1
|
Chen H, Xie M, Ouyang M, Yuan F, Yu J, Song S, Liu N, Zhang N. The impact of illness duration on brain activity in goal-directed and habit-learning systems in obsessive-compulsive disorder progression: A resting-state functional imaging study. Neuroscience 2024; 553:74-88. [PMID: 38964449 DOI: 10.1016/j.neuroscience.2024.06.018] [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: 12/07/2023] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
It is increasingly evident that structural and functional changes in brain regions associated with obsessive-compulsive disorder (OCD) are often related to the development of the disease. However, limited research has been conducted on how the progression of OCD may lead to an imbalance between goal-directed and habit-learning systems. This study employs resting-state functional imaging to examine the relationship between illness duration and abnormal brain function in goal-directed/habitual-learning systems. Demographic, clinical, and multimodal fMRI data were collected from participants. Our findings suggest that, compared to healthy controls, individuals with OCD exhibit abnormal brain functional indicators in both goal-directed and habit-learning brain regions, with a more pronounced reduction observed in the goal-directed regions. Additionally, abnormal brain activity is associated with illness duration, and the abnormalities observed in goal-directed regions are more effective in distinguishing different courses of OCD patients. Patients with different durations of OCD have functional abnormalities in the goal-directed and habitual-learning brain regions. There are differences in the degree of abnormality in different brain regions, and these abnormalities may disrupt the balance between goal-directed and habitual-learning systems, leading to increasing reliance on repetitive behaviors.
Collapse
Affiliation(s)
- Haocheng Chen
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Minyao Xie
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Mengyuan Ouyang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Fangzheng Yuan
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jianping Yu
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Shasha Song
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Na Liu
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Ning Zhang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| |
Collapse
|
2
|
Doolub D, Vibert N, Botta F, Razmkon A, Bouquet C, Wassouf I, Millet B, Harika-Germaneau G, Jaafari N. High treatment resistance is associated with lower performance in the Stroop test in patients with obsessive-compulsive disorder. Front Psychiatry 2023; 14:1017206. [PMID: 37215653 PMCID: PMC10198575 DOI: 10.3389/fpsyt.2023.1017206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Around 50% of the patients with obsessive-compulsive disorder (OCD) are resistant to treatment, and patients with OCD show alterations in a broad range of cognitive abilities. The present study investigated the links between treatment-resistance, executive and working memory abilities, and the severity of OCD symptoms among 66 patients with OCD. The patients performed seven tests gauging their executive functions and working memory and filled in questionnaires for OCD severity and insight into their pathology. In addition, the executive and working memory abilities of a subset of these patients were compared with those of individually matched control participants. In contrast with previous studies, patients' treatment resistance was evaluated by considering the clinical outcomes of all the treatments that they received during the course of their disease. Higher treatment resistance was associated with lower performance in one particular executive test, the Stroop test, which assessed patients' ability to inhibit prepotent/automatic responses. Older age and more severe OCD symptoms were also associated with higher treatment resistance. Regardless of OCD severity, the patients displayed small to moderate deficits across most components of executive functions compared to control participants. Interestingly, patients with OCD took more time than control participants to perform speeded neuropsychological tests but never made more errors. Altogether, this study shows that the treatment-resistance of patients with OCD may be reliably quantified over the course of years and treatments using Pallanti and Quercioli's (2006) treatment resistance-related scales. The data suggest that the Stroop test could be used clinically to anticipate treatment outcomes in to-be-treated patients.
Collapse
Affiliation(s)
- Damien Doolub
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Tours, Tours, France
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nicolas Vibert
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Tours, Tours, France
| | - Fabiano Botta
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Ali Razmkon
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
- Research Center for Neuromodulation and Pain, Shiraz, Iran
| | - Cédric Bouquet
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Tours, Tours, France
| | - Issa Wassouf
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Tours, Tours, France
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
- Centre Hospitalier du Nord Deux-Sèvres, Service de Psychiatrie Adulte, Thouars, France
| | - Bruno Millet
- Institut du Cerveau et de la Moelle, UMR 7225 CNRS, INSERM, Sorbonne Université et Département de Psychiatrie Adulte, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ghina Harika-Germaneau
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Tours, Tours, France
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nematollah Jaafari
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, CNRS UMR 7295, Université de Tours, Tours, France
- Unité de Recherche Clinique Pierre Deniker du Centre Hospitalier Henri Laborit, Poitiers, France
| |
Collapse
|
3
|
Pinciotti CM, Piacsek K, Kay B, Bailey B, Riemann BC. OCD in the time of COVID-19: A global pandemic's impact on mental health patients and their treatment providers. Bull Menninger Clin 2021; 86:91-112. [PMID: 34346726 DOI: 10.1521/bumc_2021_85_04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals with obsessive-compulsive disorder (OCD) have evidenced resilience against large-scale crises, although emerging research on the impact of COVID-19 is mixed. Little is known about the impact of COVID-19 on mental health providers. Items from an instrument evaluating the impact of the September 11, 2001, terrorist attack were adapted to measure the impact of COVID-19 on emotions, cognitions, and behaviors. Using a sample of 65 patients with primary OCD diagnoses and OCD treatment providers in intensive programs for OCD and anxiety, the authors found that COVID-19 evidenced a less significant overall impact on patients than providers. Specifically, providers reported more significant impact on the amount of time spent worrying about COVID-19, taking additional cleaning and sanitization precautions, and time spent socializing with loved ones. Findings support previous literature indicating that individuals with OCD demonstrate resilience to large-scale crises, and offer insights into the specific struggles of providers who treat OCD.
