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Crowe E, Rosário MC, Ferrão YA, Albertella L, Miguel EC, Fontenelle LF. Obsessional slowness in obsessive-compulsive disorder: identifying characteristics and comorbidities in a clinical sample. Int J Psychiatry Clin Pract 2022:1-10. [PMID: 36409661 DOI: 10.1080/13651501.2022.2147441] [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: 11/22/2022]
Abstract
BACKGROUND Obsessional slowness (OS) is characterised by debilitating motor slowness during initiation and completion of daily tasks such as washing, dressing, eating or walking. Yet, the clinical features of OS are still poorly understood. METHODS This study aimed to delineate demographics, comorbid disorders and obsessive-compulsive symptoms (OCS) associated with OS. Cross sectional data from 667 OCD outpatients aged 9-82 years (M = 37.86, SD = 12.78) who underwent comprehensive standardised assessments administered by trained clinicians were analysed. Participants with (n = 189) and without (n = 478) OS were compared and contrasted. RESULTS Logistic regression revealed that being single, having tics and displaying higher severity of aggression, contamination, symmetry and hoarding symptoms significantly predicted participants having OS. CONCLUSIONS This is the largest-scale descriptive study of OS, which also provides preliminary evidence that OS may be a more severe form of OCD. Further empirical validation of these findings is required, and future research should focus on developing OS assessment.Key PointsThis was the first large-scale descriptive study of obsessional slowness (OS), that provided preliminary evidence for an OS phenotype within obsessive-compulsive disorderOS is associated with increased severity of aggression, contamination, symmetry and hoarding obsessive-compulsive symptomsIndividuals with OS are more likely to have comorbid tics, suggesting that there may be underlying motor factors contributing to this conditionFuture research would benefit from collecting both qualitative and quantitative data when assessing OS.
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Affiliation(s)
- Erin Crowe
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
| | - Maria C Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, Brazil
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Lucy Albertella
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
| | - Euripedes C Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, Brazil
| | - Leonardo F Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia.,Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro and D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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2
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Ahmari SE, Rauch SL. The prefrontal cortex and OCD. Neuropsychopharmacology 2022; 47:211-224. [PMID: 34400778 PMCID: PMC8617188 DOI: 10.1038/s41386-021-01130-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 01/03/2023]
Abstract
Obsessive Compulsive Disorder (OCD) is a highly prevalent and severe neuropsychiatric disorder, with an incidence of 1.5-3% worldwide. However, despite the clear public health burden of OCD and relatively well-defined symptom criteria, effective treatments are still limited, spotlighting the need for investigation of the neural substrates of the disorder. Human neuroimaging studies have consistently highlighted abnormal activity patterns in prefrontal cortex (PFC) regions and connected circuits in OCD during both symptom provocation and performance of neurocognitive tasks. Because of recent technical advances, these findings can now be leveraged to develop novel targeted interventions. Here we will highlight current theories regarding the role of the prefrontal cortex in the generation of OCD symptoms, discuss ways in which this knowledge can be used to improve treatments for this often disabling illness, and lay out challenges in the field for future study.
