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Klenfeldt IF, Skoog G, Skoog J, Skoog I. The natural history of lifetime psychiatric disorders in patients with obsessive-compulsive disorder followed over half a century. Acta Psychiatr Scand 2024; 149:284-294. [PMID: 38332338 DOI: 10.1111/acps.13665] [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: 11/29/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Few long-term studies have examined the life-time prevalence of comorbid psychiatric conditions in patients with obsessive-compulsive disorder (OCD). We therefore studied the frequency of comorbid psychiatric disorders, and their relation to onset and prognosis, in patients with OCD who were followed for almost half a century. METHODS During 1947-1953, 285 OCD patients were admitted as inpatients to a university hospital in Gothenburg, Sweden. Among those, 251 (88%) accepted a structured comprehensive psychiatric examination in 1954-1956. In 1989-1993, 176 survivors were eligible and 144 (response rate 82%) were re-examined. The same psychiatrist performed both examinations. OCD was diagnosed according to the Schneider criteria, and other mental disorders according to DSM-IV. Mean follow-up since onset was 47 years. RESULTS The lifetime frequency of depressive disorders was 84.7% (major depression 43.8%), generalized anxiety disorder (GAD) 71.5%, panic anxiety disorder 47.9%, agoraphobia 52.1%, specific phobias 64.6%, social phobia 47.9%, paranoid conditions 40.3% (29.1% paranoid ideation), psychotic disorders 15.3%, alcohol abuse 13.2% (men 39%, women 3%) and substance abuse 17.4%. Specific phobia most often started before OCD, while depression had a varied onset in relation to OCD. Social phobia, agoraphobia, GAD, alcohol and substance abuse, psychotic disorders and paranoid conditions most often started after OCD. Presence of GAD, psychotic disorder and substance abuse worsened prognosis of OCD. CONCLUSION Comorbid psychiatric conditions are common in OCD patients, and have onset throughout the course. OCD signals vulnerability for other psychiatric conditions, which are important to detect in clinical practice as they negatively affect the outcome.
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Affiliation(s)
- Isak Fredén Klenfeldt
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Affective Clinic, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | - Gunnar Skoog
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Skoog
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
- The Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
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Smárason O, Boedeker PJ, Guzick AG, Tendler A, Sheth SA, Goodman WK, Storch EA. Depressive symptoms during deep transcranial magnetic stimulation or sham treatment for obsessive-compulsive disorder. J Affect Disord 2024; 344:466-472. [PMID: 37852581 DOI: 10.1016/j.jad.2023.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Evidence suggests that depressive symptoms tend to improve concurrently with obsessive-compulsive disorder (OCD) symptoms during cognitive behavioral therapy (CBT), despite depression not being the primary target of intervention. Studies examining the temporal or mediational relationships of OCD and depressive symptoms have indicated a bidirectional relationship, as prior levels of OCD symptoms influenced subsequent levels of depression, and vice versa. Deep transcranial magnetic stimulation (dTMS) has recently emerged as a treatment option for OCD. Whether dTMS affects depression symptoms similarly to CBT remains to be examined. METHODS The current study employed a random intercept cross-lagged panel model (RI-CLPM) to examine the relationship of OCD and depression symptoms in 94 treatment refractory patients, undergoing dTMS or sham treatment. RESULTS Both OCD and depression symptoms improved significantly. However, a stable, cross-lagged relationship between the variables was not supported. Changes in one symptom domain could not be used to predict the other. LIMITATIONS The present study was conducted in a treatment refractory population, meaning the present findings may not generalize to treatment naïve patients or those with less severe OCD symptoms. It is unclear whether the study was sufficiently powered to detect the effects of interest, and this concern also meant that examining the dTMS and sham groups independently was not feasible. CONCLUSIONS When treating OCD with dTMS, depression symptoms appear likely to diminish but should be monitored throughout, and additional interventions applied if needed.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Peter J Boedeker
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aron Tendler
- BrainsWay Ltd., 19 Hartum St., Jerusalem 9777518, Israel
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Belli GM, Law C, Mancebo M, Eisen J, Rasmussen S, Boisseau CL. Directionality of change in obsessive compulsive disorder and depression over six years of prospective follow-up. J Psychiatr Res 2023; 157:162-167. [PMID: 36470197 PMCID: PMC9898122 DOI: 10.1016/j.jpsychires.2022.11.034] [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: 09/09/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
Major Depressive Disorder (MDD) is often comorbid with obsessive-compulsive disorder (OCD) yet little is known about the directionality of the association between OCD and depression symptoms. We aim to investigate the effect OCD symptoms has on depression symptoms and vice versa over an extended period of time. This is one of the first longitudinal studies to evaluate the relationship between OCD and depression in a large clinical sample. Participants (n = 324) were treatment-seeking adults with a primary diagnosis of OCD. OCD and depression symptoms were assessed annually over the six-year follow-up period. Random intercepts cross-lagged panel models (RI-CLPM) were conducted to compare unidirectional and bidirectional models over time. The best-fitting and most parsimonious model included paths with OCD symptoms predicting depression symptoms, but not vice versa. OCD symptom severity in a given year predicted next year depression severity. However, depression severity did not predict next-year OCD symptom severity in this sample. Our results suggest that depression severity may be secondary to OCD symptoms and treating OCD should be prioritized over treating depression.
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Affiliation(s)
- Gina M Belli
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Mancebo
- Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jane Eisen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Steven Rasmussen
- Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Pampaloni I, Marriott S, Pessina E, Fisher C, Govender A, Mohamed H, Chandler A, Tyagi H, Morris L, Pallanti S. The global assessment of OCD. Compr Psychiatry 2022; 118:152342. [PMID: 36007341 DOI: 10.1016/j.comppsych.2022.152342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
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Affiliation(s)
- Ilenia Pampaloni
- South West London and St Georges Mental Health Trust, London, UK.
