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Hobson A. The role of the district nurse providing care to service users with obsessive compulsive disorder. Br J Community Nurs 2024; 29:432-436. [PMID: 39240802 DOI: 10.12968/bjcn.2024.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
Service users living with Obsessive compulsive disorder (OCD) often delay or avoid seeking diagnosis or treatment because of a fear of judgement or feelings of shame associated with their obsessions and compulsions. They may feel that their behaviour defies societal norms, which can lead to social isolation, and in turn, further contribute to health inequality. When such individuals present with physical illness and are seen by district nurses, it is imperative that behaviours are understood and approached appropriately. It is important to develop therapeutic relationships and consider their holistic wellbeing. Developing a close working relationship with the mental health team as a multidisciplinary team and using the team as a resource may contribute to the overall health outcome of service users with OCD.
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Affiliation(s)
- Amanda Hobson
- Community Specialist Practitioner Apprentice 23/24, Oldham, East Cluster, Northern Care Alliance, NHS England
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Holmberg A, Martinsson L, Lidin M, Rück C, Mataix-Cols D, Fernández de la Cruz L. General somatic health and lifestyle habits in individuals with obsessive- compulsive disorder: an international survey. BMC Psychiatry 2024; 24:98. [PMID: 38317127 PMCID: PMC10840209 DOI: 10.1186/s12888-024-05566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has been associated with a broad range of health-related issues. Unhealthy lifestyle habits such as physical inactivity, an unhealthy diet, smoking, and alcohol consumption are hypothesized to contribute to this association. However, the lifestyle habits of individuals with OCD have been scarcely investigated. In this international survey, we explored the physical health and lifestyle habits of adults with a self-reported diagnosis of OCD. METHODS An online global survey available in seven languages was disseminated through interest organizations and social media between July 2021 and March 2022. The survey included questions relating to socio-demographic variables and clinical characteristics (including OCD symptom severity - as measured with the 12-item self-report scale Obsessive-Compulsive Inventory [OCI-12] - and psychotropic medication), physical health, and lifestyle habits. Frequencies and percentages, or means and standard deviations, as appropriate, were calculated. Subgroup analyses by OCD symptom severity, gender, and age group were performed. RESULTS A total of 496 individuals with OCD completed the survey and were included in the analyses (mean age = 36.0 years, SD = 12.5, range 18-79; 78.8% women). Most participants were from Europe (n = 245, 49.4%) and North America (n = 187, 37.7%). OCD symptom severity scores were on the moderate range (OCI-12 mean score = 21.2, SD = 9.1). A majority (n = 354, 71.4%) reported having comorbid somatic health issues, mainly allergies, gastrointestinal conditions, and cardiometabolic conditions. Nearly half of the sample (n = 236, 47.6%) reported a body mass index ≥ 25, corresponding to at least overweight. A significant proportion of the participants reported low physical activity (n = 271, 55.0%), unhealthy dietary habits (n = 182, 36.7%), risk consumption of alcohol (n = 111, 22.3%), and non-restorative sleep (n = 268, 54.0%). Subgroup analyses showed overall similar results across groups, with some exceptions. CONCLUSIONS In this sample, individuals with OCD self-reported a range of health-related issues and a number of unhealthy lifestyle behaviors, most prominently a lack of physical activity. Interventions aimed at modifying unhealthy lifestyles to prevent or improve health conditions beyond the psychiatric symptoms should be considered.
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Affiliation(s)
- Anna Holmberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden.