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Affiliation(s)
- Susanne E Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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3
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McLaughlin NC, Dougherty DD, Eskandar E, Ward H, Foote KD, Malone DA, Machado A, Wong W, Sedrak M, Goodman W, Kopell BH, Issa F, Shields DC, Abulseoud OA, Lee K, Frye MA, Widge AS, Deckersbach T, Okun MS, Bowers D, Bauer RM, Mason D, Kubu CS, Bernstein I, Lapidus K, Rosenthal DL, Jenkins RL, Read C, Malloy PF, Salloway S, Strong DR, Jones RN, Rasmussen SA, Greenberg BD. Double blind randomized controlled trial of deep brain stimulation for obsessive-compulsive disorder: Clinical trial design. Contemp Clin Trials Commun 2021; 22:100785. [PMID: 34189335 PMCID: PMC8219641 DOI: 10.1016/j.conctc.2021.100785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/14/2021] [Accepted: 05/16/2021] [Indexed: 12/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD), a leading cause of disability, affects ~1–2% of the population, and can be distressing and disabling. About 1/3 of individuals demonstrate poor responsiveness to conventional treatments. A small proportion of these individuals may be deep brain stimulation (DBS) candidates. Candidacy is assessed through a multidisciplinary process including assessment of illness severity, chronicity, and functional impact. Optimization failure, despite multiple treatments, is critical during screening. Few patients nationwide are eligible for OCD DBS and thus a multi-center approach was necessary to obtain adequate sample size. The study was conducted over a six-year period and was a NIH-funded, eight-center sham-controlled trial of DBS targeting the ventral capsule/ventral striatum (VC/VS) region. There were 269 individuals who initially contacted the sites, in order to achieve 27 participants enrolled. Study enrollment required extensive review for eligibility, which was overseen by an independent advisory board. Disabling OCD had to be persistent for ≥5 years despite exhaustive medication and behavioral treatment. The final cohort was derived from a detailed consent process that included consent monitoring. Mean illness duration was 27.2 years. OCD symptom subtypes and psychiatric comorbidities varied, but all had severe disability with impaired quality of life and functioning. Participants were randomized to receive sham or active DBS for three months. Following this period, all participants received active DBS. Treatment assignment was masked to participants and raters and assessments were blinded. The final sample was consistent in demographic characteristics and clinical features when compared to other contemporary published prospective studies of OCD DBS. We report the clinical trial design, methods, and general demographics of this OCD DBS sample.
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Affiliation(s)
- Nicole C.R. McLaughlin
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Corresponding author. Alpert Medical School of Brown University Butler Hospital, 345 Blackstone Blvd. Providence, RI, 02906, USA.
| | - Darin D. Dougherty
- Massachusetts General Hospital, 149 13th Street; Charlestown, MA, 02129, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Emad Eskandar
- Massachusetts General Hospital, 149 13th Street; Charlestown, MA, 02129, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Herbert Ward
- Department of Psychiatry, UF Health Springhill, University of Florida, 4037 NW 86th Terrace, Gainesville, FL, 32606, USA
| | - Kelly D. Foote
- Norman Fixel Institute of Neurological Diseases, Department of Neurology, University of Florida, 3009 SW Williston Dr., Gainesville, FL, 32608, USA
| | - Donald A. Malone
- Cleveland Clinic Neurological Institute, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Andre Machado
- Cleveland Clinic Neurological Institute, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - William Wong
- Kaiser Permanente, 1100 Veterans Blvd., Redwood City, CA, 94063, USA
| | - Mark Sedrak
- Kaiser Permanente, Department of Neurosurgery, 1150 Veterans Blvd., Redwood City, CA, 94063, USA
| | - Wayne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, New York, NY, 10011, USA
| | - Brian H. Kopell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, New York, NY, 10011, USA
| | - Fuad Issa
- Department of Psychiatry & Behavioral Sciences, School of Medicine & Health Sciences, George Washington University, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
| | - Donald C. Shields
- Department of Neurosurgery, The George Washington University, 2150 Pennsylvania Ave., NW, Ste. 7-409 Washington, DC, 20037, USA
| | - Osama A. Abulseoud
- Neuroimaging Research Branch at the National Institute on Drug Abuse, 251 Bayview Boulevard, Baltimore, MD, 21224, USA
| | - Kendall Lee
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester MN, 55901, USA
| | - Mark A. Frye
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester MN, 55901, USA
| | - Alik S. Widge
- Massachusetts General Hospital, 149 13th Street; Charlestown, MA, 02129, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
- Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, USA
| | - Thilo Deckersbach
- University of Applied Sciences Europe, Dessauer Str. 3-5, 10963, Berlin, Germany
| | - Michael S. Okun
- Norman Fixel Institute of Neurological Diseases, Department of Neurology, University of Florida, 3009 SW Williston Dr., Gainesville, FL, 32608, USA