Collapse
Affiliation(s)
- Caitlin M Pinciotti
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Associate research psychologist
| | - Kelly Piacsek
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Vice president of research
| | - Brian Kay
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Vice president of continuous improvement
| | - Brenda Bailey
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Clinical supervisor
| | - Bradley C Riemann
- The Rogers Behavioral Health System, Oconomowoc, Wisconsin.,Chief clinical officer
| |
Collapse
|
4
|
Vellozo AP, Fontenelle LF, Torresan RC, Shavitt RG, Ferrão YA, Rosário MC, Miguel EC, Torres AR. Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates. J Clin Med 2021; 10:jcm10020274. [PMID: 33451078 PMCID: PMC7828517 DOI: 10.3390/jcm10020274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
Collapse
Affiliation(s)
- Aline P. Vellozo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
- D’Or Institute for Research and Education & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Correspondence: ; Tel.: +61-3-990-29755
| | - Ricardo C. Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Roseli G. Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Ygor A. Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90570-080, Brazil;
| | - Maria C. Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil;
| | - Euripedes C. Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| |
Collapse
|
5
|
Vaccaro LD, Jones MK, Menzies RG, Wootton BM. The treatment of obsessive‐compulsive checking: A randomised trial comparing danger ideation reduction therapy with exposure and response prevention. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Lisa D. Vaccaro
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Mairwen K. Jones
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Ross G. Menzies
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Bethany M. Wootton
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, New South Wales, Australia,
| |
Collapse
|
6
|
Kuckertz JM, Van Kirk N, Alperovitz D, Nota JA, Falkenstein MJ, Schreck M, Krompinger JW. Ahead of the Curve: Responses From Patients in Treatment for Obsessive-Compulsive Disorder to Coronavirus Disease 2019. Front Psychol 2020; 11:572153. [PMID: 33192865 PMCID: PMC7652992 DOI: 10.3389/fpsyg.2020.572153] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Alongside concern about the physical health impacts of the coronavirus disease 2019 (COVID-19) crisis, public health officials have also raised concerns about the potential for massive mental health impact. This has led many to wonder, how are individuals with obsessive-compulsive disorder (OCD), and especially those with contamination fears, doing in the era of COVID-19? We present data from eight patients in our residential treatment program for OCD who were admitted prior to any COVID-19 restrictions and continued in treatment at the facility during the pandemic. Much like the general population, our patients varied in the ways they were impacted by COVID-19, yet the majority experienced improvements in OCD symptoms despite the context. This is not to downplay the many ways in which our patients were personally affected by COVID-19. Rather our patients’ relatively resilient responses mirror our program’s treatment model, which emphasizes exposure and response prevention (ERP) within the complementary framework of acceptance and commitment therapy (ACT). The intention of this article is to challenge the notion that by definition this population will fare worse than the general public or that ERP cannot proceed effectively during this time. In contrast, we underscore that effective OCD treatment can and should continue in the era of COVID-19.
Collapse
Affiliation(s)
- Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Nathaniel Van Kirk
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - David Alperovitz
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jacob A Nota
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Meghan Schreck
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jason W Krompinger
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
7
|
Kracker Imthon A, Antônio Caldart C, do Rosário MC, Fontenelle LF, Constantino Miguel E, Arzeno Ferrão Y. Stressful Life Events and the Clinical Expression of Obsessive-Compulsive Disorder (OCD): An Exploratory Study. J Clin Med 2020; 9:E3371. [PMID: 33096706 PMCID: PMC7590000 DOI: 10.3390/jcm9103371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In obsessive-compulsive disorder (OCD), symptom content and severity appear to fluctuate over the course of the life cycle in accordance with stressful life events. The objective of this paper was to compare OCD patients with and without reported stressful life events (SLEs) in terms of the sociodemographics of patients and the clinical characteristics of OCD. METHODS This was a cross-sectional study involving 1001 patients with OCD. Data concerning SLEs were collected via the Yale OCD Natural History Questionnaire, while for OCD symptoms, the Dimensional Yale-Brown Obsessive-Compulsive Scale was used. RESULTS Of the 1001 OCD patients, 605 (60.5%) reported experiencing at least one SLE in their lifetime. Self-declared nonwhite skin color (odds ratio (OR) = 1.51), the presence of a sensory phenomenon (OR = 1.47), and comorbidity with post-traumatic stress disorder (PTSD) (OR = 2.38) were some of the logistic regression variables related to the reported SLEs with relevant statistical significance and risk (i.e., OR) values. CONCLUSIONS Our results indicate that SLEs may make Brazilian OCD patients vulnerable to the onset or exacerbation of obsessive-compulsive symptoms. The positive association of the occurrence of SLEs and sensory phenomena in this population could corroborate that environmental influences impact the neurobiology associated with OCD, and likely with other psychiatric disorders as well.
Collapse
Affiliation(s)
- André Kracker Imthon
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| | - César Antônio Caldart
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| | - Maria Conceição do Rosário
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Child and Adolescent Psychiatry Unit (UPIA) at the Department of Psychiatry, Federal University of São Paulo, São Paulo 04017-030, Brazil
| | - Leonardo F. Fontenelle
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Turner Institute for Brain and Mental Health, Monash University, Clayton VIC 3800, Australia
- D’Or Institute for Research and Education (IDOR) and Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Euripedes Constantino Miguel
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Department of Psychiatry, São Paulo University Medical School, São Paulo 05403-903, Brazil
| | - Ygor Arzeno Ferrão
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| |
Collapse
|
8
|
Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.
Key learning aims
(1)
To gain knowledge needed for working with clients with OCD across race, ethnicity and culture.
(2)
To understand how race, ethnicity and culture affect the assessment and treatment of OCD.
(3)
To increase awareness of critical skills needed to implement CBT effectively for OCD in ethnoracially diverse clients.
(4)
To acknowledge potential barriers experienced by minoritized clients and assist in creating accessible spaces for services.
