1
|
Aydin S, Darko K, Jenkins A, Detchou D, Barrie U. Deep brain stimulation for Tourette's syndrome. Neurosurg Rev 2024; 47:734. [PMID: 39367173 DOI: 10.1007/s10143-024-02958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 09/07/2024] [Accepted: 09/28/2024] [Indexed: 10/06/2024]
Abstract
Tourette's syndrome is a neuropsychiatric disorder characterized by formidable motor and vocal tics. Many individuals also present with comorbid neuropsychiatric conditions. Though patients often benefit from pharmacological and behavioral therapies, a subset of individuals develop severe, treatment-resistant symptoms that might necessitate more invasive interventions, such as Deep Brain Stimulation (DBS). DBS, particularly targeting regions like the globus pallidus internus (GPi) and the centromedian-parafascicular complex (CM-Pf) of the thalamus, has demonstrated effectiveness in reducing tic severity and improving quality of life. This review outlines the mechanism, clinical efficacy, and long-term outcome of DBS in TS. Results from clinical studies reveal significant reductions in tics. However, success with DBS is variable depending on a number of factors, including target selection and electrode placement. The use of DBS has ethical considerations, which include risks to the surgical procedure, the need for full and complete informed consent, and questions about the implications of such treatment on cognitive and emotional growth. Long-term follow-up will be required to ensure appropriate patient outcomes and complication management. Additional research and ethical debate will be needed with advancing DBS technology to ensure responsible and equitable treatment. This paper narratively summarizes the surgical options available for TS, with a focus on the current status of DBS in the management of the disease.
Collapse
Affiliation(s)
- Serhat Aydin
- School of Medicine, Koc University, Istanbul, Turkey
| | - Kwadwo Darko
- Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Abigail Jenkins
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donald Detchou
- Department of Neurosurgery, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Umaru Barrie
- Department of Neurosurgery, New York University Grossman School of Medicine, New York City, NYC, USA
| |
Collapse
|
2
|
Khomami Zadeh L, Corso G. Advances in Pediatric Obsessive-Compulsive Disorder (OCD) Treatment: A Comprehensive Narrative Review. Cureus 2024; 16:e68225. [PMID: 39221295 PMCID: PMC11364205 DOI: 10.7759/cureus.68225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/04/2024] Open
Abstract
Obsessive-compulsive disorder (OCD), characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions), can significantly impact a child's daily functioning, academic performance, and overall quality of life. As the prevalence of pediatric OCD continues to rise, there is a critical demand for evidence-based treatments that not only alleviate symptoms but also enhance the quality of life for affected children and adolescents. By identifying gaps in knowledge and suggesting directions for future research, this narrative review contributes to the ongoing discourse on pediatric OCD treatments. Ultimately, the synthesis of evidence aims to enhance our understanding and inform best practices in the compassionate and effective management of OCD in children and adolescents. The aim of this study is to provide a comprehensive overview of current trends and emerging strategies in the treatment of pediatric obsessive-compulsive disorder (OCD) and highlights the significance of tailoring treatment approaches to individual patient needs, considering factors such as symptom severity and treatment response. Concentrating on interventions supported by empirical evidence, the review delves into cognitive-behavioral therapy (CBT), pharmacotherapy, the synergistic effects of these modalities, and inventive therapeutic approaches, all while considering the distinctive developmental aspects pertinent to pediatric populations. We conducted this review by searching for titles in the PubMed database from 2013 to present. Our comprehensive literature review focused on advancements in treating pediatric OCD, using keywords like "Obsessive-compulsive disorder," "Pediatric," "treatment," "CBT," "SSRI," "Pharmacotherapy," and "combination therapy." While both pharmacotherapy and CBT show individual efficacy, the combination of these approaches appears to be more effective, especially for medication non-responders with no prior exposure to CBT, despite some mixed findings. These findings contribute significantly to the ongoing discussion on optimizing combined therapy strategies tailored to the complexities of pediatric OCD.
Collapse
Affiliation(s)
| | - German Corso
- Pediatric Psychiatry, Tropical Texas Behavioral Health, Harlingen, USA
| |
Collapse
|
3
|
Smith EEA, Guzick AG, Draper IA, Clinger J, Schneider SC, Goodman WK, Brout JJ, Lijffijt M, Storch EA. Perceptions of various treatment approaches for adults and children with misophonia. J Affect Disord 2022; 316:76-82. [PMID: 35970326 PMCID: PMC9884516 DOI: 10.1016/j.jad.2022.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Misophonia is a complex disorder characterized by a heightened reaction to certain sounds and associated stimuli. While there is no uniformly accepted treatment to date, different intervention approaches are being investigated. Individual's perceptions of different misophonia treatment methods may affect compliance and satisfaction with treatment options. We sought to gather data on patient perceptions of currently available misophonia treatments. METHODS Using an online survey, we collected data about treatment preferences, treatment usage, and diagnosis history from parents of children with misophonia (N = 141) and adults with misophonia (N = 252). RESULTS Most respondents were not satisfied with misophonia treatments that they or their children had previously received. Audiologic interventions including active and passive noise cancelling and lifestyle modifications were rated as most appropriate for treatment of misophonia by both parent and adult respondents. LIMITATIONS Because of the descriptive nature of this study, we chose to use a completer-only approach to ensure the data reflect the true responses of participants, though this did result in a meaningful proportion of missing data. Participants were selected through convenience sampling and responses were self-reported. Individuals with more severe misophonia symptoms may be more likely to participate and complete a research survey. CONCLUSIONS Most interventions are considered inappropriate by parents of youth with misophonia and by adults with misophonia. This should be interpreted in the light of a general lack of misophonia-specific interventions. Findings suggest dissatisfaction with currently available treatments and an opportunity for development of effective treatment strategies corresponding to participants' preferences. Deeper understanding of treatment preferences has the potential to guide future treatment development.
Collapse
Affiliation(s)
- Eleanor E A Smith
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Isabel A Draper
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Jane Clinger
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Sophie C Schneider
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | | | - Marjin Lijffijt
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA
| | - Eric A Storch
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 4-100, Houston, TX 77030, USA.
| |
Collapse
|
4
|
Wang N, Wu X, Yang Q, Wang D, Wu Z, Wei Y, Cui J, Hong L, Xiong L, Qin D. Qinglong Zhidong Decoction Alleviated Tourette Syndrome in Mice via Modulating the Level of Neurotransmitters and the Composition of Gut Microbiota. Front Pharmacol 2022; 13:819872. [PMID: 35392572 PMCID: PMC8981146 DOI: 10.3389/fphar.2022.819872] [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: 11/22/2021] [Accepted: 03/07/2022] [Indexed: 02/05/2023] Open
Abstract
Qinglong Zhidong Decoction (QLZDD), a traditional Chinese medicine (TCM) prescription, has been effectively used to alleviate Tourette syndrome (TS) in children. However, the therapeutic mechanism of QLZDD on TS has not been evaluated. The present study aims to elucidate the therapeutic effect and the possible therapeutic mechanism of QLZDD on TS in mouse model. A 3,3-iminodipropionitrile (IDPN, 350 mg/kg)-induced-TS mouse model was established. The mice were randomly divided into the control group, the model group, the haloperidol group (14 mg/kg), the low-, middle-, or high-QLZDD-dose groups (6.83 g/kg, 13.65 g/kg, 27.3 g/kg). QLZDD was administrated orally once a day for 4 weeks. The tic-like behavior was recorded weekly. Then, neurotransmitters and neurotransmitter receptors were analyzed by ELISA, immunohistochemistry (IHC), and quantitative reverse transcription PCR in striatum. Further, the alteration to intestinal flora was monitored by 16s rRNA sequencing, and the role of gut microbiota in the alleviation of TS by QLZDD was investigated. QLZDD ameliorated the tic-like behavior, and decreased the level of excitatory neurotransmitters such as Glu and DA and increased the level of the inhibitory neurotransmitter GABA significantly. Moreover, QLZDD significantly blocked the mRNA expression and the protein expression of D1R and D2R in the striatum, while activated the levels of DAT and GABAR. Interestingly, QLZDD mediated the composition of gut microbiota by increasing the abundance of Lactobacillus and Bacteroides but decreasing the abundance of Alloprevotella and Akkermansia. Taken together, QLZDD ameliorated the tic-like behavior in TS mouse, its mechanism of action may be associated with restoring the balance of gut microbiota and neurotransmitters. The study indicated a promising role of QLZDD in alleviating TS and a therapeutic strategy for fighting TS in clinical settings.