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Lina Martinsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Matthias Lidin
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22B, 8th floor, Stockholm, 113 30, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Khalkhali M, Rasekh K, Eslamdoust-Siahestalkhi F, Farrahi H, Zare R. Metabolic syndrome in patients with obsessive-compulsive disorder. Front Psychiatry 2023; 14:1164750. [PMID: 37649560 PMCID: PMC10464910 DOI: 10.3389/fpsyt.2023.1164750] [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] [Received: 02/18/2023] [Accepted: 06/15/2023] [Indexed: 09/01/2023] Open
Abstract
Objective Metabolic syndrome (MetS) is a collection of chemical and clinical risk factors. Patients with obsessive-compulsive disorder (OCD) might be at risk of MetS. This study aimed to investigate the prevalence and clinical correlates of MetS in an Iranian clinical sample of patients with OCD. Methods We included 107 patients with OCD in a cross-sectional study. Demographic and clinical characteristics including OC symptoms, duration of treatment, age of onset, medications history, and comorbidity with other psychiatric disorders were collected. Results The prevalence of MetS was 39.2%. Abdominal obesity was the most frequent component of MetS (68.2%), followed by low high-density lipoprotein cholesterol (50.5%). High serum triglycerides, high fasting serum glucose, high systolic blood pressure, and high diastolic blood pressure were observed in 47.7, 20.6, 18.7, and 9.3% of patients, respectively. Patients with MetS were older, married, had a low education level, had a high body mass index, and had no aggressive OC symptoms. MetS was not associated with psychiatric disorders comorbidities, age of onset, and duration of treatment. Conclusion The results of this study were in line with the results of other studies that reported the poor health status of patients with OCD. A large number of patients are affected or are at risk of developing MetS. These patients need medical care along with the usual OCD treatments.
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Affiliation(s)
- Mohammadrasoul Khalkhali
- Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kiarash Rasekh
- Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Eslamdoust-Siahestalkhi
- Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hassan Farrahi
- Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Roghaye Zare
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Conradi-Hünerman-Happle Syndrome and Obsessive-Compulsive Disorder: a clinical case report. BMC Psychiatry 2023; 23:87. [PMID: 36747187 PMCID: PMC9900547 DOI: 10.1186/s12888-023-04579-1] [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] [Received: 11/05/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Obsessive-Compulsive Disorder (OCD) is a common and chronic psychiatric disorder with significant morbidity characterized by intrusive, uncontrollable and reoccurring thoughts (i.e., obsessions) and/or ritualistic behaviours (i.e., compulsions). Conradi-Hünerman-Happle Syndrome (CHHS) is a rare inherited X-linked dominant variant of chondrodysplasia punctata, a heterogeneous group of rare bone dysplasias characterized by punctate epiphyseal calcifications of complex etiology and pathophysiology that remain to be defined. Available literature reveals a lacuna in regards to the coexistence of the entities with no clinical reports described. CASE PRESENTATION A 12 year old female patient with diagnosis of CHHS, presents to psychiatric consultation due to aggravation of her OCD clinical picture, with aggravation of hand-washing frequency during the Covid-19 pandemic with significant functional impact. Psychopharmacological treatment aimed at OCD with Selective Serotonin Reuptake Inhibitor (SSRI) and antipsychotic was instituted with favourable, albeit partial response. CONCLUSIONS The authors aim to describe a clinical case in which the patient presents with Conradi-Hünerman-Happle Syndrome and Obsessive-Compulsive Disorder. Clinical descriptions of CHHS and OCD are not available in the literature. Through this case description the authors aim to present a rare case as well as discuss an eventual association between etiology and/or pathophysiology of the two disorders.
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Bakhshaie J, Storch EA, Rogers AH, Zvolensky MJ. Pain Intensity Moderates the Association between Obsessive-Compulsive Symptoms and Problematic Alcohol Use among Emerging Adults. J Dual Diagn 2023; 19:16-25. [PMID: 36576218 DOI: 10.1080/15504263.2022.2157181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Emerging adulthood is a vulnerable period for problematic alcohol use, defined by a pattern of use associated with physical and functional impairment. Obsessive-compulsive psychopathology, which demonstrates high rates of onset in emerging adults, seems to be related to problematic alcohol use in this age group, consistent with research among the general population suggesting an association between emotional disorders and alcohol use in the context of coping drinking motives. Pain intensity, another risk factor of problematic alcohol use, may link obsessive-compulsive symptoms to problematic alcohol use among emerging adults. Therefore, the current study examined the moderating role of pain intensity on the association between obsessive-compulsive symptoms and problematic alcohol use among emerging adults. Methods: Participants were 198 college students (81.30% female, Mage = 22.33, SD = 4.38) who reported problematic alcohol use. Results: Results from the current study supported a significant moderation role of pain intensity for the association between obsessive-compulsive symptoms and problematic alcohol use, whereby the association between obsessive-compulsive symptoms and problematic alcohol use was stronger for emerging adults with high compared to low pain intensity. Conclusions: These results highlighted a clinically-relevant interaction between obsessive-compulsive symptoms and pain intensity concerning the risk of problematic alcohol use among emerging adults as a vulnerable population.