Collapse
|
9
|
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
|
10
|
Koorenhof LJ, Dommett EJ. An Investigation Into Response Inhibition in Distinct Clinical Groups Within Obsessive-Compulsive Disorder. J Neuropsychiatry Clin Neurosci 2020; 31:228-238. [PMID: 30888920 DOI: 10.1176/appi.neuropsych.18070166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Response inhibition has been frequently studied in obsessive-compulsive disorder (OCD) with mixed results. The inconsistent findings may stem in part from failure to consider the heterogeneity of the disorder. METHODS The authors examined behavioral and event-related potential (ERP) components (N2 and P3) during a simple response inhibition go/nogo task in a sample of patients with OCD (N=48) and control subjects (N=53). Comparisons in behavioral and electrophysiological measures were made between groups (OCD compared with control) and within the OCD group in terms of symptom clusters (symmetry, forbidden thoughts, and cleaning) and comorbidity status (OCD only and OCD with depression). RESULTS In the OCD group, the N2 component appeared more frontally localized compared with the control group. Participants with OCD demonstrated longer N2 latency and a larger difference in N2 between the nogo and go conditions, suggesting slower but greater conflict monitoring. P3 had a larger amplitude in the OCD group compared with the control group, indicative of greater response inhibition, but was also reduced in the nogo compared with go condition, suggesting suppressed response inhibition. No significant differences were found between symptom clusters, but patients with OCD only made more omission errors compared with patients with OCD and comorbid depression. The latter cohort also had faster P3 latencies, which, combined with the behavioral data, indicates slightly improved response inhibition when comorbid depression is found. CONCLUSIONS On the basis of these results, it would seem unlikely that symptom clusters have contributed to previous inconsistencies in the literature. Comorbid depression, which may have affected previous results, should be considered in future research.
Collapse
Affiliation(s)
- Loes J Koorenhof
- The School of Life, Health and Chemical Sciences, Open University, Milton Keynes, United Kingdom (Koorenhof); and the Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Dommett)
| | - Eleanor J Dommett
- The School of Life, Health and Chemical Sciences, Open University, Milton Keynes, United Kingdom (Koorenhof); and the Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Dommett)
| |
Collapse
|
11
|
Barcia JA, Reneses B, Nombela C. Precision surgery for obsessive compulsive disorder-which is the proper target? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S184. [PMID: 31656763 DOI: 10.21037/atm.2019.07.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Juan Antonio Barcia
- Department of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Blanca Reneses
- Department of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Nombela
- Department of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
12
|
du Mortier JAM, Visser HAD, van Balkom AJLM, van Megen HJGM, Hoogendoorn AW, Glas G, van Oppen P. Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist. Psychiatry Res 2019; 271:299-305. [PMID: 30521999 DOI: 10.1016/j.psychres.2018.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 10/18/2018] [Accepted: 11/18/2018] [Indexed: 12/20/2022]
Abstract
Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.
Collapse
Affiliation(s)
| | - Henny A D Visser
- GGz Centraal, Innova Postbus 3051, 3800 DB Amersfoort, The Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | | | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Gerrit Glas
- Dimence Groep, Postbus 473, 8000 AL Zwolle, The Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| |
Collapse
|
13
|
de Avila RCS, do Nascimento LG, Porto RLDM, Fontenelle L, Filho ECM, Brakoulias V, Ferrão YA. Level of Insight in Patients With Obsessive-Compulsive Disorder: An Exploratory Comparative Study Between Patients With "Good Insight" and "Poor Insight". Front Psychiatry 2019; 10:413. [PMID: 31333508 PMCID: PMC6619338 DOI: 10.3389/fpsyt.2019.00413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive-compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight (n = 148), and those with scores above the 75% percentile composed the group with poor insight (n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics (p = 0.05); higher untreated time interval (p < 0.001); higher total Yale-Brown obsessive-compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale-Brown obsessive-compulsive scale total and dimensional scores (p from 0.04 to 0.001); higher prevalence of contamination/cleaning (p = 0.006) and hoarding (p < 0.001) symptoms dimensions; more prevalent sensory phenomena (p = 0.023); higher levels of depression (p = 0.007); and more prevalent comorbidity with bipolar affective disorder (p = 0.05) and post-traumatic stress disorder (PTSD) (p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to conventional OCD treatments. Studies based on neurobiological aspects such as neuroimaging and neuropsychology may help to elucidate more consistently the role of insight in patients with OCD and the repercussions concerning available treatments.
Collapse
Affiliation(s)
- Richard Chuquel Silveira de Avila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Laura Gratsch do Nascimento
- Departamento de Psicologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rafaella Landell de Moura Porto
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Leonardo Fontenelle
- Departamento de Psiquiatria, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Vlasios Brakoulias
- School of Medicine of Western Sydney University, University of Sydney, Sydney, NSW, Australia
| | - Ygor Arzeno Ferrão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| |
Collapse
|
14
|
Barcia JA, Avecillas-Chasín JM, Nombela C, Arza R, García-Albea J, Pineda-Pardo JA, Reneses B, Strange BA. Personalized striatal targets for deep brain stimulation in obsessive-compulsive disorder. Brain Stimul 2018; 12:724-734. [PMID: 30670359 DOI: 10.1016/j.brs.2018.12.226] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychiatric conditions currently treated with deep brain stimulation (DBS), such as obsessive-compulsive disorder (OCD), are heterogeneous diseases with different symptomatic dimensions, indicating that fixed neuroanatomical DBS targets for all OCD cases may not be efficacious. OBJECTIVE/HYPOTHESIS We tested whether the optimal DBS target for OCD is fixed for all patients or whether it is individualized and related to each patient's symptomatic content. Further, we explored if the optimal target can be predicted by combining functional neuroimaging and structural connectivity. METHODS In a prospective, randomized, double-blinded study in 7 OCD patients, symptomatic content was characterized pre-operatively by clinical interview and OCD symptom-provocation during functional MRI. DBS electrode implantation followed a trajectory placing 4 contacts along a striatal axis (nucleus accumbens to caudate). Patients underwent three-month stimulation periods for each contact (and sham), followed by clinical evaluation. Probabilistic tractography, applied to diffusion-weighted images acquired pre-operatively, was used to study the overlap between projections from the prefrontal areas activated during symptom provocation and the volume of activated tissue of each electrode contact. RESULTS Six patients were classified responders, with median symptomatic reduction of 50% achieved from each patient's best contact. This was located at the caudate in 4 cases and at the accumbens in 2. Critically, the anatomical locus of the best contact (accumbens or caudate) was related to an index derived by combining functional MRI responses to prevailing symptom provocation and prefronto-cortico-striatal projections defined by probabilistic tractography. CONCLUSION Our results therefore represent a step towards personalized, content-specific DBS targets for OCD.
