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OCD and Comorbid Depression: Assessment, Conceptualization, and Cognitive Behavioral Treatment. J Cogn Psychother 2022; 36:191-206. [PMID: 35882535 DOI: 10.1891/jcp-2022-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders-especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depression on OCD, the conceptualization, assessment, and treatment of OCD when it appears along with depression is covered in detail. The derivation and implementation of a cognitive behavioral treatment program specifically for depressed OCD patients is described and illustrated using a case example.
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2
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Mancebo MC, Yip AG, Boisseau CL, Rasmussen SA, Zlotnick C. Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center. Behav Ther 2021; 52:1296-1309. [PMID: 34452681 PMCID: PMC8629130 DOI: 10.1016/j.beth.2021.02.009] [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] [Received: 08/03/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.
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Affiliation(s)
- Maria C. Mancebo
- Butler Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA,Corresponding Author: Maria C. Mancebo, Ph.D., Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. Phone:401-455-6216 Fax:401-680-4122
| | | | - Christina L Boisseau
- Butler Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
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Thamby A, Balachander S, Ali SF, Arumugham SS, Ts J, Narayanaswamy JC, Janardhan Reddy YC. Naturalistic outcome of medication-naïve obsessive compulsive disorder treated with serotonin reuptake inhibitors. Asian J Psychiatr 2021; 60:102642. [PMID: 33930709 DOI: 10.1016/j.ajp.2021.102642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/08/2021] [Accepted: 04/05/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The data on the course of obsessive compulsive disorder (OCD) is mostly derived from studying chronic, severely ill patients with varying degree of treatment resistance. We studied the course and outcome of OCD patients who were medication-naïve at initial assessment compared to those who were medicated. MATERIAL AND METHODS We analyzed the clinical chart data of all patients with a primary diagnosis of OCD attending a speciality OCD clinic in India during a specified period and compared outcome between medication-naïve (n = 75) and medicated (n = 117) patients. RESULTS The mean time to remission was shorter in the medication-naïve [18.99 months (95 % CI: 14.61-23.37)] compared to medicated [33.91 months (95 % CI: 27.55-40.28)] patients. The survival distribution of the two groups was significantly different as per the log-rank test (χ2 = 5.76, p = 0.02). In the Cox proportional hazards regression, medication-naïve status predicted time to remission. Overall, the rate of remission was the same in both groups (57 %). CONCLUSIONS Medication-naïve OCD patients seem to remit faster than the previously treated patients. Future prospective naturalistic studies can compare the outcome of medication naïve OCD patients treated with medications and CBT.
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Affiliation(s)
- Abel Thamby
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Srinivas Balachander
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Syed Farooq Ali
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jaisoorya Ts
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | - Y C Janardhan Reddy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Ma J, Wang C, Huang P, Wang X, Shi L, Li H, Sang D, Kou S, Li Z, Zhao H, Lian H, Hu X. Effects of short-term cognitive-coping therapy on resting-state brain function in obsessive-compulsive disorder. Brain Behav 2021; 11:e02059. [PMID: 33559216 PMCID: PMC8035441 DOI: 10.1002/brb3.2059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) tends to be treatment refractory. Recently, cognitive-coping therapy (CCT) for OCD is reported to be an efficacious psychotherapy. However, the underlying neurophysiological mechanism remains unknown. Here, the effects of CCT on OCD and the resting-state brain function were investigated. METHODS Fifty-nine OCD patients underwent CCT, pharmacotherapy plus CCT (pCCT), or pharmacotherapy. Before and after a 4-week treatment, Yale-Brown obsessive-compulsive scale (Y-BOCS) was evaluated and resting-state functional magnetic resonance imaging (rs-fMRI) was scanned. RESULTS Compared with the baseline, significant reduction of Y-BOCS scores was found after four-week treatment (p < .001) in groups of CCT and pCCT, not in pharmacotherapy. Post-treatment Y-BOCS scores of CCT group and pCCT group were not different, but significantly lower than that of pharmacotherapy group (p < .001). Compared with pretreatment, two clusters of brain regions with significant change in amplitude of low-frequency fluctuation (ALFF) were obtained in those who treated with CCT and pCCT, but not in those who received pharmacotherapy. The ALFF in cluster 1 (insula, putamen, and postcentral gyrus in left cerebrum) was decreased, while the ALFF in cluster 2 (occipital medial gyrus, occipital inferior gyrus, and lingual gyrus in right hemisphere) was increased after treatment (corrected p < .05). The changes of ALFF were correlated with the reduction of Y-BOCS score and were greater in remission than in nonremission. The reduction of the fear of negative events was correlated to the changes of ALFF of clusters and the reduction of Y-BOCS score. CONCLUSIONS The effectiveness of CCT for OCD was related to the alteration of resting-state brain function-the brain plasticity. TRIAL REGISTRATION ChiCTR-IPC-15005969.
