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Kapıcı OB, Kapıcı Y, Tekin A. Comparison of accidental findings of brain magnetic resonance imaging of patients with obsessive-compulsive disorder and healthy controls. BMC Psychiatry 2023; 23:899. [PMID: 38041033 PMCID: PMC10693021 DOI: 10.1186/s12888-023-05393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Abnormalities in brain magnetic resonance imaging (MRI) have been reported in drug-naive and chronic patients with obsessive-compulsive disorder (OCD). The Fazekas scale is a method used to categorize and grade the severity of white matter hyperintensities (WMH) in brain MRI. These lesions can be indicative of various neurological conditions, particularly small vessel disease or cerebrovascular pathology. METHODS Brain MRIs of patients followed up with the diagnosis of OCD were retrospectively analyzed. 58 OCD (36 females, 22 males) and 58 healthy controls (HC) (30 females, 28 males) were included in the study. Age, gender, and brain MRI findings of the participants were recorded. RESULTS The mean ages of the OCD and HC groups were 33.4 ± 10.6 and 35.9 ± 9.3. There was no difference between the groups in terms of mean ages and gender distribution (p = 0.180 and p = 0.260, accordingly). Generalized cerebral atrophy was more common in patients with OCD than in HC (p = 0.008). Fazekas grade 1 was detected in 17.2% of the patients with OCD and 1.7% of HC. Accordingly, it was significantly more common in Fazekas grade 1 OCD patients (p = 0.002). Fazekas grade 2 was detected in only 2 patient with OCD. CVI was present in 20.7% of the patients with OCD and 1.7% of HC. There was a significant difference between the groups regarding CVI (p = 0.001). Ethmoidal thickening was more common in patients with OCD than in HC (p = 0.004). The YBOCS scores and ages of OCD patients with Fazekas grade 1 and 2 were significantly higher than those of patients with Fazekas grade 0. Likewise, the YBOCS scores and ages of OCD patients with generalized cerebral atrophy were significantly higher than those of patients without atrophy. CONCLUSION It is understood from the present study's findings that CVI, a neurodevelopmental malformation, is more common in patients with OCD. Due to the potential relationship of this anomaly with neuronal migration, it would be appropriate to pay attention to OCD symptoms in individuals with CVI and to perform white matter examination on brain imaging. In future studies, Fazekas grade can be evaluated in drug-naive OCD patients, and data on the pre-disease period can be obtained.
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Affiliation(s)
- Olga Bayar Kapıcı
- Department of Radiology, Adıyaman Training and Research Hospital, Adıyaman, Turkey
| | - Yaşar Kapıcı
- Department of Psychiatry, Adıyaman University Medical Faculty, Adıyaman, Turkey.
| | - Atilla Tekin
- Department of Psychiatry, Adıyaman University Medical Faculty, Adıyaman, Turkey
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Huang Y, Weng Y, Lan L, Zhu C, Shen T, Tang W, Lai HY. Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment. PSYCHORADIOLOGY 2023; 3:kkad025. [PMID: 38666121 PMCID: PMC10917385 DOI: 10.1093/psyrad/kkad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 04/28/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic disabling disease with often unsatisfactory therapeutic outcomes. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the diagnostic criteria for OCD, acknowledging that some OCD patients may lack insight into their symptoms. Previous studies have demonstrated that insight can impact therapeutic efficacy and prognosis, underscoring its importance in the treatment of mental disorders, including OCD. In recent years, there has been a growing interest in understanding the influence of insight on mental disorders, leading to advancements in related research. However, to the best of our knowledge, there is dearth of comprehensive reviews on the topic of insight in OCD. In this review article, we aim to fill this gap by providing a concise overview of the concept of insight and its multifaceted role in clinical characteristics, neuroimaging mechanisms, and treatment for OCD.
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Affiliation(s)
- Yueqi Huang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Yazhu Weng
- Fourth Clinical School of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lan Lan
- Department of Psychology and Behavior Science, Zhejiang University, Hangzhou 310058, China
| | - Cheng Zhu
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Ting Shen
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 19104, PA, USA
| | - Wenxin Tang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Hsin-Yi Lai
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310029, China
- MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-machine Intelligence, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou 311121, China
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
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Broekhuizen A, Vriend C, Wolf N, Koenen EH, van Oppen P, van Balkom AJLM, Visser HAD, van den Heuvel OA. Poor Insight in Obsessive-Compulsive Disorder as a Multifaceted Phenomenon: Evidence From Brain Activation During Symptom Provocation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1135-1144. [PMID: 37121397 DOI: 10.1016/j.bpsc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/24/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Poor insight in obsessive-compulsive disorder (OCD) is associated with higher symptom severity, more comorbidities, and worse response to treatment. This study aimed to elucidate underlying mechanisms of poor insight in OCD by exploring its neurobiological correlates. METHODS Using a symptom provocation task during functional magnetic resonance imaging, we compared brain activation of patients with poor insight (n = 19; 14 female, 5 male), good/fair insight (n = 63; 31 female, 32 male), and healthy control participants (n = 42; 22 female, 20 male) using a Bayesian region-of-interest and a general linear model whole-brain approach. Insight was assessed using the Overvalued Ideas Scale. RESULTS Compared with patients with good/fair insight and healthy control participants, patients with OCD and poor insight showed widespread lower task-related activation in frontal areas (subgenual anterior cingulate cortex, ventromedial prefrontal cortex, dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, supplementary motor area, precentral gyrus), parietal areas (posterior parietal cortex, precuneus), and the middle temporal gyrus and insula. Results were not driven by interindividual differences in OCD symptom severity, medication usage, age of disorder onset, or state distress levels. CONCLUSIONS During symptom provocation, patients with OCD and poor insight show altered activation in brain circuits that are involved in emotional processing, sensory processing, and cognitive control. Future research should focus on longitudinal correlates of insight and/or use tasks that probe emotional and sensory processing and cognitive control.
