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Marzuki AA, Banca P, Garofalo S, Degni LAE, Dalbagno D, Badioli M, Sule A, Kaser M, Conway-Morris A, Sahakian BJ, Robbins TW. Compulsive avoidance in youths and adults with OCD: an aversive pavlovian-to-instrumental transfer study. Transl Psychiatry 2024; 14:308. [PMID: 39060253 PMCID: PMC11282188 DOI: 10.1038/s41398-024-03028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Compulsive behaviour may often be triggered by Pavlovian cues. Assessing how Pavlovian cues drive instrumental behaviour in obsessive-compulsive disorder (OCD) is therefore crucial to understand how compulsions develop and are maintained. An aversive Pavlovian-to-Instrumental transfer (PIT) paradigm, particularly one involving avoidance/cancellation of negative outcomes, can enable such investigation and has not previously been studied in clinical-OCD. Forty-one participants diagnosed with OCD (21 adults; 20 youths) and 44 controls (21 adults; 23 youths) completed an aversive PIT task. Participants had to prevent the delivery of unpleasant noises by moving a joystick in the correct direction. They could infer these correct responses by learning appropriate response-outcome (instrumental) and stimulus-outcome (Pavlovian) associations. We then assessed whether Pavlovian cues elicited specific instrumental avoidance responses (specific PIT) and induced general instrumental avoidance (general PIT). We investigated whether task learning and confidence indices influenced PIT strength differentially between groups. There was no overall group difference in PIT performance, although youths with OCD showed weaker specific PIT than youth controls. However, urge to avoid unpleasant noises and preference for safe over unsafe stimuli influenced specific and general PIT respectively in OCD, while PIT in controls was more influenced by confidence in instrumental and Pavlovian learning. Thus, in OCD, implicit motivational factors, but not learnt knowledge, may contribute to the successful integration of aversive Pavlovian and instrumental cues. This implies that compulsive avoidance may be driven by these automatic processes. Youths with OCD show deficits in specific PIT, suggesting cue integration impairments are only apparent in adolescence. These findings may be clinically relevant as they emphasise the importance of targeting such implicit motivational processes when treating OCD.
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Affiliation(s)
- Aleya A Marzuki
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia.
| | - Paula Banca
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sara Garofalo
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Luigi A E Degni
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Marco Badioli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Akeem Sule
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Muzaffer Kaser
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, UK.
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Zevedei DE, Penelo E, Navarro JB, de la Osa N, Ezpeleta L. Predictive associations of executive functions and oppositional defiant problems and obsessive-compulsive problems in preschoolers. Child Neuropsychol 2024:1-20. [PMID: 39016189 DOI: 10.1080/09297049.2024.2380393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024]
Abstract
Oppositional defiant problems (ODP) and obsessive-compulsive problems (OCP) may co-occur in children, though the way they interact is not known. The aim of the study was to examine longitudinal associations between executive functions at age 3 and ODP, ODP dimensions, and OCP at age 6. The sample consisted of 622 preschoolers (50% were boys) from the general population. Executive functions were assessed by teachers using the Behavior Rating Inventory of Executive Functioning - Preschool version questionnaire when children were 3 years old, and ODP and OCP were informed by parents and teachers at the age of 6 years. Multiple linear regression analyses indicated that higher Inhibit and Emotional Control and lower Shift deficits were associated with higher ODP reported by teachers, while higher Shift but lower Inhibit deficits were related to higher OCP. Moreover, ODP and OCP shared difficulties on the Flexibility Index, which means that the capacity to modulate emotions and behavior according to contextual and environmental demands is compromised in both disorders. The findings inform etiology and prevention, pointing out not only the executive function specificities related to each problem, but also common cognitive challenges related to Flexibility. Young children could benefit from training and programs designed to improve executive function processes at an early age to prevent later behavioral difficulties.
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Affiliation(s)
- Denisa-Elena Zevedei
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Penelo
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Blas Navarro
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria de la Osa
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lourdes Ezpeleta
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Barcelona, Spain
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Uhre CF, Ritter M, Jepsen JRM, Uhre VF, Lønfeldt NN, Müller AD, Plessen KJ, Vangkilde S, Blair RJ, Pagsberg AK. Atypical neurocognitive functioning in children and adolescents with obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry 2024; 33:2291-2300. [PMID: 37917157 PMCID: PMC11255040 DOI: 10.1007/s00787-023-02301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/11/2023] [Indexed: 11/03/2023]
Abstract
Atypical neurocognitive functioning has been found in adult patients with obsessive-compulsive disorder (OCD). However, little work has been done in children and adolescents with OCD. In this study, we investigated neurocognitive functioning in a large and representative sample of newly diagnosed children and adolescents with OCD compared to non-psychiatric controls. Children and adolescents with OCD (n = 119) and non-psychiatric controls (n = 90) underwent psychopathological assessment, intelligence testing, and a neurocognitive test battery spanning cognitive flexibility, planning and decision-making, working memory, fluency, and processing speed. The MANOVA main effect revealed that children and adolescents with OCD performed significantly worse than the control group (p < .001, η p 2 = 0.256). Atypical patient performance was particularly found for indices of cognitive flexibility, decision-making, working memory, and processing speed. We found no evidence of differences in planning or fluency. Moreover, we found no significant associations between neurocognitive performance and OCD symptom severity or comorbidity status. Our results indicate that children and adolescents with OCD show selective atypical neurocognitive functioning. These difficulties do not appear to drive their OCD symptoms. However, they may contribute to lifespan difficulties and interfere with treatment efficacy, an objective of our research currently.
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Affiliation(s)
- Camilla Funch Uhre
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
- Center for Clinical Neuropsychology, Children and Adolescents, Rigshospitalet, Copenhagen, Denmark.
| | - Melanie Ritter
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital - Mental Health Services CPH, Glostrup, Denmark
| | - Valdemar Funch Uhre
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Nicole Nadine Lønfeldt
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Anne Dorothee Müller
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Signe Vangkilde
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert James Blair
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- The Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Conte G, Costanza C, Novelli M, Scarselli V, Arigliani E, Valente F, Baglioni V, Terrinoni A, Chiarotti F, Cardona F. Comorbidities and Disease Duration in Tourette Syndrome: Impact on Cognition and Quality of Life of Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:226. [PMID: 38397337 PMCID: PMC10887127 DOI: 10.3390/children11020226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Cognitive functions represent foundational factors for mental health and quality of life (QoL). In Tourette syndrome (TS), psychiatric comorbidities are common and have been inconsistently reported to affect the cognition and QoL of patients, while the role of tic disorder duration has not been yet explored. METHODS To examine how comorbidities and TS duration may influence cognition and QoL, N = 80 children with TS (6-16 years) were evaluated using the Wechsler Intelligence Scale for Children (WISC-IV). Standardized questionnaires were used to assess the presence and severity of TS main comorbidities and QoL. Data were interpreted using linear correlations, regression, and mediation analysis. RESULTS Depression and attention-deficit/hyperactivity disorder (ADHD) symptoms accounted for poorer cognitive performance. Anxiety oppositely predicted better cognitive performance, while no significant role for obsessive compulsive disorder (OCD) was observed. Disease duration was associated with lower total IQ, verbal reasoning, and working memory abilities. Depression, anxiety, and TS duration also deeply influenced QoL measures. CONCLUSIONS TS common comorbidities have a differential impact on the cognitive abilities of children and adolescents, which translates into a complex influence on their perceived QoL. A longer clinical history of tics was related to worse cognitive outcomes, which prompts further consideration of disease duration in both clinical and research settings involving children and adolescents.
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Affiliation(s)
- Giulia Conte
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Carola Costanza
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90128 Palermo, Italy;
| | - Maria Novelli
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Veronica Scarselli
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Elena Arigliani
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Francesca Valente
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Valentina Baglioni
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Arianna Terrinoni
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Flavia Chiarotti
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Francesco Cardona
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
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Perkes IE, Morris RW, Griffiths KR, Quail S, Waters F, O’Brien M, Hazell PL, Balleine BW. The Motivational Determinants of Human Action, Their Neural Bases and Functional Impact in Adolescents With Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:1062-1072. [PMID: 37881550 PMCID: PMC10593889 DOI: 10.1016/j.bpsgos.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background Establishing the motivational influences on human action is essential for understanding choice and decision making in health and disease. Here we used tests of value-based decision making, manipulating both predicted and experienced reward values to assess the motivational control of goal-directed action in healthy adolescents and those with obsessive-compulsive disorder (OCD). Methods After instrumental training on a two action-two outcome probabilistic task, adolescents (n = 21) underwent Pavlovian conditioning using distinct stimuli predicting either the instrumental outcomes, a third outcome, or nothing. We then assessed functional magnetic resonance imaging during choice tests in which we varied the predicted value, using specific and general Pavlovian-instrumental transfer, and the experienced value, using outcome devaluation. To establish functional significance, we tested a matched cohort of adolescents with OCD (n = 20). Results In healthy adolescents, both predicted and experienced values influenced the performance of goal-directed actions, mediated by distinct orbitofrontal-striatal circuits involving the lateral orbitofrontal cortex (OFC) and medial OFC, respectively. However, in adolescents with OCD, choice was insensitive to changes in either predicted or experienced values. These impairments were related to hypoactivity in the lateral OFC and hyperactivity in the medial OFC during specific Pavlovian-instrumental transfer and hypoactivity in the anterior prefrontal cortex, caudate nucleus, and their connectivity in the devaluation test. Conclusions We found that predicted and experienced values exerted a potent influence on the performance of goal-directed actions in adolescents via distinct orbitofrontal- and prefrontal-striatal circuits. Furthermore, the influence of these motivational processes was severely blunted in OCD, as was the functional segregation of circuits involving medial and lateral OFC, producing dysregulated action control.