| | - Dawn Bowers
- Department of Clinical & Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610, USA
| | - Russell M. Bauer
- Department of Clinical & Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610, USA
| | - Dana Mason
- Department of Psychiatry, UF Health Springhill, University of Florida, 4037 NW 86th Terrace, Gainesville, FL, 32606, USA
| | - Cynthia S. Kubu
- Cleveland Clinic Neurological Institute, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Ivan Bernstein
- Kaiser Permanente, 1100 Veterans Blvd., Redwood City, CA, 94063, USA
| | - Kyle Lapidus
- Northwell Health, 300 West 72 Street, #1D, New York, NY, 10023, USA
| | - David L. Rosenthal
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, New York, NY, 10011, USA
| | - Robert L. Jenkins
- Department of Psychiatry & Behavioral Sciences, School of Medicine & Health Sciences, George Washington University, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
| | - Cynthia Read
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
| | - Paul F. Malloy
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Stephen Salloway
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - David R. Strong
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, Ca, 92093, USA
| | - Richard N. Jones
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Steven A. Rasmussen
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Benjamin D. Greenberg
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA
- Center for Neurorestoration & Neurotechnology, Providence VA Medical Center, 830 Chalkstone Ave., Bldg 32, Providence, RI, 02908, USA
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Abstract
OCD has lagged behind other psychiatric illnesses in the identification of molecular treatment targets, due in part to a lack of significant findings in genome-wide association studies. However, while progress in this area is being made, OCD's symptoms of obsessions, compulsions, and anxiety can be deconstructed into distinct neural functions that can be dissected in animal models. Studies in rodents and non-human primates have highlighted the importance of cortico-basal ganglia-thalamic circuits in OCD pathophysiology, and emerging studies in human post-mortem brain tissue point to glutamatergic synapse abnormalities as a potential cellular substrate for observed dysfunctional behaviors. In addition, accumulated evidence points to a potential role for neuromodulators including serotonin and dopamine in both OCD pathology and treatment. Here, we review current efforts to use animal models for the identification of molecules, cell types, and circuits relevant to OCD pathophysiology. We start by describing features of OCD that can be modeled in animals, including circuit abnormalities and genetic findings. We then review different strategies that have been used to study OCD using animal model systems, including transgenic models, circuit manipulations, and dissection of OCD-relevant neural constructs. Finally, we discuss how these findings may ultimately help to develop new treatment strategies for OCD and other related disorders.
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Affiliation(s)
- Brittany L Chamberlain
- Department of Psychiatry, Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neuroscience Program and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susanne E Ahmari
- Department of Psychiatry, Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, USA. .,Center for Neuroscience Program and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
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5
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Rodriguez CI, Kegeles LS, Levinson A, Ogden RT, Mao X, Milak MS, Vermes D, Xie S, Hunter L, Flood P, Moore H, Shungu DC, Simpson HB. In vivo effects of ketamine on glutamate-glutamine and gamma-aminobutyric acid in obsessive-compulsive disorder: Proof of concept. Psychiatry Res 2015; 233:141-7. [PMID: 26104826 PMCID: PMC4715460 DOI: 10.1016/j.pscychresns.2015.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/18/2015] [Accepted: 06/01/2015] [Indexed: 12/21/2022]
Abstract
We previously reported the rapid and robust clinical effects of ketamine versus saline infusions in a proof-of-concept crossover trial in unmedicated adults with obsessive-compulsive disorder (OCD). This study examined the concurrent neurochemical effects of ketamine versus saline infusions using proton magnetic resonance spectroscopy ((1)H MRS) during the clinical proof-of-concept crossover trial. Levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and the excitatory neurochemicals glutamate+glutamine (Glx) were acquired in the medial prefrontal cortex (MPFC), a region implicated in OCD pathology. Seventeen unmedicated OCD adults received two intravenous infusions at least 1 week apart, one of saline and one of ketamine, while lying supine in a 3.0 T GE MR scanner. The order of each infusion pair was randomized. Levels of GABA and Glx were measured in the MPFC before, during, and after each infusion and normalized to water (W). A mixed effects model found that MPFC GABA/W significantly increased over time in the ketamine compared with the saline infusion. In contrast, there were no significant differences in Glx/W between the ketamine and saline infusions. Together with earlier evidence of low cortical GABA in OCD, our findings suggest that models of OCD pathology should consider the role of GABAergic abnormalities in OCD symptomatology.