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Affiliation(s)
- Aniek Broekhuizen
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands; Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Anatomy & Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Amsterdam, the Netherlands.
| | - Chris Vriend
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Anatomy & Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Amsterdam, the Netherlands
| | - Nadja Wolf
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands
| | - Emma H Koenen
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Geestelijke Gezondheidszorg (GGZ) in Geest Specialized Mental Healthcare, Amsterdam, the Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Geestelijke Gezondheidszorg (GGZ) in Geest Specialized Mental Healthcare, Amsterdam, the Netherlands
| | - Henny A D Visser
- Mental Healthcare Institute Geestelijke Gezondheidszorg (GGZ) Centraal, Amersfoort, the Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Department of Anatomy & Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity, Impulsivity & Attention, Amsterdam, the Netherlands
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Cavaco TB, Ribeiro JS. Drawing the Line Between Obsessive-Compulsive Disorder and Schizophrenia. Cureus 2023; 15:e36227. [PMID: 37069876 PMCID: PMC10105491 DOI: 10.7759/cureus.36227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
The schizo-obsessive spectrum has been a central focus of interest and research within the scientific community in mental health. The increased comorbidity of schizophrenia and obsessive-compulsive symptoms (OCS) or obsessive-compulsive disorder (OCD) appears to be considerably higher than previously expected, with more recent studies suggesting growing prevalence rates. Despite this phenomenon, OCS are not considered primary manifestations of schizophrenia and are therefore not usually explored in these patients. The concept of schizo-obsessiveness mostly emerged in the 1990s, progressing into OCD-schizophrenia spectrum disorders as a dual diagnosis of OCD and schizophrenia. The manifestations of the schizo-obsessive spectrum are diverse, and its diagnoses may be divided overall into four main categories: schizophrenia with OCS; schizotypal personality disorder (SPD) with OCD; OCD with poor insight; schizo-obsessive disorder (SOD). In some cases, distinguishing an intrusive thought from delirium in OCD with poor insight might be challenging. Poor or absent insight can be present in many diagnoses of OCD. Those patients within the schizo-obsessive spectrum present a worse insight than those with OCD without schizophrenia. The comorbidity has important clinical implications, considering its association with an earlier onset of the disorder, more severe positive and negative psychotic symptoms, a greater cognitive deficit, more severe depressive symptoms, more suicide attempts, a reduced social network, increased psychosocial dysfunction, and consequently a worse quality of life and greater psychological suffering. The presence of OCS or OCD in schizophrenia may lead to more severe psychopathology and a worse prognosis. More precise diagnoses allow for a more targeted intervention by offering an optimized psychotherapeutic and psychopharmacological approach. We hereby present four clinical cases that represent each of the four designated categories of the schizo-obsessive spectrum. This case-series report aims to enhance clinical insight regarding the diversity of the schizo-obsessive spectrum and to illustrate the difficult and sometimes misleading process of differentiating OCD from schizophrenia and establishing a diagnosis due to the potential overlap of phenomenology, as well as the course and assessment of symptoms manifested within the spectrum.
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Manarte L, Andrade AR, do Rosário L, Sampaio D, Figueira ML, Morgado P, Sahakian BJ. Executive functions and insight in OCD: a comparative study. BMC Psychiatry 2021; 21:216. [PMID: 33926404 PMCID: PMC8082868 DOI: 10.1186/s12888-021-03227-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Around 25 to 30% of patients with obsessive-compulsive disorder (OCD) do not respond to treatment. These patients have the longest duration of disease and the worst prognosis. Following years of research on this topic, insight has emerged as a potential explanation for this therapeutic resistance. Therefore, it has become important to characterize OCD patients with poor insight. Few studies have focused on the neuropsychological and cognitive characteristics of these patients. METHODS To help fill this gap, we divided 57 patients into two groups, one with good insight and the other with poor insight, assessed their neuropsychological functions-through a Rey's figure test, a California verbal learning test, a Toulouse-Piéron test and a Wisconsin Card Sorting Test (WCST)-and compared the results with those of a paired control group. RESULTS The statistical analysis, with a significance level of 95%, revealed differences in the executive function tests, and particularly in the WCST (p ≤ 0.001) and trail-making-test (TMT A/B) (p = 0.002). CONCLUSIONS These differences suggest that the neuropsychological profile of poor-insight patients is different from their good-insight counterparts, emphasize the role played by the executive functions in insight and highlights the need for more accurate neurocognitive research and treatment.
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Affiliation(s)
- Lucas Manarte
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
| | - António R Andrade
- IDMEC. Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal
| | - Linete do Rosário
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Daniel Sampaio
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Maria Luísa Figueira
- Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, R. da Universidade, 4710-057, Braga, Portugal
| | - Barbara J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
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Abstract
Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms and is normally considered a heterogeneous disorder. Sometimes, OCD seems to be psychotic in nature, being complex in the differentiation between OCD and schizophrenia. This report describes a female adult patient who was diagnosed in her adolescence with schizophrenia due to her complains of "hearing voices "criticizing her. In response to team request for a second evaluation, she was admitted to the acute inpatient service. After a careful reassessment, the core symptom was recognized as obsession, and her diagnosis was revised to OCD; this allowed for a more direct treatment and management, with cognitive-behavior therapy and high doses of selective serotonin reuptake inhibitors, achieving a sustained clinical improvement over 2 years of follow-up. Currently, she is more functional, participates in social activities, and totally recognizes the egodystonic and intrusive thoughts. This case demonstrates the importance of eliciting psychopathology in greater detail for specific diagnosis and treatment decisions, especially in a complex clinical presentation.