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Affiliation(s)
- Jian‐Dong Ma
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
| | - Chang‐Hong Wang
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
| | - Ping Huang
- The Fifth People's Hospital of KaifengKaifengHenanP. R. China
| | - Xunan Wang
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
| | - Li‐Jing Shi
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
| | - Heng‐Fen Li
- Zhengzhou University First Affiliated HospitalZhengzhouHenanP. R. China
| | - De‐En Sang
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
| | - Shao‐Jie Kou
- The Fifth People's Hospital of KaifengKaifengHenanP. R. China
- Workstation of Henan Province for Psychiatry expertsKaifengHenanP. R. China
| | - Zhi‐Rong Li
- The Fifth People's Hospital of KaifengKaifengHenanP. R. China
| | - Hong‐Zeng Zhao
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
| | - Hong‐Kai Lian
- Zhengzhou University Affiliated Zhengzhou Central HospitalZhengzhouP. R. China
| | - Xian‐Zhang Hu
- Xinxiang Medical University Affiliated Second HospitalXinxiangHenanP. R. China
- Workstation of Henan Province for Psychiatry expertsKaifengHenanP. R. China
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Zemestani M, Salavati M, Seyedolshohadayi A, Petersen JM, Ong CW, Twohig MP, Ghaderi E. A Preliminary Examination of Acceptance and Commitment Therapy Versus Exposure and Response Prevention for Patients with Obsessive-Compulsive Disorder on an Optimal Dose of SSRIs: A Randomized Controlled Trial in Iran. Behav Modif 2020; 46:553-580. [DOI: 10.1177/0145445520982977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study compared the effects of adding acceptance and commitment therapy (ACT) or exposure and response prevention (ERP) to adults diagnosed with obsessive compulsive disorder (OCD) already on an optimal and stable dose of selective serotonin reuptake inhibitors (SSRIs). Forty adults on SSRIs who were diagnosed with OCD participated in a randomized controlled trial in Iran of 12 individual weekly sessions of either ACT+SSRI, ERP+SSRI, or continued SSRI only. The results showed significant reductions in OCD symptom severity in ACT+SSRI and ERP+SSRI conditions at posttreatment with significantly greater reductions in both conditions compared to SSRI-only at follow-up. Additionally, psychological inflexibility and use of thought control strategies significantly decreased in the ACT+SSRI condition at posttreatment and follow-up compared to the ERP+SSRI and SSRI conditions. Both conditions led to decreases in perceived importance of stop signals. Results provide cross-cultural support for the treatment of OCD using ACT and ERP as adjuncts to SSRI and modest process of change differences between ACT and ERP. Future directions and study limitations are discussed.
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Taj M J RJ, Ganesh S, Shukla T, Deolankar S, Nadella RK, Sen S, Purushottam M, Reddy YCJ, Jain S, Viswanath B. BDNF gene and obsessive compulsive disorder risk, symptom dimensions and treatment response. Asian J Psychiatr 2018; 38:65-69. [PMID: 29079096 DOI: 10.1016/j.ajp.2017.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/16/2017] [Indexed: 11/26/2022]
Abstract
AIM Genetic etiology of Obsessive Compulsive Disorder (OCD) has been investigated extensively, with mixed results across candidate gene studies. The dimensional subtypes of OCD are shown to better correlate with brain imaging endophenotypes and thus could potentially enhance the power of genetic association. In this study, we perform a case control analysis of association of a single nucleotide polymorphism rs6265(Val66Met) in Brain Derived Neurotrophic Factor gene, that has been previously implicated in a variety of psychiatric syndromes, and examine its association with symptom dimensions of OCD. METHODS Individuals diagnosed to have OCD (n=377) and controls (n=449) of South Indian origin were genotyped for polymorphism rs6265 (196G/A, Val66Met). Detailed phenotypic assessment of the cases were carried out in the cases using structured instruments. The genotypic association was tested for clinical variables such as age of onset, gender, family history, co-morbidity, treatment response, and factor analyzed OCD symptom dimensions. RESULTS The allele 'A' frequency was found to be significantly higher in the controls, as compared to cases suggesting a protective effect. The contamination/washing symptom dimension score was significantly lower in carriers of 'A' allele which remained significant even after testing for confounding effects on linear regression. CONCLUSIONS Our results support findings from previous studies on a possible protective effect of the 'Met' allele at the Val66Met locus in OCD. Its association with lower scores on the contamination/washing dimension is a novel finding of this study.
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Affiliation(s)
- Reshma Jabeen Taj M J
- Molecular Genetics Laboratory, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Suhas Ganesh
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Tulika Shukla
- Department of Psychiatry, Dr. Ram Manohar Lohia hospital, New Delhi, India.
| | - Sayali Deolankar
- Molecular Genetics Laboratory, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Ravi K Nadella
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Somdatta Sen
- Molecular Genetics Laboratory, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Meera Purushottam
- Molecular Genetics Laboratory, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
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Sharma M, Reeves K, Deogaonkar M, Rezai AR. Deep Brain Stimulation for Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Zhao HZ, Wang CH, Gao ZZ, Ma JD, Huang P, Li HF, Sang DE, Shan XW, Kou SJ, Li ZR, Ma L, Zhang ZH, Zhang JH, Ouyang H, Lian HK, Zang YF, Hu XZ. Effectiveness of cognitive-coping therapy and alteration of resting-state brain function in obsessive-compulsive disorder. J Affect Disord 2017; 208:184-190. [PMID: 27792961 DOI: 10.1016/j.jad.2016.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/27/2016] [Accepted: 10/17/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Cognitive-coping therapy (CCT), integrating cognitive theory with stress-coping theory, is an efficacious therapy for obsessive-compulsive disorder (OCD). However, the potential brain mediation for the effectiveness remains unclear. We sought to investigate differences of resting-state brain function between OCD and healthy controls and if such differences would be changed by a four-week CCT. PATIENTS AND METHODS Thirty-one OCD patients were recruited and randomized into CCT (n=15) and pharmacotherapy plus CCT (pCCT, n=16) groups, together with 25 age-, gender- and education-matched healthy controls. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was scored to evaluate the severity in symptoms. Resting-state functional magnetic resonance imaging was scanned pre- and post-treatment. RESULTS For patients, Y-BOCS scores were reduced during four-week treatment for CCT and pCCT (P<0.001), but no group difference was observed. No differences in amplitude of low-frequency fluctuation (ALFF) values were found between CCT and pCCT either pre- or post-treatment. Compared to controls, ALFF in OCD patients was higher in the left hippocampus, parahippocampus, and temporal lobes, but lower in the right orbitofrontal cortex, rectus, bilateral calcarine, cuneus, lingual, occipital, left parietal, postcentral, precentral, and parietal (corrected P<0.05). The ALFF in those regions was not significantly correlated to the severity of OCD symptoms. After a 4-week treatment, the ALFF differences between OCD patients and controls disappeared. LIMITATIONS The pharmacotherapy group was not included since OCD patients generally do not respond to pharmacotherapy in four weeks. CONCLUSIONS Our data indicated that resting-state brain function was different between OCD and controls; such differences disappeared after OCD symptoms were relieved.