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Affiliation(s)
- Iain E. Perkes
- Decision Neuroscience Laboratory, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health and Discipline of Paediatrics and Children’s Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
| | - Richard W. Morris
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristi R. Griffiths
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Stephanie Quail
- Decision Neuroscience Laboratory, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
| | - Felicity Waters
- Child and Adolescent Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Margot O’Brien
- Child and Adolescent Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Philip L. Hazell
- Child and Adolescent Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
- Specialty of Psychiatry, The University of Sydney, Sydney, New South Wales, Australia
| | - Bernard W. Balleine
- Decision Neuroscience Laboratory, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
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Rydqvist F, Hoff E, Daukantaitè D, Cervin M. Everyday executive functioning in pediatric obsessive-compulsive disorder: diagnostic specificity, clinical correlations, and outcome. BMC Psychiatry 2023; 23:622. [PMID: 37620782 PMCID: PMC10464101 DOI: 10.1186/s12888-023-05111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) typically onsets during childhood or adolescence and difficulties with executive functioning (EF) may be involved in its onset and maintenance. Yet, few studies have examined everyday EF difficulties in youth with OCD and no study has compared EF in youth with OCD to EF in youth with anxiety disorders, leaving the diagnostic specificity of EF unclear. METHODS In this study, parents of treatment-seeking children and adolescents with OCD (n = 96, Mage = 13.3, SD = 2.7, 59% girls) or anxiety disorders (n = 67, Mage = 14.0, SD = 2.6, 78% girls) reported on their children's everyday EF using the Behavior Rating Inventory of Executive Function (BRIEF) measure. RESULTS Compared to community youth, the two clinical groups showed moderately elevated EF deficits but did not differ significantly from each other. EF deficits were not associated with the major symptom dimensions of OCD, age of OCD symptom onset, duration of OCD symptoms, and OCD severity, and did not predict treatment outcome in OCD. CONCLUSIONS Compared to peers, youth with OCD show moderate difficulties with EF, but very similar difficulties are seen in youth with anxiety disorders, and it is unclear whether these difficulties are of clinical relevance. Among youth with OCD, EF difficulties were not differentially associated with the major symptom dimensions of OCD, which is inconsistent with findings from adults. Difficulties with EF did not predict treatment outcome, indicating that integrating EF modules into OCD treatment may be of limited value, although EF may be important for treatment planning in individual cases.
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Affiliation(s)
| | - Eva Hoff
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Matti Cervin
- Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Sofiavägen 2D, Lund, SE-22241, Sweden.
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Early Identification and Intervention in Pediatric Obsessive-Compulsive Disorder. Brain Sci 2023; 13:brainsci13030399. [PMID: 36979207 PMCID: PMC10046131 DOI: 10.3390/brainsci13030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and course from adult OCD. Delayed and inadequate treatment is associated with a worse prognosis, making the need for early identification and intervention in pediatric OCD very urgent. In this paper, we reflected on the current constraints that make early interventions for pediatric OCD unpromoted and reviewed the approaches with potential application for early identification and early intervention in pediatric OCD, categorized by three-level prevention stages corresponding to a clinical staging model. Since the etiology of pediatric OCD is still unclear, primary prevention is most lacking, and early interventions for pediatric OCD are currently focused on the secondary prevention stage, which aims to prevent the conversion of obsessive-compulsive symptoms into full-blown OCD; tertiary prevention mostly focuses on the alleviation of mild to moderate OCD, while interventions for co-morbidities are still in their infancy. We closed by considering the important research questions on this topic.
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Conelea CA, Morris S, McLaughlin N, Mamaril E, Benito K, Case B, Garcia A. Response Inhibition in Youth Undergoing Intensive Treatment for Obsessive Compulsive Disorder. J Obsessive Compuls Relat Disord 2023; 36:100764. [PMID: 36644665 PMCID: PMC9835685 DOI: 10.1016/j.jocrd.2022.100764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Response Inhibition (RI) is the ability to suppress behaviors that are inappropriate for a given context. Obsessive-compulsive disorder (OCD) has been associated with impaired RI in adults as measured by the Stop Signal Task (SST). Conflicting results have been found in terms of the relationship between OCD severity and SST performance, and no studies to date have examined the relationship between SST and response to OCD treatment. Also relatively unknown is whether RI performance in OCD is associated with developmental or gender differences. This naturalistic study examined the relationship between SST performance, OCD severity, and OCD treatment response in a pediatric sample undergoing intensive treatment involving exposure and response prevention and medication management (n = 36). The SST and Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS) were administered at admission and program discharge. OCD severity was not significantly related to stop signal reaction time (SSRT) in the whole sample and among subgroups divided by age and gender. Baseline SSRT and SSRT change did not predict CYBOCS change across treatment in the whole sample, but exploratory analyses indicated both were significant predictors among female adolescents. Results suggest there may be developmental gender differences in the relationship between RI and clinical improvement in pediatric OCD.
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Affiliation(s)
- Christine A. Conelea
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, Minneapolis, MN, USA
| | - Sarah Morris
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Nicole McLaughlin
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | - Erin Mamaril
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
| | - Kristen Benito
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Brady Case
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Abbe Garcia
- Bradley Hospital, Pediatric Anxiety Research Center, East Providence, RI, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
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Piras F, Banaj N, Ciullo V, Piras F, Ducci G, Demaria F, Vicari S, Spalletta G. Dysfunctional Beliefs and Cognitive Performance across Symptom Dimensions in Childhood and Adolescent OCD. J Clin Med 2022; 12:219. [PMID: 36615019 PMCID: PMC9821226 DOI: 10.3390/jcm12010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Although etiological and maintenance cognitive factors have proved effective in predicting the disease course in youths with OCD, their contribution to symptom severity and specific OCD dimensions has been scarcely examined. In a cohort of children and adolescents with OCD (N = 41; mean age = 14; age range = 10-18 yrs.), we investigated whether certain dysfunctional beliefs and cognitive traits could predict symptom severity, and whether they were differentially associated with specific symptom dimensions. We found that self-oriented and socially prescribed perfectionism and intolerance to uncertainty were associated with higher obsession severity, which was not uniquely related to any neuropsychological variable. Greater severity of obsessions and compulsions about harm due to aggression/injury/violence/natural disasters was predicted by excessive concerns with the expectations of other people. Severity in this dimension was additionally predicted by decreasing accuracy in performing a problem-solving, non-verbal reasoning task, which was also a significant predictor of severity of obsessions about symmetry and compulsions to count or order/arrange. Apart from corroborating both the belief-based and neuropsychological models of OCD, our findings substantiate for the first time the specificity of certain dysfunctional beliefs and cognitive traits in two definite symptom dimensions in youth. This bears important clinical implications for developing treatment strategies to deal with unique dysfunctional core beliefs, and possibly for preventing illness chronicity.
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Affiliation(s)
- Federica Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Nerisa Banaj
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Ciullo
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Giuseppe Ducci
- Mental Health Department, ASL Roma 1, Piazza Santa Maria della Pietà 5–Pad. 26, 00193 Rome, Italy
| | - Francesco Demaria
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, USA
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Marzuki AA, Vaghi MM, Conway‐Morris A, Kaser M, Sule A, Apergis‐Schoute A, Sahakian BJ, Robbins TW. Atypical action updating in a dynamic environment associated with adolescent obsessive-compulsive disorder. J Child Psychol Psychiatry 2022; 63:1591-1601. [PMID: 35537441 PMCID: PMC9790358 DOI: 10.1111/jcpp.13628] [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] [Accepted: 04/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Computational research had determined that adults with obsessive-compulsive disorder (OCD) display heightened action updating in response to noise in the environment and neglect metacognitive information (such as confidence) when making decisions. These features are proposed to underlie patients' compulsions despite the knowledge they are irrational. Nonetheless, it is unclear whether this extends to adolescents with OCD as research in this population is lacking. Thus, this study aimed to investigate the interplay between action and confidence in adolescents with OCD. METHODS Twenty-seven adolescents with OCD and 46 controls completed a predictive-inference task, designed to probe how subjects' actions and confidence ratings fluctuate in response to unexpected outcomes. We investigated how subjects update actions in response to prediction errors (indexing mismatches between expectations and outcomes) and used parameters from a Bayesian model to predict how confidence and action evolve over time. Confidence-action association strength was assessed using a regression model. We also investigated the effects of serotonergic medication. RESULTS Adolescents with OCD showed significantly increased learning rates, particularly following small prediction errors. Results were driven primarily by unmedicated patients. Confidence ratings appeared equivalent between groups, although model-based analysis revealed that patients' confidence was less affected by prediction errors compared to controls. Patients and controls did not differ in the extent to which they updated actions and confidence in tandem. CONCLUSIONS Adolescents with OCD showed enhanced action adjustments, especially in the face of small prediction errors, consistent with previous research establishing 'just-right' compulsions, enhanced error-related negativity, and greater decision uncertainty in paediatric-OCD. These tendencies were ameliorated in patients receiving serotonergic medication, emphasising the importance of early intervention in preventing disorder-related cognitive deficits. Confidence ratings were equivalent between young patients and controls, mirroring findings in adult OCD research.
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Affiliation(s)
- Aleya A. Marzuki
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK,Department of PsychologySchool of Medical and Life SciencesSunway UniversityPetaling JayaMalaysia
| | - Matilde M. Vaghi
- Department of PsychologySchool of Humanities and SciencesStanford UniversityStanfordCAUSA
| | | | - Muzaffer Kaser
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK,Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Akeem Sule
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | - Barbara J. Sahakian
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK,Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience InstituteDepartment of PsychologyUniversity of CambridgeCambridgeUK
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11
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Colzato LS, Hommel B, Zhang W, Roessner V, Beste C. The metacontrol hypothesis as diagnostic framework of OCD and ADHD: A dimensional approach based on shared neurobiological vulnerability. Neurosci Biobehav Rev 2022; 137:104677. [PMID: 35461986 DOI: 10.1016/j.neubiorev.2022.104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are multi-faceted neuropsychiatric conditions that in many aspects appear to be each other's antipodes. We suggest a dimensional approach, according to which these partially opposing disorders fall onto a continuum that reflects variability regarding alterations of cortico-striato-thalamo-cortical (CSTC) circuits and of the processing of neural noise during cognition. By using theoretical accounts of human cognitive metacontrol, we develop a framework according to which OCD can be characterized by a chronic bias towards exaggerated cognitive persistence, equivalent to a high signal-to-noise ratio (SNR)-which facilitates perseverative behaviour but impairs mental flexibility. In contrast, ADHD is characterized by a chronic bias towards inflated cognitive flexibility, equivalent to a low SNR-which increases behavioural variability but impairs the focusing on one goal and on relevant information. We argue that, when pharmacology is not feasible, novel treatments of these disorders may involve methods to manipulate the signal-to-noise ratio via non-invasive brain stimulation techniques, in order to normalize the situational imbalance between cognitive persistence and cognitive flexibility.
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Affiliation(s)
- Lorenza S Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany; Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Bernhard Hommel
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany; Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Wenxin Zhang
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany.