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Neurological Soft Signs and Clinical Features of Tic-Related Obsessive-Compulsive Disorder Indicate a Unique Subtype. J Nerv Ment Dis 2020; 208:21-27. [PMID: 31688495 DOI: 10.1097/nmd.0000000000001098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tic-related obsessive-compulsive disorder (OCD) may be a unique OCD subtype. This study examined whether neurological soft signs (NSSs) of patients with tic-related and tic-free OCD enable discrimination of these subgroups. We used the Neurological Evaluation Scale to assess 32 patients with tic-related and 94 with tic-free OCD, as well as 84 controls. Most patients with tic-related OCD were male, with earlier illness onset and poorer insight scores than those of patients with tic-free OCD. Patients with tic-related OCD had poorer motor coordination, sensory integration, and motor sequencing than did tic-free patients. Logistic regression using NSS subscale scores predicted tic-related OCD. Patients with tic-related OCD displayed greater neurodevelopmental abnormalities than did tic-free patients. NSSs of the former group suggest the need to separate this subgroup. Our results also support the newly introduced tic-related specifier in the fifth edition of the Diagnostic and statistical manual of mental disorders.
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Liu W, Gan J, Fan J, Zheng H, Li S, Chan RCK, Tan C, Zhu X. Associations of cortical thickness, surface area and subcortical volumes with insight in drug-naïve adults with obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2019; 24:102037. [PMID: 31704545 PMCID: PMC6978222 DOI: 10.1016/j.nicl.2019.102037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 12/27/2022]
Abstract
• We first used the SBM method to explore the neuroanatomical basis underlying insight in OCD. • OCD-GI and OCD-PI displayed mostly shared, but partly distinct brain structural alterations. • Decreased cortical thickness in the left dmPFC, the left ACC and the right lateral parietal cortex was associated with poorer insight. • The potential effect of other clinical variables on the results has been ruled out.
Poor insight in obsessive-compulsive disorder (OCD) is associated with several adverse clinical outcomes. However, the neurobiological basis of this insight deficit is not clearly understood. The present study thus aimed to investigate associations of cortical thickness, cortical surface area and subcortical volumes with insight in a sample of drug-naïve adults with OCD. Forty-seven OCD patients and 42 healthy controls (HCs) underwent MRI scanning, depression and anxiety assessments. The Brown Assessment of Beliefs Scale (BABS) measured insight levels and patients were divided into two groups: poor insight (OCD-PI; n = 21), and good insight (OCD-GI; n = 26). Cortical thickness and surface area between groups were compared with whole-brain exploratory vertex-by-vertex analyses, while subcortical volumes were compared on a structure-by-structure basis. Partial correlation analyses were then performed to assess associations between regional cortical and subcortical measures and insight levels. OCD-GI and OCD-PI groups displayed partly shared, but also partly distinct brain structural alterations. Strikingly, OCD-PI showed decreased cortical thickness in the left superior frontal gyrus, left anterior cingulate cortex (ACC) and right inferior parietal gyrus, compared to both OCD-GI and HCs. Average cortical thickness extracted from these areas was further negatively correlated with BABS scores in the OCD-PI patients. Our findings suggest that poor insight in patients with OCD may have a neural substrate involving the left medial frontal and the right inferior parietal cortices.
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Affiliation(s)
- Wanting Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Central South University, Changsha, Hunan, China
| | - Jun Gan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Zheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sihui Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Changlian Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Central South University, Changsha, Hunan, China.
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Nissen JB, Parner E. The importance of insight, avoidance behavior, not-just-right perception and personality traits in pediatric obsessive-compulsive disorder (OCD): a naturalistic clinical study. Nord J Psychiatry 2018; 72:489-496. [PMID: 29993297 DOI: 10.1080/08039488.2018.1486454] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The primary aim of the present explorative naturalistic study was to examine the association of poor insight, avoidance behavior, and not-just-right sensation with baseline parameters including obsessive-compulsive disorder (OCD) symptoms, baseline severity scores, comorbidity, and personality traits. A second aim was to examine how insight, avoidance and not-just-right sensation influence treatment outcome. MATERIALS AND METHODS In total, 317 medical records from children and adolescents with OCD referred to a specialized OCD clinic in Denmark were recorded for baseline parameters and treatment outcome. All information was used. RESULTS Avoidance behavior and poor insight were associated with an increased baseline severity, whereas not-just-right perception was not. Avoidance behavior was associated with the contamination/cleaning subtype, and a not-just-right sensation with the hoarding/symmetry subtype. Lower insight and avoidance behavior were associated with comorbid conditions. At post-treatment, not-just-right perception was associated with a risk of relapse, whereas lower insight was negatively associated with gaining remission. Avoidance behavior reduced the probability of remission and increased the number of offered sessions as well as and the likelihood of having SRI prescribed. Different personality traits were associated with treatment outcome. CONCLUSION Insight, avoidance behavior, and not-just-right perceptions seem important for baseline severity and post-treatment outcome. Baseline examination should include a systematic description, which could guide treatment. The present study is an explorative study describing a naturalistic clinical population. Therefore, a number of limitations should be taken into consideration when interpreting the results. More systematic studies on the importance of insight, avoidance behavior and not-just-right perceptions are warranted.