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Affiliation(s)
- Hong-Zeng Zhao
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Chang-Hong Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Zhong-Zhan Gao
- Hangzhou Institute of Service Engineering, Hangzhou Normal University, Hangzhou, Zhejiang, PR China; Center for Cognition and Brain Disorders, Affiliated Hospital, Hangzhou Normal University, Hangzhou 310015, Zhejiang, PR China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, PR China
| | - Jian-Dong Ma
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Ping Huang
- The Fifth People Hospital of Kaifeng, Kaifeng City 475003, Henan Province, PR China
| | - Heng-Fen Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou City 450052, Henan Province, PR China
| | - De-En Sang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Xiao-Wen Shan
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Shao-Jie Kou
- The Fifth People Hospital of Kaifeng, Kaifeng City 475003, Henan Province, PR China; Workstation of Henan Province for Psychiatry Experts, Kaifeng City 475003, Henan Province, PR China
| | - Zhi-Rong Li
- The Fifth People Hospital of Kaifeng, Kaifeng City 475003, Henan Province, PR China
| | - Li Ma
- The Medical Group of Zhengzhou First People's Hospital, Zhengzhou City, Henan Province, PR China
| | - Zhao-Hui Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Jian-Hong Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Hua Ouyang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
| | - Hong-Kai Lian
- The Medical Group of Zhengzhou First People's Hospital, Zhengzhou City, Henan Province, PR China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, Affiliated Hospital, Hangzhou Normal University, Hangzhou 310015, Zhejiang, PR China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, PR China
| | - Xian-Zhang Hu
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China; Workstation of Henan Province for Psychiatry Experts, Kaifeng City 475003, Henan Province, PR China.
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Hatalova H, Radostova D, Pistikova A, Vales K, Stuchlik A. Detrimental effect of clomipramine on hippocampus-dependent learning in an animal model of obsessive-compulsive disorder induced by sensitization with d2/d3 agonist quinpirole. Behav Brain Res 2016; 317:210-217. [PMID: 27659555 DOI: 10.1016/j.bbr.2016.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 11/27/2022]
Abstract
Quinpirole (QNP) sensitization is one of the commonly used animal models of obsessive-compulsive disorder (OCD). We have previously shown that QNP-sensitized animals display a robust cognitive flexibility deficit in an active place avoidance task with reversal in Carousel maze. This is in line with numerous human studies showing deficits in cognitive flexibility in OCD patients. Here we explored the effect of clomipramine, an effective OCD drug that attenuates compulsive checking in QNP, on sensitized rats in acquisition and reversal performances in an active place avoidance task. We found that the addition of clomipramine to QNP-sensitization impairs acquisition learning to a degree that reversal learning could not be tested. In a hippocampal-independent two-way active avoidance task clomipramine did not have an effect on acquisition learning in QNP-treated rats; suggesting that the detrimental effect of clomipramine is hippocampus based. We also tested the effect of risperidone in QNP-sensitized animals, which is not effective in OCD treatment. Risperidone also marginally impaired acquisition learning of QNP-sensitized animals, but not reversal. Moreover, we explored the effect of the augmentation of clomipramine treatment with risperidone in QNP-sensitized rats- a common step in treating SRI-unresponsive OCD patients. Only under this treatment regime animals were unimpaired in both acquisition and reversal learning. Augmentation of SRI with neuroleptics therefore could be beneficial for improving cognitive flexibility, and possibly be considered a first line of treatment in patients with reduced cognitive flexibility.
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Affiliation(s)
- Hana Hatalova
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic.
| | - Dominika Radostova
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic
| | - Adela Pistikova
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic
| | - Karel Vales
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic; National Institute of Mental Health, Topolova 748, 250 67, Klecany, Czech Republic
| | - Ales Stuchlik
- Institute of Physiology, Academy of Sciences of the Czech Republic, Videnska 1083, 142 20, Prague, Czech Republic.