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Affiliation(s)
- Carolyn I Rodriguez
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Lawrence S Kegeles
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Radiology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - Amanda Levinson
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
| | - R Todd Ogden
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY 10032, USA
| | - Xiangling Mao
- Department of Radiology, Weill Medical College of Cornell University, NY 10021, USA
| | - Matthew S Milak
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Donna Vermes
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Shan Xie
- Analytical Psychopharmacology Laboratory, the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Liane Hunter
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Pamela Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, Palo Alto, CA 94305, USA
| | - Holly Moore
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Dikoma C Shungu
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA; Department of Radiology, Weill Medical College of Cornell University, NY 10021, USA
| | - Helen B Simpson
- Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
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6
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Simpson HB, Kegeles LS, Hunter L, Mao X, Van Meter P, Xu X, Kimeldorf MB, Pearlstein SL, Slifstein M, Shungu DC. Assessment of glutamate in striatal subregions in obsessive-compulsive disorder with proton magnetic resonance spectroscopy. Psychiatry Res 2015; 232:65-70. [PMID: 25715904 PMCID: PMC4404189 DOI: 10.1016/j.pscychresns.2015.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/14/2014] [Accepted: 01/10/2015] [Indexed: 01/24/2023]
Abstract
Glutamatergic signaling abnormalities in cortico-striatal circuits are hypothesized to lead to the repetitive thoughts and behaviors of obsessive-compulsive disorder (OCD). To test this hypothesis, studies have used proton magnetic resonance spectroscopy (1H MRS) to measure glutamatergic compounds in the striatum of individuals with OCD. However, no studies have used methods that could measure glutamate minimally contaminated by glutamine and γ-aminobutyric acid (GABA) in striatal subregions. Therefore, in this study, a proton MRS imaging (1H MRSI) technique with relatively high spatial resolution at 3.0 T was used to measure minimally contaminated glutamate levels in three striatal subregions (i.e., dorsal caudate, dorsal putamen, and ventral striatum) in 15 unmedicated adults with OCD and 16 matched healthy control subjects. No significant group differences in glutamate levels were found in any of the three striatal subregions. In contrast, a study in unmedicated pediatric OCD patients that measured glutamatergic compounds in the dorsal caudate by MRS at 1.5 T found significant elevations. Further studies are warranted to assess whether these discrepant MRS findings are due to differences in subject age or MRS methodology, or potentially are associated with glutamatergic gene variants implicated in OCD.
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Affiliation(s)
- Helen Blair Simpson
- Department of Psychiatry at Columbia University Medical Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Division of Clinical Therapeutics at the New York State Psychiatric Institute, New York, NY, United States.