| | - Sabina Marriott
- South West London and St Georges Mental Health Trust, London, UK
| | | | - Claire Fisher
- South West London and St Georges Mental Health Trust, London, UK
| | - Anusha Govender
- South West London and St Georges Mental Health Trust, London, UK
| | - Heba Mohamed
- South West London and St Georges Mental Health Trust, London, UK
| | - Augusta Chandler
- South West London and St Georges Mental Health Trust, London, UK
| | - Himanshu Tyagi
- University College London Hospital NHS foundation Trust, London, UK
| | - Lucy Morris
- South West London and St Georges Mental Health Trust, London, UK
| | - Stefano Pallanti
- Albert Einstein Institute, New York, USA; Istututo di Neuroscienze, Firenze, Italy
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The relationship between symptoms of obsessive compulsive disorder and depression during therapy: A random intercept cross-lagged panel model. J Behav Ther Exp Psychiatry 2022; 76:101748. [PMID: 35738694 DOI: 10.1016/j.jbtep.2022.101748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES We know little about how symptoms of obsessive-compulsive disorder and depression interact during psychological therapy. Although some previous research suggests that reductions in the severity of depression are driven by reductions in OCD, support for this conclusion is limited due to the exclusion of individuals with severe depression and limitations of the statistical approaches used. METHODS This study re-examined the interaction between symptoms of OCD and depression during therapy in a sample of 137 adults with a primary diagnosis of OCD and a full range of depression severity. All participants received a 12 to 16-week specialist residential treatment. Participants completed the Florida Obsessive Compulsive Inventory and Patient Health Questionnaire for depression weekly. The relationship between severity of OCD and depression was examined using a random intercept cross-lagged panel model. RESULTS Both cross-lagged paths were significant, with prior levels of OCD influencing subsequent levels of depression, and prior levels of depression influencing subsequent levels of OCD. LIMITATIONS The present study was conducted in a residential setting, meaning the findings may not generalise to outpatient settings characterised by less severe OCD and depression. CONCLUSIONS Contrary to previous findings, which suggest that the influence of OCD on depression is far greater than the reverse, our findings suggest that OCD and depression influence each other equally. As improvements in mood can help to improve symptoms of OCD, it appears important to target depression concurrently during treatment for OCD. This would be a new treatment target for improvement outcomes in OCD.
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The long-term association of OCD and depression and its moderators: A four-year follow up study in a large clinical sample. Eur Psychiatry 2020; 44:76-82. [DOI: 10.1016/j.eurpsy.2017.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 11/23/2022] Open
Abstract
AbstractBackground:Depression is the most common comorbidity in obsessive-compulsive disorder (OCD). However, the mechanisms of depressive comorbidity in OCD are poorly understood. We assessed the directionality and moderators of the OCD-depression association over time in a large, prospective clinical sample of OCD patients.Methods:Data were drawn from 382 OCD patients participating at the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study. Cross-lagged, structural equation modeling analyses were used to assess the temporal association between OCD and depressive symptoms. Assessments were conducted at baseline, two-year and four-year follow up. Cognitive and interpersonal moderators of the prospective association between OCD and depressive symptoms were tested.Results:Cross-lagged analyses demonstrated that OCD predicts depressive symptoms at two-year follow up and not vice a versa. This relationship disappeared at four-year follow up. Secure attachment style moderated the prospective association between OCD and depression.Conclusions:Depressive comorbidity in OCD might constitute a functional consequence of the incapacitating OCD symptoms. Both OCD and depression symptoms demonstrated strong stability effects between two-year and four-year follow up, which may explain the lack of association between them in that period. Among OCD patients, secure attachment represents a buffer against future depressive symptoms.
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Gupta A, Khanna S, Jain R. Deep brain stimulation of ventral internal capsule for refractory obsessive-compulsive disorder. Indian J Psychiatry 2019; 61:532-536. [PMID: 31579146 PMCID: PMC6767810 DOI: 10.4103/psychiatry.indianjpsychiatry_222_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The main objective of this study is to assess the effectiveness of deep brain stimulation (DBS) of the ventral striatum (VS) of the anterior limb of internal capsule for patients suffering from refractory obsessive-compulsive disorder (OCD) and to compare its result with traditional anterior capsulotomy. The present study consisted of two patients subjected to stimulation of ventral capsule (VC)/VS region of internal capsule for refractory OCD. Leads were implanted on both sides stereotactically using fused images of magnetic resonance imaging and computed tomography scan brain and connected to pulse generator (Medtronic). Outcome of both the patients was measured by Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), and Mini-Mental Status Examination. The first case was followed for 4 years and 6 months, while the second case was followed for 2 years and 6 months. Both the patients responded very well to stimulation with reduction of Y-BOCS from 38 to 12 (68.42% improvement) in the first patient and 38 to 10 (78.68% improvement) in the second patient after 1 year. BDI also improved in both the patients with no significant change in mental state. No adverse effect was seen in any of the patient. The beneficial effect of DBS persisted in both the patients till follow-up and was much superior to the beneficial effect of anterior capsulotomy. We conclude that DBS of VC/VS complex is very safe and effective in refractory OCD and shows considerable promise for the future. The result of two treated patients was much better as compared to lesioning (anterior capsulotomy) and the beneficial effect persisted for long time.
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Affiliation(s)
- Alok Gupta
- Department of Neurosurgery, Metro Heart Institute with Multispeciality Faridabad, Gurugram, Haryana, India
| | - Sumant Khanna
- Consultant Psychiatrist, D 5/4, DLF Phase 1, Sector 28, Gurugram, Haryana, India
| | - Rahul Jain
- Consultant Neurosurgeon, PSRI Hospital, Sheikh Sarai, New Delhi, India
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Perera MPN, Bailey NW, Herring SE, Fitzgerald PB. Electrophysiology of obsessive compulsive disorder: A systematic review of the electroencephalographic literature. J Anxiety Disord 2019; 62:1-14. [PMID: 30469123 DOI: 10.1016/j.janxdis.2018.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/04/2018] [Accepted: 11/03/2018] [Indexed: 01/04/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic disease that causes significant decline in the quality of life of those affected. Due to our limited understanding of the underlying pathophysiology of OCD, successful treatment remains elusive. Although many have studied the pathophysiology of OCD through electroencephalography (EEG), limited attempts have been made to synthesize and interpret their findings. To bridge this gap, we conducted a comprehensive literature review using Medline/PubMed and considered the 65 most relevant studies published before June 2018. The findings are categorised into quantitative EEG, sleep related EEG and event related potentials (ERPs). Increased frontal asymmetry, frontal slowing and an enhancement in the ERP known as error related negativity (ERN) were consistent findings in OCD. However, sleep EEG and other ERP (P3 and N2) findings were inconsistent. Additionally, we analysed the usefulness of ERN as a potential candidate endophenotype. We hypothesize that dysfunctional frontal circuitry and overactive performance monitoring are the major underlying impairments in OCD. Additionally, we conceptualized that defective fronto-striato-thalamic circuitry causing poor cerebral functional connectivity gives rise to the OCD behavioural manifestations. Finally, we have discussed transcranial magnetic stimulation and EEG (TMS-EEG) applications in future research to further our knowledge of the underlying pathophysiology of OCD.