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Effectiveness of Risperidone Augmentation in Obsessive-Compulsive Disorder: Experience From a Specialty Clinic in India. J Clin Psychopharmacol 2016; 36:381-4. [PMID: 27219093 DOI: 10.1097/jcp.0000000000000515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Risperidone is the most widely used augmenting agent in the treatment of obsessive-compulsive disorder (OCD). However, a recent controlled study found risperidone to be no different from placebo, raising doubts about its effectiveness. In this context, we sought to examine the real-world effectiveness of risperidone from the large database of an OCD clinic in India. A total of 1314 consecutive patients who registered at the OCD clinic between 2004 and 2014 were evaluated with structured interviews and scales. Patients with OCD initiated on risperidone augmentation without concurrent cognitive behavior therapy and who were on stable and adequate doses of serotonin reuptake inhibitors for at least 12 preceding weeks were included for analysis. The primary outcome measure was all-cause discontinuation. Logistic regression was performed to identify the factors predicting improvement with risperidone augmentation. A total of 92 patients were eligible for analysis. Risperidone continued to be used in 23 patients (25%) at the time of last follow-up, and the remaining discontinued either because of ineffectiveness or intolerability. The fall in the Yale-Brown Obsessive-Compulsive Scale scores was significantly greater in patients who continued to take risperidone when compared with those who did not (41.6% vs 3.7%, t = 6.95, P < 0.001). A total of 22 patients (24%) were noted to have at least a 25% reduction on the Yale-Brown Obsessive-Compulsive Scale scores. On regression analysis, no predictors of improvement with risperidone augmentation could be identified. The study demonstrated, in a real-world setting, that risperidone may be a useful augmenting agent in a proportion of patients with partial/poor response to serotonin reuptake inhibitors.
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Abstract
Obsessive-compulsive disorder (OCD) is one of the most common comorbidities in bipolar disorder (BD). Clinicians often get perplexed in making treatment decisions when encountering comorbid OCD and BD as treatment of OCD by pharmacotherapy may induce or exacerbate mood instability and psychotherapeutic approaches for OCD may not be feasible in acute manic or depressive state of BD. In this study, we reviewed literature, whether existing guideline-based treatments of BD may be effective in OCD and whether newer agents will be of use for treating this comorbidity. We could find that treatment of such comorbid disorder is largely understudied. Adjuvant topiramate or olanzapine- selective serotonin reuptake inhibitor/clomipramine combination along with mood stabilizer is found to be effective for treating OCD in BD. Use of other conventional pharmacological agents and psychotherapy for treating comorbid OCD in BD lacks evidence and is limited to case reports. Our review also highlights the need for further studies regarding the treatment strategies in this highly prevalent comorbid disorder.
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Affiliation(s)
- Firoz Kazhungil
- Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India
| | - E Mohandas
- Chief Consultant Psychiatrist, Sun Medical and Research Centre, Trissur, Kerala, India
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12
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Hazari N, Narayanaswamy JC, Arumugham SS. Predictors of response to serotonin reuptake inhibitors in obsessive-compulsive disorder. Expert Rev Neurother 2016; 16:1175-91. [DOI: 10.1080/14737175.2016.1199960] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Zhang L, Dong Y, Ji Y, Tao R, Chen X, Ye J, Zhang L, Yu F, Zhu C, Wang K. Trait-related decision making impairment in obsessive-compulsive disorder: evidence from decision making under ambiguity but not decision making under risk. Sci Rep 2015; 5:17312. [PMID: 26601899 PMCID: PMC4658550 DOI: 10.1038/srep17312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/28/2015] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate whether deficits in decision making were potential
endophenotype markers for OCD considering different phases of the disease.
Fifty-seven non-medicated OCD patients (nmOCD), 77 medicated OCD patients (mOCD), 48
remitted patients with OCD (rOCD) and 115 healthy controls were assessed with the
Iowa Gambling Task (IGT), which measured decision making under ambiguity, and the
Game of Dice Task (GDT), which measured decision making under risk. While the three
patients groups showed impaired performance on the IGT compared with healthy
controls, all patients showed intact performance on the GDT. Furthermore, the rOCD
patients showed a preference for deck B, indicating that they showed more
sensitivity to the frequency of loss than to the magnitude of loss, whereas the mOCD
patients showed a preference for deck A, indicating that they had more sensitivity
to the magnitude of loss than to the frequency of loss. These data suggested that
OCD patients had trait-related impairments in decision making under ambiguity but
not under risk, and that dissociation of decision making under ambiguity and under
risk is an appropriate potential neurocognitive endophenotype for OCD. The subtle
but meaningful differences in decision making performance between the OCD groups
require further study.
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Affiliation(s)
- Long Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Yi Dong
- Mental Health Center of Anhui Province, Hefei, China
| | - Yifu Ji
- Mental Health Center of Anhui Province, Hefei, China
| | - Rui Tao
- Mental Health Center of Anhui Province, Hefei, China
| | - Xuequan Chen
- Mental Health Center of Anhui Province, Hefei, China
| | - Jianguo Ye
- Psychological Consultation Center of Anhui Medical University, Hefei, China
| | - Lei Zhang
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Fengqiong Yu
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Chunyan Zhu
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
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14
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Highly efficacious cognitive-coping therapy for overt or covert compulsions. Psychiatry Res 2015; 229:732-8. [PMID: 26275705 DOI: 10.1016/j.psychres.2015.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/14/2015] [Accepted: 08/05/2015] [Indexed: 11/20/2022]
Abstract
Pharmacotherapy and cognitive-behavioral therapy (CBT) present limitations when they are used to treat obsessive-compulsive disorder (OCD), a severe and debilitating psychiatric disorder. To search for more efficacious treatment, we investigated the effects of pharmacotherapy plus cognitive-coping therapy (pCCT) on adult OCD patients with overt or covert compulsions. Two hundred and fifteen OCD patients were randomized into pharmacotherapy plus psychological support (PPS, n=107) and pCCT (n=108). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to measure severity of symptoms in the OCD patients. The Y-BOCS scores were significantly lower in pCCT than in PPS in both acute term (<3 months) and long-term follow-up. In pCCT, severity of symptoms was not different between those with covert compulsions and those with overt compulsions, but was significantly reduced at any post-treatment time-point. Y-BOCS scores in the two subtype compulsions were significantly lower in pCCT than in PPS at any post-treatpost-treatment time-point. Compared with PPS, effect size, response rate and remission rate were significantly higher in pCCT. Our findings corroborated with the hypothesis that pCCT could efficaciously treat OCD with overt compulsions or covert compulsion, suggesting that pCCT might be a potential option for adult OCD.