| | - Lawrence S. Kegeles
- Department of Psychiatry at Columbia University Medical Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States,Department of Radiology at Columbia University Medical Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States,Division of Translational Imaging at the New York State Psychiatric Institute, New York, NY, United States
| | - Liane Hunter
- Division of Clinical Therapeutics at the New York State Psychiatric Institute, New York, NY, United States
| | - Xiangling Mao
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Page Van Meter
- Division of Clinical Therapeutics at the New York State Psychiatric Institute, New York, NY, United States
| | - Xiaoyan Xu
- Division of Translational Imaging at the New York State Psychiatric Institute, New York, NY, United States
| | - Marcia B. Kimeldorf
- Division of Clinical Therapeutics at the New York State Psychiatric Institute, New York, NY, United States
| | - Sarah L. Pearlstein
- Division of Clinical Therapeutics at the New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Department of Psychiatry at Columbia University Medical Center, College of Physicians and Surgeons, Columbia University, New York, NY, United States,Division of Translational Imaging at the New York State Psychiatric Institute, New York, NY, United States
| | - Dikoma C. Shungu
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
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7
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Pinto A, Greene AL, Storch EA, Simpson HB. Prevalence of Childhood Obsessive-Compulsive Personality Traits in Adults with Obsessive Compulsive Disorder versus Obsessive Compulsive Personality Disorder. J Obsessive Compuls Relat Disord 2015; 4:25-29. [PMID: 25574456 PMCID: PMC4283832 DOI: 10.1016/j.jocrd.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Identifying risk factors of psychopathology has been an important research challenge. Prior studies examining the impact of childhood temperament on adult disorder have largely focused on undercontrolled and inhibited presentations, with little study of overcontrolled traits such as obsessive-compulsive personality traits (OCPTs). We compared rates of childhood OCPTs in adults with OCD (without OCPD) (n = 28) to adults with OCPD (without OCD) (n = 27), adults with both OCD and OCPD (n = 28), and healthy controls (HC) (n= 28), using the Childhood Retrospective Perfectionism Questionnaire, a validated measure of perfectionism, inflexibility, and drive for order. Adults with OCPD (both with and without comorbid OCD) reported higher rates of all three childhood OCPTs relative to HC. Individuals with OCD (without OCPD) reported higher rates of inflexibility and drive for order relative to HC, suggesting that these traits may presage the development of OCD, independent of OCPD. Childhood OCPTs were associated with particular OCD symptom dimensions in adulthood (contamination/cleaning, doubt/checking, and symmetry/ordering), independent of OCD onset age and OCPD diagnosis. Longitudinal prospective studies evaluating OCPTs in children are needed to better understand the progression of these traits from childhood to adulthood and their ability to predict future psychopathology.
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Affiliation(s)
- Anthony Pinto
- Division of Psychiatry Research, Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY, USA
- Department of Psychiatry, Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Eric A. Storch
- Departments of Pediatrics and Psychiatry, University of South Florida, FL, USA
| | - H. Blair Simpson
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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8
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Assessing neurocognitive function in psychiatric disorders: a roadmap for enhancing consensus. Neurobiol Learn Mem 2014; 115:10-20. [PMID: 24994503 DOI: 10.1016/j.nlm.2014.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 12/27/2022]
Abstract
It has been challenging to identify core neurocognitive deficits that are consistent across multiple studies in patients with Obsessive Compulsive Disorder (OCD). In turn, this leads to difficulty in translating findings from human studies into animal models to dissect pathophysiology. In this article, we use primary data from a working memory task in OCD patients to illustrate this issue. Working memory deficiencies have been proposed as an explanatory model for the evolution of checking compulsions in a subset of OCD patients. However, findings have been mixed due to variability in task design, examination of spatial vs. verbal working memory, and heterogeneity in patient populations. Two major questions therefore remain: first, do OCD patients have disturbances in working memory? Second, if there are working memory deficits in OCD, do they cause checking compulsions? In order to investigate these questions, we tested 19 unmedicated OCD patients and 23 matched healthy controls using a verbal working memory task that has increased difficulty/task-load compared to classic digit-span tasks. OCD patients did not significantly differ in their performance on this task compared to healthy controls, regardless of the outcome measure used (i.e. reaction time or accuracy). Exploratory analyses suggest that a subset of patients with predominant doubt/checking symptoms may have decreased memory confidence despite normal performance on trials with the highest working memory load. These results suggest that other etiologic factors for checking compulsions should be considered. In addition, they serve as a touchstone for discussion, and therefore help us to generate a roadmap for increasing consensus in the assessment of neurocognitive function in psychiatric disorders.
