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Harika-Germaneau G, Heit D, Drapier D, Sauvaget A, Bation R, Chatard A, Doolub D, Wassouf I, Langbour N, Jaafari N. Treating refractory obsessive compulsive disorder with cathodal transcranial direct current stimulation over the supplementary motor area: a large multisite randomized sham-controlled double-blind study. Front Psychiatry 2024; 15:1338594. [PMID: 38827437 PMCID: PMC11140596 DOI: 10.3389/fpsyt.2024.1338594] [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: 11/14/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Background The present study evaluated the therapeutic efficacy and tolerability of 10 transcranial direct current stimulation (tDCS) sessions in treatment-resistance obsessive-compulsive disorder (OCD) patients using a multisite double-blind sham-controlled design. Methods Eighty treatment-resistance outpatients suffering from obsessive-compulsive disorder were randomized to receive either active or sham transcranial direct current stimulation. The cathode was positioned over the supplementary motor area and the anode over the right supraorbital area. Patients were evaluated at baseline, end of treatment (day 14), one-month follow-up (day 45), and three-month follow-up (day 105) on the Yale-Brown Obsessive Compulsive Scale. Results Although a significant interaction between time and treatment was observed, the primary endpoint-measuring the change in Yale-Brown obsessive compulsive scale scores after two weeks-was not achieved. Conversely, the secondary endpoint, which concerned the change in Yale-Brown obsessive compulsive scale scores after three months, was successfully met. It is important to note, however, that there were no significant differences in the percentage of responders and remitters at any of the post-treatment assessments. This suggests that the treatment may not have had a clinically relevant impact. Patients well received the transcranial direct current stimulation treatment, indicating its good tolerability. Conclusion This is the largest controlled trial using transcranial direct current stimulation in treatment-resistance obsessive-compulsive disorder patients. Our results indicate the importance of studying the placebo effect in transcranial direct current stimulation and the necessity to consider a long follow-up time to best evaluate the effects of the intervention. Clinical trial registration ClinicalTrials.gov, identifier NCT03304600.
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Affiliation(s)
- Ghina Harika-Germaneau
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
- HUGOPSY Network, Rennes, France
| | - Damien Heit
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
| | - Dominique Drapier
- HUGOPSY Network, Rennes, France
- Adult Psychiatry Department, Guillaume-Régnier Hospital, University of Rennes 1, Centre d’investigation Clinique (CIC) Inserm 1414, Rennes University Hospital, Rennes, France
| | - Anne Sauvaget
- HUGOPSY Network, Rennes, France
- Nantes Université, CHU Nantes, Mouvement, Interactions, Performance, MIP, UR 4334, Nantes, France
| | - Remy Bation
- Université Lyon 1, Lyon University, Villeurbanne, France
- INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Lyon, France
- Psychiatric Unit, Wertheimer Neurologic Hospital, Bron, France
| | - Armand Chatard
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
| | - Damien Doolub
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
| | - Issa Wassouf
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
- Centre Hospitalier Nord Deux-Sèvres, Service de Psychiatrie Adulte, Thouars, France
| | - Nicolas Langbour
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
- HUGOPSY Network, Rennes, France
| | - Nematollah Jaafari
- Unité de Recherché Clinique Intersectorielle en Psychiatrie à vocation régionale du Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, Poitiers, France
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
- HUGOPSY Network, Rennes, France
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Huang Y, Weng Y, Lan L, Zhu C, Shen T, Tang W, Lai HY. Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment. PSYCHORADIOLOGY 2023; 3:kkad025. [PMID: 38666121 PMCID: PMC10917385 DOI: 10.1093/psyrad/kkad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 04/28/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic disabling disease with often unsatisfactory therapeutic outcomes. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the diagnostic criteria for OCD, acknowledging that some OCD patients may lack insight into their symptoms. Previous studies have demonstrated that insight can impact therapeutic efficacy and prognosis, underscoring its importance in the treatment of mental disorders, including OCD. In recent years, there has been a growing interest in understanding the influence of insight on mental disorders, leading to advancements in related research. However, to the best of our knowledge, there is dearth of comprehensive reviews on the topic of insight in OCD. In this review article, we aim to fill this gap by providing a concise overview of the concept of insight and its multifaceted role in clinical characteristics, neuroimaging mechanisms, and treatment for OCD.