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15
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Amerio A, Odone A, Marchesi C, Ghaemi SN. Treatment of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. J Affect Disord 2014; 166:258-63. [PMID: 25012439 DOI: 10.1016/j.jad.2014.05.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 05/17/2014] [Accepted: 05/19/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND More than 20% of patients with bipolar disorder (BD) show lifetime comorbidity for obsessive-compulsive disorder (OCD), but treatment of BD-OCD is a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. METHODS We systematically reviewed MEDLINE, Embase, PsychINFO and the Cochrane Library and retrieved data on clinical management of comorbid BD-OCD patients. Pharmacologic, psychotherapeutic and others alternative approaches were included. RESULTS Fourteen studies were selected. In all selected studies BD-OCD patients received mood stabilizers. In the largest study, 42.1% of comorbid patients required a combination of multiple mood stabilizers and 10.5% a combination of mood stabilizers with atypical antipsychotics. Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one study. Some BD-OCD patients on mood stabilizer therapy benefitted from adjunctive psychotherapy. LIMITATIONS Most studies are case reports or cross-sectional studies based on retrospective assessments. Enrollment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that mood stabilization should be the primary goal in treating BD-OCD patients. Addition of SRI agents seems unnecessary in most cases, although it may be needed in a minority of BD patients with refractory OCD.
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Affiliation(s)
- A Amerio
- Section of Psychiatry, Department of Neuroscience, University of Parma, 43126 Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - A Odone
- School of Medicine - Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Marchesi
- Section of Psychiatry, Department of Neuroscience, University of Parma, 43126 Parma, Italy
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA
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16
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Central 5-HT4 receptor binding as biomarker of serotonergic tonus in humans: a [11C]SB207145 PET study. Mol Psychiatry 2014; 19:427-32. [PMID: 24189342 DOI: 10.1038/mp.2013.147] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/10/2013] [Accepted: 09/09/2013] [Indexed: 01/22/2023]
Abstract
Identification of a biomarker that can inform on extracellular serotonin (5-HT) levels in the brains of living humans would enable greater understanding of the way brain circuits are modulated by serotonergic neurotransmission. Substantial evidence from studies in animals and humans indicates an inverse relationship between central 5-HT tonus and 5-HT type 4 receptor (5-HT4R) density, suggesting that 5-HT4R receptor density may be a biomarker marker for 5-HT tonus. Here, we investigated whether a 3-week administration of a selective serotonin reuptake inhibitor, expected to increase brain 5-HT levels, is associated with a decline in brain 5-HT4R binding. A total of 35 healthy men were studied in a placebo-controlled, randomized, double-blind study. Participants were assigned to receive 3 weeks of oral dosing with placebo or fluoxetine, 40 mg per day. Brain 5-HT4R binding was quantified at baseline and at follow-up with [(11)C]SB207145 positron emission tomography (PET). Three weeks of intervention with fluoxetine was associated with a 5.2% reduction in brain 5-HT4R binding (P=0.017), whereas placebo intervention did not change 5-HT4R binding (P=0.52). Our findings are consistent with a model, wherein the 5-HT4R density adjusts to changes in the extracellular 5-HT tonus. Our data demonstrate for the first time in humans that the imaging of central 5-HT4R binding may be used as an in vivo biomarker of the central 5-HT tonus.
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17
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Arumugham SS, Reddy JYC. Augmentation strategies in obsessive–compulsive disorder. Expert Rev Neurother 2014; 13:187-202; quiz 203. [DOI: 10.1586/ern.12.160] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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18
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Cherian AV, Math SB, Kandavel T, Reddy YCJ. A 5-year prospective follow-up study of patients with obsessive-compulsive disorder treated with serotonin reuptake inhibitors. J Affect Disord 2014; 152-154:387-94. [PMID: 24157088 DOI: 10.1016/j.jad.2013.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although obsessive-compulsive disorder is usually regarded as a chronic illness, there is limited data on the naturalistic long-term outcome of the disorder and on predictors of remission and relapse. The study examines the 5-year course prospectively in outpatients with the primary diagnosis of DSM-IV OCD who were mostly treated with serotonin reuptake inhibitors (SRIs). METHOD 106 of 115 subjects recruited over a period of 2 years from the outpatient services of an OCD clinic in India were followed periodically up to 5 years. RESULTS Subjects were moderately ill, mostly self-referred (89%), and less than a half was treatment-naive. Cumulative probability of at least partial remission and full remission at 5 years was 93% and 65% respectively. Most achieved remission by 2 years. In those who achieved either partial or full remission, cumulative probability of relapse by 5 years was 36%. Percentage of time on treatment and treatment-naive status at intake predicted at least partial remission, whereas only percentage of time on treatment predicted full remission. Full remission and doubts/checking dimension predicted lesser likelihood of a relapse. LIMITATIONS Patients were recruited from a specialty OCD clinic and treatment was not controlled during the follow-up period. CONCLUSIONS The outcome of OCD seems to be better than generally assumed, at least in moderately ill outpatients. Regular treatment over extended period may enhance likelihood of remission. Full remission should be the goal of treatment since it is associated with lesser propensity for relapse. Most patients remit in the first 2 years of treatment; therefore, early detection and intervention may improve the outcome.