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9
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Investigation of cortical glutamate-glutamine and γ-aminobutyric acid in obsessive-compulsive disorder by proton magnetic resonance spectroscopy. Neuropsychopharmacology 2012; 37:2684-92. [PMID: 22850733 PMCID: PMC3473334 DOI: 10.1038/npp.2012.132] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Glutamatergic abnormalities in corticostriatal brain circuits are thought to underlie obsessive-compulsive disorder (OCD). Whether these abnormalities exist in adults with OCD is not clear. We used proton magnetic resonance spectroscopy (¹H MRS) to test our hypothesis that unmedicated adults with OCD have reduced glutamate plus glutamine (Glx) levels in the medial prefrontal cortex (MPFC) compared with healthy controls. Levels of γ-aminobutyric acid (GABA) were also explored. Twenty-four unmedicated adults with OCD and 22 matched healthy control subjects underwent ¹H MRS scans at 3.0 T. Resonances of both Glx and GABA were obtained using the standard J-editing technique and assessed as ratios relative to voxel tissue water (W) in the MPFC (the region of interest) and the dorsolateral prefrontal cortex (DLPFC) to explore the regional specificity of any finding. In the MPFC, Glx/W did not differ by diagnostic group (p=0.98) or sex (p=0.57). However, GABA/W was decreased in OCD (2.16±0.46 × 10⁻³) compared with healthy controls (2.43±0.45 × 10⁻³, p=0.045); moreover, age of OCD onset was inversely correlated with MPFC GABA/W (r=-0.50, p=0.015). MPFC GABA/W was higher in females than in males. In the DLPFC, there were no main effects of diagnosis or gender on Glx/W or GABA/W. These data indicate that unmedicated adults with OCD do not have Glx abnormalities in a MPFC voxel that includes the pregenual anterior cingulate cortex. However, they may have decreased MPFC GABA levels. How GABA abnormalities might contribute to corticostriatal dysfunction in OCD deserves further study.
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10
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Ahmari SE, Risbrough VB, Geyer MA, Simpson HB. Impaired sensorimotor gating in unmedicated adults with obsessive-compulsive disorder. Neuropsychopharmacology 2012; 37:1216-23. [PMID: 22218093 PMCID: PMC3306882 DOI: 10.1038/npp.2011.308] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Functional and structural imaging studies suggest that obsessive-compulsive disorder (OCD) symptoms arise from dysfunction in cortico-striato-thalamo-cortical circuits. It has therefore been hypothesized that neurophysiological tasks subserved by these circuits should be abnormal in OCD patients. One neurocognitive probe associated with this circuitry is prepulse inhibition (PPI) of the acoustic startle response. PPI deficits are thought to reflect abnormalities in processing and integration of sensory and motor information. Two prior studies found that OCD patients had PPI deficits at single prepulse (PP) intensities. However, most patients in these studies were taking psychotropic medications at the time of PPI testing, and preclinical studies have demonstrated effects of psychotropic medications on PPI. We examined PPI in 22 unmedicated OCD patients and 22 matched healthy controls at three different PP intensities (74, 78, and 86 dB). OCD patients had significantly less PPI across all three PP intensities compared with controls. Exploratory analyses indicated that OCD patients with a history of tics had lower levels of PPI. Our results demonstrate that unmedicated OCD patients have impaired sensorimotor gating as measured by PPI. This indicates that PPI deficits are present in OCD patients and are not the result of medication effects. Our findings also suggest that OCD patients with a history of tics may have greater impairment in sensorimotor gating than the general OCD population. Future studies should be designed to examine whether PPI deficits characterize tic-related OCD.