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Affiliation(s)
- Jafar Bakhshaie
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,HEALTH Institute, University of Houston, Houston, Texas, USA
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Abstract
Obsessive-compulsive disorder (OCD) has a bidirectional relationship with metabolic disorders. The purposes of this review are to decipher the links between OCD and metabolic disorders and to explore the etiological mechanism of OCD in metabolism, which may aid in early identification of and tailored interventions for OCD and metabolic disorders.
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Fontenelle LF, Nicolini H, Brakoulias V. Early intervention in obsessive-compulsive disorder: From theory to practice. Compr Psychiatry 2022; 119:152353. [PMID: 36341748 DOI: 10.1016/j.comppsych.2022.152353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/03/2022] [Accepted: 10/24/2022] [Indexed: 01/31/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is frequent and often disabling. Yet, correct diagnosis and appropriate treatment implementation are usually delayed, with undesirable consequences. In this paper we review the rationale for early intervention in OCD and provide recommendations for early intervention services. Two scenarios are discussed, i.e., subclinical (prodromal) obsessive-compulsive symptoms (OCS) and full-blown OCD. Although the typical patient with OCD reports a long history of subclinical OCS, longitudinal studies suggest most individuals with OCS in the community do not convert to full-blown OCD. Thus, research on "at risk" phenotypes for OCD and how they should incorporate different risk factors (e.g., polygenic risk scores) are badly needed. For this specific scenario, preventative treatments that are cheap, well tolerated and highly scalable (e.g., lifestyle interventions) are of major interest. On the other hand, increasing evidence suggests OCD to be a progressive disorder and the severity and duration of illness to be associated with both biological changes and increased clinical complexity, including greater number of physical and psychiatric comorbidities, increased family accommodation and worse treatment response. Therefore, prompt identification and early treatment implementation for full-blown OCD are also critical for ethical, clinical and therapeutic reasons. Based on the existing findings, we argue that, regardless of focusing on subclinical OCS or clinical OCD, early intervention services need to target a childhood age group. In addition to delivering well established treatments to people with full-blown OCD early on their illness, early intervention services also need to provide psychoeducation for patients, families and teachers.
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Affiliation(s)
- Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
| | - Humberto Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico; Clinical Research, Carracci Medical Group, Mexico City, Mexico
| | - Vlasios Brakoulias
- Western Sydney Obsessive-Compulsive and Related Disorders Service, Western Sydney Local Health District Mental Health Service, Sydney, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Proietti L, Aguglia A, Amerio A, Costanza A, Fesce F, Magnani L, Serafini G, Amore M. The efficacy of brief strategic therapy in treating obsessive-compulsive disorder: a case series. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022271. [PMID: 36134720 PMCID: PMC10510989 DOI: 10.23750/abm.v93is1.13064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIM International guidelines indicate pharmacological therapy and cognitive-behavioral therapy (CBT) as gold standard treatments for obsessive-compulsive disorder (OCD). However, up to 40% patients do not fully respond to CBT, thus manifesting persistent symptomatology. Empirical research reported brief strategic therapy (BST) as a potential treatment for OCD. The aim of the present study is to evaluate the efficacy of BST in treating OCD and to identify the clinical characteristics associated to response. METHODS BST protocol was administered to patients with OCD. During a 24-weeks observational phase, the following scales have been administered at the baseline and every 4 weeks: Yale Brown Obsessive-Compulsive scale (Y-BOCS), Clinical Global Impression, Global Assessment of Functioning, Quality of Life Index, Medical Outcomes Study Short Form 12-item, Clinical Outcomes in Routine Evaluation-Outcome Measure, Generalized Anxiety Disorder Scale, Patient Health Questionnaire - 9 and Somatic Symptom Scale-8. RESULTS eight patients completed the treatment and a subgroup of five patients obtained clinical remission, defined as Y-BOCS total score < 25. The repeated measures ANOVA performed showed a significant decreased of the Y-BOCS total scores (p<.001). Comparisons between the two subgroups (remitters vs. non-remitters) highlighted some potential baseline characteristics associated with remission: i.e., higher mean level of anxiety, quality of life, physical health, and lower mean level of somatic symptoms and lower prevalence of personality disorders comorbidity. CONCLUSIONS BST could be a useful therapeutic strategy in treating OCD patients. Further studies with larger samples and with long-term follow-up are needed to assess the post-treatment maintenance of clinical effects.