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Affiliation(s)
- Yueqi Huang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Yazhu Weng
- Fourth Clinical School of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lan Lan
- Department of Psychology and Behavior Science, Zhejiang University, Hangzhou 310058, China
| | - Cheng Zhu
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Ting Shen
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 19104, PA, USA
| | - Wenxin Tang
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
| | - Hsin-Yi Lai
- Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310007, China
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310029, China
- MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-machine Intelligence, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou 311121, China
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou 310027, China
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Wolf N, du Mortier JAM, van Oppen P, Hoogendoorn AW, van Balkom AJLM, Visser HAD. Changes in insight throughout the natural four-year course of obsessive-compulsive disorder and its association with OCD severity and quality of life. Front Psychiatry 2023; 14:1231293. [PMID: 37900299 PMCID: PMC10613061 DOI: 10.3389/fpsyt.2023.1231293] [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: 05/30/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Patients with obsessive-compulsive disorder (OCD) and poor insight show higher symptom severity, lower quality of life (QoL), and a reduced treatment response compared to patients with good insight. Little is known about changes in insight. This study explored the course of insight and its association with OCD severity and QoL among 253 patients with OCD participating in the prospective naturalistic Netherlands Obsessive Compulsive Disorder Association (NOCDA) Study. Results In 70% of the participants with available insight data, the level of insight changed during the four-year course. Insight was most variable in participants with poor insight. Improvement of insight scores was statistically significantly associated with improvement of Y-BOCS scores (r = 0.19), but not with changes in QoL scores. Change in insight in the first 2 years was not statistically significantly predictive of OCD severity or QoL at four-year follow-up. Conclusion These findings suggest that patients' levels of insight may change during the natural four-year course of OCD and that improvement in the level of insight have a positive association with improvement in OCD severity.
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Affiliation(s)
- Nadja Wolf
- Mental Health Care Institute Geestelijke gezondheidszorg (GGZ) Centraal, Amersfoort, Netherlands
| | - Johanna A. M. du Mortier
- Mental Health Care Institute Geestelijke gezondheidszorg (GGZ) Centraal, Amersfoort, Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
- Geestelijke gezondheidszorg (GGZ) inGeest, Specialized Mental Health Care, Amsterdam, Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands
- Geestelijke gezondheidszorg (GGZ) inGeest, Specialized Mental Health Care, Amsterdam, Netherlands
| | - Henny A. D. Visser
- Mental Health Care Institute Geestelijke gezondheidszorg (GGZ) Centraal, Amersfoort, Netherlands
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desousa A, Nayak OP, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Insight in patients with bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Indian J Psychiatry 2023; 65:767-773. [PMID: 37645363 PMCID: PMC10461589 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_714_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/17/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background There are limited number of studies evaluating insight among patients with bipolar disorder (BD). Aim This study aimed to examine insight and its correlates in BD using the data from the multicenter BD course and outcome study from India (BiD-CoIN). The additional aim was to evaluate the insight in patients with BD using different scales and understand the correlates of insight. Materials and Methods 773 BD patients presently in clinical remission were evaluated on the Insight Scale for Affective Disorders (ISAD), insight items of the Hamilton Depression Rating Scale (HDRS), and the Young Mania Rating Scale (YMRS). Results The assessment scales influenced the prevalence of poor insight. Poorer insight irrespective of the assessment scale was consistently associated with higher residual depressive and manic symptoms, and a higher level of cognitive impairment and disability. Poor insight as assessed by ISAD was associated with a higher number of episodes in the lifetime, shorter duration of current remission, a higher number of depressive episodes, a higher amount of time spent in depressive episodes, higher depressive affective morbidity, a higher number of manic episodes, and higher residual depressive and manic symptoms. Conclusion Poor insight in BD is consistently associated with higher residual depressive and manic symptoms and a higher level of cognitive impairment and disability. However, in terms of course variables, the correlates vary depending on the assessment method.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Chakravarty
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Department of Psychiatry, Burdwan Medical College and Hospital, Burdwan, Bardhaman, West Bengal, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and JNM Hospital WBUHS, Kalyani, West Bengal, India
