Obsessive-compulsive disorder

Association Between Unemployment and Mental Disorders: A Narrative Update of the Literature

The relationship between unemployment and mental disorders has been a significant subject of study since at least the Industrial Revolution. However, most data show associations of unemployment and isolated mental disorders, and this study field has been neglected in the last years. Therefore, this narrative review aims to provide an updated overview of the association between unemployment and mental health in general as well as the most prevalent mental disorders. A literature search was conducted using PubMed with the initial search terms "unemployment" and "mental health". The identified disorders were then used as search terms for a more in-depth search. Two raters screened abstracts and identified the literature containing relevant information. As a main result, it could be demonstrated that regardless of age and sex, there is still a broad association between unemployment and mental well-being in general (e.g., quality of life measure for example by the General Health Questionnaire), suicide attempts, suicide rates, as well as specific psychiatric disorders (substance use disorder, schizophrenia, depression, bipolar disorders, compulsive/obsessive disorders, eating disorders, specific personality disorders, intelligence disorders/impairment, and ADHD). The most significant association was found for affective disorders (depression) and substance use disorders. The association in general was particularly evident for long-term unemployment and mental disorders. Returning to work reduced the prevalence rates of mental disorders significantly. The literature review confirms the results of much older and disease centered studies that unemployment and mental disorders are associated with each other. The main conclusion is that early medical detection and intervention among the mentally ill are as crucial as labor market policy interventions to prevent, avoid, and reduce unemployment.

Correlation between compulsive behaviors and plastic changes in the dendritic spines of the prefrontal cortex and dorsolateral striatum of male rats

Obsessive-compulsive disorder (OCD) is a mental affliction characterized by compulsive behaviors often manifested in intrusive thoughts and repetitive actions. The quinpirole model has been used with rats to replicate compulsive behaviors and study the neurophysiological processes associated with this pathology. Several changes in the dendritic spines of the medial prefrontal cortex (mPFC) and dorsolateral striatum (DLS) have been related to the occurrence of compulsive behaviors. Dendritic spines regulate excitatory synaptic contacts, and their morphology is associated with various brain pathologies. The present study was designed to correlate the occurrence of compulsive behaviors (generated by administering the drug quinpirole) with the morphology of the different types of dendritic spines in the mPFC and DLS. A total of 18 male rats were used. Half were assigned to the experimental group, the other half to the control group. The former received injections of quinpirole, while the latter rats were injected with physiological saline solution, for 10 days in both cases. After the experimental treatment, the quinpirole rats exhibited all the parameters indicative of compulsive behavior and a significant correlation with the density of stubby and wide neckless spines in both the mPFC and DLS. Dendritic spines from both mPFC and DLS neurons showed plastic changes correlatively with the expression of compulsive behavior induced by quinpirole. Further studies are suggested to evaluate the involvement of glutamatergic neurotransmission in the neurobiology of OCD.

Psilocybin in pharmacotherapy of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a chronic mental disease that affects approximately 2% of the population. Obsessions and compulsions are troublesome for patients and may disturb their everyday activities. The pathogenesis of this disease is still not fully elucidated, but dysfunctions of serotonin-, dopamine- and glutamate-mediated neurotransmission together with early maladaptive schemas seem of importance. Pharmacological treatment includes drugs affecting the serotoninergic, dopaminergic, and glutamatergic systems, such as selective serotonin reuptake inhibitors (SSRIs). Providing that up to 40% of patients with OCD are resistant to the currently available medications, there is a need for novel and effective therapies. Recent discoveries suggest that psilocybin, a non-physically addictive psychoactive substance, may ameliorate disease symptoms. When used in appropriate doses and under strict clinical control, psilocybin appears as a valuable treatment for OCD. This narrative article provides a thorough overview of OCD's etiology, current treatment options, and the emerging evidence supporting psilocybin's efficacy in managing OCD symptoms.

Structural and resting-state connection abnormalities of habenula in obsessive-compulsive disorder

BACKGROUND

Previous studies have suggested that the habenula (Hb) may be involved in the mechanism of obsessive-compulsive disorder (OCD). However, the specific role of Hb in OCD remains unclear. This study aimed to explore the structural and functional abnormalities of Hb in OCD and their relationship with the clinical symptoms.

METHODS

Eighty patients with OCD and 85 healthy controls (HCs) were recruited as the primary dataset. The grey matter volume, resting-state functional connectivity (FC), and effective connectivity (EC) of the Hb were calculated and compared between OCD group and HCs. An independent replication dataset was used to verify the stability and robustness of the results.

RESULTS

Patients with OCD exhibited smaller Hb volume and increased FC of right Hb-left hippocampus than HCs. Dynamic causal model revealed an increased EC from left hippocampus to right Hb and a less inhibitory causal influence from the right Hb to left hippocampus in the OCD group compared to HCs. Similar results were found in the replication dataset.

CONCLUSIONS

This study suggested that abnormal structure of Hb and hippocampus-Hb connectivity may contribute to the pathological basis of OCD.

Management and Treatment of Obsessive-Compulsive Disorder (OCD): A Literature Review

Obsessive-compulsive disorder (OCD) is a prevalent and debilitating mental health condition. This literature review examines the latest strategies in managing and treating OCD, with an emphasis on psychotherapy, pharmacological interventions, and neurosurgical options. A comprehensive literature search utilizing PubMed, Google Scholar, ClinicalKey, and Embase databases was conducted. Utilizing chosen keywords, the resulting articles were filtered based on inclusion and exclusion criteria. Included articles were used to discuss current research regarding OCD treatment and management. Findings reveal the efficacy and obstacles of treatments such as cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and evidence-based neurosurgical methods, offering a broad perspective on OCD management. We discuss the limitations of these established treatments and examine the innovative response of neurosurgery in treating patients with OCD. This review highlights the importance of individualized treatment plans and areas for future research.