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Baykal D, Kutlu L, Demir BD. The correlation between nursing students' healthy lifestyle behaviors, cardiovascular disease risk factors' knowledge level, and obsession symptoms. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:281. [PMID: 36325215 PMCID: PMC9621382 DOI: 10.4103/jehp.jehp_902_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nursing students have a role in the awareness of risk factors in the development of healthy lifestyle behaviors. Nursing students' awareness of disease risk factors plays a role in developing healthy lifestyle behaviors. Therefore, it was aimed to determine the relationship between the effect of nursing students' healthy lifestyle behaviors and cardiovascular disease risk factors' knowledge levels and obsessive-compulsive symptoms. MATERIALS AND METHODS This was a descriptive cross-sectional study. Two hundred and twenty-four students studying in the nursing departments of two foundation universities participated in the study between April and October 2020. Sociodemographic information form, Health Promoting Lifestyle Profile II (HPLP-II), Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL), and Maudsley Obsessive-Compulsive Inventory (MOCI) were applied to the students. RESULTS It was found that the nursing students' healthy lifestyle behaviors (123.53 ± 25.78) and cardiovascular risk factors' knowledge level (21.08 ±± 2.70) were high. Obsessive-compulsive symptoms (16.12 ± 6.22) were moderate. In the correlation of sociodemographic characteristics, it was found that age correlated with the nutrition subdimension of CARRF-KL and HPLP-II, income level correlated with HPLP-II, place of residence correlated with HPLP-II, CARRF-KL, and MOCI, and having a health problem correlated with health responsibility. Income status, place of residence, and presence of health problems were found to be correlated with HPLP-II in all subdimensions in the regression analysis. In the regression analysis of HPLP-II with CARRF-KL and MOCI scales, it was found that it was significantly related to interpersonal relations, spiritual growth, stress management, and total score dimensions. CONCLUSION Healthy lifestyle behaviors of nursing students are related to cardiovascular risk factors' knowledge level and obsession symptoms. In addition, some demographic characteristics affect healthy lifestyle behaviors.
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Affiliation(s)
- Dilek Baykal
- Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Leman Kutlu
- Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Burcu D. Demir
- Department of Nursing, Faculty of Health Sciences, Arel University, Istanbul, Turkey
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Grassi G, Figee M, Pozza A, Dell'Osso B. Obsessive-compulsive disorder, insulin signaling and diabetes - A novel form of physical health comorbidity: The sweet compulsive brain. Compr Psychiatry 2022; 117:152329. [PMID: 35679658 DOI: 10.1016/j.comppsych.2022.152329] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While a growing body of research highlights a bi-directional link between diabetes and mood disorders, little is known about the relationship between diabetes and obsessive-compulsive disorder (OCD). The aim of the present review is to investigate current evidence linking OCD, insulin-signaling and diabetes. METHODS A PubMed search was conducted to review all the available studies assessing diabetes, glucose metabolism and insulin-signaling in OCD patients and vice versa. RESULTS Some clinical and epidemiological studies show a higher prevalence of diabetes in OCD and vice versa compared to the general population. Animal and genetic studies suggest a possible role of insulin-signaling in the pathophysiology of OCD. Deep brain stimulation (DBS) studies suggest that abnormal dopaminergic transmission in the striatum may contribute to impaired insulin sensitivity in OCD. While DBS seems to increase insulin sensitivity, a possible protective role of serotonin reuptake-inhibitors on diabetic risk needs further studies. CONCLUSION Despite their preliminary nature, these data highlight the importance of further investigations aimed at assessing metabolic features in OCD patients and OCD symptoms in diabetes patients to understand the impact of each condition on the pathophysiology and course of the other. Understanding the role of insulin in the obsessive-compulsive brain could open new treatment pathways for OCD.