Collapse
Affiliation(s)
- Juan A Barcia
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
| | - Josué M Avecillas-Chasín
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Nombela
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Rocío Arza
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Julia García-Albea
- Service of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - José A Pineda-Pardo
- CINAC, HM Puerta del Sur, Hospitales de Madrid, Mostoles, and CEU-San Pablo University, Madrid, Spain
| | - Blanca Reneses
- Service of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politecnica de Madrid, Spain; Department of Neuroimaging, Reina Sofia Centre for Alzheimer's Disease, Madrid, Spain
| |
Collapse
|
15
|
Saremi AA, Shariat SV, Nazari MA, Dolatshahi B. Neuropsychological Functioning in Obsessive-Compulsive Washers: Drug-Naive Without Depressive Symptoms. Basic Clin Neurosci 2017; 8:233-248. [PMID: 28781731 PMCID: PMC5535329 DOI: 10.18869/nirp.bcn.8.3.233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Obsessive-Compulsive Disorder (OCD) is a complex and heterogeneous neuropsychiatric syndrome. Contamination obsessions and washing/cleaning compulsions are the most frequent clinical OCD subtypes. The current study aimed at examining the neuropsychological impairments in drug-naive obsessive-compulsive (OC) washers without depressive symptoms and their association with the severity of symptoms. METHODS In the current causal-comparative study, 35 patients with diagnostic and statistical mental disorders class (DSM)-IV diagnosed with washing-subtype OCD and 35 healthy subjects were selected by the convenience sampling method and evaluated by computerized neuropsychology battery and clinical tests as Stroop Color-Word Test (SCWT), Wisconsin Card Sorting Test (WCST), Go/No-Go Test, Digits Forward (DF), Digits Backward (DB), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and General Health Questionnaire (GHQ)-28. The patients were matched to the comparison group with regard to age, gender, intelligence quotient (IQ), education, and handedness. All the tests were standardized in Iran. SPSS version 20.00 was used for descriptive and analytical data analysis. RESULTS There was no statistically significant different between the OCD washing and the control groups regarding socio-demographic variables or IQ. There were significant differences between the OC washer and the healthy control groups on the neuropsychological functioning. The obtained results suggested that OC washers performed significantly worse on neuropsychological measures than the controls. There was no significant association between the severity of OC symptoms and the neuropsychological functions in the OCD washing group. CONCLUSION It was concluded that executive function impairment, which is a core feature in OC washers was trait-like in nature.
Collapse
Affiliation(s)
- Ali Akbar Saremi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Tehran Institute of Psychiatry, School of Behavioural Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Nazari
- Department of Psychology, Faculty of Education & Psychology, University of Tabriz, Tabriz, Iran
| | - Behrooz Dolatshahi
- Department of Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
16
|
Asadi S, Daraeian A, Rahmani B, Kargari A, Ahmadiani A, Shams J. Exploring yale-brown obsessive-compulsive scale symptom structure in Iranian OCD patients using item-based factor analysis. Psychiatry Res 2016; 245:416-422. [PMID: 27620324 DOI: 10.1016/j.psychres.2016.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/29/2016] [Accepted: 08/07/2016] [Indexed: 11/25/2022]
Abstract
Obsessive compulsive disorder (OCD) is a heterogeneous psychiatric disorder. This study aimed to reach a comprehensive perspective of OCD symptoms in Iranian patients. Item-based factor analysis of Y-BOCS checklist from 216 outpatients resulted in five factors including aggression/checking, contamination/cleaning, symmetry/ordering/repeating/counting/hoarding, sexual and somatic. Regression analyses showed that miscellaneous items can be predicted by these factors. Results showed that OCD subtypes in Iranian patients resemble to those of other nations except the aggressive, sexual and religious obsessions; demonstrating the influence of the culture on obsession manifestation. The correlation analyses of factors and clinical characteristics demonstrated that aggression/checking was associated with high obsession scores and more avoidance. Contamination/cleaning was correlated with higher compulsion score. Patients with higher scores on symmetry/ordering/counting/repeating/hoarding had familial OCD pattern with earlier age of onset, lower age at assessment, higher obsession and more avoidance. Sexual factor was associated with less compulsion scores and somatic factor was associated with higher obsessions and compulsions as well as less familial history and more avoidance. These findings provide a comprehensive view of OCD symptom structure in Iranian OCD patients and will be of value to studies using symptom factor to lead investigation of its causes, correlates and treatment strategies considering cross-cultural differences.
Collapse
Affiliation(s)
- Sareh Asadi
- NeuroBiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azin Daraeian
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Rahmani
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Section of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Atiye Kargari
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolhassan Ahmadiani
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamal Shams
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Differences in duration of untreated illness, duration, and severity of illness among clinical phenotypes of obsessive-compulsive disorder. CNS Spectr 2015; 20:474-8. [PMID: 24967664 DOI: 10.1017/s1092852914000339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a prevalent, disabling, and comorbid condition that is frequently under-recognized and poorly treated. OCD phenotypes may differ in terms of clinical presentation and severity. However, few studies have investigated whether clinical phenotypes differ in terms of latency to treatment (ie, duration of untreated illness[DUI]), duration, and severity of illness. The present study was aimed to quantify the aforementioned variables in a sample of OCD patients. METHODS One hundred fourteen outpatients with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnosis of OCD were recruited, and their main clinical features were collected. Severity of illness was assessed through the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and the main phenotypes were identified through the Y-BOCS Symptom Checklist. A one-way analysis of variance (ANOVA) test, followed by a Bonferroni post-hoc test, were performed to compare DUI, duration, and severity of illness across subgroups. RESULTS In the whole sample, the mean DUI exceeded 7 years (87.35±11.75 months), accounting for approximately half of the mean duration of illness (172.2±13.36 months). When subjects were categorized into 4 main clinical phenotypes, respectively, aggressive/checking (n=31), contamination/cleaning (n=37), symmetry/ordering (n=32), and multiple phenotypes (n=14), DUI, duration, and severity of illness resulted significantly higher in the aggressive/checking subgroup, compared to other subgroups (F=3.58, p<0.01; F=3.07, p<0.01; F=4.390, p<0.01). DISCUSSION In a sample of OCD patients, along with a mean latency to treatment of approximately 7 years, regardless of the phenotype, patients had spent half of their duration of illness (DI) without being treated. DUI, duration, and severity of illness resulted significantly higher in the aggressive/checking subgroup.
