Dysfunctional beliefs in patients with obsessive-compulsive disorder and depression as assessed with the Beliefs Questionnaire (BQ)

Unlocking the healing power of psilocybin: an overview of the role of psilocybin therapy in major depressive disorder, obsessive-compulsive disorder and substance use disorder

Resistance to traditional treatment methods is still a major obstacle in modern psychiatry. As a result, several studies are currently being conducted to find effective alternatives to traditional therapies. One of these alternatives is psilocybin, a psychedelic substance that has been tested in clinical trials as an adjunct to psychotherapy. These studies focus on patients with major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and substance use disorder (SUD), particularly alcohol and nicotine dependence. This article looks at the current understanding of psilocybin, including data from clinical trials conducted, psilocybin's mechanism of action, its safety and the level of risk associated with it.

Obsessive-Compulsive Symptom Dimensions and Their Relationships with Obsessive Beliefs: A Structural Equation Modeling Analysis

Dysfunctional beliefs are central in the development and maintenance of obsessive-compulsive disorder (OCD) as well as its treatment. Yet, research suggests that not all dysfunctional beliefs are equally important for each of the symptom dimensions of OCD. However, results are inconsistent in that studies contradict each other regarding the associations between specific symptom dimensions and belief domains. The aim of the present study was to clarify which belief domain is specifically associated with which OCD symptom dimension. Results could help to tailor treatments more specifically to the patient's OCD symptom dimension. In- and outpatients with OCD (N = 328; 43.6% male and 56.4% female) filled out questionnaires on symptom dimensions of OCD (Obsessive-Compulsive Inventory Revised) and dysfunctional beliefs (Obsessive Beliefs Questionnaire). A structural equation model analysis was conducted to identify the associations between dysfunctional beliefs and symptom dimensions. Our results showed that perfectionism/intolerance of uncertainty was associated with hoarding and symmetry/ordering, (2) overestimation of threat/inflated responsibility was associated with checking compulsions, and (3) importance of thoughts/control of thoughts was associated with obsessing. These results were largely supported by a backward selection. Our results demonstrated associations of specific dysfunctional beliefs and specific OCD symptom dimensions. However, future studies are necessary to replicate these findings with other measures (e.g., clinician ratings).

The magnitude of neurocognitive impairment is overestimated in depression: the role of motivation, debilitating momentary influences, and the overreliance on mean differences

BACKGROUND

Meta-analyses agree that depression is characterized by neurocognitive dysfunctions relative to nonclinical controls. These deficits allegedly stem from impairments in functionally corresponding brain areas. Increasingly, studies suggest that some performance deficits are in part caused by negative task-taking attitudes such as poor motivation or the presence of distracting symptoms. A pilot study confirmed that these factors mediate neurocognitive deficits in depression. The validity of these results is however questionable given they were based solely on self-report measures. The present study addresses this caveat by having examiners assess influences during a neurocognitive examination, which were concurrently tested for their predictive value on performance.

METHODS

Thirty-three patients with depression and 36 healthy controls were assessed on a battery of neurocognitive tests. The examiner completed the Impact on Performance Scale, a questionnaire evaluating mediating influences that may impact performance.

RESULTS

On average, patients performed worse than controls at a large effect size. When the total score of the Impact on Performance Scale was accounted for by mediation analysis and analyses of covariance, group differences were reduced to a medium effect size. A total of 30% of patients showed impairments of at least one standard deviation below the mean.

CONCLUSIONS

This study confirms that neurocognitive impairment in depression is likely overestimated; future studies should consider fair test-taking conditions. We advise researchers to report percentages of patients showing performance deficits rather than relying solely on overall group differences. This prevents fostering the impression that the majority of patients exert deficits, when in fact deficits are only true for a subgroup.

Remote cognitive assessment in severe mental illness: a scoping review

Many individuals living with severe mental illness, such as schizophrenia, present cognitive deficits and reasoning biases negatively impacting clinical and functional trajectories. Remote cognitive assessment presents many opportunities for advancing research and treatment but has yet to be widely used in psychiatric populations. We conducted a scoping review of remote cognitive assessment in severe mental illness to provide an overview of available measures and guide best practices. Overall, 34 studies (n = 20,813 clinical participants) were reviewed and remote measures, psychometrics, facilitators, barriers, and future directions were synthesized using a logic model. We identified 82 measures assessing cognition in severe mental illness across 11 cognitive domains and four device platforms. Remote measures were generally comparable to traditional versions, though psychometric properties were infrequently reported. Facilitators included standardized procedures and wider recruitment, whereas barriers included imprecise measure adaptations, technology inaccessibility, low patient engagement, and poor digital literacy. Our review identified several remote cognitive measures in psychiatry across all cognitive domains. However, there is a need for more rigorous validation of these measures and consideration of potentially influential factors, such as sex and gender. We provide recommendations for conducting remote cognitive assessment in psychiatry and fostering high-quality research using digital technologies.

Co-occurring depression and obsessive-compulsive disorder: A dimensional network approach

BACKGROUND

Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally.

METHODS

Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined.

RESULTS

Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed.

CONCLUSIONS

Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.

Sexual response in obsessive-compulsive disorder: the role of obsessive beliefs

BACKGROUND

Sexual response in obsessive-compulsive disorder (OCD) research and practice is overlooked. According to the Dual Control Model, satisfactory sexual response is based upon a balance of sexual excitation and inhibition. The assessment of sexual response in OCD may have clinical implications, such as the integration of sex therapy in psychotherapeutic intervention. The present study was aimed at comparing sexual excitation and inhibition levels between OCD patients and matched control subjects, and investigating whether obsessive beliefs might predict sexual excitation/inhibition.