Collapse
Affiliation(s)
- Na Wang
- Yunnan University of Chinese Medicine, Kunming, China.,Huanghe S & T University, Zhengzhou, China.,Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinchen Wu
- Yunnan University of Chinese Medicine, Kunming, China
| | - Qi Yang
- Yunnan University of Chinese Medicine, Kunming, China
| | - Dingyue Wang
- Yunnan University of Chinese Medicine, Kunming, China
| | - Zhao Wu
- Yunnan University of Chinese Medicine, Kunming, China
| | - Yuanyuan Wei
- Yunnan University of Chinese Medicine, Kunming, China
| | - Jieqiong Cui
- Yunnan University of Chinese Medicine, Kunming, China
| | - Li Hong
- Yunnan University of Chinese Medicine, Kunming, China
| | - Lei Xiong
- Yunnan University of Chinese Medicine, Kunming, China
| | - Dongdong Qin
- Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
5
|
Rizzo R, Prato A, Scerbo M, Saia F, Barone R, Curatolo P. Use of Nutritional Supplements Based on L-Theanine and Vitamin B6 in Children with Tourette Syndrome, with Anxiety Disorders: A Pilot Study. Nutrients 2022; 14:nu14040852. [PMID: 35215501 PMCID: PMC8875106 DOI: 10.3390/nu14040852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by tics and co-occurring disorders. It has been suggested that anxiety occurs in 2–45% patients affected by Tourette syndrome. Despite dietary and nutritional factors have been found to affect a range of neurological conditions, no more studies have investigated the relationship between nutritional supplements and tics. Objective: To evaluate the effectiveness of supplementation of both L-Theanine and Vitamin B6 in reducing tics and co-occurring disorders in a sample of youth with chronic tic disorder (CTD) or Tourette syndrome with anxiety symptoms. Design: A open-label trial. Patients affected by Tourette syndrome were randomized to receive nutritional supplements based on L-Theanine and vitamin B6, or psychoeducation (PE). Participants: 34 children (30 boys and 4 girls) aged between 4 and 17 years affected by Tourette syndrome or chronic tic disorder, associated with anxiety symptoms. Results: Patients in both groups showed a reduction in the severity of tic and anxiety symptoms. Supplementation with L-Theanine and vitamin B6 was significantly more effective than psychoeducation in reducing tics and co-occurring disorders, as measured by neuropsychological findings. Conclusions: Supplementation of both L-Theanine and Vitamin B6 may help in the treatment of tic disorders associated with anxious symptoms. Between-group differences in clinician-rated severity did reach statistical significance only for tics. Despite this finding, further placebo-controlled trials are needed.
Collapse
Affiliation(s)
- Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy; (A.P.); (M.S.); (F.S.); (R.B.)
- Correspondence:
| | - Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy; (A.P.); (M.S.); (F.S.); (R.B.)
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, 98121 Messina, Italy
| | - Miriam Scerbo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy; (A.P.); (M.S.); (F.S.); (R.B.)
| | - Federica Saia
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy; (A.P.); (M.S.); (F.S.); (R.B.)
| | - Rita Barone
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy; (A.P.); (M.S.); (F.S.); (R.B.)
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, 00133 Rome, Italy;
| |
Collapse
|
6
|
Maraone A, Tarsitani L, Pinucci I, Pasquini M. Antiglutamatergic agents for obsessive-compulsive disorder: Where are we now and what are possible future prospects? World J Psychiatry 2021; 11:568-580. [PMID: 34631461 PMCID: PMC8474998 DOI: 10.5498/wjp.v11.i9.568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Recent data suggest that obsessive-compulsive disorder (OCD) is driven by an imbalance among the habit learning system and the goal-directed system. The frontostriatal loop termed cortico-striatal-thalamo-cortical (CSTC) circuitry loop is involved in habits and their dysfunction plays an important role in OCD. Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD. Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABAergic transmission, and could represent the pathophysiology of OCD. Moreover, the dysregulation of glutamate levels can lead to neurotoxicity, acting as a neuronal excitotoxin. The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients. Indeed, some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission. Although robust data supporting a progression of such brain changes are not available so far, an early intervention could help interrupt damage from neurotoxicity. Moreover, agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients.
Collapse
Affiliation(s)
- Annalisa Maraone
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| |
Collapse
|
7
|
Piacentini J, Wu M, Rozenman M, Bennett S, McGuire J, Nadeau J, Lewin A, Sookman D, Lindsey Bergman R, Storch E, Peris T. Knowledge and competency standards for specialized cognitive behavior therapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113854. [PMID: 33765492 DOI: 10.1016/j.psychres.2021.113854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Although exposure-based cognitive behavior therapy (CBT) and pharmacotherapy have demonstrated efficacy for obsessive-compulsive disorder (OCD), the lack of clinicians effectively trained in these treatments significantly limit effective intervention options for affected youth. This is very unfortunate since child onset is reported by 50% of adults with OCD. To ameliorate this serious global issue the 14 nation International Obsessive-Compulsive Disorders Accreditation Task Force (ATF) of The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) has developed knowledge and competency standards recommended for specialized treatments for OCD through the lifespan. Currently available guidelines are considered by experts to be essential but insufficient because there are not enough clinicians with requisite knowledge and competencies to effectively treat OCD. This manuscript presents knowledge and competency standards recommended for specialized cognitive behavior therapy (CBT) for pediatric OCD, derived from comprehensive literature review and expert synthesis. In addition to standards covering the elements of individual CBT-based assessment and treatment, family and school interventions are addressed given the critical role these domains play in the psychosocial development of youths. The ATF standards presented in these phase two papers will be foundational to the upcoming development of certification (individuals) and accreditation (sites) for specialized treatments in OCD through the lifespan.
Collapse
Affiliation(s)
- John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA.
| | - Monica Wu
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA.
| | | | - Shannon Bennett
- Department of Psychiatry, Weill Cornell Medical College, NY, NY USA
| | - Joseph McGuire
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Josh Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, and Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Adam Lewin
- Departments of Psychiatry and Behavioral Neurosciences and Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Debbie Sookman
- Department of Psychology, McGill University Health Center, and Department of Psychiatry, McGill University, Montreal, Quebec, CANADA
| | | | - Eric Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - Tara Peris
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| |
Collapse
|
8
|
Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113858. [PMID: 33770712 DOI: 10.1016/j.psychres.2021.113858] [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: 08/27/2020] [Accepted: 03/06/2021] [Indexed: 12/28/2022]
Abstract
Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.
Collapse
|
9
|
Giménez M, Cano M, Martínez-Zalacaín I, Real E, Alonso P, Segalàs C, Munuera J, Kegeles LS, Weinstein JJ, Xu X, Menchón JM, Cardoner N, Soriano-Mas C, Fullana MA. Is glutamate associated with fear extinction and cognitive behavior therapy outcome in OCD? A pilot study. Eur Arch Psychiatry Clin Neurosci 2020; 270:1003-1014. [PMID: 31432262 DOI: 10.1007/s00406-019-01056-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/07/2019] [Indexed: 12/15/2022]
Abstract
Cognitive behavioral therapy (CBT) including exposure and response prevention is a well-established treatment for obsessive-compulsive disorder (OCD) and is based on the principles of fear extinction. Fear extinction is linked to structural and functional variability in the ventromedial prefrontal cortex (vmPFC) and has been consistently associated with glutamate neurotransmission. The relationship between vmPFC glutamate and fear extinction and its effects on CBT outcome have not yet been explored in adults with OCD. We assessed glutamate levels in the vmPFC using 3T magnetic resonance spectroscopy, and fear extinction (learning and recall) using skin conductance responses during a 2-day experimental paradigm in OCD patients (n = 17) and in healthy controls (HC; n = 13). Obsessive-compulsive patients (n = 12) then received manualized CBT. Glutamate in the vmPFC was negatively associated with fear extinction recall and positively associated with CBT outcome (with higher glutamate levels predicting a better outcome) in OCD patients. Glutamate levels in the vmPFC in OCD patients were not significantly different from those in HC, and were not associated with OCD severity. Our results suggest that glutamate in the vmPFC is associated with fear extinction recall and CBT outcome in adult OCD patients.