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Affiliation(s)
- M Prabhavi N Perera
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and Alfred Hospital, Level 4, 607, St. Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Neil W Bailey
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and Alfred Hospital, Level 4, 607, St. Kilda Road, Melbourne, Victoria 3004, Australia; Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
| | - Sally E Herring
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and Alfred Hospital, Level 4, 607, St. Kilda Road, Melbourne, Victoria 3004, Australia; Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
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Abstract
Obsessive-compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak - in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long-term outcomes in OCD are not necessarily bleak and that at least half the treatment-seeking patients with OCD show symptomatic remission over long term. A short duration illness, of low severity that is treated early and intensively, with continued maintenance treatment over long term possibly has a good outcome. Recent studies have also identified neuroimaging and neuropsychological correlates of good outcome, but these need further replication. This paper presents an overview of conceptual issues and studies on long-term outcome of OCD and predictors of outcome.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Wood RL, Worthington A. Neurobehavioral Abnormalities Associated with Executive Dysfunction after Traumatic Brain Injury. Front Behav Neurosci 2017; 11:195. [PMID: 29123473 PMCID: PMC5662637 DOI: 10.3389/fnbeh.2017.00195] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: This article will address how anomalies of executive function after traumatic brain injury (TBI) can translate into altered social behavior that has an impact on a person’s capacity to live safely and independently in the community. Method: Review of literature on executive and neurobehavioral function linked to cognitive ageing in neurologically healthy populations and late neurocognitive effects of serious TBI. Information was collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the authors’ own catalogs. Conclusions: The conventional distinction between cognitive and emotional-behavioral sequelae of TBI is shown to be superficial in the light of increasing evidence that executive skills are critical for integrating and appraising environmental events in terms of cognitive, emotional and social significance. This is undertaken through multiple fronto-subcortical pathways within which it is possible to identify a predominantly dorsolateral network that subserves executive control of attention and cognition (so-called cold executive processes) and orbito-frontal/ventro-medial pathways that underpin the hot executive skills that drive much of behavior in daily life. TBI frequently involves disruption to both sets of executive functions but research is increasingly demonstrating the role of hot executive deficits underpinning a wide range of neurobehavioral disorders that compromise relationships, functional independence and mental capacity in daily life.
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Affiliation(s)
- Rodger Ll Wood
- Clinical Neuropsychology, College of Medicine, Swansea University, Swansea, United Kingdom
| | - Andrew Worthington
- College of Medicine and College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
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Ghassemzadeh H, Raisi F, Firoozikhojastefar R, Meysamie A, Karamghadiri N, Nasehi AA, Fallah J, Sorayani M, Ebrahimkhani N. A Study on Sexual Function in Obsessive-Compulsive Disorder (OCD) Patients With and Without Depressive Symptoms. Perspect Psychiatr Care 2017; 53:208-213. [PMID: 27061854 DOI: 10.1111/ppc.12160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/16/2016] [Accepted: 02/03/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of study was to evaluate sexual function in obsessive-compulsive disorder (OCD) patients with and without depressive symptoms. DESIGN AND METHOD Fifty-six married OCD patients referred to the outpatient clinic of Roozbeh Hospital from 2011 to 2013 filled out the demographic questionnaire, obsessive compulsive inventory-revised OCI-R, Maudsley obsessional-compulsive inventory (MOCI), Beck depression inventory-II (BDI-II), international index of erectile function (IIEF), and female sexual function index (FSFI). FINDINGS In total, 80.6% of women and 25% of men had sexual dysfunction and 82% of them had depressive symptoms. Comparing sexual dysfunction in OCD patients with and without depressive symptoms demonstrated that the mean index of IIEF in subscales of erection and satisfaction without depressive symptoms (BDI-II index ≤ 15) is higher than in those with depressive symptoms and the mean index of FSFI showed a marginal significance in the pain subscale of the FSFI. PRACTICE IMPLICATIONS Regarding the possible role of the symptoms of depression on sexual function, sexual assessment in OCD patients should be considered.
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Affiliation(s)
- Habibollah Ghassemzadeh
- Habibollah Ghassemzadeh, PhD, is Professor of Psychology in the Department of Psychiatry, Roozbeh Psychiatry Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Firoozeh Raisi, MD, is Psychiatrist in Psychiatric and Clinical Psychology Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reihaneh Firoozikhojastefar
- Reihaneh Firoozikhojastefar, MSc, is Master in Psychology in Psychosexual Department, Roozbeh Hospital, Tehran, Iran
| | - Alipasha Meysamie
- Alipasha Meysamie, MD, MPH, is Professor in Community and Preventive Medicine, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Karamghadiri
- Narges Karamghadiri, MSc, is PhD Student of Health Psychology in Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Nasehi
- Abbas Ali Nasehi, MD, is Psychiatrist at Iran Helal Institute of Applied Science & Technology, Tehran, Iran
| | - Jalil Fallah
- Jalil Fallah, MD, is Psychiatrist, Department of Health, National Organization for Civil Registration, Tehran, Iran
| | - Maryam Sorayani
- Maryam Sorayani, MD, is Psychiatrist, Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimkhani
- Narges Ebrahimkhani, BA, is Master Student of Health Psychology, Department of Clinical Psychology, Bahonar Hospital, Alborz University of Medical Sciences, Alborz, Iran
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Rickelt J, Viechtbauer W, Lieverse R, Overbeek T, van Balkom AJ, van Oppen P, van den Heuvel OA, Marcelis M, Eikelenboom M, Tibi L, Schruers KR. The relation between depressive and obsessive-compulsive symptoms in obsessive-compulsive disorder: Results from a large, naturalistic follow-up study. J Affect Disord 2016; 203:241-247. [PMID: 27310102 DOI: 10.1016/j.jad.2016.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/28/2016] [Accepted: 06/03/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Despite the frequent occurrence of depressive symptoms in obsessive-compulsive disorder (OCD), little is known about the reciprocal influence between depressive and obsessive-compulsive symptoms during the course of the disease. The aim of the present study is to investigate the longitudinal relationship between obsessive-compulsive and depressive symptoms in OCD patients. METHOD We used the baseline and 1-year follow-up data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. In 276 patients with a lifetime diagnosis of obsessive-compulsive disorder, depressive and obsessive-compulsive symptoms were assessed at baseline and at one-year follow-up with the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) scale. Relations were investigated using a cross-lagged panel design. RESULTS The association between the severity of depressive symptoms at baseline and obsessive-compulsive symptoms at follow-up was significant (β=0.244, p<0.001), while the association between the severity of obsessive-compulsive symptoms at baseline and depressive symptoms at follow-up was not (β=0.097, p=0.060). Replication of the analyses in subgroups with and without current comorbid major depressive disorder (MDD) and subgroups with different sequence of onset (primary versus secondary MDD) revealed the same results. LIMITATIONS There may be other factors, which affect both depressive and obsessive-compulsive symptoms that were not assessed in the present study. CONCLUSION The present study demonstrates a relation between depressive symptoms and the course of obsessive-compulsive symptoms in OCD patients, irrespective of a current diagnosis of MDD and the sequence of onset of OCD and MDD.