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Affiliation(s)
- Anish V Cherian
- National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Arumugham SS, Reddy YCJ. Commonly asked questions in the treatment of obsessive-compulsive disorder. Expert Rev Neurother 2013; 14:151-63. [PMID: 24372473 DOI: 10.1586/14737175.2014.874287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common and often a highly disabling condition that was considered untreatable before the 1960s. The advent of serotonin reuptake inhibitors and exposure and response prevention revolutionized the treatment of OCD. Although they are still the first line treatments for OCD, new treatments like augmentation strategies, brain stimulation techniques, psychosurgery, newer forms of psychotherapy (like cognitive therapy, acceptance and commitment therapy) have been added to the armamentarium. With the available treatment strategies, many patients can achieve at least partial remission of symptoms. Nevertheless, the plethora of information gives rise to many questions on their application for practicing clinicians. We provide evidence-based responses to these questions and suggest a broad guideline for treatment of OCD.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, Obsessive-Compulsive Disorder (OCD) Clinic, National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India-560029
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Ma JD, Wang CH, Li HF, Zhang XL, Zhang YL, Hou YH, Liu XH, Hu XZ. Cognitive-coping therapy for obsessive-compulsive disorder: a randomized controlled trial. J Psychiatr Res 2013; 47:1785-90. [PMID: 23988179 DOI: 10.1016/j.jpsychires.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Pharmacotherapy and cognitive-behavioral therapy (CBT) are widely used to treat obsessive-compulsive disorder (OCD). These treatments have helped many patients with OCD, but there still is room for improvement. Recently, a promising psychotherapy for OCD, cognitive-coping therapy (CCT), has been developed. Pharmacotherapy plus CCT (PCCT) demonstrates higher efficacy in a shorter period of time and lower relapses than pharmacotherapy or pharmacotherapy plus CBT. In this randomized controlled trial, we investigated the efficacy of CCT for OCD treatment. One hundred and forty-five OCD patients were randomly assigned into two groups: pharmacotherapy (N = 72) and PCCT (N = 73). In each group, drug-resistant (DR) and non-drug-resistant (NDR) OCD were further analyzed to examine the efficacy of CCT. Some clinical features and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were blindly assessed pre-treatment and post-treatment at week 1, 2, 3, 4, and 12. The Y-BOCS scores were significantly lower in PCCT than in the pharmacotherapy group at any post-treatment time-point (P < 0.001). Compared with pre-treatment, the Y-BOCS scores were significantly reduced at any time-point (P < 0.001) in PCCT group, but only at week 12 (P < 0.001) in the pharmacotherapy group. In the PCCT group, there were no differences between DR and NDR groups' Y-BOCS scores at any post-treatment time-point. The response rates and remission rates were higher in PCCT than in the pharmacotherapy group. Three variables, the number of weeks of treatment, insight, and disregarding of obsessions, were significantly correlated with the Y-BOCS score. Therefore, CCT might be a potential treatment for OCD.
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Affiliation(s)
- Jian-Dong Ma
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City 453002, Henan Province, PR China
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Viswanath B, Taj M J RJ, Purushottam M, Kandavel T, Shetty PH, Reddy YCJ, Jain S. No association between DRD4 gene and SRI treatment response in obsessive compulsive disorder: need for a novel approach. Asian J Psychiatr 2013; 6:347-8. [PMID: 23810146 DOI: 10.1016/j.ajp.2013.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
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22
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Taj M J RJ, Viswanath B, Purushottam M, Kandavel T, Janardhan Reddy YC, Jain S. DRD4 gene and obsessive compulsive disorder: do symptom dimensions have specific genetic correlates? Prog Neuropsychopharmacol Biol Psychiatry 2013; 41:18-23. [PMID: 23127570 DOI: 10.1016/j.pnpbp.2012.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 10/24/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The dopamine D4 receptor (DRD4) is a promising candidate gene in obsessive compulsive disorder (OCD). A 48-bp variable number of tandem repeats (VNTR) sequence in exon 3 has been studied previously, and alleles containing 2-11 repeats (2R-11R) have been identified. We investigated the association of DRD4 VNTR polymorphism with OCD and its relationship with various clinical parameters (age of onset, gender, family history, co-morbidity, factor-analyzed symptom dimensions and insight). METHODOLOGY One hundred and seventy three South Indian OCD patients (DSM-IV) recruited from a specialty OCD clinic were evaluated using the Yale-Brown obsessive compulsive scale (YBOCS), YBOCS item-11 for insight, Mini International Neuropsychiatric Interview (MINI) plus, tic disorder subsection of the MINI-KID and Clinical Global Impression scale. 201 healthy controls were evaluated using MINI plus. All subjects were genotyped for the DRD4 VNTR polymorphism. RESULTS Genotype frequencies did not deviate significantly from the Hardy-Weinberg equilibrium. Case-control association analysis revealed that the 7R allele frequency was significantly greater in OCD patients than controls. This difference was restricted to the women subsample when performing the gender sub-analysis. Among other clinical variables examined, factor 3 (symmetry) was associated with presence of 2R allele. Linear regression analysis confirmed the association of symmetry dimension with the 2R allele (Beta=0.23, t=2.96, p=0.004, CI=0.19-0.95). CONCLUSIONS Our data provides further evidence that DRD4 VNTR polymorphism is associated with OCD. Furthermore, the presence of the 2R allele was significantly associated with the symmetry dimension. This dimension may represent a more homogeneous subtype of OCD with a genetic etiology.