Collapse
Affiliation(s)
- M Giménez
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - M Cano
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - I Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - E Real
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - P Alonso
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - C Segalàs
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain
| | - J Munuera
- Diagnostic Imaging Department, Fundació de Recerca Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - L S Kegeles
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA
| | - J J Weinstein
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA.,Department of Psychiatry, Stony Brook University, Stony Brook, 101 Nicolls Rd, Stony Brook, New York, 11794, USA
| | - X Xu
- Department of Psychiatry and Radiology, Columbia University, 622 W 168th St, New York, 10032, USA.,New York State Psychiatric Institute, 1051 Riverside Dr, New York, 10032, USA
| | - J M Menchón
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Casanova 143, 08036, Barcelona, Spain
| | - N Cardoner
- Depression and Anxiety Program, Department of Mental Health, Parc Taulí Sabadell, Hospital Universitari, Parc Taulí 1, 08208, Sabadell, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola Del Vallès Barcelona, Barcelona, Spain
| | - C Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Building B1, Ca n'Altayó, s/n, Bellaterra, 08193, Barcelona, Spain
| | - M A Fullana
- Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental-CIBERSAM, Av. de Monforte de Lemos 5, 28029, Madrid, Spain. .,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola Del Vallès Barcelona, Barcelona, Spain. .,Psychiatry Department, Hospital Clínic-Institute of Neurosciences, CIBERSAM, C/Rosselló 140, 08036, Barcelona, Spain.
| |
Collapse
|
10
|
Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
Collapse
Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| |
Collapse
|
11
|
Cost-Effectiveness of Treatment Alternatives for Treatment-Refractory Pediatric Obsessive-Compulsive Disorder. J Anxiety Disord 2020; 69:102151. [PMID: 31864218 DOI: 10.1016/j.janxdis.2019.102151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/16/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Current guidelines for first-line treatment of childhood OCD are cognitive-behavioral therapy (CBT) utilizing exposure and response prevention (ERP), and/or antidepressant (ADM) pharmacotherapy, specifically serotonin reuptake inhibitors (SRI). Given that first-line are relatively similar in terms of clinical effectiveness, the role of costs to provide such services may help influence treatment decisions. In the case of treatment refractory pediatric OCD, this cost-effectiveness analysis (CEA) aims to further evaluate two additional, higher intensity combination therapies, namely OCD-specific Intensive Outpatient (IOP) and Partial Hospitalization Programs (PHP), to determine the additional benefits, in terms of effectiveness, that may result, and the corresponding increase in costs for these higher-intensity courses of therapy. RESULTS IOP was the most cost-effective strategy in terms of change in CY-BOCS, pre/post treatment, equal to 16.42 units, followed by PHP and CBT monotherapy augmented with ADM CBT-monotherapy augmented with additional CBT and ADM-only augmented with CBT followed closely with 15.56 and 14.75 unit improvements in CY-BOCS. IOP accomplished its superior cost-effectiveness with an Incremental Cost-Effectiveness Ratio (ICER), of $48,834, lower than either of the established willingness to Pay thresholds. CONCLUSIONS Lack of access to high fidelity, high dose CBT paired with pharmacotherapy is an issue for OCD patients and families. Among youth who were treatment non-responsive, these results indicate the superiority of a high dosage CBT strategy, indicating the need to increase access to these treatments.
Collapse
|
12
|
Lamothe H, Baleyte JM, Mallet L, Pelissolo A. Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:87-104. [PMID: 31576938 PMCID: PMC6986481 DOI: 10.1590/1516-4446-2019-0471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
Collapse
Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Université de Caen Normandie (UNICAEN), INSERM, U1077, Caen, France
| | - Luc Mallet
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
- Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Antoine Pelissolo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
| |
Collapse
|
13
|
Wechsler TF, Kümpers F, Mühlberger A. Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?-A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia. Front Psychol 2019; 10:1758. [PMID: 31551840 PMCID: PMC6746888 DOI: 10.3389/fpsyg.2019.01758] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is in vivo exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and in vivo exposure in studies applying an equivalent amount of exposure in both treatments is necessary. Methods: We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and in vivo. We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' g effect sizes for the treatment effects of VR exposure, in vivo exposure, and the comparison of VR to in vivo exposure in all studies and separately for studies on each diagnosis. Results: Nine studies (n = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and in vivo exposure both showed large, significant effect sizes. The comparison of VR to in vivo exposure revealed a small, but non-significant effect size favoring in vivo (g = -0.20). Specifically, effect sizes for Specific Phobia (g = -0.15) and Agoraphobia (g = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring in vivo (g = -0.50). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring in vivo exposure. Conclusions: We found no evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
Collapse
Affiliation(s)
- Theresa F. Wechsler
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany
| | | | | |
Collapse
|
14
|
Rozenman M, Piacentini J, O'Neill J, Bergman RL, Chang S, Peris TS. Improvement in anxiety and depression symptoms following cognitive behavior therapy for pediatric obsessive compulsive disorder. Psychiatry Res 2019; 276:115-123. [PMID: 31075706 PMCID: PMC7197731 DOI: 10.1016/j.psychres.2019.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/12/2023]
Abstract
Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD.
Collapse
Affiliation(s)
- Michelle Rozenman
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA.
| | - John Piacentini
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
15
|
Storch EA, Gregory S, Salloum A, Quast T. Psychopharmacology Utilization Among Children with Anxiety and Obsessive-Compulsive and Related Disorders Following Hurricane Katrina. Child Psychiatry Hum Dev 2018; 49:632-642. [PMID: 29299728 PMCID: PMC11189098 DOI: 10.1007/s10578-017-0779-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study aimed to examine the impact of Hurricane Katrina exposure on medication utilization among children with pre-existing anxiety and obsessive-compulsive and related disorders (OCRDs). Medicaid claims data from 2004 to 2006 were analyzed. Children with pre-existing anxiety/OCRDs were compared as a function of those living in a Louisiana disaster area, Louisiana non-disaster area, or Texas in terms of filled prescriptions and average days medication supply. This was further examined as a function of disorder/medication type. Prescriptions filled and average days medication supply were lower for those who resided in the disaster area of Louisiana relative to non-disaster zones in Texas (but not Louisiana). Children with OCD who lived in a disaster zone in Louisiana had 16.6 fewer days supply of antidepressants relative to youth in Texas. Similarly, children with PTSD who lived in a disaster zone in Louisiana had approximately 7 fewer days supply of stimulant medication relative to those who lived in Texas. Medication utilization was reduced for those youth directly exposed to Katrina relative to children in Texas, suggesting potential service disruption. Children with OCD and PTSD may be more likely to experience treatment disruption. Following disasters, particular attention should be given to ensuring continued treatment access for youth with pre-existing anxiety and OCRDs (as well as other conditions).