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Affiliation(s)
- Judith Becker Nissen
- a Centre for Child and Adolescent Psychiatry , Aarhus University Hospital Risskov , Risskov , Denmark
| | - Erik Parner
- b Department of Public Health , Section of Biostatistics Aarhus University , Aarhus , Denmark
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Tulacı RG, Cankurtaran EŞ, Özdel K, Öztürk N, Kuru E, Özdemir İ. The relationship between theory of mind and insight in obsessive-compulsive disorder. Nord J Psychiatry 2018; 72:273-280. [PMID: 29426262 DOI: 10.1080/08039488.2018.1436724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND It is known that obsessive-compulsive disorder (OCD) patients with poor insight display more severe neuropsychological impairments than other patients with OCD. There are limited studies of OCD and theory of mind (ToM). AIM To investigate ToM skills in patients with OCD and the relationship between insight and ToM skills by comparing OCD patients with good and poor insight. METHODS Eighty patients with OCD and 80 healthy controls completed the structured clinical interview for DSM-IV axis I disorders, the Yale Brown Obsessive-Compulsive Scale, the Beck Anxiety and Beck Depression Inventories, and the Brown Assessment of Beliefs Scale. To assess ToM skills, first- and second-order false-belief tests, a hinting test, a faux pas test, a reading the mind in the eyes test, and a double-bluff test were administered. RESULTS Patients with OCD had poorer ToM abilities than healthy controls. All ToM scores were significantly lower in the poor insight group than in the good insight group (p < .001). A significant negative correlation was found between the BABS-total scores and all the ToM test mean scores (p < .05). CONCLUSIONS The finding of significantly lower ToM skills in OCD with poor insight than in OCD with good insight may contribute to the idea of OCD with poor insight being a subtype with different clinical and neuropsychological characteristics.
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Affiliation(s)
- Rıza Gökçer Tulacı
- a Department of Psychiatry , Uşak University Teaching and Research Hospital , Uşak , Turkey
| | | | - Kadir Özdel
- c Department of Psychiatry , University of Health Science, Dşkapı YB Teaching and Research Hospital , Ankara , Turkey
| | - Nefise Öztürk
- d Department of Psychiatry , Elazığ Mental Health Hospital , Elazığ , Turkey
| | - Erkan Kuru
- e Private Practice, Psychiatry , Ankara , Turkey
| | - İlker Özdemir
- f Department of Psychiatry , Tavşanlı State Hospital , Tavşanlı, Kütahya , Turkey
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Lei H, Cui Y, Fan J, Zhang X, Zhong M, Yi J, Cai L, Yao D, Zhu X. Abnormal small-world brain functional networks in obsessive-compulsive disorder patients with poor insight. J Affect Disord 2017; 219:119-125. [PMID: 28549329 DOI: 10.1016/j.jad.2017.05.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are limited data on neurobiological correlates of poor insight in obsessive-compulsive disorder (OCD). This study explored whether specific changes occur in small-world network (SWN) properties in the brain functional network of OCD patients with poor insight. METHOD Resting-state electroencephalograms (EEGs) were recorded for 12 medication-free OCD patients with poor insight, 50 medication-free OCD patients with good insight, and 36 healthy controls. RESULTS Both of the OCD groups exhibited topological alterations in the brain functional network characterized by abnormal small-world parameters at the beta band. However, the alterations at the theta band only existed in the OCD patients with poor insight. LIMITATIONS A relatively small sample size. Subjects were naïve to medications and those with Axis I comorbidity were excluded, perhaps limiting generalizability. CONCLUSIONS Disrupted functional integrity at the beta bands of the brain functional network may be related to OCD, while disrupted functional integrity at the theta band may be associated with poor insight in OCD patients, thus this study might provide novel insight into our understanding of the pathophysiology of OCD.
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Affiliation(s)
- Hui Lei
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; College of Education, Hunan Agricultural University, Changsha, Hunan, China
| | - Yan Cui
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Center South University, Changsha, Hunan, China
| | - Xiaocui Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Center South University, Changsha, Hunan, China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, Guangdong, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Center South University, Changsha, Hunan, China
| | - Lin Cai
- School of Sociology and Psychology, Southwest University for Nationalities, Chengdu, Sichuan, China
| | - Dezhong Yao
- Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute of Center South University, Changsha, Hunan, China.
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Abstract
The presence of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorders (OCD) in schizophrenia is frequent, and a new clinical entity has been proposed for those who show the dual diagnosis: the schizo-obsessive disorder. This review scrutinizes the literature across the main academic databases, and provides an update on different aspects of schizo-obsessive spectrum disorders, which include schizophrenia, schizotypal personality disorder (SPD) with OCD, OCD with poor insight, schizophrenia with OCS, and schizophrenia with OCD (schizo-obsessive disorder). An epidemiological discussion on the discrepancies observed in the prevalence of OCS and OCD in schizophrenia across time is provided, followed by an overview of the main clinical and phenomenological features of the disorder in comparison to the primary conditions under a spectral perspective. An updated and comparative analysis of the main genetic, neurobiological, neurocognitive, and pharmacological treatment aspects for the schizo-obsessive spectrum is provided, and a discussion on endophenotypic markers is introduced in order to better understand its substrate. There is sufficient evidence in the literature to demonstrate the clinical relevance of the schizo-obsessive spectrum, although little is known about the neurobiology, genetics, and neurocognitive aspects of these groups. The pharmacological treatment of these patients is still challenging, and efforts to search for possible specific endophenotypic markers would open new avenues in the knowledge of schizo-obsessive spectrum.