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany; University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany; Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
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12
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Yıldız Miniksar D, Yüksel T, Öz B, Özdemir M. A comparison of phenomenological, clinical and familial psychiatric features of pediatric OCD and trichotillomania. Int J Psychiatry Clin Pract 2022; 26:139-147. [PMID: 34124985 DOI: 10.1080/13651501.2021.1933041] [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] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Although trichotillomania (TTM) is classified in the obsessive-compulsive disorders (OCD) chapter of the DSM-5, several studies showed that it has several differences. The aim of this study was to examine the phenomenology, comorbidity, and family psychiatric characteristisc of childhood TTM and OCD. METHODS This study compared youth ages 6-17 years with a primary diagnosis of TTM (n = 63) to those with primary OCD (n = 65) on clinical and familial psychiatric characteristics. RESULTS In our study, the findings showed that family history of schizophrenia (42.3%) was higher among patients with TTM than the OCD group, while the history of OCD (55.8%) in the family was significantly higher among the OCD group (p < 0.001). The behaviour of plucking eyebrows was significantly higher among patients with TTM comorbid OCD than patients with only trichotillomania. TTM patients with comorbid OCD had one-dimensional symptom distribution than the presence of the OCD-only group, and the severity of OCD was lower. The incidence of pathological doubting was higher among the TTM group with comorbid OCD, than those with only OCD diagnosis. CONCLUSIONS These findings support significant differences between OCD and TTM. Differences between OCD and TTM may reflect differences in underlying psychobiology, and may necessitate contrasting treatment approaches.KEYPOINTSWe aimed to compare the trichotillomania in itself and in the presence of OCD with the OCD group.Even if OCD accompanied trichotillomania, OCD symptom dimensions and severity were found to be lower than in the OCD-only group.Trichotillomania is a heterogeneous disorder with different dimensions besides the OCD spectrum.
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Affiliation(s)
- Dilşad Yıldız Miniksar
- Department of Child and Adolescent Psychiatry, Yozgat Bozok University Faculty of Medicine, Yozgat, Turkey
| | - Tuğba Yüksel
- Department of Child and Adolescent Psychiatry, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Büşra Öz
- Department of Child and Adolescent Psychiatry, Düzce Atatürk Training and Research Hospital, Düzce, Turkey
| | - Mikail Özdemir
- Public Health Professional, Osmaniye Community Health Center, Tuberculosis Dispensary, Osmaniye, Turkey
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13
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Rueppel M, Mannella KA, Fitzgerald KD, Schroder HS. Post-error slowing in anxiety and obsessive-compulsive disorders. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2022; 22:610-624. [PMID: 34966981 DOI: 10.3758/s13415-021-00976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
Altered brain response to errors in anxiety and obsessive-compulsive disorders (OCD) suggests cognitive control abnormalities across both types of illness, but behavioral metrics of cognitive control function have yet to be compared in patients selected from these different diagnostic categories. Thus, we examined post-error slowing (PES), a behavioral adjustment that typically occurs after a mistake, in children and adolescents with and without a primary anxiety disorder (N = 103 anxiety and N = 28 healthy controls) and adolescents and adults with and without OCD (N = 118 OCD and N = 60 healthy controls) using a go/no-go task. Primary analyses tested for differences in PES between diagnostic groups (anxiety, OCD, healthy), controlling for age, overall reaction time, and overall accuracy. Results indicated that patients with anxiety disorders exhibited more post-error slowing than both patients with OCD and healthy volunteers. In contrast, participants with OCD did not differ from healthy volunteers in post-error slowing. In subgroup analyses restricted to adolescent participants (ages 13-17 years), more post-error slowing was observed in the anxiety disorders group compared with either the OCD or healthy groups. These data suggest that excessive post-error slowing, an index of behavioral adjustment following errors, may uniquely characterize patients with anxiety disorders relative to healthy individuals and those with OCD.
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Affiliation(s)
- Meryl Rueppel
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
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14
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Stedal K, Scherer R, Touyz S, Hay P, Broomfield C. Research Review: Neuropsychological functioning in young anorexia nervosa: A meta-analysis. J Child Psychol Psychiatry 2022; 63:616-625. [PMID: 34970745 DOI: 10.1111/jcpp.13562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive inflexibility and compulsive behaviours are commonly observed in patients with anorexia nervosa (AN) and are often considered to be caused by impairments in executive functioning and visuospatial processing. Despite an increasing number of young individuals presenting with AN, there is a lack of meta-analytic evidence on the neuropsychological functioning in this population. Our primary aim was to review and synthesize the differences in neuropsychological test performance between young people with AN and healthy controls, and to explore potential moderators. METHODS A database search following PRISMA guidelines of MEDLINE, PsycINFO, ISI Web of Science and Epistemonikos was conducted. Hedges' g served as an effect size indicating the standardized mean differences. We utilized mixed-effects meta-regression and machine learning meta-analyses to identify relevant moderators. RESULTS Sixteen studies met the inclusion criteria with a total of 1333 participants (665 with AN) and 59 effect sizes. Random-effects meta-analyses demonstrated a small and insignificant difference between young individuals with AN and controls ( g¯ = -0.144, 95% CI [-0.328, 0.041]) in overall neuropsychological functioning. However, the difference was significant for the cognitive domains of memory, working memory and visuospatial abilities. Moderator and machine-learning analyses revealed a stronger negative effect in older participants and moderator effects of country and assessment quality. CONCLUSIONS Our findings highlight the significant impact of age on neuropsychological test performance in patients with AN. There is a need for a more widespread inclusion of potentially confounding variables in primary studies as well as instruments specifically targeted at younger populations.
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Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital Oslo Ullevål, Oslo, Norway
| | - Ronny Scherer
- Faculty of Educational Sciences, Centre for Educational Measurement at the University of Oslo (CEMO), University of Oslo, Oslo, Norway
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Catherine Broomfield
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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15
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Thomas KS, Birch RE, Jones CRG, Vanderwert RE. Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder. Front Hum Neurosci 2022; 16:841633. [PMID: 35693540 PMCID: PMC9179647 DOI: 10.3389/fnhum.2022.841633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.
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Affiliation(s)
- Kai S. Thomas
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | | | - Catherine R. G. Jones
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Ross E. Vanderwert
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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16
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Irritability, Defiant and Obsessive-Compulsive Problems Development from Childhood to Adolescence. J Youth Adolesc 2021; 51:1089-1105. [PMID: 34727300 PMCID: PMC9090682 DOI: 10.1007/s10964-021-01528-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/16/2021] [Indexed: 11/07/2022]
Abstract
Little is known about the coexistence of oppositionality and obsessive-compulsive problems (OCP) in community children and how it affects their development until adolescence to prevent possible dysfunctions. The co-development of oppositional defiant dimensions and OCP is studied in 563 children (49.7% female) from ages 6 to 13 years, assessed yearly with measures answered by parents and teachers. A 4-class model based on Latent Class Growth Analysis for three parallel processes (irritability, defiant, and OCP) was selected, which showed adequate fitting indexes. Class 1 (n = 349, 62.0%) children scored low on all the measures. Class 2 (n = 53, 9.4%) contained children with high OCP and low irritability and defiant. Class 3 (n = 108, 19.2%) clustered children with high irritability and defiant and low OCP. Class 4 (n = 53, 9.4%) clustered comorbid irritability, defiant, and OCP characteristics. The classes showed different clinical characteristics through development. The developmental co-occurrence of irritability and defiant plus obsessive-compulsive behaviors is frequent and adds severity through development regarding comorbidity, peer problems, executive functioning difficulties, and daily functioning. The identification of different classes when combining oppositional problems and OCP may be informative to prevent developmental dysfunctions and to promote good adjustment through development.
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17
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Marzuki AA, Tomić I, Ip SHY, Gottwald J, Kanen JW, Kaser M, Sule A, Conway-Morris A, Sahakian BJ, Robbins TW. Association of Environmental Uncertainty With Altered Decision-making and Learning Mechanisms in Youths With Obsessive-Compulsive Disorder. JAMA Netw Open 2021; 4:e2136195. [PMID: 34842925 PMCID: PMC8630570 DOI: 10.1001/jamanetworkopen.2021.36195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/01/2021] [Indexed: 02/05/2023] Open
Abstract
Importance Adults with obsessive-compulsive disorder (OCD) display perseverative behavior in stable environments but exhibit vacillating choice when payoffs are uncertain. These findings may be associated with intolerance of uncertainty and compulsive behaviors; however, little is known about the mechanisms underlying learning and decision-making in youths with OCD because research into this population has been limited. Objective To investigate cognitive mechanisms associated with decision-making in youths with OCD by using executive functioning tasks and computational modeling. Design, Setting, and Participants In this cross-sectional study, 50 youths with OCD (patients) and 53 healthy participants (controls) completed a probabilistic reversal learning (PRL) task between January 2014 and March 2020. A separate sample of 27 patients and 46 controls completed the Wisconsin Card Sorting Task (WCST) between January 2018 and November 2020. The study took place at the University of Cambridge in the UK. Main Outcomes and Measures Decision-making mechanisms were studied by fitting hierarchical bayesian reinforcement learning models to the 2 data sets and comparing model parameters between participant groups. Model parameters included reward and punishment learning rates (feedback sensitivity), reinforcement sensitivity and decision consistency (exploitation), and stickiness (perseveration). Associations of receipt of serotonergic medication with performance were assessed. Results In total, 50 patients (29 female patients [58%]; median age, 16.6 years [IQR, 15.3-18.0 years]) and 53 controls (30 female participants [57%]; median age, 16.4 years [IQR, 14.8-18.0 years]) completed the PRL task. A total of 27 patients (18 female patients [67%]; median age, 16.1 years [IQR, 15.2-17.2 years]) and 46 controls (28 female participants [61%]; median age, 17.2 [IQR, 16.3-17.6 years]) completed the WCST. During the reversal phase of the PRL task, patients made fewer correct responses (mean [SD] proportion: 0.83 [0.16] for controls and 0.61 [0.31] for patients; 95% CI, -1.31 to -0.64) and switched choices more often following false-negative feedback (mean [SD] proportion: 0.09 [0.16] for controls vs 0.27 [0.34] for patients; 95% CI, 0.60-1.26) and true-positive feedback (mean [SD] proportion: 0.93 [0.17] for controls vs 0.73 [0.34] for patients; 95% CI, -2.17 to -1.31). Computational modeling revealed that patients displayed enhanced reward learning rates (mean difference [MD], 0.21; 95% highest density interval [HDI], 0.04-0.38) but decreased punishment learning rates (MD, -0.29; 95% HDI, -0.39 to -0.18), reinforcement sensitivity (MD, -4.91; 95% HDI, -9.38 to -1.12), and stickiness (MD, -0.35; 95% HDI, -0.57 to -0.11) compared with controls. There were no group differences on standard WCST measures and computational model parameters. However, patients who received serotonergic medication showed slower response times (mean [SD], 1420.49 [279.71] milliseconds for controls, 1471.42 [212.81] milliseconds for patients who were unmedicated, and 1738.25 [349.23] milliseconds for patients who were medicated) (control vs medicated MD, -320.26 [95% CI, -547.00 to -88.68]) and increased unique errors (mean [SD] proportion: 0.001 [0.004] for controls, 0.002 [0.004] for patients who were unmedicated, and 0.008 [0.01] for patients who were medicated) (control vs medicated MD, -0.007 [95% CI, -3.14 to -0.36]) on the WCST. Conclusions and Relevance The results of this cross-sectional study indicated that youths with OCD showed atypical probabilistic reversal learning but were generally unimpaired on the deterministic WCST, although unexpected results were observed for patients receiving serotonergic medication. These findings have implications for reframing the understanding of early-onset OCD as a disorder in which decision-making is associated with uncertainty in the environment, a potential target for therapeutic treatment. These results provide continuity with findings in adults with OCD.