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Affiliation(s)
| | - Martijn Figee
- Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, USA
| | | | - Bernardo Dell'Osso
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Sacco-Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
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Fernández de la Cruz L, Isomura K, Lichtenstein P, Rück C, Mataix-Cols D. Morbidity and mortality in obsessive-compulsive disorder: A narrative review. Neurosci Biobehav Rev 2022; 136:104602. [PMID: 35271916 DOI: 10.1016/j.neubiorev.2022.104602] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
Current knowledge on the general somatic health of individuals with obsessive-compulsive disorder (OCD) is very limited. Here, we critically review the emerging literature on the topic. Rapidly accumulating evidence indicates an association between OCD and autoimmune diseases, which is not limited to streptococcus-related conditions. Similarly, an association with metabolic and circulatory system diseases has been reported, which is at least partially independent from psychiatric comorbidities and familial confounders. Preliminary results also suggest potential links with dementia, insomnia, respiratory diseases, gastrointestinal diseases, migraine, and chronic pain, but replication is warranted. The risk of death by suicide in OCD is now well established. OCD has also been associated to increased mortality due to natural causes, but more research on specific causes of death is needed. Clarification of the mechanisms behind the observed associations will be critical to inform the rational design of prevention efforts. In the meantime, while OCD symptom reduction remains a priority, clinicians should also focus on monitoring the general health and promoting healthy lifestyles of persons with OCD.
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Affiliation(s)
- Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Abdin E, Chong SA, Vaingankar JA, Shafie S, Seah D, Chan CT, Ma S, James L, Heng D, Subramaniam M. Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016. Singapore Med J 2022; 63:196-202. [PMID: 32798362 PMCID: PMC9251260 DOI: 10.11622/smedj.2020124] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore
| | - Darren Seah
- Family Medicine Department, National Healthcare Group Polyclinics, Singapore
| | - Chun Ting Chan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
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Caldirola D, Daccò S, Cuniberti F, Grassi M, Lorusso S, Diaferia G, Perna G. Elevated C-reactive protein levels across diagnoses: The first comparison among inpatients with major depressive disorder, bipolar disorder, or obsessive-compulsive disorder. J Psychosom Res 2021; 150:110604. [PMID: 34521061 DOI: 10.1016/j.jpsychores.2021.110604] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We addressed elevated C-reactive protein level (eCRP) specificity comparing, for the first time, eCRP (i.e., serum CRP > 3 and ≤10 mg/L) in patients with major depressive disorder (MDD), bipolar disorder (BD), or obsessive-compulsive disorder (OCD). We also assessed to what extent multiple variables that can potentially increase inflammation may have influenced eCRP in our sample. METHODS We performed a retrospective, observational, cross-sectional study using information documented in the electronic medical records (EMRs) of patients hospitalized for a 4-week psychiatric rehabilitation program. We collected all information according to the standardized procedures of the hospital's clinical practice and applied a logistic regression model (α = 0.05). RESULTS We included 388 inpatients, that is, 156 (40.2%) with MDD, 135 (34.8%) with BD, and 97 (25.0%) with OCD, and found considerable eCRP rates among them (36.5%, 47.4%, and 29.9% in MDD, BD, and OCD, respectively) but without significant differences across groups. In the whole sample, eCRP variations were only partially attributable (approximately for one-third) to potential confounders. All groups presented considerable rates of cardiovascular risk factors, and we classified most patients as having medium or high CRP-based cardiovascular risk. CONCLUSION This first study comparing eCRP in MDD, BD, and OCD suggests that eCRP may be a transdiagnostic feature of different psychiatric disorders, and other mechanisms beyond the effects of multiple confounders may explain the presence of eCRP in a substantial portion of psychiatric patients. Therefore, we encourage the routine measurement of CRP in psychiatric clinical practice.