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Resting-state functional connectivity between right anterior insula and right orbital frontal cortex correlate with insight level in obsessive-compulsive disorder. NEUROIMAGE-CLINICAL 2017; 15:1-7. [PMID: 28458998 PMCID: PMC5397581 DOI: 10.1016/j.nicl.2017.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/11/2017] [Accepted: 04/04/2017] [Indexed: 12/29/2022]
Abstract
Few studies have explored the neurobiological basis of insight level in obsessive-compulsive disorder (OCD), though the salience network (SN) has been implicated in insight deficits in schizophrenia. This study was then designed to investigate whether resting-state (rs) functional connectivity (FC) of SN was associated with insight level in OCD patients. We analyzed rs-functional magnetic resonance imaging (fMRI) data from 21 OCD patients with good insight (OCD-GI), 19 OCD patients with poor insight (OCD-PI), and 24 healthy controls (HCs). Seed-based whole-brain FC and ROI (region of interest)-wise connectivity analyses were performed with seeds/ROIs in the bilateral anterior insula (AI) and dorsal anterior cingulate cortex (dACC). The right AI-right medial orbital frontal cortex (mOFC) connectivity was found to be uniquely decreased in the OCD-PI group, and the value of this aberrant connectivity correlated with insight level in OCD patients. In addition, we found that the OCD-GI group had significantly increased right AI-left dACC connectivity within the SN, relative to HCs (overall trend for groups: OCD-GI > OCD-PI > HC). Our findings suggest that abnormal right AI-right mOFC FC may mediate insight deficits in OCD, perhaps due to impaired encoding and integration of self-evaluative information about OCD-related beliefs and behaviors. Our findings indicate a SN connectivity dissociation between OCD-GI and OCD-PI patients and support the notion of considering OCD-GI and OCD-PI as two distinct disorder subtypes. We examined the functional connectivity of SN in OCD-GI and OCD-PI. OCD-PI patients had decreased right AI-right mOFC connectivity. Right AI- right mOFC connectivity correlated with insight level in OCD. OCD-GI patients had elevated right AI-left dACC connectivity within SN. These results are helpful toward elucidating insight presentation in OCD.
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Fan J, Zhong M, Gan J, Liu W, Niu C, Liao H, Zhang H, Tan C, Yi J, Zhu X. Spontaneous neural activity in the right superior temporal gyrus and left middle temporal gyrus is associated with insight level in obsessive-compulsive disorder. J Affect Disord 2017; 207:203-211. [PMID: 27723545 DOI: 10.1016/j.jad.2016.08.027] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/15/2016] [Accepted: 08/24/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Insight into illness is an important issue for psychiatry disorder. Although the existence of a poor insight subtype of obsessive-compulsive disorder (OCD) was recognized in the DSM-IV, and the insight level in OCD was specified further in DSM-V, the neural underpinnings of insight in OCD have been rarely explored. The present study was designed to bridge this research gap by using resting-state functional magnetic resonance imaging (fMRI). METHODS Spontaneous neural activity were examined in 19 OCD patients with good insight (OCD-GI), 18 OCD patients with poor insight (OCD-PI), and 25 healthy controls (HC) by analyzing the amplitude of low-frequency fluctuation (ALFF) in the resting state. Pearson correlation analysis was performed between regional ALFFs and insight levels among OCD patients. RESULTS OCD-GI and OCD-PI demonstrated overlapping and distinct brain alterations. Notably, compared with OCD-GI, tOCD-PI had reduced ALFF in left middle temporal gyrus (MTG) and right superior temporal gyrus (STG), as well as increased ALFF in right middle occipital gyrus. Further analysis revealed that ALFF values for the left MTG and right STG were correlated negatively with insight level in patients with OCD. LIMITATIONS Relatively small sample size and not all patients were un-medicated are our major limitations. CONCLUSIONS Spontaneous brain activity in left MTG and right STG may be neural underpinnings of insight in OCD. Our results suggest the great role of human temporal brain regions in understanding insight, and further underscore the importance of considering insight presentation in understanding the clinical heterogeneity of OCD.
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Affiliation(s)
- Jie Fan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China; Medical Psychological institute of Central South University, Changsha, Hunan 410011, PR China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, PR China
| | - Jun Gan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Wanting Liu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Chaoyang Niu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Haiyan Liao
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Hongchun Zhang
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Changlian Tan
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Jinyao Yi
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China.
| | - Xiongzhao Zhu
- Medical Psychological center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China; Medical Psychological institute of Central South University, Changsha, Hunan 410011, PR China.
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The dysfunctional inner mirror: poor insight in obsessive-compulsive disorder, contributions to heterogeneity and outcome. CNS Spectr 2015; 20:460-2. [PMID: 26425799 DOI: 10.1017/s1092852915000619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schiepek G, Tominschek I, Heinzel S, Aigner M, Dold M, Unger A, Lenz G, Windischberger C, Moser E, Plöderl M, Lutz J, Meindl T, Zaudig M, Pogarell O, Karch S. Discontinuous patterns of brain activation in the psychotherapy process of obsessive-compulsive disorder: converging results from repeated FMRI and daily self-reports. PLoS One 2013; 8:e71863. [PMID: 23977168 PMCID: PMC3744482 DOI: 10.1371/journal.pone.0071863] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022] Open
Abstract
This study investigates neuronal activation patterns during the psychotherapeutic process, assuming that change dynamics undergo critical instabilities and discontinuous transitions. An internet-based system was used to collect daily self-assessments during inpatient therapies. A dynamic complexity measure was applied to the resulting time series. Critical phases of the change process were indicated by the maxima of the varying complexity. Repeated functional magnetic resonance imaging (fMRI) measurements were conducted over the course of the therapy. The study was realized with 9 patients suffering from obsessive-compulsive disorder (subtype: washing/contamination fear) and 9 matched healthy controls. For symptom-provocative stimulation individualized pictures from patients’ personal environments were used. The neuronal responses to these disease-specific pictures were compared to the responses during standardized disgust-provoking and neutral pictures. Considerably larger neuronal changes in therapy-relevant brain areas (cingulate cortex/supplementary motor cortex, bilateral dorsolateral prefrontal cortex, bilateral insula, bilateral parietal cortex, cuneus) were observed during critical phases (order transitions), as compared to non-critical phases, and also compared to healthy controls. The data indicate that non-stationary changes play a crucial role in the psychotherapeutic process supporting self-organization and complexity models of therapeutic change.