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Affiliation(s)
- Reshma Jabeen Taj M J
- Molecular Genetics Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
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Kreiss DS, Coffman CF, Fiacco NR, Granger JC, Helton BM, Jackson JC, Kim LV, Mistry RS, Mizer TM, Palmer LV, Vacca JA, Winkler SS, Zimmer BA. Ritualistic Chewing Behavior induced by mCPP in the rat is an animal model of Obsessive Compulsive Disorder. Pharmacol Biochem Behav 2013; 104:119-24. [DOI: 10.1016/j.pbb.2013.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/26/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Hu X, Wen Y, Ma J, Han D, Li Y, Wang S. A promising randomized trial of a new therapy for obsessive-compulsive disorder. Brain Behav 2012; 2:443-54. [PMID: 22950048 PMCID: PMC3432967 DOI: 10.1002/brb3.67] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 04/16/2012] [Accepted: 04/21/2012] [Indexed: 01/23/2023] Open
Abstract
Pharmacotherapy and cognitive-behavioral therapy (CBT) are currently the most effective interventions for treating obsessive-compulsive disorder (OCD). These treatments, however, are time consuming and in some cases the patients do not show significant improvement. In all, 30%-60% of OCD patients do not respond adequately to pharmacotherapy and 20%-40% of OCD patients who complete CBT do not improve significantly, suggesting a more efficacious approach is needed. The objectives of this study are to demonstrate an efficacious pharmacotherapy plus psychotherapy, named cognitive-coping therapy (CCT), for OCD and to investigate the efficacy of this approach in a larger sample size. Therefore, a total of 108 patients with OCD were randomly allocated into three groups: pharmacotherapy (N = 38), pharmacotherapy plus CBT (PCBT, N = 34), and pharmacotherapy plus CCT (PCCT, N = 36). The severity of symptoms and the patients' functioning were assessed pretreatment and after 7, 14, 21 days, and 1-, 3-, 6-, and 12-month treatment using the Yale-Brown Obsessive Compulsive Scale and Global Assessment of Functioning (GAF). Compared with the pharmacotherapy and PCBT groups, the severity of OCD symptoms was significantly reduced (P < 0.001), the rates of response (100%) and remission (85.0%) were significantly higher (P < 0.001), and relapse rate was lower (P = 0.017) in PCCT group during the 1-year follow-up. In addition, the GAF score was significantly higher in the PCCT group than in the other two groups (P < 0.001). Our preliminary data suggest that PCCT is a more efficacious psychotherapy for OCD patients than pharmacotherapy or PCBT.
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Affiliation(s)
- Xian‐Zhang Hu
- The Second Affiliated Hospital of Xinxiang Medical University Xinxiang City 453002 Henan Province China
| | - You‐Sheng Wen
- The Second Affiliated Hospital of Xinxiang Medical University Xinxiang City 453002 Henan Province China
| | - Jian‐Dong Ma
- Wuhan Mental Health Center (Wuhan Hospital for Psychotherapy) Tongji Medical College of Huazhong University of Science and Technique Wuhan City Hubei Province China
| | - Dong‐Ming Han
- The First Affiliated Hospital of Xinxiang medical University Xinxiang City 453002 Henan Province China
| | - Yu‐Xia Li
- The First Affiliated Hospital of Xinxiang medical University Xinxiang City 453002 Henan Province China
| | - Shu‐Fan Wang
- Zhengzhou Hospital of Traditional Chinese Medicine Zhengzhou City 450007 Henan Province China
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Diniz JB, Shavitt RG, Pereira CAB, Hounie AG, Pimentel I, Koran LM, Dainesi SM, Miguel EC. Quetiapine versus clomipramine in the augmentation of selective serotonin reuptake inhibitors for the treatment of obsessive-compulsive disorder: a randomized, open-label trial. J Psychopharmacol 2010; 24:297-307. [PMID: 19164490 DOI: 10.1177/0269881108099423] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
After 12 weeks of selective serotonin reuptake inhibitor (SSRI) monotherapy with inadequate response, 10 patients received clomipramine and 11 received quetiapine as augmentation agents of the SSRI. The primary outcome measure was the difference between initial and final scores of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), rated in a blinded fashion, and the score of clinical global improvement (CGI-I). Statistical analyses were performed using nonparametric tests to evaluate treatment efficacy and the difference between treatment groups. Percentile plots were constructed with YBOCS scores from the clomipramine and quetiapine groups. Considering response a >or=35% reduction in the initial Y-BOCS score plus a rating of 'much improved' or 'very much improved' on CGI-I, four of eleven quetiapine patients and one out of ten clomipramine patients were classified as responders. The mean final Y-BOCS score was significantly lower than baseline in the quetiapine augmentation group (P = 0.023), but not in the clomipramine augmentation group (P = 0.503). The difference between groups showed a trend towards significance only at week 4, the mean Y-BOCS score being lower for those receiving quetiapine (P = 0.052). A difference between groups was also observed at week 4 according to percentile plots. These results corroborate previous findings of quetiapine augmentation efficacy in obsessive-compulsive disorder (OCD). Clomipramine augmentation did not produce a significant reduction in Y-BOCS scores. Higher target maximum dosages might have yielded different results.