Amelioration of obsessive-compulsive disorder by intracellular acidification of cortical neurons with a proton pump inhibitor

Obsessive-compulsive disorder (OCD) is a highly prevalent neuropsychiatric disorder poorly controlled with pharmacological treatment because of the wide variation in symptom patterns. We analysed real-world data on adverse self-reports and insurance claims to identify a novel therapeutic target for OCD. We found that dopamine D2 receptor (D2R) agonists increased the incidence of OCD-like symptoms, which were suppressed by the concomitant use of proton pump inhibitors (PPIs). Further, OCD-like repetitive and habitual behaviours were observed in mice repeatedly injected with a D2R agonist, quinpirole. However, these abnormalities were suppressed by short-term PPI treatment. In quinpirole-treated mice, PPI inhibited pyramidal neuron hyperactivity in the lateral orbitofrontal cortex, a region where the P-type proton pump gene Atp4a is abundantly expressed. In primary cultured cortical neurons, short-term PPI treatment lowered intracellular pH and decreased firing activity, which was mimicked by Atp4a knockdown. Our findings show that inhibition of P-type proton pumps may be a novel therapeutic strategy for OCD.

Alterations of regional spontaneous brain activity in obsessive-compulsive disorders: A meta-analysis

BACKGROUND

Recent studies using resting-state functional magnetic resonance imaging (rs-fMRI) demonstrate that there is aberrant regional spontaneous brain activity in obsessive-compulsive disorders (OCD). Nevertheless, the results of previous studies are contradictory, especially in the abnormal brain regions and the directions of their activities. It is necessary to perform a meta-analysis to identify the common pattern of altered regional spontaneous brain activity in patients with OCD.

METHODS

The present study conducted a systematic search for studies in English published up to May 2023 in PubMed, Web of Science, and Embase. These studies measured differences in regional spontaneous brain activity at the whole brain level using regional homogeneity (ReHo), the amplitude of low-frequency fluctuations (ALFF) and the fractional amplitude of low-frequency fluctuations (fALFF). Then the Anisotropic effect-size version of seed-based d mapping (AES-SDM) was used to investigate the consistent abnormality of regional spontaneous brain activity in patients with OCD.

RESULTS

27 studies (33 datasets) were included with 1256 OCD patients (650 males, 606 females) and 1176 healthy controls (HCs) (588 males, 588 females). Compared to HCs, patients with OCD showed increased spontaneous brain activity in the right inferior parietal gyrus (Brodmann Area 39), left median cingulate and paracingulate gyri (Brodmann Area 24), bilateral inferior cerebellum, right middle frontal gyrus (Brodmann Area 46), left inferior frontal gyrus in triangular part (Brodmann Area 45) and left middle frontal gyrus in orbital part (Brodmann Area 11). Meanwhile, decreased spontaneous brain activity was identified in the right precentral gyrus (Brodmann Area 4), right insula (Brodmann Area 48), left postcentral gyrus (Brodmann Area 43), bilateral superior cerebellum and left caudate (Brodmann Area 25).

CONCLUSIONS

This meta-analysis provided a quantitative review of spontaneous brain activity in OCD. The results demonstrated that the brain regions in the frontal lobe, sensorimotor cortex, cerebellum, caudate and insula are crucially involved in the pathophysiology of OCD. This research contributes to the understanding of the pathophysiologic mechanism underlying OCD and could provide a new perspective on future diagnosis and treatment of OCD.

Reduction of aggressive behaviour following hypothalamic deep brain stimulation: Involvement of 5-HT1A and testosterone

BACKGROUND

Aggressive behaviour (AB) may occur in patients with different neuropsychiatric disorders. Although most patients respond to conventional treatments, a small percentage continue to experience AB despite optimized pharmacological management and are considered to be treatment-refractory. For these patients, hypothalamic deep brain stimulation (pHyp-DBS) has been investigated. The hypothalamus is a key structure in the neurocircuitry of AB. An imbalance between serotonin (5-HT) and steroid hormones seems to exacerbate AB.

OBJECTIVES

To test whether pHyp-DBS reduces aggressive behaviour in mice through mechanisms involving testosterone and 5-HT.

METHODS

Male mice were housed with females for two weeks. These resident animals tend to become territorial and aggressive towards intruder mice placed in their cages. Residents had electrodes implanted in the pHyp. DBS was administered for 5 h/day for 8 consecutive days prior to daily encounters with the intruder. After testing, blood and brains were recovered for measuring testosterone and 5-HT receptor density, respectively. In a second experiment, residents received WAY-100635 (5-HT_1A antagonist) or saline injections prior to pHyp-DBS. After the first 4 encounters, the injection allocation was crossed, and animals received the alternative treatment during the next 4 days.

RESULTS

DBS-treated mice showed reduced AB that was correlated with testosterone levels and an increase in 5-HT1_A receptor density in the orbitofrontal cortex and amygdala. Pre-treatment with WAY-100635 blocked the anti-aggressive effect of pHyp-DBS.

CONCLUSIONS

This study shows that pHyp-DBS reduces AB in mice via changes in testosterone and 5-HT1_A mechanisms.

Thiol disulfide homeostasis in psychiatric disorders: A comprehensive review

Thiol-disulfide couple maintains an intracellular redox status. Dynamic thiol-disulfide homeostasis acts crucial parts in metabolic processes involving signal mechanisms, inflammation, antioxidant defense. Thiol-disulfide homeostasis have been implicated in numerous diseases. In this comprehensive review we identified the studies that examined the thiol-disulfide homeostasis in psychiatric disorders. Most cases demonstrated alterations in thiol-disulfide homeostasis and in most of them the thiol-disulfide balance tended to change direction to the disulfide side, that is, to the oxidative side. Currently, the fact that N-acetylcysteine, a thiol-containing compound, is of great interest as a new treatment approach in psychiatric disorders and the role of glutathione, the most abundant thiol, in the brain highlights the importance of evaluating the thiol-disulfide balance in psychiatric disorders.