Collapse
Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA.
| | | | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, USA
| | - Troy Quast
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, USA
| |
Collapse
|
16
|
Hartmann A, Millet B. Repetitive movements and behaviors in neurological and psychiatric practice: Distinctions and similarities between Tourette disorder and obsessive–compulsive disorder. Rev Neurol (Paris) 2018; 174:199-202. [DOI: 10.1016/j.neurol.2018.01.364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/26/2022]
|
17
|
Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders. Semin Pediatr Neurol 2018; 25:123-135. [PMID: 29735110 DOI: 10.1016/j.spen.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric movement disorders may present with psychiatric symptoms at many points during the course of the disease. For the relatively common pediatric movement disorder, Tourette syndrome, psychiatric comorbidities are well-described and treatment is well-studied. Managing these comorbidities may be more effective than improving the movements themselves. For more uncommon movement disorders, such as juvenile-onset Huntington disease, treatment of psychiatric comorbidities is not well-characterized, and best-practice recommendations are not available. For the least common movement disorders, such as childhood neurodegeneration with brain iron accumulation, psychiatric features may be nonspecific so that underlying diagnosis may be apparent only after recognition of other symptoms. However, psychiatric medication, psychotherapy, and psychosocial support for these disorders may prove helpful to many children and adolescents.
Collapse
|
18
|
An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents. COGNITIVE AND BEHAVIORAL PRACTICE 2018; 26:214-224. [PMID: 31205406 DOI: 10.1016/j.cbpra.2017.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive-compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.
Collapse
|
19
|
Rizzo R, Pellico A, Silvestri PR, Chiarotti F, Cardona F. A Randomized Controlled Trial Comparing Behavioral, Educational, and Pharmacological Treatments in Youths With Chronic Tic Disorder or Tourette Syndrome. Front Psychiatry 2018; 9:100. [PMID: 29636706 PMCID: PMC5880916 DOI: 10.3389/fpsyt.2018.00100] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
CONTEXT The existing literature on the treatment of pediatric chronic tic disorder (CTD) and Tourette syndrome (TS) indicates that both behavioral therapy (BT) and pharmacotherapy (PT) are effective for reducing symptoms. OBJECTIVE To evaluate the efficacy of BT compared to psychoeducation (PE) or PT for reducing tics and co-occurring symptoms and for improving quality of life (QoL) in a sample of youths with CTD and TS. DESIGN A 10 weeks, 2 sites (Catania, Rome) randomized controlled trial. Participants were randomized to receive one of the following treatments: BT, PE, or PT. PARTICIPANTS 110 outpatients aged between 8 and 17 years affected by CTD or TS. RESULTS Patients in the BT and PT groups showed a significant reduction in the severity of tic symptoms, while the PE group did not show any improvement. PT was more effective for reducing obsessive compulsive symptoms than BT, while PE group did not show any improvement. Both BT and PT groups showed an improvement in most QoL domains, whereas no differences were found in the PE group. CONCLUSIONS BT is as effective as pharmacological therapy in the treatment of tic disorders in children and adolescents, thus offering an alternative to medications for CTD and TS.
Collapse
Affiliation(s)
- Renata Rizzo
- Università degli Studi di Catania, Catania, Italy
| | | | | | - Flavia Chiarotti
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | | |
Collapse
|
20
|
Winter C, Greene DM, Mavrogiorgou P, Schaper H, Sohr R, Bult-Ito A, Juckel G. Altered serotonergic and GABAergic neurotransmission in a mice model of obsessive-compulsive disorder. Behav Brain Res 2018; 337:240-245. [DOI: 10.1016/j.bbr.2017.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 01/04/2023]
|
21
|
Peris TS, Rozenman MS, Sugar CA, McCracken JT, Piacentini J. Targeted Family Intervention for Complex Cases of Pediatric Obsessive-Compulsive Disorder: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2017; 56:1034-1042.e1. [PMID: 29173737 PMCID: PMC5875916 DOI: 10.1016/j.jaac.2017.10.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/29/2017] [Accepted: 10/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Although evidence-based treatments for pediatric obsessive-compulsive disorder (OCD) exist, many youth fail to respond, and interventions tailored to the needs of specific subsets of patients are lacking. This study examines the efficacy of a family intervention module designed for cases of OCD complicated by poor family functioning. METHOD Participants were 62 youngsters aged 8 to 17 years (mean age = 12.71 years; 57% male; 65% white) with a primary diagnosis of OCD and at least 2 indicators of poor family functioning. They were randomized to receive 12 sessions of individual child cognitive-behavioral therapy (CBT) plus weekly parent psychoeducation and session review (standard treatment [ST]) or the same 12 child sessions plus 6 sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving (positive family interaction therapy [PFIT]). Blinded raters evaluated outcomes and tracked responders to 3-month follow-up. RESULTS Compared to ST, PFIT demonstrated better overall response rates on the Clinician Global Impression-Improvement scale (CGI-I; 68% versus 40%, p = .03, φ = 0.28) and rates of remission (58% PFIT versus 27% ST, p = .01, φ = 0.32). PFIT also produced significantly greater reductions in functional impairment, symptom accommodation, and family conflict, and improvements in family cohesion. As expected, these shifts in family functioning constitute an important treatment mechanism, with changes in accommodation mediating treatment response. CONCLUSION PFIT is efficacious for reducing OCD symptom severity and impairment and for improving family functioning. Findings are discussed in terms of personalized medicine and mechanisms of change in pediatric OCD treatment. Clinical trial registration information-Family Focused Treatment of Pediatric Obsessive Compulsive Disorder; http://clinicaltrials.gov/; NCT01409642.
Collapse
Affiliation(s)
- Tara S Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles.
| | | | - Catherine A Sugar
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles; Fielding School of Public Health, UCLA
| | - James T McCracken
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles
| |
Collapse
|
22
|
McGuire JF, Ginder N. Behavior Therapy for Tics and Tic Disorders. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20171026-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
23
|
Iniesta-Sepúlveda M, Rosa-Alcázar AI, Sánchez-Meca J, Parada-Navas JL, Rosa-Alcázar Á. Cognitive-behavioral high parental involvement treatments for pediatric obsessive-compulsive disorder: A meta-analysis. J Anxiety Disord 2017; 49:53-64. [PMID: 28431305 DOI: 10.1016/j.janxdis.2017.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/16/2017] [Accepted: 03/30/2017] [Indexed: 01/04/2023]
Abstract
A meta-analysis on the efficacy of cognitive-behavior-family treatment (CBFT) on children and adolescents with obsessive-compulsive disorder (OCD) was accomplished. The purposes of the study were: (a) to estimate the effect magnitude of CBFT in ameliorating obsessive-compulsive symptoms and reducing family accommodation on pediatric OCD and (b) to identify potential moderator variables of the effect sizes. A literature search enabled us to identify 27 studies that fulfilled our selection criteria. The effect size index was the standardized pretest-postest mean change index. For obsessive-compulsive symptoms, the adjusted mean effect size for CBFT was clinically relevant and statistically significant in the posttest (dadj=1.464). For family accommodation the adjusted mean effect size was also positive and statistically significant, but in a lesser extent than for obsessive-compulsive symptoms (dadj=0.511). Publication bias was discarded as a threat against the validity of the meta-analytic results. Large heterogeneity among effect sizes was found. Better results were found when CBFT was individually applied than in group (d+=2.429 and 1.409, respectively). CBFT is effective to reduce obsessive-compulsive symptoms, but offers a limited effect for family accommodation. Additional modules must be included in CBFT to improve its effectiveness on family accommodation.