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Affiliation(s)
- Aleya A. Marzuki
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
- International University Malaya–Wales, Kuala Lumpur, Malaysia
| | - Ivan Tomić
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Samantha Hiu Yan Ip
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Julia Gottwald
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan W. Kanen
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Muzaffer Kaser
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Akeem Sule
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Anna Conway-Morris
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Barbara J. Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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18
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Wanderer S, Roessner V, Strobel A, Martini J. WISC-IV performance of children with Chronic Tic Disorder, Obsessive-Compulsive Disorder and Attention-Deficit/Hyperactivity Disorder: results from a German clinical study. Child Adolesc Psychiatry Ment Health 2021; 15:44. [PMID: 34465371 PMCID: PMC8408972 DOI: 10.1186/s13034-021-00392-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic Tic Disorder (CTD), Obsessive-Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are complex neuropsychiatric disorders that frequently co-occur. The aim of this study was to examine WISC-IV performance of a clinical cohort of children with CTD, OCD and/or ADHD. METHODS N = 185 children aged 6 to 17 years from Germany with CTD, OCD and/or ADHD were examined with the WISC-IV that comprises four index scores (VCI: Verbal Comprehension Index, PRI: Perceptual Reasoning Index, WMI: Working Memory Index, PSI: Processing Speed Index) and a Full Scale Intelligence Quotient (FSIQ). WISC-IV profiles of children with CTD-only, OCD-only, ADHD-only, CTD+ADHD, CTD+OCD and CTD+OCD+ADHD were compared with the WISC-IV norm (N = 1650, M = 100 and SD = 15) and among each other. RESULTS Unpaired t-tests revealed that children with ADHD-only showed significant lower PSI scores, whereas children with CTD-only and OCD-only had significant higher VCI scores as compared to the German WISC-IV norm. One-way ANOVA revealed that children with ADHD-only showed significant lower WMI scores as compared to children with CTD+OCD. CONCLUSIONS We were able to confirm previous evidence on WISC-IV profiles in ADHD in a German clinical sample and contribute new findings on cognitive performance in children with (non-)comorbid CTD and OCD that have to be seen in light of the study's limitations.
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Affiliation(s)
- Sina Wanderer
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Veit Roessner
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Anja Strobel
- grid.6810.f0000 0001 2294 5505Department of Psychology, Chemnitz University of Technology, Wilhelm-Raabe-Str. 43, 09120 Chemnitz, Germany
| | - Julia Martini
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany. .,Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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19
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Abramovitch A, De Nadai AS, Geller DA. Neurocognitive endophenotypes in pediatric OCD probands, their unaffected parents and siblings. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110283. [PMID: 33609605 PMCID: PMC8222154 DOI: 10.1016/j.pnpbp.2021.110283] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limited extant research on neurocognitive endophenotypes in obsessive-compulsive disorder (OCD) show inconsistent results. Limitations of this body of literature include small sample sizes, strict exclusion criteria, lack of objective standard normalized test scores, and significant lack of studies utilizing pediatric probands. This study aimed to address these limitations. METHODS A large carefully screened cohort of pediatric OCD (n = 102), their unaffected siblings (n = 78), and parents (n = 164), completed a neuropsychological battery. To compare participants at different ages and developmental stages, standard scores were computed using test norms. Cluster-robust regression with sample size-adjusted sandwich estimates of variance, and interclass correlations were computed. False Discovery Rate procedures were employed to correct for multiplicity. RESULTS Probands, siblings and parents demonstrated deficient task performance (Z < -0.5) on the 'number of trials to complete first category' on the Wisconsin Card Sorting Test, and on the Stroop color naming trials. Compared to test norms, the three groups exhibited medium to large effect sizes on these outcome measures. No other meaningful familial trends were found. CONCLUSIONS OCD probands, their unaffected siblings and parents exhibited deficiencies in specific subdomains of cognitive flexibility and inhibitory control, namely, initial concept formation and proactive control, which may be valid candidate neurocognitive endophenotypes of OCD. No other meaningful familial effect has been found on other functions, including other executive function indices such as perseverations and interference control. These results highlight the need to carefully examine individual outcomes from executive function tests instead of the tendency to focus largely on major outcome measures.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, USA; Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | | | - Daniel A Geller
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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20
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Ivarsson T, Melin K, Carlsson Å, Ljungberg M, Forssell-Aronsson E, Starck G, Skarphedinsson G. Neurochemical properties measured by 1H magnetic resonance spectroscopy may predict cognitive behaviour therapy outcome in paediatric OCD: a pilot study. J Neural Transm (Vienna) 2021; 128:1361-1370. [PMID: 34415439 DOI: 10.1007/s00702-021-02407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
To identify neurochemical factors measured pre-treatment that may predict cognitive behavioural treatment (CBT) outcome, aiming at understanding possible causes of poor CBT response. 1H magnetic resonance spectroscopy was used before treatment with CBT in treatment naïve 11-18 year-old patients with moderate-severe OCD. Diagnoses and assessment of OCD severity were based on semi-structured interviews. Linear mixed effects models were used to analyse the association between metabolite level and treatment outcome. Worse CBT outcome was associated with higher concentration of glutamine and glutamate combined (Glx) in middle cingulate cortex (MCC) (F = + 3.35, p = 0.004) and of N-acetylaspartate and N-acetylaspartylglutamate combined (tNAA) (F = + 2.59, p = 0.019). Also, we noted a tendency towards higher thalamic Glx concentration (F = + 1.91, p = 0.077) to be associated with worse CBT outcome. In general, the findings of the current pilot study are compatible with the hypothesis of an overweight of excitatory to inhibitory factors in brain circuits driving goal-directed behaviours (GDB). Higher MCC Glx and tNAA may be involved in the selection of GDB. A more detailed understanding of how these brain areas function in health and illness is needed.
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Affiliation(s)
- Tord Ivarsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Child and Adolescent Psychiatry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Carlsson
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Ljungberg
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Forssell-Aronsson
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Starck
- Department of Medical Physics and Biomedical Engineering, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudmundur Skarphedinsson
- Faculty of Psychology, University of Iceland, Nyi Gardur, Saemundargata 12, 102, Reykjavík, Iceland.
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21
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Mennies RJ, Stewart LC, Olino TM. The relationship between executive functioning and repetitive negative thinking in youth: A systematic review of the literature. Clin Psychol Rev 2021; 88:102050. [PMID: 34144296 DOI: 10.1016/j.cpr.2021.102050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
Repetitive negative thinking (RNT) and executive functioning (EF) deficits are each characteristic of many forms of youth psychopathology. Extensive work has examined the relationship between rumination, a form of RNT, and EF in adults. However, less is known about the relationship between RNT more broadly and EF in youth, for whom these constructs are developing and emerging. Here, we systematically and qualitatively reviewed 27 studies on the associations between EF (e.g., shifting, inhibition, working memory) and RNT (e.g., rumination, worry, obsessions) in youth. All forms of RNT were more commonly positively associated with questionnaire-reported EF problems in daily life, most frequently in the domain of shifting. Task-based assessments of EF were less consistently associated with RNT in youth, with no strong pattern of presence vs. absence of associations. Further, limited longitudinal work has been conducted on this topic to date. This review integrates initial work with regard to RNT and EF deficits in a still-developing population, and discusses clear future need for longitudinal, multi-method assessments of the relationship between RNT and EF subtypes in youth.
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Affiliation(s)
| | | | - Thomas M Olino
- Temple University, Department of Psychology, Philadelphia, PA, USA
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22
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Deepthi K, Roopesh BN, Balachander S, Vijay Sagar JK, Kandavel T, Reddy YCJ. Neuropsychological performance in youth with obsessive-compulsive disorder. J Psychiatr Res 2021; 138:301-310. [PMID: 33892268 DOI: 10.1016/j.jpsychires.2021.03.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/03/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
There is a paucity of literature on neuropsychological functions in youth with obsessive-compulsive disorder (OCD). Most studies have small sample sizes and have yielded inconsistent results. A recent meta-analysis failed to identify any significant impairments. We studied neuropsychological functions (attention, verbal fluency, working memory, set-shifting, response inhibition, planning and visuospatial abilities) in a large sample of youth with OCD (n = 97) in comparison with controls who did not have OCD (n = 50). After controlling for the confounding effects (age, sex, severity of depression and anxiety, presence of comorbid attention-deficit hyperactivity disorder, any tic disorder, number of comorbidities, and non-verbal intelligence measured by the standard progressive matrices), the youth with OCD significantly underperformed with large effect sizes compared to controls, only on the test of 'behavioral reversal', measured by the Object Alternation Test (trials to reach criterion p < 0.001, Cohen's d = 1.49; perseverative errors p < 0.001, Cohen's d = 1.31). Patients also underperformed on a task of planning, but it was statistically insignificant. Certain comorbid disorders, antipsychotic use and age of onset did not influence neuropsychological performance significantly. Our study demonstrates that youth with OCD may have impaired 'set-shifting' in the form of 'behavioral reversal' and possibly planning, findings broadly consistent with the literature in adults and with the fronto-striatal model of OCD. It is possible that youth may accumulate more neuropsychological impairments over a period, as the illness continues into adulthood.
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Affiliation(s)
- K Deepthi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Bangalore N Roopesh
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - John K Vijay Sagar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Thennarasau Kandavel
- Department of Biostatistics, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
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23
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Vogt C. Clinical Conundrums When Integrating the QbTest into a Standard ADHD Assessment of Children and Young People. Neuropediatrics 2021; 52:155-162. [PMID: 33445192 DOI: 10.1055/s-0040-1722674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The uptake of the QbTest in clinical practice is increasing and has recently been supported by research evidence proposing its effectiveness in relation to clinical decision-making. However, the exact underlying process leading to this clinical benefit is currently not well established and requires further clarification. For the clinician, certain challenges arise when adding the QbTest as a novel method to standard clinical practice, such as having the skills required to interpret neuropsychological test information and assess for diagnostically relevant neurocognitive domains that are related to attention-deficit hyperactivity disorder (ADHD), or how neurocognitive domains express themselves within the behavioral classifications of ADHD and how the quantitative measurement of activity in a laboratory setting compares with real-life (ecological validity) situations as well as the impact of comorbidity on test results. This article aims to address these clinical conundrums in aid of developing a consistent approach and future guidelines in clinical practice.