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Affiliation(s)
- Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Christian Doppler University Hospital, Salzburg, Austria
- * E-mail:
| | - Igor Tominschek
- Clinic of Psychosomatic Medicine, Windach/Ammersee and Munich, Germany
| | - Stephan Heinzel
- Psychiatric University Hospital St. Hedwig, Charité Campus Mitte, Berlin, Germany
| | - Martin Aigner
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Annemarie Unger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Gerhard Lenz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Christian Windischberger
- MR Centre of Excellence, Center for Medical Physics and Biomedical Engineering, MedicalUniversity of Vienna, Austria
| | - Ewald Moser
- MR Centre of Excellence, Center for Medical Physics and Biomedical Engineering, MedicalUniversity of Vienna, Austria
| | - Martin Plöderl
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Christian Doppler University Hospital, Salzburg, Austria
- Department of Suicide Prevention, Paracelsus Medical University, Christian Doppler University Hospital, Salzburg, Austria
| | - Jürgen Lutz
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Germany
| | - Thomas Meindl
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Germany
| | - Michael Zaudig
- Clinic of Psychosomatic Medicine, Windach/Ammersee and Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
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Neurological soft signs and cognitive impairment in obsessive–compulsive disorder patients and their first-degree relatives. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000422796.47259.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Phillips KA, Pinto A, Hart AS, Coles ME, Eisen JL, Menard W, Rasmussen SA. A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder. J Psychiatr Res 2012; 46:1293-9. [PMID: 22819678 PMCID: PMC3432724 DOI: 10.1016/j.jpsychires.2012.05.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/25/2012] [Accepted: 05/31/2012] [Indexed: 11/19/2022]
Abstract
Insight/delusionality of beliefs is an important dimension of psychopathology across psychiatric disorders. This construct is of increasing interest in obsessive-compulsive and related disorders, including obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). Even though OCD and BDD are considered closely related, no prior study has compared these disorders across a range of categories of global insight (excellent, good, fair, poor, absent/delusional), and only one study has compared these disorders on individual components of insight. Using the reliable and valid Brown Assessment of Beliefs Scale (BABS), this study examined insight/delusionality of OCD- or BDD-related beliefs in 211 individuals with primary OCD versus 68 individuals with primary BDD. In both disorders, levels of insight spanned the full range, from excellent to absent (i.e., delusional beliefs). However, the distribution of BABS scores across insight categories differed significantly by disorder, with the majority of OCD subjects showing excellent or good insight, and the majority of BDD subjects showing poor or absent insight. Compared to OCD subjects, BDD subjects had significantly poorer insight both overall (total BABS score) and on all individual BABS items. BABS score was significantly correlated with BDD and OCD severity, but in regressions it accounted for only 21% of the variance in OCD and 28% in BDD. In summary, both global insight and its individual components are poorer in BDD than in OCD, which has implications for research and clinical care, as well as understanding of the relationship between these disorders. Disorder severity is associated with but not equivalent to insight/delusionality.
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Venkatasubramanian G, Zutshi A, Jindal S, Srikanth SG, Kovoor JME, Kumar JK, Janardhan Reddy YC. Comprehensive evaluation of cortical structure abnormalities in drug-naïve, adult patients with obsessive-compulsive disorder: a surface-based morphometry study. J Psychiatr Res 2012; 46:1161-8. [PMID: 22770508 DOI: 10.1016/j.jpsychires.2012.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/21/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
Abstract
The study objective was to comprehensively evaluate drug-naïve, adult patients with Obsessive Compulsive Disorder (OCD) for cortical structure abnormalities in comparison with healthy controls. In this cross-sectional study of case-control design, Magnetic Resonance Imaging (1-mm) was performed in drug-naïve OCD patients (N = 50) & age- sex-, education- and handedness-matched healthy controls (N = 40). We examined cortical volume, thickness, surface area & local Gyrification Index (LGI) through a completely automated surface-based morphometric analysis using FreeSurfer software. OCD symptoms and insight were assessed using Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) check-list and severity scale. Illness severity was assessed using Clinical Global Impression Severity (CGI-S) Scale. OCD patients had significantly deficient volume, thickness and surface area of right anterior cingulate gyrus (ACG). Right lingual gyrus surface area was found to be significantly decreased in patients. Y-BOCS obsession score had significant negative correlation with left frontal pole volume. Y-BOCS compulsion score had significant negative correlations with right ACG volume and surface area and right lateral orbitofrontal cortex LGI. CGI-Severity score had significant negative correlations with right lingual gyrus volume, thickness and surface area as well as right lateral orbitofrontal area. Y-BOCS insight score showed a significant negative correlation with LGI of left medial OFC and left rostral ACG. Identification of novel deficits involving occipital brain regions and first-time observations of relevant correlations between various illness characteristics and cortical measures in OCD patients supports a network involving anterior cingulate, orbitofrontal and occipital brain regions in the pathogenesis of OCD.
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20
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Kashyap H, Kumar JK, Kandavel T, Reddy YCJ. Neuropsychological correlates of insight in obsessive-compulsive disorder. Acta Psychiatr Scand 2012; 126:106-14. [PMID: 22375841 DOI: 10.1111/j.1600-0447.2012.01845.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are limited data on neuropsychological correlates of poor insight in obsessive-compulsive disorder (OCD). We hypothesize that poor insight may be associated with greater impairment in tasks of conflict resolution/response inhibition and possibly impairment in a task of verbal learning and memory. METHOD Insight and neuropsychological functions were assessed in 150 subjects with DSM-IV OCD. The neuropsychological data of 177 healthy control subjects were used for comparison. RESULTS Insight score correlated significantly with the Stroop Interference Test for conflict resolution/response inhibition (P = 0.002), and showed trends for significance with the Controlled Oral Word Association (COWA) average for verbal fluency (P = 0.021) and delayed recall on the Auditory Verbal Learning Test (AVLT) for verbal memory (P = 0.015). On regression analysis, the AVLT delayed recall, the COWA average, the Matrix score, the Yale-Brown Obsessive-Compulsive Scale total score, and current antipsychotic use emerged as significant predictors of poorer insight. CONCLUSION Poor insight is associated with greater impairments in conflict resolution/response inhibition, verbal memory, and fluency. Individuals with poorer insight may have difficulty in appropriately processing conflicting information, updating their memory with corrective information, and then accessing this corrective information to modify their irrational beliefs.