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Affiliation(s)
- Judith Rickelt
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands.
| | - Wolfgang Viechtbauer
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ritsaert Lieverse
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Mondriaan Mental Health Center, Maastricht, The Netherlands
| | - Thea Overbeek
- Mondriaan Mental Health Center, Maastricht, The Netherlands
| | - Anton J van Balkom
- Department of Psychiatry, VU University Medical Center (Vumc), Amsterdam, The Netherlands; EMGO+, VU University Medical Center (Vumc), Amsterdam, The Netherlands; GGZ inGeest, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, VU University Medical Center (Vumc), Amsterdam, The Netherlands; EMGO+, VU University Medical Center (Vumc), Amsterdam, The Netherlands; GGZ inGeest, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center (Vumc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Neuroscience Campus Amsterdam (NCA), VU/VUmc, Amsterdam, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry, VU University Medical Center (Vumc), Amsterdam, The Netherlands; EMGO+, VU University Medical Center (Vumc), Amsterdam, The Netherlands
| | - Lee Tibi
- Psychology Department, Ben Gurion University, Be'er-Sheva, Israel
| | - Koen Rj Schruers
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Mondriaan Mental Health Center, Maastricht, The Netherlands; Department of Health Psychology, University of Leuven, Belgium
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13
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Wu MS, Storch EA. Personalizing cognitive-behavioral treatment for pediatric obsessive-compulsive disorder. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1209972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Monica S. Wu
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Health Management and Policy, University of South Florida, Tampa, FL, USA
- Rogers Behavioral Health – Tampa Bay, Tampa, FL, USA
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Brown HM, Lester KJ, Jassi A, Heyman I, Krebs G. Paediatric Obsessive-Compulsive Disorder and Depressive Symptoms: Clinical Correlates and CBT Treatment Outcomes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:933-42. [PMID: 25301176 PMCID: PMC4465665 DOI: 10.1007/s10802-014-9943-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 – 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 – 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms.
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Affiliation(s)
- H M Brown
- Institute of Psychiatry, King's College, London, SE5 8AF, UK,
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Kyrios M, Hordern C, Fassnacht DB. Predictors of response to cognitive behaviour therapy for obsessive-compulsive disorder. Int J Clin Health Psychol 2015; 15:181-190. [PMID: 30487835 PMCID: PMC6225019 DOI: 10.1016/j.ijchp.2015.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/19/2015] [Indexed: 11/28/2022] Open
Abstract
Response to psychological treatment for Obsessive-Compulsive Disorder (OCD) varies, and dropout and relapse rates remain troubling. However, while studies examining symptom reductions are favourable, outcomes are less encouraging when outcome is defined in terms of clinically significant change. Moreover, there is little understanding of what predicts treatment outcome. This study examined demographic, symptomatic and cognitive predictors of outcome in 79 participants undertaking individualised cognitive-behavioural therapy for OCD. After investigating differences between treatment completers and non-completers, we examined treatment response as defined by post-treatment symptom severity and clinically reliable change, as well as predictors of treatment response. Completers were less likely to present with co-morbidity. The treatment was highly efficacious irrespective of whether completer or intention-to-treat analysis was undertaken, with 58% of treatment completers considered “recovered” at post-treatment. Lower pre-treatment levels of OCD symptoms and greater perfectionism/intolerance of uncertainty were the best unique predictors of OCD severity outcomes at post-treatment. Changes in obsessional beliefs were associated with symptomatic change, although only perfectionism/intolerance of uncertainty was a significant unique predictor of post-treatment change. Recovery status was predicted only by pre-treatment OCD severity. In helping to identify those at risk for poorer outcomes, such research can lead to the development of more effective interventions.
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Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res 2015; 227:104-13. [PMID: 25937054 DOI: 10.1016/j.psychres.2015.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/26/2014] [Indexed: 11/22/2022]
Abstract
Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy (CT), has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.
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McKay D, Sookman D, Neziroglu F, Wilhelm S, Stein DJ, Kyrios M, Matthews K, Veale D. Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Res 2015; 225:236-46. [PMID: 25613661 DOI: 10.1016/j.psychres.2014.11.058] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
Abstract
Cognitive-behavioral therapy (CBT), which encompasses exposure with response prevention (ERP) and cognitive therapy, has demonstrated efficacy in the treatment of obsessive-compulsive disorder (OCD). However, the samples studied (reflecting the heterogeneity of OCD), the interventions examined (reflecting the heterogeneity of CBT), and the definitions of treatment response vary considerably across studies. This review examined the meta-analyses conducted on ERP and cognitive therapy (CT) for OCD. Also examined was the available research on long-term outcome associated with ERP and CT. The available research indicates that ERP is the first line evidence based psychotherapeutic treatment for OCD and that concurrent administration of cognitive therapy that targets specific symptom-related difficulties characteristic of OCD may improve tolerance of distress, symptom-related dysfunctional beliefs, adherence to treatment, and reduce drop out. Recommendations are provided for treatment delivery for OCD in general practice and other service delivery settings. The literature suggests that ERP and CT may be delivered in a wide range of clinical settings. Although the data are not extensive, the available research suggests that treatment gains following ERP are durable. Suggestions for future research to refine therapeutic outcome are also considered.
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Affiliation(s)
| | | | | | - Sabine Wilhelm
- Harvard University & Massachusetts General Hospital, Boston, MA, USA
| | - Dan J Stein
- University of Cape Town, Cape Town, South Africa
| | | | | | - David Veale
- NIHR Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and The Institute of Psychiatry, King׳s College London, UK
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Storch EA, Wu MS, Small BJ, Crawford EA, Lewin AB, Horng B, Murphy TK. Mediators and moderators of functional impairment in adults with obsessive-compulsive disorder. Compr Psychiatry 2014; 55:489-96. [PMID: 24342055 DOI: 10.1016/j.comppsych.2013.10.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/19/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022] Open
Abstract
The current study examined correlates, moderators, and mediators of functional impairment in 98 treatment-seeking adults with obsessive-compulsive disorder (OCD). Participants completed or were administered measures assessing obsessive-compulsive symptom severity, functional impairment, resistance against symptoms, interference due to obsessive-compulsive symptoms, depressive symptoms, insight, and anxiety sensitivity. Results indicated that all factors, except insight into symptoms, were significantly correlated with functional impairment. The relationship between obsessive-compulsive symptom severity and functional impairment was not moderated by patient insight, resistance against obsessive-compulsive symptoms, or anxiety sensitivity. Mediational analyses indicated that obsessive-compulsive symptom severity mediated the relationship between anxiety sensitivity and obsessive-compulsive related impairment. Indeed, anxiety sensitivity may play an important contributory role in exacerbating impairment through increases in obsessive-compulsive symptom severity. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and obsessive-compulsive related impairment. Implications for assessment and treatment are discussed.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL 33701, USA.
| | - Monica S Wu
- Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA; Department of Psychology, University of South Florida, St. Petersburg, FL 33701, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, St. Petersburg, FL 33701, USA
| | - Erika A Crawford
- Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL 33701, USA
| | - Betty Horng
- Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, St. Petersburg, FL 33701, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL 33701, USA
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Labouliere CD, Arnold EB, Storch EA, Lewin AB. Family-Based Cognitive-Behavioral Treatment for a Preschooler With Obsessive-Compulsive Disorder. Clin Case Stud 2013. [DOI: 10.1177/1534650113504985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cognitive-behavioral therapy (CBT) with exposure and response prevention is known to be effective in the treatment of older youth (8-17) and adults with obsessive-compulsive disorder (OCD); however, very little is known about the effectiveness of these procedures during early childhood. As such, this case describes the application of a modularized family-based CBT approach focusing on exposure, differential reinforcement of other behaviors (DRO), and reductions in family accommodation with a preschool boy with a primary diagnosis of OCD. Following 12 consecutive family sessions over 6 weeks, “Charley,” a 4-year-old Caucasian male, showed substantial reductions in OCD symptomatology. Charley’s parents also reported improvements in oppositionality, peer functioning with siblings and at preschool, and in the parent–child relationship. All improvements were maintained at 3-month follow-up. These results provide preliminary support that CBT incorporating exposure, DRO, behavioral parent training, and reductions in family accommodation may be effective for preschoolers with OCD.