Collapse
Affiliation(s)
| | - Ana I Rosa-Alcázar
- Dept. Personality, Assessment & Psychological Treatment, University of Murcia, Spain.
| | | | | | | |
Collapse
|
24
|
Summer Camp Program for Children With Obsessive–Compulsive Disorder: Description and Preliminary Observations. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
25
|
A preliminary study of cognitive-behavioral family-based treatment versus parent training for young children with obsessive-compulsive disorder. J Affect Disord 2017; 208:265-271. [PMID: 27792972 DOI: 10.1016/j.jad.2016.09.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive-Behavioral Family-Based Treatment (CBFT) is the standard of care in young children with OCD. Developmental considerations, parent desires, and cost-effective advantages motivate research to explore the relative efficacy of parent-only interventions. The main goal in this study was to test the effectiveness and feasibility of a parent only intervention for OCD in young children, comparing, in a preliminary fashion the relative efficacy of reducing obsessive-compulsive symptoms through two treatment conditions: 1) an individual CBFT for early OCD involving both parents and children, and 2) the family component of the intervention involving only individual Parent Training (PT). METHODS Twenty treatment-seeking families from two private outpatient clinics in Spain were alternately assigned to one of the two treatment conditions. Participants had a primary diagnosis of OCD and a mean age of 6.62 years (65% males). Interventions were conducted by the same therapist and the assessments were administered by independent clinicians who were blind to the experimental conditions of the participants. Assessment time-points were pretreatment, posttreatment, and 3-month follow-up (including diagnosis, symptom severity, global functioning, family accommodation, externalizing and internalizing symptoms, and satisfaction measures). RESULTS The two ways of implementation, involving child and parents (CBFT) or involving only parents (PT), produced clinical improvements and were well-accepted by parents and children. The CBFT condition was superior to the PT condition in reducing externalizing problems. LIMITATIONS reduced sample size and absence of randomization were the main limitations of this study. CONCLUSIONS these results suggest, in a preliminary manner, that the need to have the child present at session with the clinician could be decreased for some children, as well as the overall feasibility of working only with parents for the implementation of CBT for OCD in very young children.
Collapse
|
26
|
McGuire JF, McBride N, Piacentini J, Johnco C, Lewin AB, Murphy TK, Storch EA. The premonitory urge revisited: An individualized premonitory urge for tics scale. J Psychiatr Res 2016; 83:176-183. [PMID: 27643476 PMCID: PMC5107126 DOI: 10.1016/j.jpsychires.2016.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Premonitory urge ratings have advanced our understanding of urge phenomenology among individuals with tic disorders (TD). However, these ratings have been limited by their reliance on a single global dimension of urge severity. This study examined the psychometric properties of a novel scale called the Individualized Premonitory Urge for Tics Scale (I-PUTS) that assesses urge severity across multiple dimensions (number, frequency, and intensity). METHOD Seventy-five youth with a TD and their parents participated. Clinicians assessed youth's tic severity, depression severity, rages, and premonitory urges. Parents completed ratings of youth's anxiety, affect lability, and general psychopathology. Youth completed self-report ratings of anxiety, urge severity, and distress tolerance. RESULTS The I-PUTS identified that youth experienced an average of three distinct urges, but had an average of seven tics over the past week. Urges were primarily localized in the head/face, neck/throat, and arm regions. All I-PUTS dimensions exhibited excellent inter-rater reliability. The I-PUTS dimensions exhibited good convergent validity with global urge ratings and tic severity, and appropriate divergent validity from other clinical constructs. Youth who exhibited discrepant reports between clinician-administered and self-report urge ratings had less anxiety and tic severity, and greater inattention and externalizing problems compared to youth who exhibited good agreement. CONCLUSIONS The I-PUTS is a reliable and valid assessment of urge phenomena, which provides additional and complementary information to existing urge scales. It highlights the existence of multiple dimensions of urge severity, and presents particular utility when assessing urges in youth with TD who have inattention and externalizing problems.
Collapse
Affiliation(s)
- Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - Nicole McBride
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
| |
Collapse
|
27
|
Sampaio T, Lima C, Corregiari F, Bernik M. The putative catalytic role of higher serotonin bioavailability in the clinical response to exposure and response prevention in obsessive-compulsive disorder. ACTA ACUST UNITED AC 2016; 38:287-293. [PMID: 27798711 PMCID: PMC7111354 DOI: 10.1590/1516-4446-2015-1721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 12/08/2015] [Indexed: 12/02/2022]
Abstract
Objective: Exposure and response prevention (ERP) is effective to treat obsessive-compulsive disorder (OCD), but the lack of tolerance to the aversion nature of exposure techniques results in a high drop-out rate. There have been reports of a generic stress endurance effect of serotonin (5-HT) in the central nervous system (CNS) which might be explained by suppression of defensive fixed action patterns. Previous studies have proposed that higher baseline 5-HT concentration and slow decrease in concentration during drug treatment of OCD were predictors of good clinical response to 5-HT reuptake inhibitors. The objective of this study was to investigate whether pre-treatment platelet rich plasma (PRP) 5-HT concentration is associated with latency of treatment response and final response to an ERP protocol for obsessive-compulsive disorder (OCD). Methods: Thirty adult and treatment-free OCD patients were included in an 8-week, 16-session ERP protocol. 5-HT concentration was determined at baseline and after treatment. Patients with a reduction ≥30% on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at the end of ERP were defined as responders. Results: A positive correlation between baseline 5-HT concentration and reduction of symptoms on the Y-BOCS was observed after 4 weeks. Baseline 5-HT concentration was not correlated with clinical response after 8 weeks of ERP, possibly due to the similar though delayed clinical response of patients with lower (compared to those with higher) baseline 5-HT concentration. Patients with higher 5-HT baseline concentration also showed more improvement in depressive symptoms with treatment. Conclusion: The present results partially support the hypothesis of a stress endurance effect of 5-HT in OCD patients. According to the literature, fast onset responders possibly have more or larger 5-HT containing neurons, higher endogenous 5-HT synthesis or lower monoamine oxidase activity; all these hypotheses remain to be investigated.
Collapse
Affiliation(s)
- Thiago Sampaio
- Programa Ansiedade (AMBAN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Cristiane Lima
- Programa Ansiedade (AMBAN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Fabio Corregiari
- Programa Ansiedade (AMBAN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Marcio Bernik
- Programa Ansiedade (AMBAN), Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| |
Collapse
|
28
|
Collins LM, Coles ME. Initial data on a 5-item measure of OCD symptom severity and change: The obsessive compulsive session change index (OCSCI). J Anxiety Disord 2016; 43:8-13. [PMID: 27467028 DOI: 10.1016/j.janxdis.2016.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/20/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
Repeated measurement of symptoms throughout treatment allows providers to assess individual patterns of symptom change. However, outside of a clinical trial, administration of lengthy measures at each session is unlikely. Therefore, in order to bridge the gap between clinical research and actual clinical practice we developed a brief self-report measure of obsessive compulsive symptoms that can be used at each session, the Obsessive Compulsive Session Change Index (OCSCI). The OCSCI assesses time spent on obsessions, time spent on compulsions, interference and distress related to obsessions and compulsions, and relative change in symptoms from the beginning of treatment. This paper reports initial psychometric properties of the OCSCI. Twenty-seven adults receiving exposure and ritual prevention for obsessive compulsive disorder (OCD) completed the OCSCI at each session. Results showed that the OCSCI had good internal consistency, and convergent and divergent validity. Specifically, the OCSCI had moderate to strong correlations with both self-reported and clinician rated OCD. Finally, the OCSCI was not as strongly correlated with depressive symptoms as it was with OCD symptoms. The findings presented herein suggest that the OCSCI can be useful as a measure of client progress throughout treatment.