| | - Rajarshi Neogi
- Department of Psychiatry, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avinash Desousa
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Omkar P. Nayak
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital (Sion Hospital), Mumbai, Maharashtra, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manish Bathla
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Haryana, India
| | - Alka A. Subramanyam
- Department of Psychiatry, Topiwala National Medical College (Nair Hospital), Mumbai, Maharashtra, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prasonjit Ghosh
- Department of Psychiatry, Silchar Medical College, Silchar, Assam, India
| | - Bhaveshkumar Lakdawala
- Department of Psychiatry, Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
| | - Ranjan Bhattacharya
- Department of Psychiatry, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India
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Jalal B, Chamberlain SR, Sahakian BJ. Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction. Brain Behav 2023; 13:e3000. [PMID: 37137502 PMCID: PMC10275553 DOI: 10.1002/brb3.3000] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This review provides an overview of obsessive-compulsive disorder (OCD) symptoms, including the four partially distinct subtypes of the disorder, current diagnostic criteria, and common comorbidities. Critically, it focuses on the etiology of OCD, including its underlying neuropathology, and examines cognitive dysfunction in OCD. METHODS This review study was conducted by library method. RESULTS We show how dysfunction in cortico-striato-thalamo-cortical (CSTC) circuits may underpin symptoms; and shed light on the putative neurochemistry within these loops such as the role of serotonin, dopamine, and glutamate systems. We also show how OCD is characterized by cognitive dysfunction including problems in cognitive flexibility, visuospatial memory, response inhibition, and goal-directed behavior, linked to aberrant activity within CSTC circuits. CONCLUSIONS In brief, research questions we shed light on include (1) what are the symptoms in OCD; (2) what is the etiology of the disorder and do existing models explain OCD; and (3) what are key cognitive deficits in OCD and do these improve with treatment?
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Affiliation(s)
- Baland Jalal
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Samuel R. Chamberlain
- Faculty of Medicine, Department of PsychiatryUniversity of SouthamptonSouthamptonUK
- Specialist Clinic for Impulsive and Compulsive Disorders, and the Southern Gambling ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Barbara J. Sahakian
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
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Picó-Pérez M, Barbosa R, Couto B, Castro I, Magalhães R, Sousa N, Ferreira S, Morgado P. Altered frontoparietal connectivity in patients with obsessive-compulsive disorder during an fMRI cognitive reappraisal task. Psychiatry Res 2022; 317:114874. [PMID: 36206590 DOI: 10.1016/j.psychres.2022.114874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
Patients with obsessive-compulsive disorder (OCD) present increased brain activity in orbitofrontal and limbic regions when experiencing negative emotions, which could be related to deficits in emotion regulation abilities. 30 OCD patients and 29 healthy controls (HC) performed a cognitive reappraisal functional magnetic resonance imaging (fMRI) task and completed emotion regulation and OCD symptomatology questionnaires. Besides task activation, connectivity was also compared between groups through psychophysiological interaction analysis (PPI), using regions previously reported to be hyperactive in OCD as seeds. Finally, brain-behavior correlations were performed between activation/connectivity strength in group differential regions and the questionnaires' scores, as well as the emotional ratings reported during the task. Behaviorally, patients with OCD were less successful than controls at lowering the emotional impact of negative images. At the brain level, there were no significant between-group differences in brain activation. Contrarily, PPI analyses showed that HC had increased frontoparietal connectivity when experiencing negative emotions in comparison to OCD patients, while this pattern was reversed when regulating emotions (increased connectivity in patients). Finally, frontoparietal connectivity was correlated with measures of emotion regulation success and OCD symptomatology. Our findings point towards frontoparietal altered connectivity as a potential compensatory mechanism during emotion regulation in OCD patients.
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Affiliation(s)
- Maria Picó-Pérez
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Departamento de Psicología Básica, Clínica y Psicobiología, Universitat Jaume I, Castelló de la Plana, Spain.
| | - Renato Barbosa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Beatriz Couto
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Inês Castro
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Ricardo Magalhães
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center - Braga, Braga, Portugal
| | - Sónia Ferreira
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center - Braga, Braga, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center - Braga, Braga, Portugal
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