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Affiliation(s)
- J B Diniz
- Department & Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
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Abstract
A large proportion of obsessive-compulsive disorder (OCD) patients are refractory to pharmacological and cognitive-behavioral therapy. The aim of this pilot, waitlist-controlled trial was to evaluate the effectiveness of electroacupuncture (EA) as add-on therapy for treatment-resistant OCD. Nineteen patients with treatment-resistant OCD were assigned to EA treatment for 12 sessions (5 sessions per week, n = 10) or waitlist for controls (n = 9) while continuing their current anti-OCD medications. The clinical outcomes were measured using the Yale-Brown Obsessive-Compulsive Scale and the Clinical Global Impression-Severity at baseline and end point. EA additional treatment produced significantly greater improvements at end point compared with the waitlist group in reducing both Yale-Brown Obsessive-Compulsive Scale (10.2 +/- 4.2 vs. 18.8 +/- 7.4, p = 0.004) and Clinical Global Impression-Severity scores (3.0 +/- 1.1 vs. 4.4 +/- 1.1, p = 0.002). As an additional therapy, EA is effective in alleviating OCD symptoms of treatment-resistant patients. A large-scale controlled study is warranted.
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Barbui C, Andretta M, De Vitis G, Rossi E, D'Arienzo F, Mezzalira L, De Rosa M, Cipriani A, Berti A, Nosè M, Tansella M, Bozzini L. Antidepressant drug prescription and risk of abnormal bleeding: a case-control study. J Clin Psychopharmacol 2009; 29:33-8. [PMID: 19142104 DOI: 10.1097/jcp.0b013e3181929f7a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study assessed the risk of any bleeding abnormalities, including the risk of gastrointestinal bleeding, associated with antidepressant exposure. We used a case-control methodology. Case patients were individuals admitted with a diagnosis of abnormal bleeding. Control subjects were individuals admitted on the same date without evidence of abnormal bleeding. During the study period, 11,025 case patients were admitted for bleeding abnormalities (matched with 21,846 eligible control subjects), and 1008 were admitted for gastrointestinal bleeding (matched with 1990 eligible control subjects). With respect to any bleeding abnormalities, antidepressants as a group were not associated with an increased risk (adjusted odds ratio [OR], 0.99; 95% confidence interval [CI], 0.90-1.08). Similarly, selective serotonin reuptake inhibitors as a group, the group of tricyclic and related antidepressants, and the group of other antidepressants were not associated with an increased risk of bleeding. With respect to gastrointestinal bleeding abnormalities, antidepressants as a group were associated with a modestly increased risk (adjusted OR, 1.34; 95% CI, 1.01-1.80). Whereas the group of tricyclic and related antidepressants was not associated with an increased risk of bleeding, the group of selective serotonin reuptake inhibitors was associated with a nonsignificant trend toward an increased risk of bleeding (adjusted OR, 1.31; 95% CI, 0.91-1.88) and the group of other antidepressants with a statistically significant increase in the risk of bleeding (adjusted OR, 1.74; 95% CI, 1.04-2.93). In a population with a low baseline risk of bleeding, we detected a significant increase in the risk of gastrointestinal bleeding only.
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Affiliation(s)
- Corrado Barbui
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, WHO Collaborating Centre for Research and Training in Mental Health, University of Verona, Italy. corrado.barbui@unoiv
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Sarkar R, Klein J, Krüger S. Aripiprazole augmentation in treatment-refractory obsessive-compulsive disorder. Psychopharmacology (Berl) 2008; 197:687-8. [PMID: 18264798 DOI: 10.1007/s00213-008-1091-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 01/24/2008] [Indexed: 11/28/2022]
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Ting JT, Feng G. Glutamatergic Synaptic Dysfunction and Obsessive-Compulsive Disorder. CURRENT CHEMICAL GENOMICS 2008; 2:62-75. [PMID: 19768139 PMCID: PMC2746669 DOI: 10.2174/1875397300802010062] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 11/13/2008] [Accepted: 11/16/2008] [Indexed: 01/22/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric condition estimated to afflict 1-3% of the world population. The estimated financial impact in the treatment and management of OCD is in the billions of dollars annually in the US alone. At present there is a marked lack of evidence on the specific causes of OCD. Current hypotheses largely focus on the serotonin (5-HT) system on the basis of the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in alleviating symptoms of patients with OCD, yet a considerable fraction of patients are non-responsive or minimally responsive to these agents. Despite this fact, SSRIs have remained the primary pharmacological treatment avenue for OCD. In recent years, multiple lines of evidence have implicated glutamatergic synaptic dysfunction within the cortico-striatal-thalamo-cortical (CSTC) brain circuit in the etiology of OCD and related disorders, thereby prompting intensified effort in the development and evaluation of agents that modulate glutamatergic neurotransmission for the treatment of OCD. With this in mind, here we review the following topics with respect to synaptic dysfunction and the neural circuitry underlying OCD: (1) evidence supporting the critical involvement of the CSTC circuit, (2) genetic studies supporting the involvement of glutamatergic dysfunction, (3) insights from genetic animal models of OCD, and (4) preliminary findings with glutamatergic neurotransmission-modulating agents in the treatment of OCD. Given the putative mechanistic overlap between OCD and the broader OC-spectrum of disorders, unraveling the synaptic basis of OCD has potential to translate into more effective treatments for an array of poorly understood human disorders.
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Affiliation(s)
| | - Guoping Feng
- Department of Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
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Antai-Otong D. The art of prescribing: pharmacotherapy of obsessive-compulsive disorder: an evidence-based approach. Perspect Psychiatr Care 2007; 43:219-22. [PMID: 17894672 DOI: 10.1111/j.1744-6163.2007.00137.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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