Collapse
Affiliation(s)
- Lindsey M Collins
- Department of Psychology, Binghamton University, 4400 Vestal Pkwy E, Vestal, NY 13850, United States.
| | - Meredith E Coles
- Department of Psychology, Binghamton University, 4400 Vestal Pkwy E, Vestal, NY 13850, United States
| |
Collapse
|
29
|
McGuire JF, Orr SP, Essoe JKY, McCracken JT, Storch EA, Piacentini J. Extinction learning in childhood anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder: implications for treatment. Expert Rev Neurother 2016; 16:1155-74. [PMID: 27275519 PMCID: PMC5967402 DOI: 10.1080/14737175.2016.1199276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Threat conditioning and extinction play an important role in anxiety disorders, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Although these conditions commonly affect children, threat conditioning and extinction have been primarily studied in adults. However, differences in phenomenology and neural architecture prohibit the generalization of adult findings to youth. AREAS COVERED A comprehensive literature search using PubMed and PsycInfo was conducted to identify studies that have used differential conditioning tasks to examine threat acquisition and extinction in youth. The information obtained from this review helps to clarify the influence of these processes on the etiology and treatment of youth with OCD, PTSD and other anxiety disorders. Thirty studies of threat conditioning and extinction were identified Expert commentary: Youth with anxiety disorders, OCD, and PTSD have largely comparable threat acquisition relative to unaffected controls, with some distinctions noted for youth with PTSD or youth who have suffered maltreatment. However, impaired extinction was consistently observed across youth with these disorders and appears to be consistent with deficiencies in inhibitory learning. Incorporating strategies to improve inhibitory learning may improve extinction learning within extinction-based treatments like cognitive behavioral therapy (CBT). Strategies to improve inhibitory learning in CBT are discussed.
Collapse
Affiliation(s)
- Joseph F. McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Scott P. Orr
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - James T. McCracken
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- Department of Health Policy and Management, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| |
Collapse
|
30
|
Abstract
Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co-occur among youth with obsessive-compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha-2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14-year-old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20-session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic-related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.
Collapse
Affiliation(s)
- Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.
| |
Collapse
|
31
|
Storch EA. Introduction: Cognitive-Behavioral Treatment for Pediatric Obsessive-Compulsive Disorder. J Clin Psychol 2016; 72:1117-1119. [PMID: 27627740 DOI: 10.1002/jclp.22391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric A Storch
- University of South Florida, Rogers Behavioral Health; All Children's Hospital-Johns Hopkins Medicine.
| |
Collapse
|
32
|
Rapp AM, Bergman RL, Piacentini J, McGuire JF. Evidence-Based Assessment of Obsessive-Compulsive Disorder. J Cent Nerv Syst Dis 2016; 8:13-29. [PMID: 27594793 PMCID: PMC4994744 DOI: 10.4137/jcnsd.s38359] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/26/2016] [Accepted: 07/11/2016] [Indexed: 01/06/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric illness that often develops in childhood, affects 1%-2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight) are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress.
Collapse
Affiliation(s)
- Amy M Rapp
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - R Lindsay Bergman
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
33
|
Iorizzo M, Oranje AP. Current and future treatments of alopecia areata and trichotillomania in children. Expert Opin Pharmacother 2016; 17:1767-73. [DOI: 10.1080/14656566.2016.1217990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Arnold P. Oranje
- Kinderhuid.nl, Rotterdam & Hair Outpatient Clinic, Breda & Dermicis Skin Clinic, Alkmaar, the Netherlands
| |
Collapse
|
34
|
Storch EA, Wilhelm S, Sprich S, Henin A, Micco J, Small BJ, McGuire J, Mutch PJ, Lewin AB, Murphy TK, Geller DA. Efficacy of Augmentation of Cognitive Behavior Therapy With Weight-Adjusted d-Cycloserine vs Placebo in Pediatric Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:779-88. [PMID: 27367832 PMCID: PMC5734635 DOI: 10.1001/jamapsychiatry.2016.1128] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Cognitive behavior therapy (CBT) among youth with obsessive-compulsive disorder (OCD) is effective, but many patients remain symptomatic after intervention. d-cycloserine, a partial agonist at the N-methyl-d-aspartate receptor in the amygdala, has been associated with enhanced CBT outcome for OCD among adults but requires evaluation among youth. OBJECTIVES To examine the relative efficacy of weight-adjusted d-cycloserine (25 or 50 mg) vs placebo augmentation of CBT for youth with OCD and to assess if concomitant antidepressant medication moderated effects. DESIGN, SETTING, AND PARTICIPANTS In a placebo-controlled randomized clinical trial, 142 youths (age range, 7-17 years) enrolled between June 1, 2011, and January 30, 2015, at 2 academic health science centers (University of South Florida and Massachusetts General Hospital) with a primary diagnosis of OCD were randomized in a double-blind fashion to d-cycloserine plus CBT or placebo plus CBT. Intent-to-treat analysis was performed. INTERVENTIONS Patients were randomly assigned in a 1:1 ratio to either 10 sessions of d-cycloserine plus CBT or placebo plus CBT. d-cycloserine (25 or 50 mg) or placebo was taken 1 hour before sessions 4 through 10. MAIN OUTCOMES AND MEASURES Children's Yale-Brown Obsessive Compulsive Scale at randomization, biweekly, midtreatment, and posttreatment. Secondary outcomes included the Clinical Global Impressions-Severity or Clinical Global Impressions-Improvement, remission status, Children's Depression Rating Scale, Multidimensional Anxiety Scale for Children, and Children's Obsessive-Compulsive Impact Scale-Parent Version. RESULTS The study cohort comprised 142 participants. Their mean (SD) age was 12.7 (2.9) years, and 53.5% (76 of 142) were female. A mixed-effects model using all available data indicated significant declines in the Children's Yale-Brown Obsessive Compulsive Scale total score and Clinical Global Impressions-Severity. No significant interaction between treatment group and changes in the Children's Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions-Severity indicated that the d-cycloserine plus CBT group and the placebo plus CBT group declined at similar rates per assessment point on the Children's Yale-Brown Obsessive Compulsive Scale total score (estimate, -2.31, 95% CI, -2.79 to -1.83 and estimate, -2.03, 95% CI, -2.47 to -1.58, respectively) and Clinical Global Impressions-Severity (estimate, -0.29, 95% CI, -0.35 to -0.22 and estimate, -0.23, 95% CI, -0.29 to -0.17, respectively). No group differences in secondary outcomes were present. Antidepressant medication use at baseline did not moderate changes for either group. CONCLUSIONS AND RELEVANCE d-cycloserine augmentation of CBT did not confer additional benefit relative to placebo among youth with OCD. Other augmentation approaches should be examined to enhance outcome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00864123.
Collapse
Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida, Tampa2Department of Health Policy and Management, University of South Florida, Tampa3Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa4Rogers Behavioral Health–
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Boston7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Susan Sprich
- Department of Psychiatry, Massachusetts General Hospital, Boston7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Aude Henin
- Department of Psychiatry, Massachusetts General Hospital, Boston7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jamie Micco
- Department of Psychiatry, Massachusetts General Hospital, Boston7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa
| | - Joseph McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - P. Jane Mutch
- Department of Pediatrics, University of South Florida, Tampa
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, Tampa3Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida, Tampa3Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa5Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - Daniel A. Geller
- Department of Psychiatry, Massachusetts General Hospital, Boston7Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
35
|
Iniesta-Sepúlveda M, Storch EA. Clinical Considerations to Enhance the Efficacy of Cognitive Behavioral Treatments for OCD Including Parental Involvement. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:60-1. [DOI: 10.1111/jcap.12143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Eric A. Storch
- Departments of Pediatrics, Health Policy & Management, Psychiatry & Behavioral Neurosciences, and Psychology; University of South Florida; Tampa FL USA
| |
Collapse
|
36
|
Mavrogiorgou P, Bader A, Stockfleth E, Juckel G. Obsessive-compulsive disorder in dermatology. J Dtsch Dermatol Ges 2016; 13:991-9. [PMID: 26408459 DOI: 10.1111/ddg.12781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with obsessive-compulsive (OCD) and related disorders - primarily trichotillomania, body dysmorphic disorder, and skin picking disorder - frequently present to dermatologists due to associated hair and skin symptoms. It is therefore crucial that dermatologists be familiar with these disorders. In this review article, we provide an update on clinical features, neurobiology factors, and treatment options for OCD spectrum disorders. Employing PubMed and Cochrane Library databases, a selective literature search was conducted using keywords related to dermatological disorders within the OCD spectrum. OCD and its related disorders share several phenomenological as well as pathophysiological similarities, thus warranting their classification within a separate nosological category of psychiatric disorders. Another similarity of OCD spectrum disorders is the frequent concurrence of hair and skin diseases. Besides symptomatic dermatological treatment, the combination of psychotherapy (behavioral therapy) and psychopharmacotherapy (SSRIs) may be helpful. Although recent insights into OCD have contributed to a better understanding and treatment thereof, more research is required, especially with respect to OCD spectrum disorders, for which large controlled treatment studies are still lacking.