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Affiliation(s)
- Carsten Vogt
- Child and Adolescent Mental Health Services (CAMHS), Children Young People and Families Services (CYPF), Berkshire Healthcare NHS Foundation Trust, United Kingdom
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24
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Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113858. [PMID: 33770712 DOI: 10.1016/j.psychres.2021.113858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/06/2021] [Indexed: 12/28/2022]
Abstract
Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.
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25
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Fitzgerald KD, Schroder HS, Marsh R. Cognitive Control in Pediatric Obsessive-Compulsive and Anxiety Disorders: Brain-Behavioral Targets for Early Intervention. Biol Psychiatry 2021; 89:697-706. [PMID: 33454049 PMCID: PMC8353584 DOI: 10.1016/j.biopsych.2020.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
The DSM provides distinct criteria for obsessive-compulsive disorder (OCD) and various types of anxiety disorders, but phenomenological overlap, high rates of comorbidity, and early onset suggest common underlying mechanisms. This notion is further supported by use of the same treatments-cognitive behavioral therapy and serotonin reuptake inhibitor medication-for managing both OCD and non-OCD anxiety disorders in clinical settings. While early intervention with these gold standard treatments is recommended for pediatric OCD and anxiety disorders, young patients often remain symptomatic even after treatment. To guide the development of novel, mechanistically targeted treatments to better resolve OCD and anxiety symptoms, the identification of neural circuits underlying psychological constructs with relevance across disorders has been recommended. One construct that may be relevant for understanding pediatric OCD and anxiety disorders is cognitive control, given the difficulty that young patients experience in dismissing obsessions, compulsions, and worry despite recognition that these symptoms are excessive and unreasonable. In this review, we examine findings from a growing body of literature implicating brain-behavioral markers of cognitive control in pediatric OCD and anxiety disorders, including before and after treatment. We conclude by suggesting that interventions designed to enhance the functioning of the task control circuits underlying cognitive control may facilitate brain maturation to help affected youth overcome symptoms.
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Affiliation(s)
- Kate D Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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26
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Grassi G, Cecchelli C, Mazzocato G, Vignozzi L. Early onset obsessive-compulsive disorder: the biological and clinical phenotype. CNS Spectr 2021:1-7. [PMID: 33517936 DOI: 10.1017/s1092852921000122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Moving from a behavioral-based to a biological-based classification of mental disorders is a crucial step toward a precision-medicine approach in psychiatry. In the last decade, a big effort has been made in order to stratify genetic, immunological, neurobiological, cognitive, and clinical profiles of patients. Making the case of obsessive-compulsive disorder (OCD), a lot have been made in this direction. Indeed, while the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of OCD aimed to delineate a homogeneous group of patients, it is now clear that OCD is instead an heterogeneous disorders both in terms of neural networks, immunological, genetic, and clinical profiles. In this view, a convergent amount of literature, in the last years, indicated that OCD patients with an early age at onset seem to have a specific clinical and biological profile, suggesting it as a neurodevelopmental disorder. Also, these patients tend to have a worse outcome respect to adult-onset patients and there is growing evidence that early-interventions could potentially improve their prognosis. Therefore, the aim of the present paper is to review the current available genetic, immunological, neurobiological, cognitive, and clinical data in favor of a more biologically precise subtype of OCD: the early-onset subtype. We also briefly resume current available recommendations for the clinical management of this specific population.
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27
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Kashyap H, Abramovitch A. Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions. Front Psychiatry 2021; 12:721601. [PMID: 34790136 PMCID: PMC8591286 DOI: 10.3389/fpsyt.2021.721601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neuropsychological functions in obsessive-compulsive disorder (OCD) have been extensively investigated. Despite some common findings across studies indicating deficient test performance across cognitive domains with small to medium effect sizes, results remain inconsistent and heterogeneous. However, multiple past attempts to identify moderators that may account for such variability have been unrewarding. Typical moderators including symptom severity, age at onset, medication status, and comorbid conditions failed to provide sufficient explanatory power. It has then been posited that these inconsistencies may be attributed to the inherent heterogeneous nature of the disorder (i.e., symptom dimensions), or to the natural fluctuation in symptom severity. However, recent meta-analyses suggest that these factors may not account for the persistent unexplained variability. Other potential factors-some of which are unique to neuropsychological testing-received scarce research attention, including definition of cognitive impairments, specificity and selection of test and outcome measures, and their limited ecological validity. Other moderators, particularly motivational aspects, and metacognitive factors (e.g., self-efficacy) were not previously addressed despite their potential association to OCD, and their documented impact on cognitive function. The aim of the present mini-review is to provide an updated succinct overview of the current status of the neuropsychological literature in OCD and expanding upon oft-neglected potential moderators and their putative impact on neuropsychological findings in OCD. Our goal is to highlight important avenues for further research and provide a road map for investigators in order to advance our understanding of cognitive functions in OCD that has been stagnant in the past decade.
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Affiliation(s)
- Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, United States
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28
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Nishat E, Dockstader C, Wheeler AL, Tan T, Anderson JAE, Mendlowitz S, Mabbott DJ, Arnold PD, Ameis SH. Visuomotor Activation of Inhibition-Processing in Pediatric Obsessive Compulsive Disorder: A Magnetoencephalography Study. Front Psychiatry 2021; 12:632736. [PMID: 33995145 PMCID: PMC8116532 DOI: 10.3389/fpsyt.2021.632736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Response inhibition engages the cortico-striato-thalamo-cortical (CSTC) circuit, which has been implicated in children, and youth with obsessive compulsive disorder (OCD). This study explored whether CSTC engagement during response inhibition, measured using magnetoencephalography (MEG), differed in a sample of medication-naïve youth with OCD, compared to typically developing controls (TDC). Methods: Data was analyzed in 17 medication-naïve children and youth with OCD (11.7 ± 2.2 SD years) and 13 TDC (12.6 ± 2.2 SD years). MEG was used to localize and characterize neural activity during a Go/No-Go task. Task performance on Go/No-Go conditions and regional differences in amplitude of activity during Go and No-Go condition between OCD vs. TDC were examined using two-sample t-tests. Post-hoc analysis with Bayesian t-tests was used to estimate the certainty of outcomes. Results: No differences in Go/No-Go performance were found between OCD and TDC groups. In response to the visual cue presented during the Go condition, participants with OCD showed significantly increased amplitude of activity in the primary motor (MI) cortex compared to TDC. In addition, significantly reduced amplitude of PCu was found following successful stopping to No-Go cues in OCD vs. TDC during No-Go task performance. Bayesian t-tests indicated high probability and large effect sizes for the differences in MI and PCu amplitude found between groups. Conclusion: Our preliminary study in a small medication-naïve sample extends previous work indicating intact response inhibition in pediatric OCD. While altered neural response in the current study was found during response inhibition performance in OCD, differences localized to regions outside of the CSTC. Our findings suggest that additional imaging research in medication-naïve samples is needed to clarify regional differences associated with OCD vs. influenced by medication effects, and suggest that MEG may be sensitive to detecting such differences.
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Affiliation(s)
- Eman Nishat
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Colleen Dockstader
- Department of Human Biology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Anne L Wheeler
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Thomas Tan
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - John A E Anderson
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sandra Mendlowitz
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Donald J Mabbott
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stephanie H Ameis
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
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29
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Fullana MA, Abramovitch A, Via E, López-Sola C, Goldberg X, Reina N, Fortea L, Solanes A, Buckley MJ, Ramella-Cravaro V, Carvalho AF, Tortella-Feliu M, Vieta E, Soriano-Mas C, Lázaro L, Stein DJ, Fernández de la Cruz L, Mataix-Cols D, Radua J. Diagnostic biomarkers for obsessive-compulsive disorder: A reasonable quest or ignis fatuus? Neurosci Biobehav Rev 2020; 118:504-513. [DOI: 10.1016/j.neubiorev.2020.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022]
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30
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Loosen AM, Hauser TU. Towards a computational psychiatry of juvenile obsessive-compulsive disorder. Neurosci Biobehav Rev 2020; 118:631-642. [PMID: 32942176 DOI: 10.1016/j.neubiorev.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 01/22/2023]
Abstract
Obsessive-Compulsive Disorder (OCD) most often emerges during adolescence, but we know little about the aberrant neural and cognitive developmental mechanisms that underlie its emergence during this critical developmental period. To move towards a computational psychiatry of juvenile OCD, we review studies on the computational, neuropsychological and neural alterations in juvenile OCD and link these findings to the adult OCD and cognitive neuroscience literature. We find consistent difficulties in tasks entailing complex decision making and set shifting, but limited evidence in other areas that are altered in adult OCD, such as habit and confidence formation. Based on these findings, we establish a neurocomputational framework that illustrates how cognition can go awry and lead to symptoms of juvenile OCD. We link these possible aberrant neural processes to neuroimaging findings in juvenile OCD and show that juvenile OCD is mainly characterised by disruptions of complex reasoning systems.
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Affiliation(s)
- Alisa M Loosen
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, United Kingdom.
| | - Tobias U Hauser
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, United Kingdom.
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31
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Bernardes ET, Saraiva LC, e Souza MDM, Hoexter MQ, Chacon P, Requena G, Miguel EC, Shavitt RG, Polanczyk GV, Cappi C, Batistuzzo MC. Cognitive performance in children and adolescents at high-risk for obsessive-compulsive disorder. BMC Psychiatry 2020; 20:380. [PMID: 32690046 PMCID: PMC7370498 DOI: 10.1186/s12888-020-02751-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cognitive performance has been studied in adults with obsessive-compulsive symptoms (OCS) and in adult relatives of patients with obsessive-compulsive disorder (OCD) Meanwhile, few studies have been conducted with children under the same conditions. This study compared the neurocognitive domains previously associated with dysfunction in OCD, especially visuoconstructive ability, visuospatial memory, executive functions, and intelligence, in children and adolescents at high risk (HR) for OCD (n = 18) and non-OCD controls (NOC) (n = 31). METHODS For the HR group, we considered the first-degree relatives of patients with OCD that present OCS, but do not meet diagnostic criteria for OCD. Psychiatric diagnosis was assessed by experienced clinicians using the Structured Clinical Interview for DSM-IV and OCS severity was measured by the Yale-Brown Obsessive-Compulsive Scale. Neurocognitive assessment was performed with a comprehensive neuropsychological battery. Performance on the cognitive domains was compared between groups using Multivariate Analysis of Variance, whereas performance on the neuropsychological variables was compared between groups using independent t-tests in a cognitive subdomain analysis. RESULTS The cognitive domain analysis revealed a trend towards significance for impairments in the motor and processing speed domain (p = 0.019; F = 3.12) in the HR group. Moreover, the cognitive subdomain analysis identified a statistically significant underperformance in spatial working memory in the HR group when compared to the NOC group (p = 0.005; t = - 2.94), and a trend towards significance for impairments in non-verbal memory and visuoconstructive tasks in the HR group. CONCLUSIONS Our results suggest impairments in spatial working memory and motor and processing speed in a non-clinical sample of HR participants. Considering the preliminary nature of our findings, further studies investigating these neurocognitive domains as potential predictors of pediatric OCD are warranted.