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Affiliation(s)
- Daniela Caldirola
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy.
| | - Silvia Daccò
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
| | - Francesco Cuniberti
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
| | - Massimiliano Grassi
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
| | - Simona Lorusso
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy.
| | - Giuseppina Diaferia
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy.
| | - Giampaolo Perna
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
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14
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Kang JI, Park CI, Lin J, Kim ST, Kim HW, Kim SJ. Alterations of cellular aging markers in obsessive- compulsive disorder: mitochondrial DNA copy number and telomere length. J Psychiatry Neurosci 2021; 46:E451-E458. [PMID: 34291629 PMCID: PMC8519490 DOI: 10.1503/jpn.200238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The present study examined whether mitochondrial DNA copy number (mtDNAcn) and telomere length - key markers of cellular aging - were altered in male and female participants with obsessive-compulsive disorder (OCD) compared to healthy controls. We also tested for associations between these alterations and OCD-related clinical features and inflammatory index. METHODS A total of 235 patients with OCD (38.7% female) and 234 healthy controls (41.5% female) were included. We quantified whole-blood mtDNAcn and leukocyte telomere length using quantitative polymerase chain reaction. We also calculated the neutrophil-to-lymphocyte ratio from complete blood cell counts. RESULTS Multivariate analysis of covariance showed that OCD status had a significant overall effect on cellular aging markers in men (Wilks λ = 0.889, F2,275 = 17.13, p < 0.001) and women (Wilks λ = 0.742, F2,182 = 31.61, p < 0.001) after controlling for age, body mass index and childhood trauma. In post-hoc comparisons, men with OCD had lower mtDNAcn than controls (p < 0.001), but we found no between-group difference for telomere length (p = 0.55). Women with OCD had a significantly lower mtDNAcn (p < 0.001) and shortened telomere length (p = 0.023) compared to controls. Moreover, the lower mtDNAcn shown in the OCD group was significantly correlated with an increase in systemic inflammation for both sexes, as measured by neutrophil-to-lymphocyte ratio. LIMITATIONS The present cross-sectional design did not allow us to infer a causal relationship between OCD disease status and cellular aging markers. CONCLUSION The present study is, to our knowledge, the first to demonstrate alterations in mtDNAcn and telomere shortening in OCD. These results suggest that aging-associated molecular mechanisms may be important in the pathophysiology of OCD.
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Affiliation(s)
- Jee In Kang
- From the Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, S.-T. Kim, S.-J. Kim); the Department of Psychiatry, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea (Park); the Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA (Lin); and the Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea (H.-W. Kim)
| | - Chun Il Park
- From the Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, S.-T. Kim, S.-J. Kim); the Department of Psychiatry, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea (Park); the Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA (Lin); and the Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea (H.-W. Kim)
| | - Jue Lin
- From the Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, S.-T. Kim, S.-J. Kim); the Department of Psychiatry, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea (Park); the Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA (Lin); and the Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea (H.-W. Kim)
| | - Shin Tae Kim
- From the Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, S.-T. Kim, S.-J. Kim); the Department of Psychiatry, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea (Park); the Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA (Lin); and the Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea (H.-W. Kim)
| | - Hae Won Kim
- From the Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, S.-T. Kim, S.-J. Kim); the Department of Psychiatry, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea (Park); the Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA (Lin); and the Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea (H.-W. Kim)
| | - Se Joo Kim
- From the Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Kang, S.-T. Kim, S.-J. Kim); the Department of Psychiatry, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea (Park); the Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA (Lin); and the Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea (H.-W. Kim)
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15
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Freedman DE, Richter MA. A narrative review of exercise and obsessive-compulsive disorder. Gen Hosp Psychiatry 2021; 71:1-10. [PMID: 33887525 DOI: 10.1016/j.genhosppsych.2021.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Individuals with obsessive-compulsive disorder (OCD) suffer significant distress due to their condition; however, there can be multiple barriers to treatment. Even following OCD-tailored treatment, symptoms often remain. Exercise may be an effective and available approach to managing OCD, and yet, there are no specifically dedicated reviews, limiting integration into clinical practice. This study aimed to provide an overview of the literature on exercise and OCD. METHOD Four databases, the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and EMBASE, were systematically searched. 1534 records were screened and the reference lists of eligible articles were examined. For this review, 11 extracted studies were narratively explored. RESULTS Two observational and nine interventional studies were included, of which one article focused on youth and ten studies focused on adults. Physical activity likely reduces the risk of metabolic syndrome or general health conditions. Several pre-post studies demonstrated exercise's benefits for OCD symptoms, while the only randomized controlled trial showed negative findings for its efficacy in reducing obsessions and compulsions. CONCLUSIONS The evidence for aerobic exercise's long-term benefits for the symptoms of OCD is mixed, but remains promising. Potential mechanisms of exercise's effects and future directions for research are explored.