METHODS

Seventy-two OCD patients (mean age ± standard deviation [SD]: 34.50 ± 10.39 years) and 72 matched control subjects (mean age ± SD: 34.25 ± 10.18) were included (62.50% men and 37.50% women in both groups). The Obsessive Compulsive Inventory-Revised (OCI-R), the Obsessive Beliefs Questionnaire-46 (OBQ-46), and the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) were administered.

RESULTS

Patients with OCD showed significantly higher levels of sexual excitation, inhibition due to threat of performance failure, and inhibition due to threat of performance consequences than the controls. In addition, the patients with more severe symptoms showed lower excitation than those with less severe symptoms, and those with higher perfectionism had stronger inhibition due to threat of performance failure than those with lower perfectionism.

CONCLUSIONS

This is the first study exploring sexual response in OCD according to the Dual Control Model. Sexual response is an impaired quality of life outcome in OCD that should be assessed in routine clinical practice. These findings support the importance of addressing specific obsessive beliefs to improve sexuality in OCD patients.

The reality of at risk mental state services: a response to recent criticisms

BACKGROUND

In the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.

METHODS

In this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.

RESULTS

Many of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.

CONCLUSIONS

ARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.

Obsessive-compulsive disorder during COVID-19: Turning a problem into an opportunity?

The COVID-19 pandemic has prompted global measures to prevent infection. Experts assume that it is particularly affecting people with obsessive-compulsive disorder (OCD), especially those with washing compulsions. Data, however, are currently lacking. 394 participants with OCD (n = 223 washers) participated in an online survey. Change in severity of OCD symptoms, reasons participants reported for the change (e.g., reduced mobility, reduced availability of cleaning products, economic factors, interpersonal conflicts), as well as participants' beliefs and experience associated with COVID-19 were assessed. 72 % of the participants reported an increase in OCD. This increase was significantly stronger in washers compared to non-washers. The worsening of symptoms was primarily associated with reduced mobility and interpersonal conflicts. Dysfunctional hygiene-related beliefs were significantly higher in washers than non-washers and were associated with greater symptom progression. Washers were more confident than non-washers about providing other people with helpful advice related to infection preventions. Washers, however, received more negative feedback from others in response to the advice they provided than non-washers. The majority of participants with OCD were negatively affected by the COVID-19 pandemic, and the negative effects were more pronounced in washers than in non-washers. Rapid interventions for OCD should be implemented to prevent long-term deterioration.

Implicit theories of emotion and mental health during adolescence: the mediating role of emotion regulation

Despite strong evidence of the influence of implicit theories of emotion (ITE) on mental health symptoms among adult samples, scant attention has been paid to this important relation during adolescence. Moreover, it remains unclear which proximal processes may help to explain the link between ITE and mental health. As such, the current study had two objectives: (1) to assess the association of ITE and later anxiety and depressive symptoms within an adolescent sample, and (2) evaluate the mediating role of real-world emotion regulation strategies on the association between ITE and mental health. A sample of 13-15-year-old adolescents (n = 183, mean age = 13.9, SD = 0.91, 50% female) completed a measure of ITE (Time 1), and subsequently reported on their emotion regulation strategy use via an ESM smart-phone app for two weeks (Time 2). Youth then reported on their anxiety and depressive symptoms six months later (Time 3). Mediational analyses revealed that the proportion to which adolescents used reappraisal and suppression mediated the association between ITE and depressive symptoms: higher levels of incremental theories of emotion were associated with more reappraisal, and less suppression, use, which in turn predicted fewer depressive symptoms six months later. None of the strategies measured, however, mediated the association between ITE and anxiety symptoms.

Four reasons why early detection centers for psychosis should be renamed and their treatment targets reconsidered: we should not catastrophize a future we can neither reliably predict nor change

Since the 1990s, facilities for individuals at putative risk for psychosis have mushroomed and within a very short time have become part of the standard psychiatric infrastructure in many countries. The idea of preventing a severe mental disorder before its exacerbation is laudable, and early data indeed strongly suggested that the sooner the intervention, the better the outcome. In this paper, the authors provide four reasons why they think that early detection or prodromal facilities should be renamed and their treatment targets reconsidered. First, the association between the duration of untreated psychosis and outcome is empirically established but has become increasingly weak over the years. Moreover, its applicability to those who are considered at risk remains elusive. Second, instruments designed to identify future psychosis are prone to many biases that are not yet sufficiently controlled. None of these instruments allows an even remotely precise prognosis. Third, the rate of transition to psychosis in at-risk patients is likely lower than initially thought, and evidence for the success of early intervention in preventing future psychosis is promising but still equivocal. Perhaps most importantly, the treatment is not hope-oriented. Patients are more or less told that schizophrenia is looming over them, which may stigmatize individuals who will never, in fact, develop psychosis. In addition self-stigma has been associated with suicidality and depression. The authors recommend that treatment of help-seeking individuals with mental problems but no established diagnosis should be need-based, and the risk of psychosis should be de-emphasized as it is only one of many possible outcomes, including full remission. Prodromal clinics should not be abolished but should be renamed and restructured. Such clinics exist, but the transformation process needs to be facilitated.