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Zisler EM, Meule A, Endres D, Schennach R, Jelinek L, Voderholzer U. Effects of inpatient, residential, and day-patient treatment on obsessive-compulsive symptoms in persons with obsessive-compulsive disorder: A systematic review and meta-analysis. J Psychiatr Res 2024; 176:182-197. [PMID: 38875774 DOI: 10.1016/j.jpsychires.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Patients with severe or treatment-refractory obsessive-compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive-compulsive symptoms in patients with OCD. METHODS PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. RESULTS We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and-if available-at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive-compulsive symptoms decreased from admission to discharge with large effect sizes (g = -1.59, 95%CI [-1.76; -1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [-0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. CONCLUSIONS Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are-on average-maintained after discharge.
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Affiliation(s)
- Eva M Zisler
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
| | - Adrian Meule
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | | | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Strouphauer E, Valenzuela-Flores C, Minhajuddin A, Slater H, Riddle DB, Pinciotti CM, Guzick AG, Hettema JM, Tonarelli S, Soutullo CA, Elmore JS, Gushanas K, Wakefield S, Goodman WK, Trivedi MH, Storch EA, Cervin M. The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder. J Affect Disord 2024; 349:349-357. [PMID: 38199393 DOI: 10.1016/j.jad.2024.01.070] [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: 10/20/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth. METHODS A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis. RESULTS Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged. LIMITATIONS Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis. CONCLUSIONS Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD.
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Affiliation(s)
| | | | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA; Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David B Riddle
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Andrew G Guzick
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John M Hettema
- Department of Psychiatry and Behavioral Sciences, Texas A&M Health Sciences Center, Bryan, TX, USA
| | - Silvina Tonarelli
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Cesar A Soutullo
- UT Health Houston, Louis A. Faillace MD Department of Psychiatry and Behavioral Sciences, Houston, TX, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kimberly Gushanas
- Department of Psychiatry, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Sarah Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wayne K Goodman
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Eric A Storch
- College of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Matti Cervin
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Olatunji BO, Kim J. Examining reciprocal relations between disgust proneness and OCD symptoms: A four-wave longitudinal study. J Behav Ther Exp Psychiatry 2024; 82:101907. [PMID: 37690887 DOI: 10.1016/j.jbtep.2023.101907] [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: 01/08/2023] [Revised: 06/26/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Although disgust proneness has been implicated in the development of obsessive-compulsive disorder (OCD), available studies have largely employed cross-sectional designs and the prospective and potentially reciprocal association between disgust proneness and OCD symptoms remains unclear. The present study employs cross lagged panel analysis to examine the prospective and reciprocal association between disgust proneness and OCD symptoms. METHOD A community sample of adults (N = 307) completed symptom measures of disgust proneness and OCD symptoms at four time points with 1 month intervals. RESULTS The results showed that the cross-lagged paths from disgust proneness to OCD symptoms were significant (average β = 0.07, p's < 0.001) when controlling for depression. However, the paths from total OCD symptoms to disgust proneness were not significant. In contrast, the cross-lagged paths from disgust proneness to washing OCD symptoms were not significant. However, the paths from washing OCD symptoms to disgust proneness were significant (average β = 0.05, p's < 0.01) when controlling for depression. LIMITATIONS The study is limited is limited by exclusive reliance on self-report in a nonclinical sample. CONCLUSIONS The findings offer preliminary evidence suggesting that disgust proneness may be a cause and consequence of OCD depending on the nature of the symptoms. Thus, the longitudinal relation between disgust proneness and OCD may be transactional where one influences the effect of the other.
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Affiliation(s)
| | - Jingu Kim
- Busan National University of Education, South Korea; Radboud University, the Netherlands.