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Affiliation(s)
- H Kashyap
- Neuropsychology Unit, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
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Shimshoni Y, Reuven O, Dar R, Hermesh H. Insight in obsessive-compulsive disorder: a comparative study of insight measures in an Israeli clinical sample. J Behav Ther Exp Psychiatry 2011; 42:389-96. [PMID: 21450265 DOI: 10.1016/j.jbtep.2011.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 02/14/2011] [Accepted: 02/17/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Attempts to identify the characteristics of OCD patients with poor insight have not produced a coherent picture. This may be related to the wide variety of the available insight assessment tools. The study aimed to compare five principal measure for assessing insight in OCD and to investigate the relationships between insight and central demographic and clinical variables. METHODS Sixty outpatients diagnosed with OCD (36 men, 24 women) were assessed with the following insight measures: DSM-IV insight criterion, Over-Valued Ideas Scale (OVIS), Item 11 of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Brown Assessment of Beliefs Scale (BABS) and Beck Cognitive Insight Scale (BCIS). RESULTS Correlation coefficients indicated high correspondence between all insight measures with the exception of the BCIS. At the same time, the relations of the various insight measures with demographic and clinical variables were distinctive and in some cases measure-specific. The most robust correlation was between insight and current medical treatment, so that medicated participants showed higher insight levels on most insight measures compared to non-medicated participants. Some insight measures were correlated with co-morbidity, onset age and gender. Insight levels did not correlate with OCD symptom severity. LIMITATIONS Limitations of this study include its cross-sectional design, modest sample size and an incomplete representation of the available insight measures. CONCLUSIONS The diversity of measures used in previous studies cannot account for the inconsistent findings on the role of insight in OCD.
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Affiliation(s)
- Ya'ara Shimshoni
- Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel
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22
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Karadag F, Tumkaya S, Kırtaş D, Efe M, Alacam H, Oguzhanoglu NK. Neurological soft signs in obsessive compulsive disorder with good and poor insight. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1074-9. [PMID: 21396423 DOI: 10.1016/j.pnpbp.2011.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/29/2011] [Accepted: 03/03/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Obsessive compulsive disorder (OCD) is a clinically heterogeneous disorder; OCD with poor insight has been suggested to be a specific clinical subtype. Neurological soft signs (NSSs) may be helpful to identify the specific subtypes of OCD patients. METHODS In the present study, we aimed to compare OCD patients with poor insight with OCD patients having good insight, and healthy individuals. Sixty-four OCD patients (38 with good insight and 26 with poor insight), and 32 healthy subjects were enrolled in the present study. The Overvalued Ideas Scale (OVIS) was used to determine OCD patients with poor insight. NSSs were assessed by using the Neurological Evaluation Scale (NES). RESULTS Two OCD groups had significantly higher total NES scores compared to controls (p=.000). Compared to healthy controls, OCD patients with poor insight performed significantly worse on all NES subscales, and they had significantly more NSSs on motor coordination, and sensory integration subscales compared to the OCD with good insight group. CONCLUSION Our results suggested that OCD patients with poor insight exhibit more extensive neurodevelopmental impairments compared to OCD patients with good insight.
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Affiliation(s)
- Filiz Karadag
- Pamukkale University, Medicine Faculty, Psychiatry Department, Doktorlar Cd. 20100 Denizli, Turkey.
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23
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Fontenelle JM, Santana LDS, Lessa LDR, Victoria MSD, Mendlowicz MV, Fontenelle LF. [The concept of insight in patients with obsessive-compulsive disorder]. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 32:77-82. [PMID: 20339738 DOI: 10.1590/s1516-44462010000100015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To update clinicians regarding the existence of a putative subtype of obsessive-compulsive disorder based on poor insight. METHOD Opinionative review based on studies indexed in the PubMed and PsychINFO databases, identified by means of the keywords 'obsessive-compulsive disorder' AND 'insight' OR 'ego-syntonic', and published between 1966 and October 2009. The results were analyzed according to the approach adopted, i.e. a categorical or dimensional view of insight in obsessive-compulsive disorder. RESULTS The review of recent studies led us to identify some issues that cast doubts over the existence of a clear-cut poor insight subtype of obsessive-compulsive disorder. These issues include 1) an extremely variable prevalence of poor insight obsessive-compulsive disorder in categorical studies, 2) a significant degree of homogeneity in the phenotypical findings (i.e. greater severity) associated with lower levels of insight in obsessive-compulsive disorder in both categorical and dimensional studies and, 3) a lack of studies investigating zones of rarity between poor and good insight obsessive-compulsive disorder. CONCLUSION Although a categorical approach to the insight issue in obsessive-compulsive disorder is still important in clinical settings, where decision-making is often a critical issue, a dimensional approach seems to reflect levels of impairment in these patients more reliably.