Collapse
Affiliation(s)
- Paraskevi Mavrogiorgou
- LWL University Medical Center of the Ruhr University Bochum, Department of Psychiatry, Psychotherapy, and Preventive Medicine, Bochum, Germany
| | - Armin Bader
- Department of Dermatology, Venereology, and Allergology, St. Joseph Hospital, Medical Center of the Ruhr University Bochum, Germany
| | - Eggert Stockfleth
- Department of Dermatology, Venereology, and Allergology, St. Joseph Hospital, Medical Center of the Ruhr University Bochum, Germany
| | - Georg Juckel
- LWL University Medical Center of the Ruhr University Bochum, Department of Psychiatry, Psychotherapy, and Preventive Medicine, Bochum, Germany
| |
Collapse
|
37
|
Wood J, Ahmari SE. A Framework for Understanding the Emerging Role of Corticolimbic-Ventral Striatal Networks in OCD-Associated Repetitive Behaviors. Front Syst Neurosci 2015; 9:171. [PMID: 26733823 PMCID: PMC4681810 DOI: 10.3389/fnsys.2015.00171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Significant interest in the mechanistic underpinnings of obsessive-compulsive disorder (OCD) has fueled research on the neural origins of compulsive behaviors. Converging clinical and preclinical evidence suggests that abnormal repetitive behaviors are driven by dysfunction in cortico-striatal-thalamic-cortical (CSTC) circuits. These findings suggest that compulsive behaviors arise, in part, from aberrant communication between lateral orbitofrontal cortex (OFC) and dorsal striatum. An important body of work focused on the role of this network in OCD has been instrumental to progress in the field. Disease models focused primarily on these regions, however, fail to capture an important aspect of the disorder: affective dysregulation. High levels of anxiety are extremely prevalent in OCD, as is comorbidity with major depressive disorder. Furthermore, deficits in processing rewards and abnormalities in processing emotional stimuli are suggestive of aberrant encoding of affective information. Accordingly, OCD can be partially characterized as a disease in which behavioral selection is corrupted by exaggerated or dysregulated emotional states. This suggests that the networks producing OCD symptoms likely expand beyond traditional lateral OFC and dorsal striatum circuit models, and highlights the need to cast a wider net in our investigation of the circuits involved in generating and sustaining OCD symptoms. Here, we address the emerging role of medial OFC, amygdala, and ventral tegmental area projections to the ventral striatum (VS) in OCD pathophysiology. The VS receives strong innervation from these affect and reward processing regions, and is therefore poised to integrate information crucial to the generation of compulsive behaviors. Though it complements functions of dorsal striatum and lateral OFC, this corticolimbic-VS network is less commonly explored as a potential source of the pathology underlying OCD. In this review, we discuss this network's potential role as a locus of OCD pathology and effective treatment.
Collapse
Affiliation(s)
- Jesse Wood
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
| | - Susanne E. Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of PittsburghPittsburgh, PA, USA
| |
Collapse
|
38
|
Storch EA, De Nadai AS, do Rosário MC, Shavitt RG, Torres AR, Ferrão YA, Miguel EC, Lewin AB, Fontenelle LF. Defining clinical severity in adults with obsessive-compulsive disorder. Compr Psychiatry 2015; 63:30-5. [PMID: 26555489 PMCID: PMC4643407 DOI: 10.1016/j.comppsych.2015.08.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/17/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the most commonly used instrument to assess the clinical severity of obsessive-compulsive symptoms. Treatment determinations are often based on Y-BOCS score thresholds. However, these benchmarks are not empirically based, which may result in non-evidence based treatment decisions. Accordingly, the present study sought to derive empirically-based benchmarks for defining obsessive-compulsive symptom severity. METHOD Nine hundred fifty-four adult patients with obsessive-compulsive disorder (OCD), recruited through the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, were evaluated by experienced clinicians using a structured clinical interview, the Y-BOCS, and the Clinical Global Impressions-Severity scale (CGI-Severity). RESULTS Similar to results in treatment-seeking children with OCD, our findings demonstrated convergence between the Y-BOCS and global OCD severity assessed by the CGI-Severity (Nagelkerke R(2)=.48). Y-BOCS scores of 0-13 corresponded with 'mild symptoms' (CGI-Severity=0-2), 14-25 with 'moderate symptoms' (CGI-Severity=3), 26-34 with 'moderate-severe symptoms' (CGI-Severity=4) and 35-40 with 'severe symptoms' (CGI-Severity=5-6). Neither age nor ethnicity was associated with Y-BOCS scores, but females demonstrated more severe obsessive-compulsive symptoms than males (d=.34). Time spent on obsessions/compulsions, interference, distress, resistance, and control were significantly related to global OCD severity although the symptom resistance item pairing demonstrated a less robust relationship relative to other components of the Y-BOCS. CONCLUSIONS These data provide empirically-based benchmarks on the Y-BOCS for defining the clinical severity of treatment seeking adults with OCD, which can be used for normative comparisons in the clinic and for future research.
Collapse
Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida,Department of Health Policy & Management, University of South Florida,Rogers Behavioral Health – Tampa Bay,All Children’s Hospital - Johns Hopkins Medicine
| | | | | | - Roseli G. Shavitt
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista, Brazil
| | - Ygor A. Ferrão
- Department of Psychiatry, Health Sciences Federal University of Porto Alegre, Brazil
| | | | - Adam B. Lewin
- Department of Pediatrics, University of South Florida,All Children’s Hospital - Johns Hopkins Medicine
| | - Leonardo F. Fontenelle
- Anxiety and Obsessive-Compulsive Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro & D’Or Institute for Research and Education, Brazil
| |
Collapse
|
39
|
Aslam M, Irfan M, Naeem F. Brief culturally adapted cognitive behaviour therapy for obsessive compulsive disorder: A pilot study. Pak J Med Sci 2015; 31:874-9. [PMID: 26430421 PMCID: PMC4590360 DOI: 10.12669/pjms.314.7385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To demonstrate the effectiveness of Brief Culturally adapted Cognitive Behavior Therapy (CaCBT) in the treatment of Obsessive Compulsive Disorder (OCD). Methods: This pre and post design study was conducted on out-patients with OCD at Centre for Cognitive Behaviour Therapy, Fountain House, Lahore, from April 2011 to April 2012. A semi structured questionnaire was developed to document demographic details of all the patients. All the participants were assessed at baseline (Pre Therapy session) with Yale Brown Obsessive Compulsive Disorder Scale (Y-BOCS), Hospital Anxiety & Depression Scale (Depression Subscale & Anxiety Subscale) and Brief Disability Questionnaire (BDQ). They were re-assessed on the same scales at the end of therapy in a follow up assessment session. Feedback from patients and their family member, who were trained as co-therapist, was obtained at the end of the therapy for assessing the satisfaction with the therapy. All the patients received six sessions of brief culturally adapted cognitive behavior therapy (CaCBT). Statistical analyses were carried out using SPSS v.22. Results: The mean age of the sample (n=21) was 31.14±11.9 years. There were significant differences post CBT between the scores of Y-BOCS (p=0.000), HADS – Depression subscale (p=0.001), HADS – Anxiety subscale (p=0.000) and BDQ (p=0.000). Conclusion: This study provides preliminary evidence for effectiveness of culturally adapted CBT for OCD.