Collapse
|
18
|
Martoni RM, Brombin C, Nonis A, Salgari GC, Buongiorno A, Cavallini MC, Galimberti E, Bellodi L. Evaluating effect of symptoms heterogeneity on decision-making ability in obsessive-compulsive disorder. Psychiatry Clin Neurosci 2015; 69:402-10. [PMID: 25522816 DOI: 10.1111/pcn.12264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/25/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022]
Abstract
AIMS Despite having a univocal definition, obsessive-compulsive disorder (OCD) shows a remarkably phenotypic heterogeneity. The published reports show impaired decision-making in OCD patients, using tasks such as the Iowa Gambling Task (IGT). We wanted to verify the hypothesis of an IGT worse performance in a large sample of OCD patients and healthy control (HC) subjects and to examine the relation between neuropsychological performance in IGT and the OCD symptoms heterogeneity. METHODS Binary data from the Yale-Brown Obsessive Compulsive Scale collected on a large sample of OCD patients were analyzed using a multidimensional item response theory model to explore the underlying structure of data, thus revealing latent factors. Factor scores were categorized into quartiles. Then, for each factor, we identified patients respectively with the highest versus lowest score. We evaluated whether symptom dimensions affect the probability of a correct answer over time generalized, during IGT performance, fitting a generalized linear mixed model. RESULTS We found a general deficit in ambiguous decision-making in OCD compared to HC. Moreover, our findings suggested that OCD symptoms heterogeneity affects decision-making learning abilities during IGT. In fact, while 'Symmetry' and 'Washing' patients showed a learning curve during the task, other subgroups did not. CONCLUSIONS Our study confirmed previous findings suggesting that OCD is characterized by a deficit in decision-making under uncertainty. Moreover, our study gave evidence about biological specificity for each symptom dimension in OCD. Data were discussed in the context of the somatic marker hypothesis, which was hypothesized to be reduced in OCD patients.
Collapse
Affiliation(s)
- Riccardo Maria Martoni
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.,Decision Theory in Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Brombin
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy.,CUSSB, University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Nonis
- CUSSB, University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Angela Buongiorno
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy
| | | | - Elisa Galimberti
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Bellodi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Milan, Italy.,Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
19
|
Reliability and validity of the Thai version of the Florida Obsessive-Compulsive Inventory. ScientificWorldJournal 2015; 2015:240787. [PMID: 25861673 PMCID: PMC4377463 DOI: 10.1155/2015/240787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/05/2015] [Accepted: 02/24/2015] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the reliability and validity of the Thai version of the FOCI (FOCI-T), which is a brief self-report questionnaire to assess the symptoms and severity of obsessive-compulsive disorder (OCD). Forty-seven OCD patients completed the FOCI-T, the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL). They were then interviewed to determine the OCD symptom severity by the Yale-Brown Obsessive-Compulsive Scale-Second Edition (YBOCS-II) and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D), together with the Global Assessment of Functioning (GAF) and the Clinical Global Impression-Severity Scales (CGI-S). The result showed that the FOCI-T had satisfactory internal consistency reliability on both the Symptom Checklist (KR-20 = 0.86) and the Severity Scale (α = 0.92). Regarding validity analyses, the FOCI-T Severity Scale had stronger correlations with the YBOCS-II and CGI-S than the FOCI-T Symptom Checklist. This implied the independence between the FOCI-T Symptom Checklist and the Severity Scale and good concurrent validity of the FOCI-T Severity Scale. Our results suggested that the FOCI-T was found to be a reliable and valid self-report measure to assess obsessive-compulsive symptoms and severity.
Collapse
|
20
|
Bejerot S, Edman G, Anckarsäter H, Berglund G, Gillberg C, Hofvander B, Humble MB, Mörtberg E, Råstam M, Ståhlberg O, Frisén L. The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders. Nord J Psychiatry 2014; 68:549-59. [PMID: 24568661 PMCID: PMC4221004 DOI: 10.3109/08039488.2014.884631] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive-compulsive symptoms and diagnosis of obsessive-compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date. AIM The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population. METHOD The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category "Obsessive-compulsive related disorders", accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive-compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS. RESULTS Principal component factor analysis produced five subscales titled "Symmetry", "Forbidden thoughts", "Contamination", "Magical thoughts" and "Dysmorphic thoughts". The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62-70% Cronbach's α = 0.81; Severity Scale: sensitivity = 72%, specificities = 75-84%, Cronbach's α = 0.94). CONCLUSIONS The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive-compulsive symptoms in clinical psychiatry.