Two distinct subtypes of obsessive compulsive disorder revealed by a framework integrating multimodal neuroimaging information

Patients with obsessive compulsive disorder (OCD) exhibit tremendous heterogeneity in structural and functional neuroimaging aberrance. However, most previous studies just focus on group‐level aberrance of a single modality ignoring heterogeneity and multimodal features. On that account, we aimed to uncover OCD subtypes integrating structural and functional neuroimaging features with the help of a multiview learning method and examined multimodal aberrance for each subtype. Ninety‐nine first‐episode untreated patients with OCD and 104 matched healthy controls (HCs) undergoing structural and functional MRI were included in this study. Voxel‐based morphometric and amplitude of low‐frequency fluctuation (ALFF) were adopted to assess gray matter volumes (GMVs) and the spontaneous neuronal fluctuations respectively. Structural/functional distance network was obtained by calculating Euclidean distance between pairs of regional GMVs/ALFF values across patients. Similarity network fusion, one of multiview learning methods capturing shared and complementary information from multimodal data sources, was used to fuse multimodal distance networks into one fused network. Then spectral clustering was adopted to categorize patients into subtypes. As a result, two robust subtypes were identified. These two subtypes presented opposite GMV aberrance and distinct ALFF aberrance compared with HCs while shared indistinguishable clinical and demographic features. In addition, these two subtypes exhibited opposite structure–function difference correlation reflecting distinct adaptive modifications between multimodal aberrance. Altogether, these results uncover two objective subtypes with distinct multimodal aberrance and provide a new insight into taxonomy of OCD.

The Evaluation of Thiol/Disulfide Homeostasis and Oxidative DNA Damage in Patients with Obsessive Compulsive Disorder

Objective

In this study, we aimed to examine thiol/disulfide homeostasis and oxidative DNA damage in patients with OCD and compare them with healthy controls.

Methods

Thirty-five patients previously diagnosed with OCD in Van Yuzuncu Yil University Department of Psychiatry and thirty-three healthy volunteers were included in the study. The severity of the symptoms was measured using the Yale-Brown Obsessive-Compulsive Scale. Five μL of blood samples were taken from the patient and control groups. The samples were stored at appropriate conditions until use. Leukocyte DNA was isolated and the levels of 8-hydroxy-2-deoxyguanosine (8-OHdG) and deoxyguanosine were detected to assess the oxidative DNA damage. The level of oxidative DNA damage was expressed as 8-OHdG/10⁶dG. Total thiol/native thiol levels were measured for thiol/disulfide homeostasis. The level of disulfide was determined by subtracting the native thiol value from the total thiol value and the result was divided by two. Results were given as percentages.

Results

The total and native thiol levels in patients with OCD were significantly lower, and the disulfide levels were significantly higher in patients with OCD than healthy control subjects. In addition, 8-OHdG, an indicator of DNA damage, was significantly lower in the control group compared to the patient group.

Conclusion

Increased levels of disulfide/native thiol and disulfide/total thiol in patients with OCD show that levels of oxidative stress were elevated and therefore, higher 8-OHdG levels in patients with OCD is a marker of oxidative DNA damage.

Two distinct subtypes of obsessive compulsive disorder revealed by heterogeneity through discriminative analysis

Neurobiological heterogeneity in obsessive compulsive disorder (OCD) is understudied leading to conflicting neuroimaging findings. Therefore, we investigated objective neuroanatomical subtypes of OCD by adopting a newly proposed method based on gray matter volumes (GMVs). GMVs were derived from T1‐weighted anatomical images of patients with OCD (n = 100) and matched healthy controls (HCs; n = 106). We first inquired whether patients with OCD presented higher interindividual variability HCs in terms of GMVs. Then, we identified distinct subtypes of OCD by adopting heterogeneity through discriminative analysis (HYDRA), where regional GMVs were treated as features. Patients with OCD presented higher interindividual variability than HCs, suggesting a high structural heterogeneity of OCD. HYDRA identified two distinct robust subtypes of OCD presenting opposite neuroanatomical aberrances compared with HCs, while sharing indistinguishable clinical and demographic features. Specifically, Subtype 1 exhibited widespread increased GMVs in cortical and subcortical regions, including the orbitofrontal gyrus, right anterior insula, bilateral hippocampus, and bilateral parahippocampus and cerebellum. Subtype 2 demonstrated overall decreased GMVs in regions such as the orbitofrontal gyrus, right anterior insula, and precuneus. When mixed together, none of patients presented significant differences compared with HCs. In addition, the total intracranial volume of Subtype 2 was significantly correlated with the total score of the Yale–Brown Obsessive Compulsive Scale while that of Subtype 1 was not. These results identified two distinct neuroanatomical subtypes, providing a possible explanation for conflicting neuroimaging findings, and proposed a potential objective taxonomy contributing to precise clinical diagnosis and treatment in OCD.

Possible actions of cannabidiol in obsessive-compulsive disorder by targeting the WNT/β-catenin pathway

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent and distinctive obsessions and/or compulsions. The etiologies remain unclear. Recent findings have shown that oxidative stress, inflammation, and glutamatergic pathways play key roles in the causes of OCD. However, first-line therapies include cognitive-behavioral therapy but only 40% of the patients respond to this first-line therapy. Research for new treatment is mandatory. This review focuses on the potential effects of cannabidiol (CBD), as a potential therapeutic strategy, on OCD and some of the presumed mechanisms by which CBD provides its benefit properties. CBD medication downregulates GSK-3β, the main inhibitor of the WNT/β-catenin pathway. The activation of the WNT/β-catenin could be associated with the control of oxidative stress, inflammation, and glutamatergic pathway and circadian rhythms dysregulation in OCD. Future prospective clinical trials could focus on CBD and its different and multiple interactions in OCD.

Asymmetry in the Central Nervous System: A Clinical Neuroscience Perspective

Recent large-scale neuroimaging studies suggest that most parts of the human brain show structural differences between the left and the right hemisphere. Such structural hemispheric asymmetries have been reported for both cortical and subcortical structures. Interestingly, many neurodevelopmental and psychiatric disorders have been associated with altered functional hemispheric asymmetries. However, findings concerning the relation between structural hemispheric asymmetries and disorders have largely been inconsistent, both within specific disorders as well as between disorders. In the present review, we compare structural asymmetries from a clinical neuroscience perspective across different disorders. We focus especially on recent large-scale neuroimaging studies, to concentrate on replicable effects. With the notable exception of major depressive disorder, all reviewed disorders were associated with distinct patterns of alterations in structural hemispheric asymmetries. While autism spectrum disorder was associated with altered structural hemispheric asymmetries in a broader range of brain areas, most other disorders were linked to more specific alterations in brain areas related to cognitive functions that have been associated with the symptomology of these disorders. The implications of these findings are highlighted in the context of transdiagnostic approaches to psychopathology.