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Affiliation(s)
- Júlia M Fontenelle
- Programa de Ansiedade e Depressão, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Chon MW, Choi JS, Kang DH, Jung MH, Kwon JS. MRI study of the cavum septum pellucidum in obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2010; 260:337-43. [PMID: 19856198 DOI: 10.1007/s00406-009-0081-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
Abstract
The cavum septum pellucidum (CSP), a putative marker of neurodevelopmental anomaly, has been associated with an increased risk of several psychiatric disorders. The purpose of this study was to evaluate the CSP in patients with obsessive-compulsive disorder (OCD) compared with healthy control subjects. Seventy-one patients with OCD and 71 healthy volunteers matched for age and sex were evaluated with magnetic resonance imaging. We evaluated the CSP using criteria employed in previous studies: presence of the CSP, length of the CSP, and overall size of the CSP, measured in five grades, ranging from grades 0 (no CSP) to 4 (severe CSP). We evaluated OCD symptom severity using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The CSP presence was significantly greater in the OCD group (60.6%) than in control subjects (29.6%), and CSP size grade was significantly larger in the OCD group (chi(2) = 15.609, P = 0.004). CSP length showed no significant group difference. Among patients with OCD, those with a CSP had higher scores on the obsession subscale of the Y-BOCS than those without a CSP (Z = -2.358, P = 0.018), while they did not show significant difference from those without a CSP in the compulsion subscale of the Y-BOCS, age, duration of illness, or age at onset. These results indicate that neurodevelopmental alterations in midline structures might contribute to the pathogenesis of OCD.
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Affiliation(s)
- Myong-Wuk Chon
- Department of Psychiatry, Seoul National University College of Medicine, Chongno-gu, Seoul, 110-744, Korea
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Catapano F, Perris F, Fabrazzo M, Cioffi V, Giacco D, De Santis V, Maj M. Obsessive-compulsive disorder with poor insight: a three-year prospective study. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:323-30. [PMID: 20015461 DOI: 10.1016/j.pnpbp.2009.12.007] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 11/27/2009] [Accepted: 12/09/2009] [Indexed: 11/26/2022]
Abstract
Available evidence about the relationship between poor insight and other clinical characteristics in patients with obsessive-compulsive disorder (OCD) is inconclusive and conflicting. There is also a paucity of data on the long-term course and treatment outcome of OCD patients with poor insight. The present study reports the findings of a relatively large sample (n=106) of outpatients fulfilling DSM-IV criteria for OCD, treated with serotonin reuptake inhibitors (SRIs) and prospectively followed up for 3 years. Baseline information was collected on demographic and clinical characteristics, using standardized instruments. Insight was assessed by means of the Brown Assessment of Beliefs Scale (BABS). Eighty-three patients were followed prospectively and evaluated systematically by validated measures of psychopathology. Compared to their good insight counterparts, the OCD patients with poor insight (22%) showed a greater severity of obsessive-compulsive and depressive symptomatology; an earlier age at onset; a higher rate of schizophrenia spectrum disorder in their first-degree relatives; a higher comorbidity with schizotypal personality disorder. During the follow-up period, poor insight OCD patients were less likely to achieve at least a partial remission of obsessive-compulsive symptoms; required a significantly greater number of therapeutic trials; received more frequently augmentation with antipsychotics. The results suggest that the specifier "poor insight" helps to identify a subgroup of patients at the more severe end of OCD spectrum, characterized by a more complex clinical presentation, a diminished response to standard pharmacological interventions, and a poorer prognosis. Further research is needed to identify alternative strategies for the management of these patients.
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Affiliation(s)
- Francesco Catapano
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, I-80138 Naples, Italy.
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Stein DJ, Denys D, Gloster AT, Hollander E, Leckman JF, Rauch SL, Phillips KA. Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatr Clin North Am 2009; 32:665-85. [PMID: 19716996 DOI: 10.1016/j.psc.2009.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews current issues in the diagnosis and treatment of obsessive-compulsive disorder (OCD). The introduction of the selective serotonin reuptake inhibitors and of cognitive-behavioral therapy were significant advances for treating OCD. Nevertheless, there is a need to improve awareness of OCD and its management, and to develop novel approaches to treatment-refractory patients. Although the diagnostic criteria for OCD have remained unchanged for some time, there are several areas where potential modification may be useful. There is a growing evidence base on OCD symptom dimensions and subtyping, and it is timely to consider incorporating some of these emerging data into diagnostic classification systems.
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Affiliation(s)
- Dan J Stein
- Deparment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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27
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Alonso P, Menchón JM, Segalàs C, Jaurrieta N, Jiménez-Murcia S, Cardoner N, Labad J, Real E, Pertusa A, Vallejo J. Clinical implications of insight assessment in obsessive-compulsive disorder. Compr Psychiatry 2008; 49:305-12. [PMID: 18396191 DOI: 10.1016/j.comppsych.2007.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 09/20/2007] [Accepted: 09/29/2007] [Indexed: 11/18/2022] Open
Abstract
Poor insight has been reported in 15% to 36% of patients with obsessive-compulsive disorder (OCD), but little is known about its clinical correlations. This study examines insight among patients with OCD using a standardized instrument, the Brown Assessment of Beliefs Scale, and analyzes its relationship with clinical factors. Insight was assessed in 132 patients with OCD, before and after pharmacologic treatment, using the Brown Assessment of Beliefs Scale. Differences between patients with good and poor insight on sociodemographic variables, OCD severity, comorbidity, and treatment response were studied. Stability of insight after pharmacologic treatment was also examined. Thirty-nine patients (29.5%) exhibited poor insight. They showed more depressive symptoms (P = .001) and personality disorders (P = .001), especially the schizotypal form, than did good insight subjects, but there were no significant differences in treatment response. Insight significantly improves after treatment (P < .001). Our results suggest that insight in OCD varies widely and constitutes a dynamic phenomenon that can improve after treatment and is influenced by clinical conditions such as affective status or personality.
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Affiliation(s)
- Pino Alonso
- OCD Clinical and Research Unit, Psychiatry Department, Bellvitge Hospital, Feixa Llarga s/n, L'Hospitalet de Llobregat, Barcelona, Spain.
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