Collapse
Affiliation(s)
- Susanne Bejerot
- Susanne Bejerot, M.D., Ph.D., Associate Professor, Department of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Jacob ML, Larson MJ, Storch EA. Insight in adults with obsessive-compulsive disorder. Compr Psychiatry 2014; 55:896-903. [PMID: 24445116 DOI: 10.1016/j.comppsych.2013.12.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022] Open
Abstract
The present study examined the clinical correlates of insight among adults with obsessive-compulsive disorder (OCD). One hundred and thirty treatment-seeking adults with a primary diagnosis of OCD, aged 18 to 68 years (mean 31.4 years) participated. Measures of clinical severity, obsessive-compulsive symptom dimensions, anxiety symptoms, depressive symptoms, and ability to resist and control OCD symptoms were obtained. Results indicated that poor insight was positively related to greater OCD symptom severity and poorer ability to resist and control OCD symptoms; this pattern of associations held when insight was examined continuously and categorically (i.e., high versus low insight). Insight was generally not associated with other clinical characteristics, except for a relationship with mental neutralizing behaviors. Insight did not mediate the relationship between the ability to resist and control OCD symptoms and obsessive-compulsive symptom severity. Overall, this study provides further information into the nature and role of insight in adults with OCD.
Collapse
Affiliation(s)
- Marni L Jacob
- Department of Pediatrics, University of South Florida.
| | - Michael J Larson
- Department of Psychology and Neuroscience Center, Brigham Young University
| | - Eric A Storch
- Department of Pediatrics, University of South Florida
| |
Collapse
|
22
|
Brakoulias V, Starcevic V, Berle D, Milicevic D, Moses K, Hannan A, Sammut P, Martin A. The characteristics of unacceptable/taboo thoughts in obsessive-compulsive disorder. Compr Psychiatry 2013; 54:750-7. [PMID: 23587527 DOI: 10.1016/j.comppsych.2013.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In the quest to unravel the heterogeneity of obsessive-compulsive disorder (OCD), an increasing number of factor analytic studies are recognising unacceptable/taboo thoughts as one of the symptom dimensions of OCD. AIMS This study aims to examine the characteristics associated with unacceptable/taboo thoughts. METHODS Using the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC) with 154 individuals with OCD, obsessive-compulsive symptoms were subjected to principal components analysis. The characteristics associated with the resulting symptom dimensions were then assessed using logistic and linear regression techniques. RESULTS Unacceptable/taboo thoughts comprised of sexual, religious and impulsive aggressive obsessions, and mental rituals. Higher scores on an unacceptable/taboo thoughts symptom dimension were predicted by higher Y-BOCS obsession subscores, Y-BOCS time preoccupied by obsessions scores, Y-BOCS distress due to obsessions scores, importance of control of thought ratings, male gender, and having had treatment prior to entering into the study. Unacceptable/taboo thoughts were also predicted by greater levels of hostility, and a past history of non-alcohol substance dependence. CONCLUSIONS An unacceptable/taboo thought symptom dimension of OCD is supported by a unique set of associated characteristics that should be considered in the assessment and treatment of individuals with these symptoms.
Collapse
Affiliation(s)
- Vlasios Brakoulias
- University of Sydney, Sydney Medical School-Nepean, Discipline of Psychiatry, Sydney/Penrith, NSW, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Symptom dimensions, clinical course and comorbidity in men and women with obsessive-compulsive disorder. Psychiatry Res 2013; 209:186-95. [PMID: 23298952 DOI: 10.1016/j.psychres.2012.12.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/14/2012] [Accepted: 12/08/2012] [Indexed: 12/15/2022]
Abstract
The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18-77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and "compulsive" buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups.
Collapse
|
24
|
Kichuk SA, Torres AR, Fontenelle LF, Rosário MC, Shavitt RG, Miguel EC, Pittenger C, Bloch MH. Symptom dimensions are associated with age of onset and clinical course of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2013; 44:233-9. [PMID: 23410525 PMCID: PMC3654083 DOI: 10.1016/j.pnpbp.2013.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 02/02/2013] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
Meta-analysis of the heterogeneous symptoms of obsessive-compulsive disorder (OCD) has found a four-factor structure of symptom dimensions consisting of cleaning, forbidden thoughts, symmetry, and hoarding. Research into age of onset of symptom dimensions has yielded inconsistent results, and it is unknown whether symptoms along these dimensions differ in their clinical course. We assessed age of onset and clinical course of different OCD symptom dimensions in a large cohort of adult patients. Nine-hundred fifty-five subjects were assessed using the Dimensional Yale-Brown Obsessive-Compulsive Scale. For age of onset analysis, we tested across three methods of classification: (1) primary (more severe) symptom dimension (2) clinically significant symptoms within a dimension or (3) any symptoms within a dimension. Age of onset was defined as the earliest age of onset reported for any individual item within a symptom dimension. For analysis of different types of clinical course, we used chi-square tests to assess for differences between primary symptom dimensions. OCD symptoms in the symmetry dimension had an earlier age of onset than other OCD symptom dimensions. These findings remained significant across all three methods of classification and controlling for gender and comorbid tics. No significant differences were found between the other dimensions. Subjects with primary OCD symptoms in the forbidden thoughts dimension were more likely to report a waxing-and-waning course, whereas symmetry symptoms were less likely to be associated with a waxing-and-waning course.
Collapse
|
25
|
Abstract
Attempts to explain the phenotypic heterogeneity of obsessive-compulsive disorder (OCD) have resulted in three to six OCD symptom dimensions. This study aimed to clarify the nature of these symptom dimensions using a self-report instrument (Vancouver Obsessional Compulsive Inventory [VOCI]) in addition to the clinician-rated Yale-Brown Obsessive Compulsive Scale-Symptom Checklist (YBOCS-SC). Participants (N = 154) were recruited to a study designed to specifically assess OCD symptom dimensions. Symptoms assessed via the YBOCS-SC and the VOCI were subjected to principal components analysis (PCA). Linear regression was used to assess the relationship between the YBOCS-SC-derived symptom dimensions and the VOCI symptom subscales. PCA of the YBOCS-SC and the VOCI revealed five OCD symptom dimensions that explained 68% and 60% of the variance, respectively. The results also supported a distinction between the doubt/checking symptom dimension and the unacceptable/taboo thoughts dimension that includes mental rituals. The YBOCS-SC-derived symptom components were predicted by their respective VOCI symptom subscale scores.