Is orthorexia nervosa a feature of obsessive-compulsive disorder? A multicentric, controlled study

PURPOSE

The term orthorexia nervosa (ON) was coined to describe altered thoughts and behaviours related to healthy eating. The prevalence of ON was found to scale up to almost 90% among high-risk populations (ballet dancers, athletes, and health workers). ON seem to share psychopathological aspects with both Eating Disorders (ED) and Obsessive-Compulsive Disorder (OCD). The aim of the study was to analyse the frequency and intensity of ON symptoms among subjects diagnosed with OCD, hypothesising that they would be higher than in two control groups (subjects with anxiety-depressive disorders and general population).

METHODS

We conducted a multi-centre, observational, controlled study. Subjects filled in a socio-demographic questionnaire including questions related to life-style and two psychometric instruments: ORTO-15, for ON symptoms, and OCI-R, for OCD symptoms. Post hoc analysis of the dataset was performed using the revised version of ORTO-15, the ORTO-R.

RESULTS

In the final sample of 328 subjects, the overall prevalence of ORTO-15-ON was 59.5%, mean score 37.9 ± 4.2. The mean score at the ORTO-R was 16.6 ± 4.6. No statistically significant differences were found in the prevalence of ON or in the mean ORTO-15 score among OCD patients and the two control groups, and this was confirmed by the multiple regression analysis. At the ORTO-R re-scoring, OCD patients scored significantly lower than the two clinical subgroups (p = .0005) and a lower ORTO-R score was associated to positivity at the OCI-R, confirming the initial hypothesis of the study.

CONCLUSIONS

ON symptoms do seem to be more prevalent among subjects suffering from OCD. The psychometric properties of tools available to calculate ON symptoms, namely ORTO-15 vs. ORTO-R, play a relevant role in explaining such finding. ORTO-R seems to be a valid alternative able to overcome such difficulties, though further studies are needed to confirm this.

Review of the effects of SARS-CoV2 infection and COVID-19 on common pediatric psychiatric illnesses

Severe acute respiratory syndrome coronavirus-2 is a novel coronavirus strain that causes pneumonia and acute respiratory distress syndrome along with other morbidities, collectively known as coronavirus disease 2019 (COVID-19) disease. There has been widespread discussion about the psychological impact of COVID-19 particularly on children and adolescents. There have been overarching negative effects with regards to decreased physical activity, more screen time, increasingly unhealthy diets, and irregularities in sleep/wake schedules^. This, coupled with disruptions in ongoing mental health treatment and associated support structures, has caused unprecedented declines in the emotional and psychosocial wellbeing of children and adolescents. This review aims to systematically review the literature to provide a general overview of the ways in which COVID-19 has affected common psychiatric illnesses in children and adolescents. The included articles in all subsections concluded that symptoms of these common childhood psychiatric disorders have generally been exacerbated by the COVID-19 pandemic. This review indicates that quarantine and the consequent isolation have had multiple significant and consistent negative implications on the mental health of children and adolescents. Our study indicates that there should be increased vigilance among providers and families to mitigate the negative psychological effects that the COVID-19 pandemic has on children with common childhood psychiatric disorders.

Examining the correlation between symptoms of obsessive compulsive disorder and autism spectrum disorder in a community-based sample of adults

We examined the association between obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) symptoms among a community-based sample of adults (n = 217) that completed an OCD and ASD screening instrument. Approximately 39% of the sample that met the ASD screener cutoff criteria also met the screener cutoff criteria for OCD. The correlation between overall OCD symptoms (i.e., obsessions and compulsions) and ASD symptoms was small but statistically significant for the entire sample of participants. Similarly, obsession and compulsion subscales showed almost identical results for correlation with ASD symptoms (i.e., small but statistically significant) for the entire sample. These results suggest that levels of compulsions and obsessions are equally correlated with ASD symptoms, and neither elevated compulsions nor obsessions differentially predicted the severity of ASD symptoms in a community-based sample of adults. However, when the analysis was restricted to only the participants that met screening criteria cutoff score for ASD, statistically significant results occurred with only elevated compulsions accurately predicting severity of ASD symptoms. These results suggest that compulsive behavior appears to be a good candidate for targeting intervention resources for individuals with characteristics of ASD given the mounting data suggesting that compulsions are more common than obsessions.

Lithium: a potential therapeutic strategy in obsessive-compulsive disorder by targeting the canonical WNT/β pathway

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized b-y recurrent and distinctive obsessions and/or compulsions. The etiologies remain unclear. Recent findings have shown that oxidative stress, inflammation, and the glutamatergic pathway play key roles in the causes of OCD. However, first-line therapies include cognitive-behavioral therapy but only 40% of the patients respond to this first-line therapy. Research for a new treatment is mandatory. This review focuses on the potential effects of lithium, as a potential therapeutic strategy, on OCD and some of the presumed mechanisms by which lithium provides its benefit properties. Lithium medication downregulates GSK-3β, the main inhibitor of the WNT/β-catenin pathway. The activation of the WNT/β-catenin could be associated with the control of oxidative stress, inflammation, and glutamatergic pathway. Future prospective clinical trials could focus on lithium and its different and multiple interactions in OCD.