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20
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Hofmeijer-Sevink MK, van Oppen P, van Megen HJ, Batelaan NM, Cath DC, van der Wee NJA, van den Hout MA, van Balkom AJ. Clinical relevance of comorbidity in obsessive compulsive disorder: the Netherlands OCD Association study. J Affect Disord 2013; 150:847-54. [PMID: 23597943 DOI: 10.1016/j.jad.2013.03.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study describes lifetime and current rates of comorbidity, its onset and its consequences in a large clinical sample of patients with obsessive compulsive disorder (OCD). A wide range of risk factors and clinical characteristics were also examined to determine whether pure OCD is different from OCD with current comorbidity. Finally, the temporal sequencing of the disorders was examined. METHOD Data were obtained from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. A sample of 382 participants with current OCD (during the past month) was evaluated. RESULTS Current comorbidity occurred in 55% of patients with OCD, while 78% suffered from lifetime comorbidity. Comorbidity is associated with more severe OCD, anxiety and depressive symptoms and more negative consequences on daily life. Multiple comorbid disorders often precede OCD and influence both its course and severity. Childhood trauma and neuroticism are vulnerability factors for the development of multiple comorbid disorders in OCD. LIMITATIONS It should be noted that causal inferences about the association between risk factors and OCD are precluded since our results were based on cross-sectional data. CONCLUSION (Multiple) comorbidity in OCD is clinically relevant since it is associated with a specific pattern of vulnerability, with greater chronicity, with more severe OCD and more negative consequences on daily life. This indicates that the diagnosis and treatment of all comorbid disorders is clinically relevant, and clinicians should be especially aware of multiple disorders in cases of childhood trauma and high levels of neuroticism. Primary OCD has a different developmental and comorbidity pattern compared to secondary OCD.
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Robison RA, Taghva A, Liu CY, Apuzzo ML. Surgery of the Mind, Mood, and Conscious State: An Idea in Evolution. World Neurosurg 2013; 80:S2-26. [PMID: 23916496 DOI: 10.1016/j.wneu.2013.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 10/26/2022]
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Jakubovski E, Diniz JB, Valerio C, Fossaluza V, Belotto-Silva C, Gorenstein C, Miguel E, Shavitt RG. Clinical predictors of long-term outcome in obsessive-compulsive disorder. Depress Anxiety 2013; 30:763-72. [PMID: 23109056 DOI: 10.1002/da.22013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/26/2012] [Accepted: 09/27/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate demographic and clinical factors associated with the long-term outcome of obsessive-compulsive disorder (OCD). METHODS A hundred ninety-six previously untreated patients with DSM-IV criteria OCD completed a 12-week randomized open trial of group cognitive-behavioral therapy (GCBT) or fluoxetine, followed by 21 months of individualized, uncontrolled treatment, according to international guidelines for OCD treatment. OCD severity was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at different times over the follow-up period. Demographics and several clinical variables were assessed at baseline. RESULTS Fifty percent of subjects improved at least 35% from baseline, and 21.3% responded fully (final Y-BOCS score < or = 8). Worse prognosis was associated with earlier age at onset of OCD (P = 0.045), longer duration of illness (P = 0.001) presence of at least one comorbid psychiatric disorder (P = 0.001), comorbidity with a mood disorder (P = 0.002), higher baseline Beck-Depression scores (P = 0.011), positive family history of tics (P = 0.008), and positive family history of anxiety disorders (P = 0.008). Type of initial treatment was not associated with long-term outcome. After correction for multiple testing, the presence of at least one comorbid disorder, the presence of a depressive disorder, and duration of OCD remained significant. CONCLUSIONS Patients under cognitive-behavioral or pharmacological treatment improved continuously in the long run, regardless of initial treatment modality or degree of early response, suggesting that OCD patients benefit from continuous treatment. Psychiatric comorbidity, especially depressive disorders, may impair the long-term outcome of OCD patients.
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Affiliation(s)
- Ewgeni Jakubovski
- Department of Psychology, University of Heidelberg, Heidelberg, Germany.
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23
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Krebs G, Bolhuis K, Heyman I, Mataix-Cols D, Turner C, Stringaris A. Temper outbursts in paediatric obsessive-compulsive disorder and their association with depressed mood and treatment outcome. J Child Psychol Psychiatry 2013; 54:313-22. [PMID: 22957831 PMCID: PMC4026039 DOI: 10.1111/j.1469-7610.2012.02605.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Temper outbursts in youth with obsessive-compulsive disorder (OCD) are a common source of concern, but remain poorly understood. This study examined a set of hypotheses related to: (a) the prevalence of temper outbursts in paediatric OCD, (b) the associations of temper outbursts with OCD severity and depressive symptoms; and (c) the influence of temper outbursts on treatment response. METHODS The prevalence of temper outbursts was estimated in a specialist OCD clinical sample (n = 387) using parent- and child-report. This was replicated in a community sample (n = 18,415). Associations of temper outbursts with obsessive-compulsive symptoms and with depressed mood were examined using logistic regression models. The influence of temper outbursts on treatment response was examined in a subsample of 109 patients treated with cognitive behaviour therapy (CBT) with or without medication. RESULTS Over a third of young people with OCD displayed temper outbursts, and rates were similar across the clinical and community samples. Temper outbursts were two to three times more common in youth with OCD than in healthy controls. However, OCD symptom severity was not a strong predictor of child- or parent-reported temper outbursts. Instead, both child- and parent- reported temper outbursts were significantly associated to depressive symptoms. CBT strongly reduced OCD and depressive symptoms, as well as the severity of temper outbursts. There was no significant difference in post-treatment OCD or depression scores between those with temper outbursts compared to those without. CONCLUSIONS Temper outbursts are common in youth with OCD and are particularly related to depressed mood. They improve with CBT for OCD and do not seem to impede OCD treatment response.
