Yamanishi
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | - Kensei Maebayashi
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| | | | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Hyogo, Japan
| |
Collapse
|
16
|
Trambaiolli LR, Biazoli CE, Balardin JB, Hoexter MQ, Sato JR. The relevance of feature selection methods to the classification of obsessive-compulsive disorder based on volumetric measures. J Affect Disord 2017; 222:49-56. [PMID: 28672179 DOI: 10.1016/j.jad.2017.06.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/01/2017] [Accepted: 06/26/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Magnetic resonance images (MRI) show detectable anatomical and functional differences between individuals with obsessive-compulsive disorder (OCD) and healthy subjects. Moreover, machine learning techniques have been proposed as tools to identify potential biomarkers and, ultimately, to support clinical diagnosis. However, few studies to date have investigated feature selection (FS) influences in OCD MRI-based classification. METHODS Volumes of cortical and subcortical structures, from MRI data of 38 OCD patients (split into two groups according symptoms severity) and 36 controls, were submitted to seven feature selection algorithms. FS aims to select the most relevant and less redundant features which discriminate between two classes. Then, a classification step was applied, from which the classification performances before and after different FS were compared. For the performance evaluation, leave-one-subject-out accuracies of Support Vector Machine classifiers were considered. RESULTS Using different FS algorithms, performance improvement was achieved for Controls vs. All OCD discrimination (19.08% of improvement reducing by 80% the amount of features), Controls vs. Low OCD (20.10%, 75%), Controls vs. High OCD (17.32%, 85%) and Low OCD vs. High OCD (10.53%, 75%). Furthermore, all algorithms pointed out classical cortico-striato-thalamo-cortical circuitry structures as relevant features for OCD classification. LIMITATIONS Limitations include the sample size and using only filter approaches for FS. CONCLUSIONS Our results suggest that FS positively impacts OCD classification using machine-learning techniques. Complementarily, FS algorithms were able to select biologically plausible features automatically.
Collapse
Affiliation(s)
- Lucas R Trambaiolli
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Rua Santa Adélia, 166, Santo André, SP 09210-170, Brazil.
| | - Claudinei E Biazoli
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Rua Santa Adélia, 166, Santo André, SP 09210-170, Brazil
| | - Joana B Balardin
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Rua Santa Adélia, 166, Santo André, SP 09210-170, Brazil
| | - Marcelo Q Hoexter
- Department and Institute of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo 01060-970, SP, Brazil
| | - João R Sato
- Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Rua Santa Adélia, 166, Santo André, SP 09210-170, Brazil
| |
Collapse
|
17
|
Patel V, Xiao S, Chen H, Hanna F, Jotheeswaran AT, Luo D, Parikh R, Sharma E, Usmani S, Yu Y, Druss BG, Saxena S. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet 2016; 388:3074-3084. [PMID: 27209149 DOI: 10.1016/s0140-6736(16)00160-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
Collapse
Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Centre for the Control of Chronic Conditions, Guragon, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
| | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fahmy Hanna
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - A T Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Rachana Parikh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Eesha Sharma
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Benjamin G Druss
- Mental Health School of Public Health: Health Policy & Management, Emory University, Atlanta, GA, USA
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| |
Collapse
|
18
|
Zhang L, Dong Y, Ji Y, Tao R, Chen X, Ye J, Zhang L, Yu F, Zhu C, Wang K. Trait-related decision making impairment in obsessive-compulsive disorder: evidence from decision making under ambiguity but not decision making under risk. Sci Rep 2015; 5:17312. [PMID: 26601899 PMCID: PMC4658550 DOI: 10.1038/srep17312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/28/2015] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate whether deficits in decision making were potential
endophenotype markers for OCD considering different phases of the disease.
Fifty-seven non-medicated OCD patients (nmOCD), 77 medicated OCD patients (mOCD), 48
remitted patients with OCD (rOCD) and 115 healthy controls were assessed with the
Iowa Gambling Task (IGT), which measured decision making under ambiguity, and the
Game of Dice Task (GDT), which measured decision making under risk. While the three
patients groups showed impaired performance on the IGT compared with healthy
controls, all patients showed intact performance on the GDT. Furthermore, the rOCD
patients showed a preference for deck B, indicating that they showed more
sensitivity to the frequency of loss than to the magnitude of loss, whereas the mOCD
patients showed a preference for deck A, indicating that they had more sensitivity
to the magnitude of loss than to the frequency of loss. These data suggested that
OCD patients had trait-related impairments in decision making under ambiguity but
not under risk, and that dissociation of decision making under ambiguity and under
risk is an appropriate potential neurocognitive endophenotype for OCD. The subtle
but meaningful differences in decision making performance between the OCD groups
require further study.
Collapse
Affiliation(s)
- Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Yi Dong
- Mental Health Center of Anhui Province, Hefei, China
| | - Yifu Ji
- Mental Health Center of Anhui Province, Hefei, China
| | - Rui Tao
- Mental Health Center of Anhui Province, Hefei, China
| | - Xuequan Chen
- Mental Health Center of Anhui Province, Hefei, China
| | - Jianguo Ye
- Psychological Consultation Center of Anhui Medical University, Hefei, China
| | - Lei Zhang
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Fengqiong Yu
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Chunyan Zhu
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| |
Collapse
|
19
|
Cordeiro T, Sharma MP, Thennarasu K, Reddy YCJ. Symptom Dimensions in Obsessive-Compulsive Disorder and Obsessive Beliefs. Indian J Psychol Med 2015; 37:403-8. [PMID: 26702171 PMCID: PMC4676205 DOI: 10.4103/0253-7176.168579] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a heterogeneous condition with a few major symptom dimensions. These symptom dimensions are thought to have unique clinical and neurobiological correlates. There seems to be a specific relation between OCD symptom dimensions and obsessive beliefs, but the findings are not consistent across studies. There is also a paucity of literature from culturally diverse settings. One of the reasons for the varied findings could be due to the method employed in measuring OCD symptoms. MATERIALS AND METHODS In this study, we examined the relation between symptom dimensions and obsessive beliefs using the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire respectively in 75 patients with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition OCD. RESULTS Perfectionism predicted both aggressive and symmetry dimensions whereas responsibility beliefs predicted sexual and religious dimensions. CONCLUSIONS The findings suggest that certain obsessive beliefs predicted certain OCD symptom dimensions, but results are not entirely consistent with the published literature suggesting the possibility of cross-cultural variations. That the symptom dimensions have unique belief domains support the argument that symptom dimensions could be targeted to reduce the heterogeneity in etiological and treatment studies of OCD. Therapeutic interventions may have to aim at modifying unique belief domains underlying certain symptom dimensions rather than having generic cognitive-behavioral strategies.
Collapse
Affiliation(s)
- Trinette Cordeiro
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mahendra P Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| |
Collapse
|