Future Trends in Disability and Its Determinants Among Chinese Community Patients With Anxiety Disorders: Evidence From a 5-Year Follow-Up Study

Background: Anxiety disorders (ADs) are a group of disorders with a high disability rate and bring a huge social burden. In China, information on future trends in the disability among community ADs patients and its determinants are rare. The objectives of this study are to describe the future trends in the disability among ADs patients living in community and to investigate the determinants of the disability. Methods: Participants diagnosed with 12-month ADs in the China Mental Health Survey (CMHS) were followed up by telephone from April to June 2018 to assess the future trends in the disability in a 5-year interval using the World Health Organization's Disability Assessment Schedule 2.0. The disability rate was reported and its determinants were analyzed by complex sample design multivariate logistic regression. Results: Totally 271 patients were interviewed by telephone and 33 informants finished proxy interviews. The disability rates were 45.9% and 14.3% among ADs patients at baseline and during the follow-up. Patients with general anxiety disorder (GAD) or agoraphobia with/without panic disorder (AGP) had the lower decrease and higher disability during the follow-up than patients with other subtypes. Patients aged in middle age (aged 40-49 years old, OR = 11.12, 95% CI: 4.16-29.72), having disability at baseline (OR = 7.18, 95% CI: 1.37-37.73), having comorbidity with three or more physical diseases (OR = 9.27, 95% CI: 2.48-34.71), and having comorbidity with other mental disorders (OR = 3.97, 95% CI: 1.13-13.96) had higher disability during the follow-up. Conclusions: The disability rate tends to decrease among ADs patients living in communities. Treatment priority should be given for ADs patients with disability and those in middle age. Treatments for the comorbidity of other mental disorders or physical diseases should be considered when treating anxiety.

Obsessive-Compulsive Symptoms in Obsessive-Compulsive Disorder and in Generalized Anxiety Disorder: Occurrence and Correlations

OBJECTIVE

Because of the heterogeneity of obsessive-compulsive disorders (OCDs) and their co-occurrence with anxiety disorders, we investigated the prevalence, severity, and correlations between obsessive and compulsive symptoms reported by patients diagnosed with OCD or generalized anxiety disorder (GAD).

METHODS

A retrospective study was conducted in 2 groups of patients: 76 patients diagnosed with OCD [F42 according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)], and 186 patients diagnosed with GAD (F41.1 according to ICD-10), who had presented for therapy at the day ward. The Symptom Questionnaire "O," based on the Symptom Checklist 90-Revised (SCL-90-R) questionnaire, was used to assess obsessive, compulsive, and anxiety symptoms. The analysis took into account the impact of sex and the presence or absence of cognitive dysfunction (as assessed using the Bender Benton Visual Retention and Bender-Gestalt tests) on the associations being investigated.

RESULTS

We observed that obsessive and compulsive symptoms were more prevalent and more strongly expressed in the group with OCD than in the group with GAD. However, almost all patients with GAD (94%) confirmed the presence of some obsessive-compulsive symptoms. The study revealed differences in correlations with obsessions and compulsions between the OCD and GAD groups. In the group with OCD, no significant correlation between the severity of obsessions and compulsions was identified, whereas in the group with GAD, a significant positive correlation was found between the severity of those symptoms. In both the GAD and OCD groups, a greater intensity of obsessive-compulsive symptoms was accompanied by an increase in the severity of anxiety symptoms (with this effect noted to a greater extent with obsessions than compulsions).

CONCLUSIONS

The study revealed that patients with GAD often have coexisting obsessive-compulsive symptoms, which may not be identified during routine psychiatric examination. Obsessive-compulsive symptoms observed in patients with GAD may show a different structure than obsessive-compulsive symptoms in patients with OCD. The results of this study suggest that compulsions are more specific for the diagnosis of OCD than obsessions. Compulsions, such as counting related to the need for order and symmetry, may be associated with some cognitive dysfunctions and male sex, a finding that requires further research.

Striatum-Mediated Deficits in Stimulus-Response Learning and Decision-Making in OCD

Obsessive compulsive disorder (OCD) is a prevalent psychiatric disorder characterized by obsessions and compulsions. Studies investigating symptomatology and cognitive deficits in OCD frequently implicate the striatum. The aim of this study was to explore striatum-mediated cognitive deficits in patients with OCD as they complete a stimulus-response learning task previously shown to differentially rely on the dorsal (DS) and ventral striatum (VS). We hypothesized that patients with OCD will show both impaired decision-making and learning, coupled with reduced task-relevant activity in DS and VS, respectively, compared to healthy controls. We found that patients with OCD (n = 14) exhibited decision-making deficits and learned associations slower compared to healthy age-matched controls (n = 16). Along with these behavioral deficits, OCD patients had reduced task-relevant activity in DS and VS, compared to controls. This study reveals that responses in DS and VS are altered in OCD, and sheds light on the cognitive deficits and symptoms experienced by patients with OCD.

Behavioral flexibility in a mouse model for obsessive-compulsive disorder: Impaired Pavlovian reversal learning in SAPAP3 mutants

Obsessive-compulsive disorder (OCD) is characterized by obsessive thinking, compulsive behavior and anxiety, and is often accompanied by cognitive deficits. The neuropathology of OCD involves dysregulation of cortical-striatal circuits. Similar to OCD patients, SAPAP3 knockout mice 3 (SAPAP3-/- ) exhibit compulsive behavior (grooming), anxiety and dysregulated cortical-striatal function. However, it is unknown whether SAPAP3-/- display cognitive deficits and how these different behavioral traits relate to one another. SAPAP3-/- and wild-type (WT) littermates were trained in a Pavlovian conditioning task pairing visual cues with the delivery of sucrose solution. After mice learned to discriminate between a reward-predicting conditioned stimulus (CS+) and a non-reward stimulus (CS-), contingencies were reversed (CS+ became CS- and vice versa). Additionally, we assessed grooming, anxiety and general activity. SAPAP3-/- acquired Pavlovian approach behavior similarly to WT, albeit less vigorously and with a different strategy. However, unlike WT, SAPAP3-/- were unable to adapt their behavior after contingency reversal, exemplified by a lack of re-establishing CS+ approach behavior (sign tracking). Surprisingly, such behavioral inflexibility, decreased vigor, compulsive grooming and anxiety were unrelated. This study shows that SAPAP3-/- are capable of Pavlovian learning, but lack flexibility to adapt associated conditioned approach behavior. Thus, SAPAP3-/- not only display compulsive-like behavior and anxiety, but also cognitive deficits, confirming and extending the validity of SAPAP3-/- as a suitable model for the study of OCD. The observation that compulsive-like behavior, anxiety and behavioral inflexibility were unrelated suggests a non-causal relationship between these traits and may be of clinical relevance for the treatment of OCD.