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Affiliation(s)
- Georgina Krebs
- OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Koen Bolhuis
- King’s College London, Institute of PsychiatryLondon, UK
| | - Isobel Heyman
- OCD Clinic for Young People, South London and Maudsley NHS Foundation TrustLondon, UK,King’s College London, Institute of PsychiatryLondon, UK
| | - David Mataix-Cols
- OCD Clinic for Young People, South London and Maudsley NHS Foundation TrustLondon, UK,King’s College London, Institute of PsychiatryLondon, UK
| | - Cynthia Turner
- OCD Clinic for Young People, South London and Maudsley NHS Foundation TrustLondon, UK,King’s College London, Institute of PsychiatryLondon, UK
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Valerio C, Diniz JB, Fossaluza V, de Mathis MA, Belotto-Silva C, Joaquim MA, Miguel Filho EC, Shavitt RG. Does anti-obsessional pharmacotherapy treat so-called comorbid depressive and anxiety states? J Affect Disord 2012; 139:187-92. [PMID: 22455835 DOI: 10.1016/j.jad.2012.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/31/2012] [Accepted: 02/01/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic condition that normally presents high rates of psychiatric comorbidity. Depression, tic disorders and other anxiety disorders are among the most common comorbidities in OCD adult patients. There is evidence that the higher the number of psychiatric comorbidities, the worse the OCD treatment response. However, little is known about the impact of OCD treatment on the outcome of the psychiatric comorbidities usually present in OCD patients. The aim of this study was to investigate the impact of exclusive, conventional treatments for OCD on the outcome of additional psychiatric disorders of OCD patients, detected at baseline. METHODS Seventy-six patients with primary OCD admitted to the treatment protocols of the Obsessive-Compulsive Spectrum Disorders Program between July 2007 and December 2009 were evaluated at pre-treatment and after 12 months. Data were analyzed to verify possible associations between OCD treatment response and the outcome of psychiatric comorbidities. RESULTS Results showed a significant association between OCD treatment response and improvement of major depression and dysthymia (p-value=0.002), other anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, panic disorder, agoraphobia and anxiety disorder not otherwise specified) (p-value=0.054) and tic disorders (p-value=0.043). LIMITATIONS This is an open, non-blinded study, without rating scales for comorbid conditions. Further research is necessary focusing on the possible mechanisms by which OCD treatment could improve these specific disorders. CONCLUSIONS Our results suggest that certain comorbid disorders may benefit from OCD-targeted treatment.
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Affiliation(s)
- Carolina Valerio
- Department and Institute of Psychiatry, Hospital of Clinics, Faculdade de Medicina da Universidade de São Paulo, Brazil.
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Bauer I, Wilansky-Traynor P, Rector NA. Cognitive-Behavioral Therapy for Anxiety Disorders with Comorbid Depression: A Review. Int J Cogn Ther 2012. [DOI: 10.1521/ijct.2012.5.2.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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26
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Robison RA, Taghva A, Liu CY, Apuzzo MLJ. Surgery of the mind, mood, and conscious state: an idea in evolution. World Neurosurg 2012; 77:662-86. [PMID: 22446082 DOI: 10.1016/j.wneu.2012.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 11/25/2022]
Abstract
Since the beginning of recorded history, humans have sought a physical means of altering disordered behavior and consciousness. This quest has spawned numerous innovations in neurosurgery and the neurosciences, from the earliest prehistoric attempts at trepanation to the electrocortical and anatomic localization of cerebral function that emerged in the 19th century. At the start of the 20th century, the overwhelming social impact of psychiatric illness intersected with the novel but imperfect understanding of frontal lobe function, establishing a decades-long venture into the modern origin of psychosurgery, the prefrontal lobotomy. The subsequent social and ethical ramifications of the widespread overuse of transorbital lobotomies drove psychosurgery to near extinction. However, as the pharmacologic treatment of psychiatric illness was established, numerous concomitant technical and neuroscientific innovations permitted the incremental development of a new paradigm of treating the disordered mind. In this article, we retrospectively examine these early origins of psychosurgery and then look to the recent past, present, and future for emerging trends in surgery of the psyche. Recent decades have seen a revolution in minimalism, noninvasive imaging, and functional manipulation of the human cerebrum that have created new opportunities and treatment modalities for disorders of the human mind and mood. Early contemporary efforts were directed at focal lesioning of abnormal pathways, but deep-brain stimulation now aims to reversibly alter and modulate those neurologic activities responsible for not only psychiatric disorders, but also to modulate and even to augment consciousness, memory, and other elements of cerebral function. As new tools become available, the social and medical impact of psychosurgery promises to revolutionize not only neurosurgery, but also humans' capability for positively impacting life and society.
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Affiliation(s)
- R Aaron Robison
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Belotto-Silva C, Diniz JB, Malavazzi DM, Valério C, Fossaluza V, Borcato S, Seixas AA, Morelli D, Miguel EC, Shavitt RG. Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: a practical clinical trial. J Anxiety Disord 2012; 26:25-31. [PMID: 21907540 DOI: 10.1016/j.janxdis.2011.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/11/2011] [Accepted: 08/12/2011] [Indexed: 11/16/2022]
Abstract
Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores ≥ 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n=70) or fluoxetine (n=88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p=0.875). Patients presented a mean of 2.7 psychiatric comorbidities, and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p=0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p=0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.
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Affiliation(s)
- Cristina Belotto-Silva
- Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
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Specificity of disgust vulnerability in the distinction and treatment of OCD. J Psychiatr Res 2011; 45:1236-42. [PMID: 21353249 PMCID: PMC3118257 DOI: 10.1016/j.jpsychires.2011.01.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 11/20/2022]
Abstract
A growing body of research has implicated disgust as a potential risk factor for the development and maintenance of obsessive-compulsive disorder (OCD). The first aim of the present study was to determine whether related, yet distinct, disgust vulnerabilities are endorsed more strongly by individuals with OCD than by those with another anxiety disorder. The second aim was to examine the unique contributions of changes in disgust to symptom improvement observed with exposure-based treatment for OCD. In study 1, individuals with OCD, generalized anxiety disorder (GAD), and nonclinical controls (NCCs) completed a measure of disgust propensity and disgust sensitivity. Compared to NCCs and individuals with GAD, those with OCD more strongly endorsed disgust propensity. However, individuals with OCD did not significantly differ from individuals with GAD in disgust sensitivity, although both groups reported significantly higher disgust sensitivity levels compared to NCCs. Study 2 comprised mediation analyses of symptom improvement among individuals with OCD and revealed that decreases in disgust propensity over time mediated improvement in OCD symptoms, even after controlling for improvements in negative affect. The implications of these findings for conceptualizing the role of disgust in the nature and treatment of OCD are discussed.