Collapse
|
26
|
Baioui A, Pilgramm J, Merz CJ, Walter B, Vaitl D, Stark R. Neural response in obsessive-compulsive washers depends on individual fit of triggers. Front Hum Neurosci 2013; 7:143. [PMID: 23630478 PMCID: PMC3631704 DOI: 10.3389/fnhum.2013.00143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/01/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) have highly idiosyncratic triggers. To fully understand which role this idiosyncrasy plays in the neurobiological mechanisms behind OCD, it is necessary to elucidate the impact of individualization regarding the applied investigation methods. This functional magnetic resonance imaging (fMRI) study explores the neural correlates of contamination/washing-related OCD with a highly individualized symptom provocation paradigm. Additionally, it is the first study to directly compare individualized and standardized symptom provocation. METHODS Nineteen patients with washing compulsions created individual OCD hierarchies, which later served as instructions to photograph their own individualized stimulus sets. The patients and 19 case-by-case matched healthy controls participated in a symptom provocation fMRI experiment with individualized and standardized stimulus sets created for each patient. RESULTS OCD patients compared to healthy controls displayed stronger activation in the basal ganglia (nucleus accumbens, nucleus caudatus, pallidum) for individualized symptom provocation. Using standardized symptom provocation, this group comparison led to stronger activation in the nucleus caudatus. The direct comparison of between-group effects for both symptom provocation approaches revealed stronger activation of the orbitofronto-striatal network for individualized symptom provocation. CONCLUSIONS The present study provides insight into the differential impact of individualized and standardized symptom provocation on the orbitofronto-striatal network of OCD washers. Behavioral and neural responses imply a higher symptom-specificity of individualized symptom provocation.
Collapse
Affiliation(s)
- Ali Baioui
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen Giessen, Germany ; Bender Institute of Neuroimaging, Justus Liebig University Giessen Giessen, Germany ; Outpatient Clinic for Behavior Therapy, Justus Liebig University Giessen Giessen, Germany
| | | | | | | | | | | |
Collapse
|
27
|
Impact of age of onset of illness on clinical phenotype in OCD. Psychiatry Res 2012; 200:554-9. [PMID: 22503329 DOI: 10.1016/j.psychres.2012.03.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 03/17/2012] [Accepted: 03/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aims to examine the demographic, clinical and comorbid patterns in a large sample of adult OCD subjects at a specialty OCD clinic in India. METHODS Consecutive patients (n=545) who consulted a specialty OCD Clinic over 5 years at a large psychiatric hospital in India were evaluated with the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive-Compulsive Scale, and the Clinical Global Impression scale. RESULTS Earlier age onset of OCD (years) was characterized by male preponderance (19.61±7.98 vs. 25.19±10.39, U=23453.5, p=<0.001), positive family history of OCD (19.60±10.02 vs. 22.27±9.20, U=16590.5, p<0.001) and presence of tic disorder (16.28±8.21 vs. 22.01±9.38, OR=0.86, p=0.001). In addition, early age of onset was associated with presence of sexual obsessions (18.92±7.49 vs. 22.88±9.82, OR=0.96, p=0.02), hoarding (19.61±9.32 vs. 22.21±9.36, OR=0.95, p=0.009), repeating rituals (19.76±8.37 vs. 23.29±9.84, OR=0.95, p=0.006) and need to touch compulsions (16.40±7.19 vs. 22.36±9.43, OR=0.89, p<0.001). CONCLUSIONS Our findings from a large sample not only confirm that early onset OCD could be a valid and distinct subtype of OCD but also support the cross-cultural similarity of early onset phenotype.
Collapse
|
28
|
Stasik SM, Naragon-Gainey K, Chmielewski M, Watson D. Core OCD symptoms: exploration of specificity and relations with psychopathology. J Anxiety Disord 2012; 26:859-70. [PMID: 23026094 PMCID: PMC3490030 DOI: 10.1016/j.janxdis.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/19/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a heterogeneous condition, comprised of multiple symptom domains. This study used aggregate composite scales representing three core OCD dimensions (Checking, Cleaning, and Rituals), as well as Hoarding, to examine the discriminant validity, diagnostic specificity, and predictive ability of OCD symptom scales. The core OCD scales demonstrated strong patterns of convergent and discriminant validity - suggesting that these dimensions are distinct from other self-reported symptoms - whereas hoarding symptoms correlated just as strongly with OCD and non-OCD symptoms in most analyses. Across analyses, our results indicated that Checking is a particularly strong, specific marker of OCD diagnosis, whereas the specificity of Cleaning and Hoarding to OCD was less strong. Finally, the OCD Checking scale was the only significant predictor of OCD diagnosis in logistic regression analyses. Results are discussed with regard to the importance of assessing OCD symptom dimensions separately and implications for classification.
Collapse
Affiliation(s)
- Sara M. Stasik
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
| | - Kristin Naragon-Gainey
- Center for Anxiety and Related Disorders, Boston University, 648 Beacon St., Boston, MA 02215
| | - Michael Chmielewski
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275
| | - David Watson
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
| |
Collapse
|
29
|
Mathis MAD, Alvarenga PD, Funaro G, Torresan RC, Moraes I, Torres AR, Zilberman ML, Hounie AG. Gender differences in obsessive-compulsive disorder: a literature review. BRAZILIAN JOURNAL OF PSYCHIATRY 2012; 33:390-9. [PMID: 22189930 DOI: 10.1590/s1516-44462011000400014] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/31/2011] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a heterogeneous condition, in which subtypes have been proposed. Previous studies suggested that gender plays a relevant role in OCD phenotypic expression. This study aimed to review the literature on gender differences in clinical, genetic or familial aspects of OCD. METHOD A conventional review was conducted, including all papers that investigated demographic, clinical, and genetic aspects of OCD according to gender. The search was based on data available in Medline and PsycINFO databases in the last 20 years, using as keywords: obsessive-compulsive disorder; and: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females. RESULTS Sixty three of 487 phenotypical and genetics studies were selected. Most studies indicate that male patients are more likely than females to be single, present early onset of symptoms and chronic course of the disorder, greater social impairment, more sexual-religious and aggressive symptoms, and greater comorbidity with tic and substance use disorders. Female patients present more contamination/cleaning symptoms and greater comorbidity with eating and impulse-control disorders. Genetic and family studies are inconclusive, but suggest that gender may play a role in the disease expression. CONCLUSIONS Gender is a relevant factor that should be taken into account when evaluating OCD patients. More studies are necessary to determine whether in fact it defines a homogeneous and particular group in OCD.