An Adenosine A2A Receptor Antagonist Improves Multiple Symptoms of Repeated Quinpirole-Induced Psychosis

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by the repeated rise of concerns (obsessions) and repetitive unwanted behavior (compulsions). Although selective serotonin reuptake inhibitors (SSRIs) is the first-choice drug, response rates to SSRI treatment vary between symptom dimensions. In this study, to find a therapeutic target for SSRI-resilient OCD symptoms, we evaluated treatment responses of quinpirole (QNP) sensitization-induced OCD-related behaviors in mice. SSRI administration rescued the cognitive inflexibility, as well as hyperactivity in the lateral orbitofrontal cortex (lOFC), while no improvement was observed for the repetitive behavior. D₂ receptor signaling in the central striatum (CS) was involved in SSRI-resistant repetitive behavior. An adenosine A_2A antagonist, istradefylline, which rescued abnormal excitatory synaptic function in the CS indirect pathway medium spiny neurons (MSNs) of sensitized mice, alleviated both of the QNP-induced abnormal behaviors with only short-term administration. These results provide a new insight into therapeutic strategies for SSRI-resistant OCD symptoms and indicate the potential of A_2A antagonists as a rapid-acting anti-OCD drug.

The genetic architecture of schizophrenia, bipolar disorder, obsessive-compulsive disorder and autism spectrum disorder

Considerable evidence suggests that autism spectrum disorders (ASD), schizophrenia (SCZ), bipolar disorder (BD) and obsessive-compulsive disorder (OCD) share a common molecular aetiology, despite their unique clinical diagnostic criteria. The aim of this study was therefore to determine and characterise the common and unique molecular architecture of ASD, SCZ, BD and OCD. Gene lists were obtained from previously published studies for ASD, BD, SCZ and for OCD. Genes identified to be common to all disorders, or unique to one specific disorder, were included for enrichment analyses using the web-server tool Enrichr. Ten genes were identified to be commonly associated with the aetiology of ASD, SCZ, BD and OCD. Enrichment analyses determined that these genes are predominantly involved in the dopaminergic and serotonergic pathways, the voltage-gated calcium ion channel gene network, folate metabolism, regulation of the hippo signaling pathway, and the regulation of gene silencing and expression. In addition to well-characterised and previously described pathways, regulation of the hippo signaling pathway was commonly associated with ASD, SCZ, BD and OCD, implicating neural development and neuronal maintenance as key in neuropsychiatric disorders. In contrast, a large number of previously associated genes were shown to be disorder-specific. And unique disorder-specific pathways and biological processes were presented for ASD, BD, SCZ and OCD aetiology. Considering the current global incidence and prevalence rates of mental health disorders, focus should be placed on cross-disorder commonalities in order to realise actionable and translatable results to combat mental health disorders.

Restricted, Repetitive Behaviors in Autism Spectrum Disorder and Obsessive-Compulsive Disorder: A Comparative Review

This review paper critically examines literature regarding restricted and repetitive behaviors (RRBs) in Autism Spectrum Disorder (ASD) and Obsessive-Compulsive Disorder (OCD). The similar behavioral profiles of these disorders presents the potential for confusion regarding diagnoses and intervention efforts. As such, this review highlights the similarities and differences between RRBs in ASD and OCD. The developmental trajectories of RRBs are presented, followed by an exploration of three constructs implicated in RRB manifestation: anxiety, executive functioning, and sensory phenomena. While RRBs tend to develop with some similarity in both disorders, the differing role of anxiety highlights important distinctions between ASD and OCD. We urge researchers and clinicians to think critically about the dimensions that affect RRB presentation. Future research should use this review as a starting point to further elucidate the differences between RRBs in these two populations.

Mavoglurant Augmentation in OCD Patients Resistant to Selective Serotonin Reuptake Inhibitors: A Proof-of-Concept, Randomized, Placebo-Controlled, Phase 2 Study

INTRODUCTION

To determine if mavoglurant (modified release) as an augmentation therapy to selective serotonin reuptake inhibitors (SSRIs) could have beneficial effects reducing Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score in patients with obsessive-compulsive disorder (OCD) resistant to SSRI treatment.

METHODS

This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2 study. Patients remained on their SSRI treatment and mavoglurant or placebo was added on. Non-smoking men and women aged 18-65 years primarily diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria were randomized (1:1) to mavoglurant or placebo groups. After 50 patients were randomized, an interim analysis was conducted to determine whether the study should be continued. The primary outcome measure was absolute change in Y-BOCS from baseline at week 17. Safety was assessed by recording adverse events (AEs) and serious adverse events (SAEs).

RESULTS

Interim analysis led to a decision to terminate the study. In total 38 (76.0%) participants completed 17 weeks of treatment and 37 (74.0%) completed the study. There was no significant difference in least squares (LS) mean change from baseline at week 17 in Y-BOCS total score for mavoglurant compared with placebo groups [-6.9 (1.75) vs. -8.0 (1.78), respectively; LS mean difference 1.1; 95% CI -3.9, 6.2; p = 0.671]. The incidence of AEs was higher in the mavoglurant compared with the placebo group (80.8% vs. 70.8%, respectively).

CONCLUSION

This study of mavoglurant in OCD was terminated because of the lack of efficacy at interim analysis. The study did not support the use of an antagonist of mGluR5 receptors for OCD treatment.

TRIAL REGISTRATION

The study was registered with ClinicalTrials.gov: NCT01813019.

FUNDING

This study was sponsored by Novartis Pharma AG, Basel, Switzerland.

Neuronal nitric oxide synthase polymorphisms in obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) is a mental disease characterized by recurrent and intrusive thoughts and repetitive behaviours that negatively affect the quality-of-life of the patients. Recent studies have implicated the participation of neuronal nitric oxide in OCD pathogenesis as a neurotransmitter modulator.

AIMS

To identify whether variations in neuronal nitric oxide synthase (nNOS) genes may render individuals susceptible to OCD development.

METHODS

This study examined nNOS polymorphisms in 100 OCD patients and 121 unrelated healthy controls by polymerase chain reaction and restriction enzyme digestion methods.

RESULTS

nNOS 276 C + genotype incidence was significantly higher in OCD patients than controls and conferred a 2-fold increased risk for OCD. No significant differences were observed in frequencies of nNOS 84 genotypes between patients and controls.