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Abstract
Neurological disorders are becoming increasingly common in developed countries as a result of the aging population. In spite of medications, these disorders can result in progressive loss of function as well as chronic physical, cognitive, and emotional disability that ultimately places enormous emotional and economic on the patient, caretakers, and the society in general. Neuromodulation is emerging as a therapeutic option in these patients. Neuromodulation is a field, which involves implantable devices that allow for the reversible adjustable application of electrical, chemical, or biological agents to the central or peripheral nervous system with the objective of altering its functioning with the objective of achieving a therapeutic or clinically beneficial effect. It is a rapidly evolving field that brings together many different specialties in the fields of medicine, materials science, computer science and technology, biomedical, and neural engineering as well as the surgical or interventional specialties. It has multiple current and emerging indications, and an enormous potential for growth. The main challenges before it are in the need for effective collaboration between engineers, basic scientists, and clinicians to develop innovations that address specific problems resulting in new devices and clinical applications.
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Affiliation(s)
- Chima O Oluigbo
- Department of Neurosurgery and the Center for Neuromodulation, The Ohio State University Medical Center, Columbus, OH 43210, USA
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30
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Longitudinal course of obsessive-compulsive disorder in patients with anxiety disorders: a 15-year prospective follow-up study. Compr Psychiatry 2011; 52:670-7. [PMID: 21349511 PMCID: PMC3683832 DOI: 10.1016/j.comppsych.2011.01.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/31/2010] [Accepted: 01/01/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although obsessive-compulsive disorder (OCD) is typically described as a chronic condition, relatively little is known about the naturalistic, longitudinal course of the disorder. The purpose of the current study was to examine the probability of OCD remission and recurrence as well as to explore demographic and clinical predictors of remission. METHODS This study uses data from the Harvard/Brown Anxiety Disorders Research Program, which is a prospective, naturalistic, longitudinal study of anxiety disorders. Diagnoses were established by means of a clinical interview at study intake. One hundred thirteen Harvard/Brown Anxiety Disorders Research Program participants with OCD were included in the study; all had a history of at least 1 other anxiety disorder. Assessments were conducted at 6-month and/or annual intervals during 15 years of follow-up. RESULTS Survival analyses showed that the probability of OCD remission was .16 at year 1, .25 at year 5, .31 at year 10, and .42 at year 15. For those who remitted from OCD, the probability of recurrence was .07 at year 1, .15 by year 3, and by year 5, it reached .25 and remained at .25 through year 15. In predictors of course, those who were married and those without comorbid major depressive disorder (MDD) were more likely to remit from OCD. By year 15, 51% of those without MDD remitted from OCD compared to only 20% of those with MDD. CONCLUSIONS In the short term, OCD appears to have a chronic course with low rates of remission. However, in the long term, a fair number of people recover from the disorder, and, for those who experience remission from OCD, the probability of recurrence is fairly low.
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31
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Storch EA, Lewin AB, Farrell L, Aldea MA, Reid J, Geffken GR, Murphy TK. Does cognitive-behavioral therapy response among adults with obsessive-compulsive disorder differ as a function of certain comorbidities? J Anxiety Disord 2010; 24:547-52. [PMID: 20399603 DOI: 10.1016/j.janxdis.2010.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 03/23/2010] [Accepted: 03/23/2010] [Indexed: 11/18/2022]
Abstract
This study examines the impact of several of the most common comorbid psychiatric disorders (i.e., generalized anxiety disorder (GAD); major depressive disorder (MDD); social phobia, and panic disorder) on cognitive-behavioral therapy (CBT) response in adults with obsessive-compulsive disorder (OCD). One hundred and forty-three adults with OCD (range=18-79 years) received 14 sessions of weekly or intensive CBT. Assessments were conducted before and after treatment. Primary outcomes included scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), response rates, and remission status. Sixty-nine percent of participants met criteria for at least one comorbid diagnosis. Although baseline OCD severity was slightly higher among individuals with OCD+MDD and OCD+GAD (in comparison to those with OCD-only), neither the presence nor the number of pre-treatment comorbid disorders predicated symptom severity, treatment response, remission, or clinically significant change rates at post-treatment. These data suggest that CBT for OCD is robust to the presence of certain common Axis-I comorbidities.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida School of Medicine, Rothman Center for Neuropsychiatry, 800 Sixth Street South, St. Petersburg, FL, USA.
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Peris TS, Bergman RL, Asarnow JR, Langley A, McCracken JT, Piacentini J. Clinical and cognitive correlates of depressive symptoms among youth with obsessive compulsive disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2010; 39:616-26. [PMID: 20706915 PMCID: PMC2950107 DOI: 10.1080/15374416.2010.501285] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, M age = 12.7 years) with primary OCD. Youths presented with a range of depressive symptoms, with 21% scoring at or above the clinical cutoff on the self-report measure of depression. Higher levels of depressive symptoms were associated with higher levels of cognitive distortions assessed on measures of insight, perceived control, competence, and contingencies. Depressive symptoms were also linked to older age and more severe OCD. Low perceived control and self-competence and high OCD severity independently predicted depression scores.
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Affiliation(s)
- Tara S Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, CA, USA.
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33
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van Kuyck K, Gabriëls L, Nuttin B. Electrical Brain Stimulation in Treatment-Resistant Obsessive–Compulsive Disorder. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00056-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Gabriëls L, Nuttin B, Cosyns P. Applicants for stereotactic neurosurgery for psychiatric disorders: role of the Flemish advisory board. Acta Psychiatr Scand 2008; 117:381-9. [PMID: 18331579 DOI: 10.1111/j.1600-0447.2008.01166.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Research on stereotactic neurosurgery for psychiatric disorders (SNPD) is rapidly evolving. Knowledge on patients undergoing SNPD is of crucial importance. We describe applicants for SNPD and examine the necessity for a multidisciplinary advisory board. METHOD Summary of the current practice of the Flemish advisory board (SNPD committee) and analysis of a questionnaire investigating the attitude of clinicians on SNPD. RESULTS In 7 years, 91 applications were submitted, nine patients did not fulfill diagnostic criteria for OCD, 65 patients received a positive recommendation, 50 SNPD procedures were performed. The prevalence of SNPD in the current year in Belgium is 0.6/million inhabitants. Ninety-seven per cent of clinicians consider the expertise and advice of the SNPD committee essential for indication setting. Forty-four percent of clinicians consider referral of a patient for capsulotomy, 82% for electrical brain stimulation. CONCLUSION Neurosurgery is exclusively considered for severe, treatment-refractory psychiatric disorders. Clinicians consider the SNPD committee essential in the decision-making process prior to intervention.