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Smárason O, Boedeker PJ, Guzick AG, Tendler A, Sheth SA, Goodman WK, Storch EA. Depressive symptoms during deep transcranial magnetic stimulation or sham treatment for obsessive-compulsive disorder. J Affect Disord 2024; 344:466-472. [PMID: 37852581 DOI: 10.1016/j.jad.2023.10.075] [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: 07/12/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Evidence suggests that depressive symptoms tend to improve concurrently with obsessive-compulsive disorder (OCD) symptoms during cognitive behavioral therapy (CBT), despite depression not being the primary target of intervention. Studies examining the temporal or mediational relationships of OCD and depressive symptoms have indicated a bidirectional relationship, as prior levels of OCD symptoms influenced subsequent levels of depression, and vice versa. Deep transcranial magnetic stimulation (dTMS) has recently emerged as a treatment option for OCD. Whether dTMS affects depression symptoms similarly to CBT remains to be examined. METHODS The current study employed a random intercept cross-lagged panel model (RI-CLPM) to examine the relationship of OCD and depression symptoms in 94 treatment refractory patients, undergoing dTMS or sham treatment. RESULTS Both OCD and depression symptoms improved significantly. However, a stable, cross-lagged relationship between the variables was not supported. Changes in one symptom domain could not be used to predict the other. LIMITATIONS The present study was conducted in a treatment refractory population, meaning the present findings may not generalize to treatment naïve patients or those with less severe OCD symptoms. It is unclear whether the study was sufficiently powered to detect the effects of interest, and this concern also meant that examining the dTMS and sham groups independently was not feasible. CONCLUSIONS When treating OCD with dTMS, depression symptoms appear likely to diminish but should be monitored throughout, and additional interventions applied if needed.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Peter J Boedeker
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aron Tendler
- BrainsWay Ltd., 19 Hartum St., Jerusalem 9777518, Israel
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Steuber ER, McGuire JF. A Meta-analysis of Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1145-1155. [PMID: 37343662 DOI: 10.1016/j.bpsc.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a debilitating illness with substantial morbidity. Although pharmacological and behavioral evidence-based treatments have shown efficacy, many patients remain unresponsive to this first-line care. Repetitive transcranial magnetic stimulation (rTMS) has shown significant promise for patients with treatment-refractory affective disorders. Therefore, we conducted a meta-analysis of randomized controlled trials to examine the therapeutic benefit of rTMS in patients with OCD and explore moderators of its treatment effects. METHODS PubMed (1997-Dec 31, 2022) and PsycINFO were searched for randomized sham-controlled trials of rTMS to treat OCD using the following terms: "obsessive-compulsive disorder," "transcranial magnetic stimulation," and "randomized controlled trial." Clinical characteristics and effect sizes were extracted from 25 randomized controlled trials (860 participants). A random effects model calculated the effect sizes for treatment efficacy and treatment response using the clinician-rated Yale-Brown Obsessive Compulsive Scale. RESULTS Across randomized controlled trials, rTMS exhibited a moderate therapeutic effect (g = 0.65) on OCD symptom severity and a 3-fold increased likelihood of treatment response (relative risk = 3.15) compared with sham conditions. Greater improvement in comorbid depression severity corresponded with greater treatment effects of rTMS on OCD symptom severity. In addition, longer rTMS sessions and fewer overall sessions predicted greater clinical improvement. CONCLUSIONS rTMS is moderately effective for reducing OCD symptom severity. It holds potential to serve as a therapeutic intervention, particularly for patients with OCD who have failed standard treatments and those with comorbid depression. Further research is needed to optimize rTMS protocols and evaluate the long-term efficacy of rTMS for OCD.
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Affiliation(s)
- Elizabeth R Steuber
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Castro-de-Araujo LF, de Araujo JAP, Morais Xavier ÉF, Kanaan RAA. Feedback-loop between psychotic symptoms and brain volume: A cross-lagged panel model study. J Psychiatr Res 2023; 162:150-155. [PMID: 37156129 DOI: 10.1016/j.jpsychires.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
Brain structural changes are known to be associated with psychotic symptoms, with worse symptoms consistently associated with brain volume loss in some areas. It is not clear whether volume and symptoms interfere with each other over the course of psychosis. In this paper, we analyse the temporal relationships between psychosis symptom severity and total gray matter volume. We applied a cross-lagged panel model to a public dataset from the NUSDAST cohorts. The subjects were assessed at three-time points: baseline, 24 months, and 48 months. Psychosis symptoms were measured by SANS and SAPS scores. The cohort contained 673 subjects with schizophrenia, healthy subjects and their siblings. There were significant effects of symptom severity on total gray matter volume and vice-versa. The worse the psychotic symptoms, the smaller the total gray volume, and the smaller the volume, the worse the symptomatology. There is a bidirectional temporal relationship between symptoms of psychosis and brain volume.
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Affiliation(s)
- Luis Fs Castro-de-Araujo
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, P.O. Box 980126, Richmond, VA, 23298-0126, USA; Deptartment of Psychiatry, The University of Melbourne, Austin Health, Victoria, Australia.
| | | | - Érika Fialho Morais Xavier
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, R. Mundo, 121. Salvador, Bahia, Brazil
| | - Richard A A Kanaan
- Deptartment of Psychiatry, The University of Melbourne, Austin Health, Victoria, Australia
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Belli GM, Law C, Mancebo M, Eisen J, Rasmussen S, Boisseau CL. Directionality of change in obsessive compulsive disorder and depression over six years of prospective follow-up. J Psychiatr Res 2023; 157:162-167. [PMID: 36470197 PMCID: PMC9898122 DOI: 10.1016/j.jpsychires.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
Major Depressive Disorder (MDD) is often comorbid with obsessive-compulsive disorder (OCD) yet little is known about the directionality of the association between OCD and depression symptoms. We aim to investigate the effect OCD symptoms has on depression symptoms and vice versa over an extended period of time. This is one of the first longitudinal studies to evaluate the relationship between OCD and depression in a large clinical sample. Participants (n = 324) were treatment-seeking adults with a primary diagnosis of OCD. OCD and depression symptoms were assessed annually over the six-year follow-up period. Random intercepts cross-lagged panel models (RI-CLPM) were conducted to compare unidirectional and bidirectional models over time. The best-fitting and most parsimonious model included paths with OCD symptoms predicting depression symptoms, but not vice versa. OCD symptom severity in a given year predicted next year depression severity. However, depression severity did not predict next-year OCD symptom severity in this sample. Our results suggest that depression severity may be secondary to OCD symptoms and treating OCD should be prioritized over treating depression.
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Affiliation(s)
- Gina M Belli
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Mancebo
- Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jane Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven Rasmussen
- Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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