CONCLUSION

This study shows an association between nNOS gene polymorphism and OCD. Exact mechanisms by which nNOS gene variants contribute to OCD pathogenesis need to be further investigated.

An Integrative Approach to Treatment-Resistant Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.

The importance of the excitatory amino acid transporter 3 (EAAT3)

The neuronal excitatory amino acid transporter 3 (EAAT3) is fairly ubiquitously expressed in the brain, though it does not necessarily maintain the same function everywhere. It is important in maintaining low local concentrations of glutamate, where its predominant post-synaptic localization can buffer nearby glutamate receptors and modulate excitatory neurotransmission and synaptic plasticity. It is also the main neuronal cysteine uptake system acting as the rate-limiting factor for the synthesis of glutathione, a potent antioxidant, in EAAT3 expressing neurons, while on GABAergic neurons, it is important in supplying glutamate as a precursor for GABA synthesis. Several diseases implicate EAAT3, and modulation of this transporter could prove a useful therapeutic approach. Regulation of EAAT3 could be targeted at several points for functional modulation, including the level of transcription, trafficking and direct pharmacological modulation, and indeed, compounds and experimental treatments have been identified that regulate EAAT3 function at different stages, which together with observations of EAAT3 regulation in patients is giving us insight into the endogenous function of this transporter, as well as the consequences of altered function. This review summarizes work done on elucidating the role and regulation of EAAT3.

Evaluation of oxidative metabolism and oxidative DNA damage in patients with obsessive-compulsive disorder

AIMS

There are limited published data about the role of oxidative stress in the pathophysiology of obsessive-compulsive disorder (OCD). In addition, oxidative stress and oxidative DNA damage have not been investigated together in OCD. In this study, we aimed to evaluate oxidative stress and oxidative DNA damage in patients with OCD.

METHODS

Forty-two patients with OCD who were diagnosed in the Psychiatry Clinic of Gaziantep University and 38 healthy volunteers were enrolled in the study. Serum 8-hydroxideoxiguanosine (8-OHdG), total antioxidant status, total oxidant status evaluation and oxidative stress index calculation were conducted in Gaziantep University Biochemical Laboratory.

RESULTS

There were no significant differences in the total antioxidant status, total oxidant status and oxidative stress index levels between the patients and control group. However, 8-OHdG levels were significantly higher in OCD patients than controls (P = 0.022). In addition, 8-OHdG levels were significantly lower in patients who took treatment than in patients who were newly diagnosed (P = 0.016).

CONCLUSIONS

In our study, we found that oxidative DNA damage increased in OCD patients even though oxidative stress was normal. In addition, DNA damage was lower in patients who were treated compared to those without treatment.

Gray and white matter volume abnormalities in generalized anxiety disorder by categorical and dimensional characterization

Increasing efforts have been made to investigate the underlying pathophysiology of generalized anxiety disorder (GAD), but only limited consistent information is available on gray (GM) and white matter (WM) volume changes in affected adults. Additionally, few studies employed dimensional approaches to GAD pathology. This study compares structural brain imaging data from n=19 GAD subjects and n=24 healthy comparison (HC) subjects, all medication-free and matched on age, sex and education. Separate categorical and dimensional models were employed using voxel-based morphometry for GM and WM. Significantly higher GM volumes were found in GAD subjects mainly in basal ganglia structures and less consistently in the superior temporal pole. For WM, GAD subjects showed significantly lower volumes in the dlPFC. Largely consistent findings in dimensional and categorical models point toward these structural alterations being reliable and of importance for GAD. While lower volume in the dlPFC could reflect impaired emotional processing and control over worry in GAD, basal ganglia alterations may be linked to disturbed gain and loss anticipation as implicated in previous functional GAD studies. As perturbations in anticipation processes are central to GAD, these areas may warrant greater attention in future studies.

Neurobiology of rodent self-grooming and its value for translational neuroscience

Self-grooming is a complex innate behaviour with an evolutionarily conserved sequencing pattern and is one of the most frequently performed behavioural activities in rodents. In this Review, we discuss the neurobiology of rodent self-grooming, and we highlight studies of rodent models of neuropsychiatric disorders--including models of autism spectrum disorder and obsessive compulsive disorder--that have assessed self-grooming phenotypes. We suggest that rodent self-grooming may be a useful measure of repetitive behaviour in such models, and therefore of value to translational psychiatry. Assessment of rodent self-grooming may also be useful for understanding the neural circuits that are involved in complex sequential patterns of action.

Association between genetic variants related to glutamatergic, dopaminergic and neurodevelopment pathways and white matter microstructure in child and adolescent patients with obsessive-compulsive disorder

BACKGROUND

Alterations in white matter (WM) integrity observed in patients with obsessive-compulsive disorder (OCD) may be at least partly determined genetically. Neuroimaging measures of WM microstructure could serve as promising intermediate phenotypes for genetic analysis of the disorder. The objective of the present study was to explore the association between variability in genes related to the pathophysiology of OCD and altered WM microstructure previously identified in child and adolescent patients with the disease.

METHODS

Fractional anisotropy (FA) and mean diffusivity (MD) measured by diffusion tensor imaging (DTI) and 262 single nucleotide polymorphisms (SNPs) in 35 candidate genes were assessed concomitantly in 54 child and adolescent OCD patients.

RESULTS

Six polymorphisms located in the glutamate transporter gene (SLC1A1 rs3087879), dopamine transporter gene (SLC6A3 rs4975646), dopamine receptor D3 (DRD3 rs3773679), nerve growth factor receptor gene (NGFR rs734194 and rs2072446), and cadherin 9 gene (CDH9 rs6885387) showed significant p-values after Bonferroni correction (p≤0.00019). More specifically, the vast majority of these associations were detected with MD in the right and left anterior and posterior cerebellar lobes.

LIMITATIONS

Patients were under pharmacological treatment at the time of the DTI examination. Sample size is limited.

CONCLUSIONS

The results provide the first evidence of the involvement of genetic variants related to glutamatergic, dopaminergic, and neurodevelopmental pathways in determining the WM microstructure of child and adolescent patients with OCD, which could be related to the neurobiology of the disorder.