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Affiliation(s)
- L Gabriëls
- Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
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35
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Torres AR, Lima MCP. Epidemiologia do transtorno obsessivo-compulsivo: uma revisão. BRAZILIAN JOURNAL OF PSYCHIATRY 2005; 27:237-42. [PMID: 16224614 DOI: 10.1590/s1516-44462005000300015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Os inquéritos populacionais são importantes, pois amostras clínicas tendem a apresentar vieses de seleção. Aspectos sociodemográficos e relacionados à própria condição mórbida podem interferir na procura por tratamento. Pela natureza egodistônica do transtorno obsessivo-compulsivo, seus portadores tendem a ocultar o problema, podendo não procurar ou demorar a procurar tratamento. Porém, a maior parte do conhecimento atual sobre o transtorno obsessivo-compulsivo advém de amostras clínicas, que não representam a totalidade dos casos. Foi feita uma revisão convencional da literatura através do Medline, PsicoInfo e Lilacs de inquéritos populacionais sobre o transtorno obsessivo-compulsivo, cobrindo o período de 1980 a 2004, utilizando-se como palavras-chave "epidemiologia", "transtorno obsessivo-compulsivo", "inquéritos populacionais" e "prevalência". Estudos realizados em diferentes países indicam para o transtorno obsessivo-compulsivo uma prevalência atual em torno de 1,0% e ao longo da vida de 2,0 a 2,5%. Diferentemente de amostras clínicas, em quase todas as amostras populacionais há predomínio de mulheres e portadores que têm apenas obsessões. A freqüente comorbidade com outros transtornos mentais, particularmente depressão e outros transtornos ansiosos, repete-se em casos da população geral, que apresentam ainda uma associação com abuso de substâncias. Muitos portadores não estão em tratamento, particularmente os casos "puros". Indicadores de incapacitação funcional demonstram um considerável impacto negativo do transtorno obsessivo-compulsivo. É preciso melhorar o conhecimento da população e dos profissionais de saúde sobre os sintomas do transtorno obsessivo-compulsivo para aumentar a procura de atendimento, assim como a correta identificação e abordagem terapêutica deste grave problema de saúde.
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Issler CK, Sant'anna MK, Kapczinski F, Lafer B. [Anxiety disorders comorbidity in bipolar disorder]. BRAZILIAN JOURNAL OF PSYCHIATRY 2004; 26 Suppl 3:31-6. [PMID: 15597137 DOI: 10.1590/s1516-44462004000700008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
High comorbidity between bipolar and anxiety disorders is frequently described in epidemiological and clinical studies. This association has important implications for diagnoses, clinical outcome, therapeutic intervention and prognoses of bipolar disorder that are presented in this review.
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Affiliation(s)
- Cilly Klüger Issler
- PROMAN, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
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Moritz S, Meier B, Hand I, Schick M, Jahn H. Dimensional structure of the Hamilton Depression Rating Scale in patients with obsessive-compulsive disorder. Psychiatry Res 2004; 125:171-80. [PMID: 15006440 DOI: 10.1016/j.psychres.2003.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2003] [Revised: 10/16/2003] [Accepted: 11/30/2003] [Indexed: 11/17/2022]
Abstract
Comorbid depression is frequent in obsessive-compulsive disorder (OCD) and is acknowledged as a major confound in biological and neurocognitive investigations in OCD. The aim of the present study was to assess the distribution of depressive symptoms in a large OCD sample (n=162) and to analyze the dimensional structure of the Hamilton Depression Rating Scale (HDRS) in OCD. Major depressive disorder according to DSM-IV criteria was apparent in approximately one third of the patients. Frequent symptoms were depressed mood, reduced ability to work, anxiety symptoms and guilt feelings. HDRS scores were submitted to a varimax-rotated factor analysis. In accordance with studies conducted with depressed samples, multi-dimensional solutions suggesting three to six factors emerged. Subsequent confirmatory factor analysis revealed satisfactory fit indices for a four-factorial solution comprising core depressive symptoms, sleep disturbance, anxiety and gastrointestinal problems. Aggression-related obsessions as well as the overall severity of obsessions were related to core depressive symptoms. Anxiety symptoms were associated with excessive rituals. Greater recognition of depressive sub-components may help to raise the replicability of empirical findings in OCD research as there is evidence from both depression and OCD samples that distinct depressive syndromes have different biological correlates.
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Affiliation(s)
- Steffen Moritz
- University Hospital Hamburg-Eppendorf, Hospital for Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany.
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Gershuny BS, Baer L, Radomsky AS, Wilson KA, Jenike MA. Connections among symptoms of obsessive-compulsive disorder and posttraumatic stress disorder: a case series. Behav Res Ther 2003; 41:1029-41. [PMID: 12914805 DOI: 10.1016/s0005-7967(02)00178-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Theoretical, clinical, and empirical implications of the functional connections between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are abundant. As such, four cases are presented here of men and women who met criteria for comorbid OCD and PTSD. All had been diagnosed with treatment-resistant OCD and were seeking treatment from an OCD specialty clinic or institute, all reported a history of traumatic experiences prior to the onset of OCD, and all appeared to demonstrate negative treatment outcomes. Upon examination, it appeared that symptoms of OCD and PTSD were connected such that decreases in OCD-specific symptoms related to increases in PTSD-specific symptoms, and increases in OCD-specific symptoms related to decreases in PTSD-specific symptoms. Speculations about the function of OCD symptoms in relation to post-traumatic psychopathology are put forth; and theoretical, research, and treatment implications are discussed.
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Affiliation(s)
- Beth S Gershuny
- Harvard Medical School and Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA 02129, USA.
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Camarena B, Rinetti G, Cruz C, Gómez A, de La Fuente JR, Nicolini H. Additional evidence that genetic variation of MAO-A gene supports a gender subtype in obsessive-compulsive disorder. ACTA ACUST UNITED AC 2001; 105:279-82. [PMID: 11353450 DOI: 10.1002/ajmg.1323] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies have recently reported a sexually dimorphic association between obsessive-compulsive disorder (OCD) and a polymorphism related with variations in MAO-A activity. These observations suggest the possibility of gender differences in genetic susceptibility for OCD. We thus reexamined the MAO-A/EcoRV polymorphism in a sample of 122 OCD patients and 124 healthy subjects. An excess of allele 1 in OCD females with major depression disorder was confirmed as previously reported. This difference was more strongly associated with OCD females than males in the total sample. Finally, we analyzed a sample of 51 OCD trios. Haplotype-based haplotype relative risk (HHRR) analysis of the inheritance of the MAO-A variants revealed in the female probands that 14 out of 19 transmitted the allele 1, providing significant evidence for an allelic association between OCD and MAO-A gene. In conclusion, our findings may provide molecular evidence to identify a clinically meaningful gender subtype. However, an effort should be made to replicate the analysis in larger samples of informative parents using strategies such as transmission disequilibrium test to allow definite conclusions.
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Affiliation(s)
- B Camarena
- Departamento de Genética Psiquiátrica, Instituto Nacional de Psiquiatría Ramón de la Fuente, México D.F., México.
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Miranda MA, Bordin IA. Curso clínico e prognóstico do transtorno obsessivo-compulsivo. BRAZILIAN JOURNAL OF PSYCHIATRY 2001. [DOI: 10.1590/s1516-44462001000600004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Isabel A Bordin
- Universidade Federal de São Paulo, Brasil; Universidade Federal de São Paulo, Brasil
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