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Affiliation(s)
- David E Freedman
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada.
| | - Margaret A Richter
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada
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16
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Isomura K, Sidorchuk A, Brander G, Jernberg T, Rück A, Song H, Valdimarsdóttir UA, Lichtenstein P, Larsson H, Rück C, Mataix-Cols D, Fernández de la Cruz L. Risk of specific cardiovascular diseases in obsessive-compulsive disorder. J Psychiatr Res 2021; 135:189-196. [PMID: 33493948 DOI: 10.1016/j.jpsychires.2020.12.066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/18/2020] [Accepted: 12/29/2020] [Indexed: 02/05/2023]
Abstract
Individuals with obsessive-compulsive disorder (OCD) may have an increased risk of cardiovascular disease (CVD), but evidence for specific types of CVD is limited. This population-based, sibling-controlled cohort study investigated the risk of specific CVD in individuals with OCD. Linking data from various Swedish population-based registers, we explored the risk of a range of CVD in a cohort of individuals diagnosed with OCD between 1973 and 2013 (n = 33,561), compared to matched (1:10) unaffected individuals (n = 335,610). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using conditional Cox proportional hazards regression models, adjusting for history of somatic diseases. To control for familial confounders, we analyzed 23,263 clusters of full siblings discordant for OCD. Individuals with psychiatric comorbidities were systematically excluded to assess the impact of these comorbidities. Over an average follow-up time of 27 years, OCD was associated with an increased risk of a broad range of CVD (adjusted HR [aHR] for any CVD = 1.25 [95% confidence interval [CI], 1.22-1.29]). These associations were strongest for the subtypes venous thrombo-embolism (aHR = 1.48 [95% CI, 1.38-1.58]) and heart failure (aHR = 1.37 [95% CI, 1.28-1.46]). When comparing OCD-exposed individuals with their non-exposed full siblings, results were largely similar. Exclusion of several groups of psychiatric comorbidities resulted in comparable results, albeit attenuated. Individuals with OCD have a moderately increased risk of CVD-related morbidity, independent from history of somatic diseases, familial confounders, and psychiatric comorbidities. The time may be ripe for the development and evaluation of lifestyle interventions to help reduce the risk of cardiovascular morbidity in OCD.
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Affiliation(s)
- Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gustaf Brander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Department of Medical Biochemistry and Microbiology, Uppsala Universitet, Uppsala, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Huan Song
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
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17
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Nutley SK, Camacho MR, Eichenbaum J, Nosheny RL, Weiner M, Delucchi KL, Mackin RS, Mathews CA. Hoarding disorder is associated with self-reported cardiovascular / metabolic dysfunction, chronic pain, and sleep apnea. J Psychiatr Res 2021; 134:15-21. [PMID: 33360440 PMCID: PMC8108138 DOI: 10.1016/j.jpsychires.2020.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/20/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Hoarding behaviors are positively associated with medical morbidity, however, current prevalence estimates and types of medical conditions associated with hoarding vary. This analysis aims to quantify the medical morbidity of hoarding disorder (HD). Cross-sectional data were collected online using the Brain Health Registry (BHR). Among 20,745 participants who completed the Hoarding and Clutter and Medical History thematic modules, 1348 had HD (6.5%), 1268 had subclinical HD (6.1%), and 18,829 did not meet hoarding criteria (87.4%). Individuals with HD were more likely to report a lifetime history of cardiovascular/metabolic conditions: diabetes (HD adjusted odds ratio (AOR):1.51, 95% confidence interval (CI):[1.20, 1.91]; subclinical HD AOR:1.24, 95% CI:[0.95, 1.61]), and hypercholesterolemia (HD AOR:1.24, 95% CI:[1.06, 1.46]; subclinical HD AOR:1.11, 95% CI:[0.94, 1.31]). Those with HD and subclinical HD were also more to report chronic pain (HD AOR: 1.69, 95% CI:[1.44, 1.98]; subclinical HD AOR: 1.44, 95% CI:[1.22, 1.69]), and sleep apnea (HD AOR: 1.58, 95% CI:[1.31, 1.89]; subclinical HD AOR:1.30, 95% CI:[1.07, 1.58]) than non-HD participants. For most conditions, likelihood of diagnosis did not differ between HD and subclinical HD. Structural equation modeling revealed that more severe hoarding symptomatology was independently associated with increased cardiovascular/metabolic vulnerability. The assessment and management of medical complications in individuals with HD is a fundamental component in improving quality of life, longevity, and overall physical health outcomes.