Developmental emergence of an obsessive-compulsive phenotype and binge behavior in rats

RATIONALE

Obsessive-compulsive disorder (OCD) gradually emerges and reaches clinical significance during early adulthood. Whether a predisposition for OCD manifests as binge eating disorder earlier during adolescence is proposed.

OBJECTIVES

To further characterize how OCD-like behaviors increase across maturation and to determine whether an OCD-like predisposition increases the likelihood of binge eating during adolescence.

METHODS

Male and female Sprague-Dawley rats were injected with the tricyclic antidepressant clomipramine (CMI, 15 mg/kg) or saline vehicle twice daily between postnatal days 9-15. Both groups were tested for perseverative (spontaneous alternation) and anxiety-like (elevated plus maze; marble burying) behaviors during juvenility (day 28), adolescence (day 60), and adulthood (day 90). Both motivations to eat sucrose pellets and binge eating on fat were investigated.

RESULTS

Sex- and age-dependent increases in anxiety-like and perseverative behavior were observed in CMI subjects. Differences in consummatory behaviors emerged during late adolescence, while no significant differences in alternation or anxiety-like behaviors were detected between CMI and vehicle animals until adulthood. Adolescent CMI females consumed more sucrose pellets in 30 min relative to vehicle females, whereas adolescent CMI males consumed approximately half as much as vehicle males. Sucrose consumption did not differ between groups in adulthood. Adolescent CMI rats demonstrated more fat bingeing than vehicles, independent of sex.

CONCLUSIONS

OCD-like behaviors are emerging during adolescence, but sucrose consumption and fat bingeing in CMI-treated animals significantly precedes the appearance of anxiety and perseveration. This OCD-like phenotype emerges fully during adulthood, suggesting that eating may likely serve as a coping strategy in these animals.

Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder

BACKGROUND

This open trial was conducted to evaluate the effectiveness of intravenous clomipramine (CMI) in refractory obsessive-compulsive disorder (OCD).

METHODS

Thirty OCD poor responders to previous multiple trials of anti-obsessive medications were selected and admitted to the hospital. Severity of the illness and response to treatment were primarily assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). CMI was gradually administered intravenously for one week. All patients were thereafter switched to oral CMI with a maximum dose of 225 mg/day.

RESULTS

The Y-BOCS total score mean at admission was in the severe range (24-31), and dropped on discharge and follow-ups to the moderate range (16-23). At discharge, 23 patients (76.7%) had a decrease in Y-BOCS ≥ 25% and were considered responders, while only 18 (60%) were still responders at 24 weeks. No relevant persistent side effects were reported.

CONCLUSION

Intravenous clomipramine could be of benefit for severe OCD cases that have not adequately responded to several therapies, including oral clomipramine.

Activation of serotonin 5-HT2A receptors inhibits high compulsive drinking on schedule-induced polydipsia

RATIONALE

Schedule-induced polydipsia (SIP) is an established model for studying compulsive behaviour in rats. Serotoninergic drugs effectively reduce compulsive drinking on SIP, and high compulsive drinker rats selected by SIP have shown differences in serotoninergic brain activity. However, the specific serotoninergic receptors that modulate compulsive SIP remain unclear.

OBJECTIVE

We investigated the functional role of serotonin 5-hydroxytryptamine 2A or C (5-HT2A/C) receptors in compulsive SIP behaviour.

METHODS

Rats were selected for low (LD) versus high drinking (HD) behaviour on SIP. The effects of the systemic administration of the selective serotonin reuptake inhibitor citalopram, selective norepinephrine reuptake inhibitor atomoxetine, serotonin 5-HT2A/C receptor agonist DOI hydrochloride ((±)-2,5-dimethoxy-4-iodoamphetamine), serotonin 5-HT2C receptor antagonist SB242084, serotonin 5-HT2A receptor antagonist ketanserin and M100907 were assessed on SIP. Subsequently, the effects of DOI were tested after the pre-administration of SB242084, ketanserin and M100907 on SIP.

RESULTS

Citalopram and DOI reduced compulsive drinking in HD compared with LD rats on SIP. In contrast, SB242084 increased compulsive drinking in HD compared with LD rats on SIP. Atomoxetine, ketanserin and M100907 had no effect on SIP. The reduction in water intake produced by DOI was blocked by ketanserin and M100907, but not by SB242084 administration, in HD rats.

CONCLUSIONS

These findings highlight the contribution of serotoninergic 5-HT2A/C receptors compared with noradrenergic mechanisms on SIP and reveal the "therapeutic" activation of serotonin 5-HT2A in the inhibition of the compulsive drinking behaviour in HD rats. Thus, it may represent a potentially new marker of vulnerability and provides additional insight for potential treatments on compulsive behaviours in neuropsychiatric populations.

Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature

Second generation antipsychotics (SGAs) have been implicated in the de novo emergence and exacerbation of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Among SGAs, clozapine, olanzapine, and risperidone are the most prominent agents associated with these sequelae, according to case reports. Comorbid OCS can impede recovery by compromising treatment benefits, medication compliance, and clinical prognoses. Previous reviews of SGA-induced OCS have predominantly focused on descriptive case reports, with limited attention paid toward experimental findings. To address this paucity of data, we sought to review the effects of SGAs on OCS in schizophrenia in the experimental literature, while addressing the role of different treatment (duration, dose, serum levels) and pharmacogenetic factors. Our findings suggest that clozapine confers the greatest risk of OCS in schizophrenia, with 20 to 28% of clozapine-treated patients experiencing de novo OCS, in addition to 10 to 18% incurring an exacerbation of pre-existing OCS. Clozapine can also yield full threshold obsessive-compulsive disorder (OCD), in some cases. Olanzapine is another high risk drug for secondary OCS which occurs in 11 to 20% of schizophrenic patients receiving olanzapine therapy. At this time, there is insufficient experimental evidence to characterize the effects of other SGAs on OCS. Despite some experimental support for the involvement of longer treatment duration and genetic factors in mediating drug-induced OCS, more research is needed to clearly elucidate these associations. Based on these results, schizophrenic patients should be routinely monitored for OCS throughout the course of SGA treatment, particularly when clozapine or olanzapine is administered.