Collapse
Affiliation(s)
- Muhammad Aslam
- Muhammad Aslam, MSc (Psychology). Psychologist, Fountain House, Lahore, Pakistan
| | - Muhammad Irfan
- Dr. Muhammad Irfan, MBBS, MCPS, FCPS, MS. Assistant Professor and Head, Department of Psychiatry and Behavioural Sciences, Peshawar Medical College, Peshawar, Riphah International University, Islamabad - Pakistan
| | - Farooq Naeem
- Dr. Farooq Naeem, MBBS, MSc (Research Methodology), MRCPsych, PhD. Associate Professor of Psychiatry, Queens University, Kingston, Ontario, Canada
| |
Collapse
|
40
|
Mavrogiorgou P, Bader A, Stockfleth E, Juckel G. [Obsessive-compulsive disorder in dermatology]. J Dtsch Dermatol Ges 2015; 13:991-1000. [PMID: 26408458 DOI: 10.1111/ddg.20_12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paraskevi Mavrogiorgou
- LWL-Universitätsklinikum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Bochum
| | - Armin Bader
- Klinik für Dermatologie, Venerologie und Allergologie, St. Joseph-Hospital, Klinikum der Ruhr-Universität Bochum
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Joseph-Hospital, Klinikum der Ruhr-Universität Bochum
| | - Georg Juckel
- LWL-Universitätsklinikum der Ruhr-Universität Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Bochum
| |
Collapse
|
41
|
McGuire JF, Piacentini J, Lewin AB, Brennan EA, Murphy TK, Storch EA. A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION. Depress Anxiety 2015; 32:580-93. [PMID: 26130211 PMCID: PMC4515191 DOI: 10.1002/da.22389] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/31/2015] [Accepted: 05/19/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-compulsive disorder (OCD). Although meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators. METHOD A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants. RESULTS Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy (g = 1.21), treatment response (relative risk [RR] = 3.93), and symptom/diagnostic remission (RR = 5.40). Greater co-occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g = 0.50), treatment response (RR = 1.80), and symptom/diagnostic remission (RR = 2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission. CONCLUSIONS Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.
Collapse
Affiliation(s)
- Joseph F. McGuire
- Department of Psychology, University of South Florida,Department of Pediatrics, University of South Florida,Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - Adam B. Lewin
- Department of Psychology, University of South Florida,Department of Pediatrics, University of South Florida,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
| | | | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
| | - Eric A. Storch
- Department of Psychology, University of South Florida,Department of Pediatrics, University of South Florida,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida,Rogers Behavioral Health – Tampa Bay,All Children’s Hospital, Johns Hopkins Medicine,Department of Health Policy and Management, University of South Florida
| |
Collapse
|
42
|
Abstract
With many youth presenting to primary care settings for mental health difficulties, knowledge of the respective evidence-based psychotherapies is imperative in ensuring that these youth receive the appropriate interventions in a timely manner. Most frequently, children present with internalizing and/or externalizing disorders, which cover a broad range of common pediatric mental disorders. Treatments of these disorders generally incorporate cognitive and/or behavioral components, which are derived from theoretical underpinnings and empirical support. Although the interventions share common components, they are distinctive in nature and are further tailored toward the idiosyncratic needs of children and their families. Careful consideration of the apposite intervention and individual needs of youth are pertinent to the effective amelioration of symptomology.
Collapse
Affiliation(s)
- Monica S Wu
- Department of Pediatrics, University of South Florida, 880 6th Street South, 4th Floor North, Box 7523, St. Petersburg, FL 33701, USA; Department of Psychology, University of South Florida, 4202 East Fowler Avenue, PCD 4118G, Tampa, FL 33620-7200, USA.
| | - Rebecca J Hamblin
- Department of Pediatrics, University of South Florida, 880 6th Street South, 4th Floor North, Box 7523, St. Petersburg, FL 33701, USA; Rogers Behavioral Health - Tampa Bay, 2002 North Lois Avenue, Suite 400, Tampa, FL 33607, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, 880 6th Street South, 4th Floor North, Box 7523, St. Petersburg, FL 33701, USA; Department of Psychology, University of South Florida, 4202 East Fowler Avenue, PCD 4118G, Tampa, FL 33620-7200, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 East Fletcher Avenue, Tampa, FL 33613, USA; Department of Health Management and Policy, University of South Florida, 13201 Bruce B. Downs Boulevard, MDC 56, Tampa, FL 33612, USA; Rogers Behavioral Health - Tampa Bay, 2002 North Lois Avenue, Suite 400, Tampa, FL 33607, USA; Mind-Body Branch, All Children's Hospital, Johns Hopkins Medicine, 880 6th Street South, 4th Floor North, Box 7523, St. Petersburg, FL 33701, USA
| |
Collapse
|
43
|
O’Neill J, Feusner JD. Cognitive-behavioral therapy for obsessive-compulsive disorder: access to treatment, prediction of long-term outcome with neuroimaging. Psychol Res Behav Manag 2015; 8:211-23. [PMID: 26229514 PMCID: PMC4516342 DOI: 10.2147/prbm.s75106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This article reviews issues related to a major challenge to the field for obsessive-compulsive disorder (OCD): improving access to cognitive-behavioral therapy (CBT). Patient-related barriers to access include the stigma of OCD and reluctance to take on the demands of CBT. Patient-external factors include the shortage of trained CBT therapists and the high costs of CBT. The second half of the review focuses on one partial, yet plausible aid to improve access - prediction of long-term response to CBT, particularly using neuroimaging methods. Recent pilot data are presented revealing a potential for pretreatment resting-state functional magnetic resonance imaging and magnetic resonance spectroscopy of the brain to forecast OCD symptom severity up to 1 year after completing CBT.
Collapse
Affiliation(s)
- Joseph O’Neill
- Division of Child Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Jamie D Feusner
- Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
44
|
Feusner JD, Moody T, Lai TM, Sheen C, Khalsa S, Brown J, Levitt J, Alger J, O'Neill J. Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive-compulsive disorder. Front Psychiatry 2015; 6:74. [PMID: 26042054 PMCID: PMC4438601 DOI: 10.3389/fpsyt.2015.00074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/30/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Intensive cognitive-behavioral therapy (CBT) can effectively reduce symptoms in obsessive-compulsive disorder (OCD). However, many relapse after treatment. Few studies have investigated biological markers predictive of follow-up clinical status. The objective was to determine if brain network connectivity patterns prior to intensive CBT predict worsening of clinical symptoms during follow-up. METHODS We acquired resting-state functional magnetic resonance imaging data from 17 adults with OCD prior to and following 4 weeks of intensive CBT. Functional connectivity data were analyzed to yield graph-theory metrics. We examined the relationship between pre-treatment connectome properties and OCD clinical symptoms before and after treatment and during a 12-month follow-up period. RESULTS Mean OCD symptom decrease was 40.4 ± 16.4% pre- to post-treatment (64.7% responded; 58.8% remitted), but 35.3% experienced clinically significant worsening during follow-up. From pre- to post-treatment, small-worldness and clustering coefficient significantly increased. Decreases in modularity correlated with decreases in OCD symptoms. Higher pre-treatment small-world connectivity was significantly associated with worsening of OCD symptoms during the follow-up period. Psychometric and neurocognitive measures pre- and post-treatment were not significant predictors. CONCLUSION This is the first graph-theory connectivity study of the effects of CBT in OCD, and the first to test associations with follow-up clinical status. Results show functional network efficiency as a biomarker of CBT response and relapse in OCD. CBT increases network efficiency as it alleviates symptoms in most patients, but those entering therapy with already high network efficiency are at greater risk of relapse. Results have potential clinical implications for treatment selection.
Collapse
Affiliation(s)
- Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Teena Moody
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Tsz Man Lai
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Courtney Sheen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Sahib Khalsa
- Laureate Institute for Brain Research , Tulsa, OK , USA ; The University of Tulsa , Tulsa, OK , USA
| | - Jesse Brown
- Department of Neurology, University of California San Francisco , San Francisco, CA , USA
| | - Jennifer Levitt
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| | - Jeffry Alger
- Department of Neurology, University of California Los Angeles , Los Angeles, CA , USA
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, CA , USA
| |
Collapse
|