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Affiliation(s)
- Elisa Teixeira Bernardes
- Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP, Brazil.
| | - Leonardo Cardoso Saraiva
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Marina de Marco e Souza
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Marcelo Queiroz Hoexter
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Priscila Chacon
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Guaraci Requena
- grid.12799.340000 0000 8338 6359Instituto de Ciencias Exatas e Tecnologicas da Universidade Federal de Vicosa, Viçosa, Brazil
| | - Euripedes Constantino Miguel
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Roseli Gedanke Shavitt
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Guilherme Vanoni Polanczyk
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Carolina Cappi
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil
| | - Marcelo Camargo Batistuzzo
- grid.11899.380000 0004 1937 0722Departamento de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr Ovidio Pires de Campos, 875, Sao Paulo, SP Brazil ,grid.412529.90000 0001 2149 6891Curso de Psicologia, Faculdade de Ciências Humanas e da Saúde, Pontifícia Universidade Católica de São Paulo, Sao Paulo, SP Brazil
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32
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Negreiros J, Belschner L, Best JR, Lin S, Franco Yamin D, Joffres Y, Selles RR, Jaspers-Fayer F, Miller LD, Woodward TS, Honer WG, Stewart SE. Neurocognitive risk markers in pediatric obsessive-compulsive disorder. J Child Psychol Psychiatry 2020; 61:605-613. [PMID: 31749150 DOI: 10.1111/jcpp.13153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has complex genetic underpinnings, particularly in its early-onset form, which places siblings at a 10-fold increased risk of developing the disorder. Examination for neurocognitive markers preceding pediatric OCD onset has not been conducted, although markers have been identified in adult OCD. This study compared neurocognition across groups of OCD-affected youth (n = 87), unaffected siblings of those with early-onset OCD (n = 67), and healthy controls (HC; n = 79). METHODS A total of 233 participants aged 6-18 years old completed standardized neurocognitive tests of cognitive flexibility, decision making, planning, response inhibition, spatial working memory, attention, recognition nonverbal memory, and intelligence. They were administered the Anxiety Disorders Interview Schedule-Parent version (ADIS-P) and completed self-report anxiety and OCD questionnaires. Linear mixed-effects models tested for differences between groups, adjusting for age, gender, IQ, state anxiety, and ethnicity, and accounting for random effects of family membership. RESULTS OCD-affected youth and unaffected siblings performed significantly worse on planning in comparison to HCs (Cohen's d = 0.74; 95% CI = [0.11, 1.36]; Cohen's d = 0.75; 95% CI = [0.12, 1.38], respectively; omnibus group effect p = .007). No other significant between-group differences were identified. CONCLUSIONS Neurocognitive performance differences between groups identified planning as a preexisting trait marker of pediatric OCD, while no other domain presented as a marker of pediatric OCD. This differs from adult OCD, which is associated with broader cognitive impairments. Investigating longitudinal trajectories and predictive significance of neurocognition in those affected by, and at risk for, early-onset OCD is warranted. Ideally, this will enhance individualized risk stratification and inform future prevention and early intervention strategies.
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Affiliation(s)
- Juliana Negreiros
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Laura Belschner
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - John R Best
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sarah Lin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Diana Franco Yamin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Yayuk Joffres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Robert R Selles
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Fern Jaspers-Fayer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Lynn D Miller
- Department of Education and Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial OCD Program, British Columbia Children's Hospital, Vancouver, BC, Canada
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Wilton EP, Flessner CA, Brennan E, Murphy Y, Walther M, Garcia A, Conelea C, Dickstein DP, Stewart E, Benito K, Freeman JB. A Neurocognitive Comparison of Pediatric Obsessive-Compulsive Disorder and Trichotillomania (Hair Pulling Disorder). JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:733-744. [DOI: 10.1007/s10802-020-00627-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lamothe H, Baleyte JM, Mallet L, Pelissolo A. Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:87-104. [PMID: 31576938 PMCID: PMC6986481 DOI: 10.1590/1516-4446-2019-0471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
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Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Université de Caen Normandie (UNICAEN), INSERM, U1077, Caen, France
| | - Luc Mallet
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
- Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Antoine Pelissolo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
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Marzuki AA, Pereira de Souza AMFL, Sahakian BJ, Robbins TW. Are candidate neurocognitive endophenotypes of OCD present in paediatric patients? A systematic review. Neurosci Biobehav Rev 2019; 108:617-645. [PMID: 31821834 DOI: 10.1016/j.neubiorev.2019.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023]
Abstract
To-date it has been difficult to ascertain the exact cognitive profile of childhood OCD as studies report variable results. Adult OCD research lately utilises the endophenotype approach; studying cognitive traits that are present in both patients and their unaffected first-degree relatives, and are thought to lie closer to the genotype than the full-blown disorder. By observing whether candidate endopenotypes of adult OCD are present in child patients, we can determine whether the two subtypes show cognitive overlap. We conducted a systematic review of the paediatric OCD literature focussing on proposed neurocognitive endophenotypes of OCD: cognitive flexibility, response inhibition, memory, planning, decision-making, action monitoring, and reversal learning. We found that paediatric patients present robust increases in brain error related negativity associated with abnormal action monitoring, impaired decision-making under uncertainty, planning, and visual working memory, but there is less evidence for deficits in other cognitive domains. This implies that children with OCD show some cognitive similarities with adult patients, but other dysfunctions may only manifest later in the disorder trajectory.
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Affiliation(s)
- Aleya A Marzuki
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EL, Cambridge, UK; Department of Psychology, Downing Site, University of Cambridge, CB2 3EB, Cambridge, UK.
| | - Ana Maria Frota Lisboa Pereira de Souza
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EL, Cambridge, UK; Department of Psychology, Downing Site, University of Cambridge, CB2 3EB, Cambridge, UK.
| | - Barbara J Sahakian
- Herchel Smith Building, Department of Psychiatry, University of Cambridge, CB2 0SZ, Cambridge, UK.
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, CB2 3EL, Cambridge, UK; Department of Psychology, Downing Site, University of Cambridge, CB2 3EB, Cambridge, UK.
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Garnaat SL, Conelea CA, McLaughlin NCR, Benito K. Pediatric OCD in the era of RDoC. J Obsessive Compuls Relat Disord 2019; 23:10.1016/j.jocrd.2018.03.002. [PMID: 32042574 PMCID: PMC7010312 DOI: 10.1016/j.jocrd.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The NIMH Research Domain Criteria (RDoC) initiative was established with the goal of developing an alternative research classification to further research efforts in mental health. While RDoC acknowledges that constructs should be considered within a developmental framework, developmental considerations have not yet been well integrated within the existing RDoC matrix. In this paper, we consider RDoC in relation to pediatric OCD, a paradigmatic example of a neuropsychiatric disorder that often has onset in childhood but is also present across the lifespan. We discuss three RDoC subdomains with relevance to OCD as exemplars, providing for each construct a brief review of normative developmental changes, the state of construct-relevant research in pediatric OCD, and challenges and limitations related to developmental considerations within each subdomain. Finally, we conclude with a brief discussion of how RDoC may continue to evolve with regard to developmental considerations in order to further research in pediatric OCD.
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Affiliation(s)
- Sarah L. Garnaat
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island
| | | | - Nicole C. R. McLaughlin
- Butler Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island
| | - Kristen Benito
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, Rhode Island
- Bradley Hospital, Providence, Rhode Island
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Executive Dysfunction and Language Deficits in a Pediatric Patient with OCD and MDD with Suicidality. Case Rep Psychiatry 2019; 2019:6574304. [PMID: 31183239 PMCID: PMC6515185 DOI: 10.1155/2019/6574304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/18/2019] [Indexed: 11/17/2022] Open
Abstract
The role of neuropsychiatric testing in psychiatric disorders is becoming more prominent. Neuropsychological measures that are similar across symptom domains and phenomena such as suicidality may help clinicians guide treatment and tailor therapies to the patient in the most effective way possible. We report the case of a 16-year-old girl who presented with bizarre, intrusive suicidal thoughts in the setting of OCD and MDD. This case is unusual in that we have accurate neuropsychological determination of our patient's language and executive function deficits, and we propose a link between them and her expression of suicidality in the context of OCD and MDD.
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38
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Kim KL, Christensen RE, Ruggieri A, Schettini E, Freeman JB, Garcia AM, Flessner C, Stewart E, Conelea C, Dickstein DP. Cognitive performance of youth with primary generalized anxiety disorder versus primary obsessive-compulsive disorder. Depress Anxiety 2019; 36:130-140. [PMID: 30375085 DOI: 10.1002/da.22848] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/12/2018] [Accepted: 09/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite gains made in the study of childhood anxiety, differential diagnosis remains challenging because of indistinct boundaries between disorders and high comorbidity. This is certainly true for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) as they share multiple cognitive processes (e.g., rumination, intolerance of uncertainty, and increased attention to threat). Disentangling such cognitive characteristics and, subsequently, underlying mechanisms could serve to inform assessment and treatment practices, and improve prognoses. METHODS The current study sought to compare the cognitive performance (working memory, visuospatial memory, planning ability/efficiency, and cognitive flexibility), indexed by the Cambridge Neuropsychological Automated Battery (CANTAB) among three nonoverlapping groups of youth: (1) those diagnosed with OCD (n = 28), (2) those diagnosed with GAD, not OCD (n = 34), and (3) typically-developing controls (TDC) (n = 65). RESULTS Results showed that OCD and GAD youth demonstrated neurocognitive deficits in planning ability/efficiency, cognitive flexibility, and visual processing when compared to TDC, with potential diagnostic specificity such that youth with GAD or OCD had unique deficits compared to TDC and to one another. Specifically, youth with OCD demonstrated significantly impaired planning ability compared to youth in the GAD and TDS groups, whereas youth with GAD demonstrated greater cognitive inflexibility and delayed visual processing compared to youth in the OCD and TDC groups. CONCLUSIONS Future studies should expand upon these findings with more comprehensive assessment of cognitive functioning by including self- and parent-report forms, and neuroimaging to link behavioral findings with subjective ratings and neurocircuitry. Altogether, data can then inform future assessment and treatment targets.