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Affiliation(s)
- Susanne E Ahmari
- Department of Psychiatry, Columbia University, College of Physicians & Surgeons, New York, NY, USA,Division of Integrative Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University, College of Physicians & Surgeons, New York, NY 10032-2695, USA, Tel: +1 212 543 5036, Fax: +1 212 543 5074, E-mail:
| | | | - Mark A Geyer
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - H Blair Simpson
- Department of Psychiatry, Columbia University, College of Physicians & Surgeons, New York, NY, USA,Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
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Simpson HB, Slifstein M, Bender J, Xu X, Hackett E, Maher MJ, Abi-Dargham A. Serotonin 2A receptors in obsessive-compulsive disorder: a positron emission tomography study with [11C]MDL 100907. Biol Psychiatry 2011; 70:897-904. [PMID: 21855857 PMCID: PMC3951757 DOI: 10.1016/j.biopsych.2011.06.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Serotonergic abnormalities are hypothesized to contribute to obsessive-compulsive disorder (OCD). This study used positron emission tomography with the radioligand [11C]MDL 100907 to examine whether the distribution of serotonin 2A (5-HT(2A)) receptors is altered in OCD. METHODS Nineteen OCD subjects, free of psychiatric medications and depression, and 19 matched healthy subjects underwent positron emission tomography scans following injection of [11C]MDL 100907. Total distribution volumes were derived by kinetic analysis using the arterial input function. Two measures of 5-HT(2A) availability were computed: the ratio at equilibrium of specifically bound radiotracer either to nondisplaceable radiotracer in tissue (BP(ND)) or to unmetabolized tracer in arterial plasma (BP(p)). Groups were compared using a region of interest (ROI) analysis and voxelwise analysis of spatially normalized parametric maps. ROIs included cortical (orbitofrontal, dorsolateral prefrontal, medial prefrontal, anterior cingulate, temporal, parietal, occipital, and insular cortex) and limbic (entorhinal cortex, parahippocampal gyrus, and medial temporal lobe) regions. RESULTS No significant group differences were observed in [11C]MDL 100907 BP(ND) or BP(p) in the ROIs or in the voxelwise analysis of BP(ND) maps. There was a significant correlation in the orbitofrontal cortex between [11C]MDL 100907 binding and age of onset, with earlier age of onset associated with higher binding. CONCLUSIONS Adults with OCD are not characterized as a group by major changes in 5-HT(2A) availability in cortical or limbic brain regions. Further research is warranted to examine potential differences in 5-HT(2A) availability between early- and late-onset OCD and to assess 5-HT(2A) function in relation to other neurotransmitter systems implicated in OCD.
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Glutamate abnormalities in obsessive compulsive disorder: neurobiology, pathophysiology, and treatment. Pharmacol Ther 2011; 132:314-32. [PMID: 21963369 DOI: 10.1016/j.pharmthera.2011.09.006] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022]
Abstract
Obsessive compulsive disorder is prevalent, disabling, incompletely understood, and often resistant to current therapies. Established treatments consist of specialized cognitive-behavioral psychotherapy and pharmacotherapy with medications targeting serotonergic and dopaminergic neurotransmission. However, remission is rare, and more than a quarter of OCD sufferers receive little or no benefit from these approaches, even when they are optimally delivered. New insights into the disorder, and new treatment strategies, are urgently needed. Recent evidence suggests that the ubiquitous excitatory neurotransmitter glutamate is dysregulated in OCD, and that this dysregulation may contribute to the pathophysiology of the disorder. Here we review the current state of this evidence, including neuroimaging studies, genetics, neurochemical investigations, and insights from animal models. Finally, we review recent findings from small clinical trials of glutamate-modulating medications in treatment-refractory OCD. The precise role of glutamate dysregulation in OCD remains unclear, and we lack blinded, well-controlled studies demonstrating therapeutic benefit from glutamate-modulating agents. Nevertheless, the evidence supporting some important perturbation of glutamate in the disorder is increasingly strong. This new perspective on the pathophysiology of OCD, which complements the older focus on monoaminergic neurotransmission, constitutes an important focus of current research and a promising area for the ongoing development of new therapeutics.
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