Collapse
|
30
|
Torres AR, Fontenelle LF, Ferrão YA, do Rosário MC, Torresan RC, Miguel EC, Shavitt RG. Clinical features of obsessive-compulsive disorder with hoarding symptoms: a multicenter study. J Psychiatr Res 2012; 46:724-32. [PMID: 22464941 DOI: 10.1016/j.jpsychires.2012.03.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 02/02/2012] [Accepted: 03/05/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Factor analyses indicate that hoarding symptoms constitute a distinctive dimension of obsessive-compulsive disorder (OCD), usually associated with higher severity and limited insight. The aim was to compare demographic and clinical features of OCD patients with and without hoarding symptoms. METHOD A cross sectional study was conducted with 1001 DSM-IV OCD patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (CTOC), using several instruments. The presence and severity of hoarding symptoms were determined using the Dimensional Yale-Brown Obsessive-Compulsive Scale. Statistical univariate analyses comparing factors possibly associated with hoarding symptoms were conducted, followed by logistic regression to adjust the results for possible confounders. RESULTS Approximately half of the sample (52.7%, n = 528) presented hoarding symptoms, but only four patients presented solely the hoarding dimension. Hoarding was the least severe dimension in the total sample (mean score: 3.89). The most common lifetime hoarding symptom was the obsessive thought of needing to collect and keep things for the future (44.0%, n = 440). After logistic regression, the following variables remained independently associated with hoarding symptoms: being older, living alone, earlier age of symptoms onset, insidious onset of obsessions, higher anxiety scores, poorer insight and higher frequency of the symmetry-ordering symptom dimension. Concerning comorbidities, major depressive, posttraumatic stress and attention deficit/hyperactivity disorders, compulsive buying and tic disorders remained associated with the hoarding dimension. CONCLUSION OCD hoarding patients are more likely to present certain clinical features, but further studies are needed to determine whether OCD patients with hoarding symptoms constitute an etiologically discrete subgroup.
Collapse
Affiliation(s)
- Albina R Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista, Botucatu (SP), Brazil.
| | | | | | | | | | | | | |
Collapse
|
31
|
Affiliation(s)
- Randy O. Frost
- Department of Psychology, Smith College, Northampton, Massachusetts 01063;
| | - Gail Steketee
- School of Social Work, Boston University, Boston, Massachusetts 02215
| | - David F. Tolin
- The Institute of Living and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520
| |
Collapse
|
32
|
Higuma H, Kanehisa M, Maruyama Y, Ishitobi Y, Tanaka Y, Tsuru J, Hanada H, Kodama K, Isogawa K, Akiyoshi J. Aripiprazole augmentation in 13 patients with refractory obsessive-compulsive disorder: a case series. World J Biol Psychiatry 2012; 13:14-21. [PMID: 22256827 DOI: 10.3109/15622975.2010.551667] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The primary treatment for obsessive-compulsive disorder (OCD) is selective serotonin reuptake inhibitors (SSRI). However, approximately a third of patients do not respond to SSRIs and remain chronically affected. METHODS Therefore, we added aripiprazole to SSRI therapy for 13 patients with treatment-refractory OCD (subjects who failed to respond to SSRI therapy for at least 2 months, and for an average of 508 days). Participants underwent at least 7 weeks of treatment with aripiprazole augmentation. RESULTS Patients were evaluated using the Y-BOCS and GAF scales. Aripiprazole (3-12 mg)/SSRI co-therapy significantly improved Y-BOCS and GAF scores. However, many patients needed to take antiparkinsonian drugs to control extrapyramidal symptoms. CONCLUSIONS These results suggest that aripiprazole augmentation of SSRI therapy may be effective for treatment-refractory OCD.
Collapse
Affiliation(s)
- Haruka Higuma
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Jaafari N, Aouizerate B, Tignol J, El-Hage W, Wassouf I, Guehl D, Bioulac B, Daniel ML, Lacoste J, Gil R, Burbaud P, Rotge JY. The relationship between insight and uncertainty in obsessive-compulsive disorder. Psychopathology 2011; 44:272-6. [PMID: 21546788 DOI: 10.1159/000323607] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 12/13/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between the levels of insight and checking-related uncertainty in patients with obsessive-compulsive disorder (OCD). SAMPLING AND METHODS Twenty OCD patients with checking compulsions and without current comorbidity were recruited. We used an experimental paradigm that gave subjects the opportunity to check during a decision-making task, thereby allowing for the calculation of a response time index (RTI) as the 'uncertainty cost' during decision-making. The level of insight was assessed with the Brown Assessment of Beliefs Scale (BABS). RESULTS Regression analyses indicated a significant positive correlation between RTI and BABS scores (r = 0.49). CONCLUSIONS The level of insight is related to cognitive characteristics underlying OCD symptoms, in particular, checking-related uncertainty in checking OCD patients. STUDY LIMITATIONS The absence of a comparison group and the low number of included patients are the main limitations of the present study.
Collapse
Affiliation(s)
- Nematollah Jaafari
- Unité de recherche clinique intersectorielle en psychiatrie, Centre Hospitalier Henri Laborit, INSERM CIC-P 0802, CHU et faculté de médecine de Poitiers, Poitiers, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|