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Affiliation(s)
- Kerri L Kim
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Rachel E Christensen
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Amanda Ruggieri
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Elana Schettini
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jennifer B Freeman
- Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island.,PARC Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbe M Garcia
- Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island.,PARC Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christopher Flessner
- Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island.,PARC Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Elyse Stewart
- Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island.,PARC Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Christine Conelea
- Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island.,PARC Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel P Dickstein
- PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Psychiatry and Human Behavior in the Alpert Medical School, Brown University, Providence, Rhode Island
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Abstract
Obsessive-compulsive disorder (OCD) is a debilitating mental illness characterized by an early onset and chronic course. Evidence from several lines of research suggests significant neuropsychological deficits in patients with OCD; executive dysfunction and nonverbal memory deficits have been reported consistently in OCD. These deficits persist despite controlling potential confounders such as comorbidity, severity of illness, and medications. Neuropsychological impairments are independent of illness severity, thus suggesting that the neuropsychological deficits are trait markers of the disease. In addition, these deficits are seen in first-degree relatives of individuals with OCD. These reports suggest that neuropsychological deficits are potential endophenotype markers in OCD. Neuropsychological studies in pediatric OCD are limited; they show impairments of small effect size across multiple domains but with doubtful clinical significance. Preliminary evidence shows that different symptom dimensions of OCD may have unique neuropsychological deficits suggestive of discrete but overlapping neuroanatomical regions for individual symptom dimensions. Overall, neuropsychological deficits further support the role of frontostriatal circuits in the neurobiology of OCD. In addition, emerging literature also suggests the important role of other areas, in particular parietal cortex. Preliminary evidence suggests the possible role of neuropsychological deficits to be markers of treatment response but needs to be examined in future. Longitudinal studies with examination of patients at different time points and examination of their potential utility as predictors of treatment response are needed in future.
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Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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40
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Zhang K, Fan X, Yuan J, Yin J, Su H, Hashimoto K, Wang G. Impact of serotonin transporter gene on rTMS augmentation of SSRIs for obsessive compulsive disorder. Neuropsychiatr Dis Treat 2019; 15:1771-1779. [PMID: 31308670 PMCID: PMC6612955 DOI: 10.2147/ndt.s209319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is beneficial for treatment-resistant patients with obsessive-compulsive disorder (OCD). The serotonin transporter gene (SLC6A4) may be associated with OCD. We aimed to determine whether SLC6A4 impacts the beneficial effects of rTMS in patients with OCD treated with selective serotonin reuptake inhibitors (SSRIs). METHODS Fifty-seven untreated patients with OCD were randomly assigned to receive active or sham rTMS in a 4-week double-blind study. The participants received 1-Hz rTMS over the supplementary motor area once per day, for 5 days a week, for 4 weeks. One of the widely employed SSRIs was utilized at the initiation of active or sham rTMS. Yale-Brown obsessive-compulsive scale (Y-BOCS) scores were used for assessing the symptoms. The most-researched polymorphism of SLC6A4, 5-HTTLPR (L/S), was also examined. RESULTS Y-BOCS scores in the active group at the completion of the treatment were significantly lower than those in the sham group. Interestingly, the improvement in Y-BOCS scores in patients with the LL genotype treated with active rTMS was significantly (p<0.05) greater than in those treated with sham rTMS. Conversely, rTMS did not produce significant improvements in S allele carriers. CONCLUSIONS The findings of this study suggest that rTMS can augment the beneficial effects of SSRIs in OCD patients with the LL genotype of 5-HTTLPR. Therefore, the presence of 5-HTTLPR (L/S) in SLC6A4 may be a predictable biomarker for the beneficial effects of rTMS, although more studies using larger sample sizes are warranted for confirming the results.
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Affiliation(s)
- Kai Zhang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, People's Republic of China.,Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Xiwang Fan
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, People's Republic of China
| | - Jianmin Yuan
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, People's Republic of China
| | - Jiajun Yin
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, People's Republic of China
| | - Hang Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Guoqiang Wang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, People's Republic of China
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Burchi E, Hollander E, Pallanti S. From Treatment Response to Recovery: A Realistic Goal in OCD. Int J Neuropsychopharmacol 2018; 21:1007-1013. [PMID: 30184141 PMCID: PMC6209853 DOI: 10.1093/ijnp/pyy079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/15/2018] [Accepted: 08/31/2018] [Indexed: 11/14/2022] Open
Abstract
Despite longitudinal studies reporting symptomatic remission rates ranging from 32% to 70%, Obsessive-Compulsive Disorder is considered a persistent and very disabling disorder. However, these studies suggest that recovery can be a realistic goal for a subgroup of the Obsessive-Compulsive Disorder population and that a clear definition of recovery is timely in Obsessive-Compulsive Disorder. The aim of this paper is to discuss the dimensions of and propose an operational definition of recovery in Obsessive-Compulsive Disorder. Considering the impact generated by the definition of recovery for other mental disorders, this article discusses how this concept may shape the future of research and clinical practice in Obsessive-Compulsive Disorder. Ultimately, the hope is that the management of Obsessive-Compulsive Disorder may parallel, and expand upon, some of the current approaches implemented in the care of schizophrenia, so that early diagnosis, stepped-care techniques, and a personalized approach can be used to create recovery-oriented treatment programs and influence policy making for Obsessive-Compulsive Disorder.
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Affiliation(s)
- Elisabetta Burchi
- Department of Scienze della Salute, University of Florence, Italy
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of medicine, Bronx, NY
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of medicine, Bronx, NY
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of medicine, Bronx, NY
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, CA
- Institute of Neuroscience, Florence, Italy (Dr Pallanti)
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42
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The impact of symptom severity on cognitive function in obsessive-compulsive disorder: A meta-analysis. Clin Psychol Rev 2018; 67:36-44. [PMID: 30528984 DOI: 10.1016/j.cpr.2018.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/16/2018] [Accepted: 09/21/2018] [Indexed: 01/23/2023]
Abstract
Research on cognitive functions in obsessive-compulsive disorder (OCD) is notoriously heterogeneous with no moderators identified that account for this variability. OCD severity is the primary potential moderator of interest given the longstanding trait versus state debate. Nevertheless, severity has been previously assessed exclusively as a moderator and was not directly and systematically investigated. To address this gap in the literature, the aim of this study was to conduct a systematic meta-analytic review of correlations between cognitive function and symptom severity in OCD samples. Thirty-eight studies were included, allowing for analysis of 132 effects and meta-regression analyses for potential moderators. Small effects were found for the association between cognitive function and symptom severity on major neuropsychological domains, and some subdomains exhibited medium effects for this association. However, several significant methodological and conceptual problems were identified, including the use of the Yale-Brown Obsessive-Compulsive Scale that assesses severity in the past week and not at time of testing, a tendency to not report non-significant correlations, and problematic ecological validity of neuropsychological tests in OCD. In conclusion, we found a small-to-moderate degree of association between OCD symptom severity and cognitive function, but results should be interpreted cautiously given the limitations identified. We offer recommendations that will facilitate future research into this association and move the field beyond the largely stagnant debate about the state versus trait nature of cognitive functioning in OCD, and across disorders.
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Gottwald J, de Wit S, Apergis-Schoute AM, Morein-Zamir S, Kaser M, Cormack F, Sule A, Limmer W, Morris AC, Robbins TW, Sahakian BJ. Impaired cognitive plasticity and goal-directed control in adolescent obsessive-compulsive disorder. Psychol Med 2018; 48:1900-1908. [PMID: 29353562 PMCID: PMC6088771 DOI: 10.1017/s0033291717003464] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Youths with obsessive-compulsive disorder (OCD) experience severe distress and impaired functioning at school and at home. Critical cognitive domains for daily functioning and academic success are learning, memory, cognitive flexibility and goal-directed behavioural control. Performance in these important domains among teenagers with OCD was therefore investigated in this study. METHODS A total of 36 youths with OCD and 36 healthy comparison subjects completed two memory tasks: Pattern Recognition Memory (PRM) and Paired Associates Learning (PAL); as well as the Intra-Extra Dimensional Set Shift (IED) task to quantitatively gauge learning as well as cognitive flexibility. A subset of 30 participants of each group also completed a Differential-Outcome Effect (DOE) task followed by a Slips-of-Action Task, designed to assess the balance of goal-directed and habitual behavioural control. RESULTS Adolescent OCD patients showed a significant learning and memory impairment. Compared with healthy comparison subjects, they made more errors on PRM and PAL and in the first stages of IED involving discrimination and reversal learning. Patients were also slower to learn about contingencies in the DOE task and were less sensitive to outcome devaluation, suggesting an impairment in goal-directed control. CONCLUSIONS This study advances the characterization of juvenile OCD. Patients demonstrated impairments in all learning and memory tasks. We also provide the first experimental evidence of impaired goal-directed control and lack of cognitive plasticity early in the development of OCD. The extent to which the impairments in these cognitive domains impact academic performance and symptom development warrants further investigation.
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Affiliation(s)
- Julia Gottwald
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Sanne de Wit
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Annemieke M. Apergis-Schoute
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Sharon Morein-Zamir
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychology, Anglia Ruskin University, Cambridge, UK
| | - Muzaffer Kaser
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Akeem Sule
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Winifred Limmer
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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Hanna GL, Liu Y, Isaacs YE, Ayoub AM, Brosius A, Salander Z, Arnold PD, Gehring WJ. Error-related brain activity in adolescents with obsessive-compulsive disorder and major depressive disorder. Depress Anxiety 2018; 35:752-760. [PMID: 29734494 PMCID: PMC6105517 DOI: 10.1002/da.22767] [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: 12/11/2017] [Revised: 02/28/2018] [Accepted: 03/31/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The error-related negativity (ERN) is a negative deflection in the event-related potential following a mistake that is often increased in patients with obsessive-compulsive disorder (OCD). The relationship of the ERN to comorbid major depressive disorder (MDD) has not been examined in adolescents with OCD. This study compared ERN amplitudes in OCD patients with MDD (OCD + MDD), OCD patients without MDD (OCD - MDD), MDD patients, and healthy controls (HC). METHOD The ERN, correct response negativity, and accuracy were measured during a flanker task to assess performance monitoring in 53 adolescents with a lifetime diagnosis of OCD, 36 adolescents with a lifetime diagnosis of MDD, and 89 age-matched HC of 13-18 years. Fourteen OCD patients had a history of MDD. RESULTS ERN amplitude was significantly increased in OCD patients compared to HC and significantly correlated in OCD patients with age at OCD symptom onset, particularly in the OCD - MDD patients. The ERN was significantly enlarged in OCD + MDD patients compared to HC, but not in MDD patients compared to HC. There was a trend for an increased ERN amplitude in OCD - MDD patients compared to HC. OCD patients were significantly less accurate than either MDD patients or HC. CONCLUSIONS An enlarged ERN is a neural correlate of adolescent OCD that is associated with age at OCD symptom onset. Adolescents with OCD may have impaired cognitive control on a flanker task. Follow-up studies with larger samples may determine whether an enlarged ERN in adolescents with OCD is associated with a higher risk for MDD.
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Hamo N, Abramovitch A, Zohar A. A computerized neuropsychological evaluation of cognitive functions in a subclinical obsessive-compulsive sample. J Behav Ther Exp Psychiatry 2018; 59:142-149. [PMID: 29408052 DOI: 10.1016/j.jbtep.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/23/2017] [Accepted: 01/10/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Ample research in obsessive-compulsive disorder (OCD) reveals a moderate degree of underperformance on various neuropsychological tasks. Less is known about neuropsychological function in subclinical obsessive-compulsive (OC) samples. Most analogue OCD studies did not use a comprehensive neuropsychological battery and none utilized a fully computerized battery. To fill this gap in the literature, the present study aimed at assessing cognitive functions in a subclinical OC sample using a validated computerized neuropsychological battery. METHODS Initially, a sample of 165 students completed the Obsessive-Compulsive Inventory-Revised (OCI-R). Using a psychometrically valid methodology, a high OC (HOC, n = 29) and low OC (LOC, n = 29) groups were selected based on scores in the upper and lower quartiles on the OCI-R. The two groups completed the NeuroTrax computerized neuropsychological battery and clinical questionnaires. RESULTS Although the HOC group underperformed on most outcome measures, controlling for state-anxiety and depression symptoms, no significant differences were found on major domains (i.e., memory, attention, executive functions, processing speed, visuospatial functions, verbal functions, and motor skills), and subdomains. Normalized scores, produced using population norms, indicated that both groups performed within the normative range. LIMITATIONS Not all neuropsychological subdomains were assessed. CONCLUSIONS Results are consistent with the general picture in analogue OC samples, and may be more reliable than paper-pencil testing, given that a full computerized neuropsychological battery minimizes examiner-examinee interactions, and increases timing accuracy. In sum, analogue OC samples, characterized by equivalent symptom severity but high functioning compared to OCD samples, do not present with cognitive deficits.
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Affiliation(s)
- Naama Hamo
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emeq Hefer 4025000, Israel
| | - Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos 78666, TX, USA.
| | - Ada Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emeq Hefer 4025000, Israel
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Cool and Hot Aspects of Executive Function in Childhood Obsessive-Compulsive Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 45:1195-1205. [PMID: 27838893 DOI: 10.1007/s10802-016-0229-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aspects of executive functioning (EF) have been put forward as endophenotypes in obsessive- compulsive disorder (OCD) and meta-analyses support EF underperformance in adult samples. Childhood-onset OCD has been suggested to constitute a separate neurodevelopmental subtype of the disorder but studies on neuropsychological functioning in childhood OCD are limited. The aim of the present study was to investigate performance-based EF in pediatric OCD using observed and latent variable analyses. A case-control design was applied including 50 unmedicated children and adolescents with OCD aged 7-17 years of which 70% were female, 50 pairwise age and gender matched non-psychiatric controls (NP) and 38 children and adolescents with mixed anxiety disorders (MA). Participants underwent structured diagnostic interviews and assessment with a battery encompassing cool EF tasks of working memory, set shifting, inhibition, and planning, and hot EF tasks of decision making and dot probe paradigm affective interference. First, groups were compared on observed variables with multilevel mixed-effects linear regression and analysis of variance. Then the latent structure of cool EF was tested with confirmatory factor analysis (CFA) and groups were compared on the CFA scores. No significant differences between groups appeared on individual cool EF tasks. On the hot EF tasks the OCD group displayed significant interference effects on the dot probe paradigm OCD-specific stimuli relative to NP, but not compared to MA and no group differences emerged for decision making. In the CFA a one-factor solution showed best fit, but the groups did not differ significantly on the resulting latent variable. The present study does not support cool or hot EF impairments in childhood OCD.
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van der Straten A, Huyser C, Wolters L, Denys D, van Wingen G. Long-Term Effects of Cognitive Behavioral Therapy on Planning and Prefrontal Cortex Function in Pediatric Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:320-328. [DOI: 10.1016/j.bpsc.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/20/2017] [Accepted: 11/26/2017] [Indexed: 12/22/2022]
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Geller DA, Abramovitch A, Mittelman A, Stark A, Ramsey K, Cooperman A, Baer L, Stewart SE. Neurocognitive function in paediatric obsessive-compulsive disorder. World J Biol Psychiatry 2018; 19:142-151. [PMID: 28090807 PMCID: PMC5555842 DOI: 10.1080/15622975.2017.1282173] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The small body of neuropsychological research in paediatric obsessive-compulsive disorder (OCD) yields inconsistent results. A recent meta-analysis found small effect sizes, concluding that paediatric OCD may not be associated with cognitive impairments, stressing the need for more research. We investigated neuropsychological performance in a large sample of youths with OCD, while assessing potential moderators. METHODS Participants with OCD (n = 102) and matched controls (n = 161) were thoroughly screened and blindly evaluated for comorbidities, and completed a neuropsychological battery assessing processing speed, visuospatial abilities (VSA), working memory (WM), non-verbal memory (NVM), and executive functions (EF). RESULTS Compared to controls, youths with OCD exhibited underperformance on tasks assessing processing speed. On tests of VSA and WM, underperformance was found only on timed tasks. There were no differences on NVM and EF tasks. Notably, the OCD group's standardised scores were in the normative range. Test performance was not associated with demographic or clinical variables. CONCLUSIONS Youths with OCD exhibited intact performance on memory and EF tests, but slower processing speed, and underperformance only on timed VSA and WM tasks. While the OCD group performed in the normative range, these findings reveal relative weaknesses that may be overlooked. Such an oversight may be of particular importance in clinical and school settings.
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Affiliation(s)
- Daniel A. Geller
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Amitai Abramovitch
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766,Department of Psychology, Texas State University, UAC 253, San Marcos, TX, 78666, USA; phone +1(512)245-2526,Address for correspondence: Amitai Abramovitch, Department of Psychology, Texas State University, San Marcos, Texas 78666, USA; Phone: +1(512)245-2526, Fax: +1(512)245-3153;
| | - Andrew Mittelman
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Abigail Stark
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Kesley Ramsey
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Allison Cooperman
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Lee Baer
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, BC Children's Hospital, A3-118, 950 West 28th Av., Vancouver, BC, V5Z4H4, Canada; phone:+1(604)-875-2000
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Hybel KA, Mortensen EL, Lambek R, Højgaard DR, Thomsen PH. Executive function predicts cognitive-behavioral therapy response in childhood obsessive-compulsive disorder. Behav Res Ther 2017; 99:11-18. [DOI: 10.1016/j.brat.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 01/07/2023]
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Carlisi CO, Norman L, Murphy CM, Christakou A, Chantiluke K, Giampietro V, Simmons A, Brammer M, Murphy DG, Mataix-Cols D, Rubia K. Disorder-Specific and Shared Brain Abnormalities During Vigilance in Autism and Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:644-654. [PMID: 29167833 PMCID: PMC5685008 DOI: 10.1016/j.bpsc.2016.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/17/2016] [Accepted: 12/27/2016] [Indexed: 11/02/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) are often comorbid and share similarities across some cognitive phenotypes, including certain aspects of attention. However, no functional magnetic resonance imaging studies have compared the underlying neural mechanisms contributing to these shared phenotypes. METHODS Age- and IQ-matched boys (11-17 years old) with ASD (n = 20), boys with OCD (n = 20), and healthy control boys (n = 20) performed a parametrically modulated psychomotor vigilance functional magnetic resonance imaging task. Brain activation and performance were compared among adolescents with OCD, adolescents with ASD, and control adolescents. RESULTS Whereas boys with ASD and OCD were not impaired on task performance, there was a significant group by attention load interaction in several brain regions. With increasing attention load, left inferior frontal cortex/insula and left inferior parietal lobe/pre/post-central gyrus were progressively less activated in boys with OCD relative to the other two groups. In addition, boys with OCD showed progressively increased activation with increasing attention load in rostromedial prefrontal/anterior cingulate cortex relative to boys with ASD and control boys. Shared neurofunctional abnormalities between boys with ASD and boys with OCD included increased activation with increasing attention load in cerebellum and occipital regions, possibly reflecting increased default mode network activation. CONCLUSIONS This first functional magnetic resonance imaging study to compare boys with ASD and OCD showed shared abnormalities in posterior cerebellar-occipital brain regions. However, boys with OCD showed a disorder-specific pattern of reduced activation in left inferior frontal and temporo-parietal regions but increased activation of medial frontal regions, which may potentially be related to neurobiological mechanisms underlying cognitive and clinical phenotypes of OCD.
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Affiliation(s)
- Christina O. Carlisi
- Department of Child and Adolescent Psychiatry, Sackler Institute for Translational Neurodevelopmental Sciences, London
| | - Luke Norman
- Department of Child and Adolescent Psychiatry, Sackler Institute for Translational Neurodevelopmental Sciences, London
| | - Clodagh M. Murphy
- Department of Child and Adolescent Psychiatry, Sackler Institute for Translational Neurodevelopmental Sciences, London
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopmental Sciences, Psychology and Neuroscience, King’s College, London
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London
| | - Anastasia Christakou
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Kaylita Chantiluke
- Department of Child and Adolescent Psychiatry, Sackler Institute for Translational Neurodevelopmental Sciences, London
| | - Vincent Giampietro
- Department of Neuroimaging, Psychology and Neuroscience, King’s College, London
| | - Andrew Simmons
- Department of Neuroimaging, Psychology and Neuroscience, King’s College, London
- National Institute for Health Research Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College, London
- Department of Neurobiology, Care Sciences and Society (AS), Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Michael Brammer
- Department of Neuroimaging, Psychology and Neuroscience, King’s College, London
| | - Declan G. Murphy
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopmental Sciences, Psychology and Neuroscience, King’s College, London
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London
| | | | - David Mataix-Cols
- Department of Clinical Neuroscience(DM-C), Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Sackler Institute for Translational Neurodevelopmental Sciences, London
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