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Affiliation(s)
- Sara K Nutley
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Monica R Camacho
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA.
| | - Joseph Eichenbaum
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Radiology, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Rachel L Nosheny
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Michael Weiner
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Radiology, 505 Parnassus Ave, San Francisco, CA, 94143, USA; University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Kevin L Delucchi
- University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - R Scott Mackin
- San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA, 94121, USA; University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Carol A Mathews
- University of Florida, Department of Psychiatry, 100 Newell Dr, Gainesville, FL, 32610, USA.
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18
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Fusar-Poli L, Amerio A, Cimpoesu P, Natale A, Salvi V, Zappa G, Serafini G, Amore M, Aguglia E, Aguglia A. Lipid and Glycemic Profiles in Patients with Bipolar Disorder: Cholesterol Levels Are Reduced in Mania. ACTA ACUST UNITED AC 2020; 57:medicina57010028. [PMID: 33396922 PMCID: PMC7824186 DOI: 10.3390/medicina57010028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Abstract
Background and Objectives: Bipolar disorder (BD) is a severe mental condition with a lifetime prevalence estimated around 2% among the general population. Due to risk factors, etiological mechanisms, and the chronic use of psychotropic medications, people with BD are frequently affected by medical comorbidities, such as metabolic syndrome (MetS), associated with altered blood levels of glucose, cholesterol, and triglycerides. Moreover, the lipid concentration may be associated with the severity of psychiatric symptoms. Materials and Methods: Five hundred and forty-two in- and outpatients (418 affected by BD and 124 affected by schizophrenia) were recruited in two Italian university hospitals. A blood examination assessing the fasting glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides was performed. Results: No significant differences were found in the lipid and glycemic profiles between patients with BD and schizophrenia. When considering only the BD sample, we found that patients experiencing a manic episode had significantly lower total cholesterol, HDL, and LDL than euthymic patients. Moreover, the total and LDL cholesterol levels were significantly lower in (hypo)manic than depressed patients. Mood episodes did not influence the triglyceride and glucose levels in our sample. Conclusions: Clinicians should pay attention to blood cholesterol levels in patients with BD, as differences in concentrations may predispose them to severe medical conditions and can be associated with the onset of mood episodes.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
- Correspondence: ; Tel.: +39-095-378-2470
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
- Department of Psychiatry, Tufts University, Boston, MA 02111, USA
| | - Patriciu Cimpoesu
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
| | - Virginio Salvi
- Department of Clinical Neurosciences, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Guendalina Zappa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, 95123 Catania, Italy; (A.N.); (E.A.)
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16123 Genoa, Italy; (A.A.); (P.C.); (G.Z.); (G.S.); (M.A.); (A.A.)
- IRCCS Ospedale Policlinico San Martino, 16123 Genoa, Italy
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19
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Pozza A, Veale D, Marazziti D, Delgadillo J, Albert U, Grassi G, Prestia D, Dèttore D. Sexual dysfunction and satisfaction in obsessive compulsive disorder: protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:8. [PMID: 31918750 PMCID: PMC6953228 DOI: 10.1186/s13643-019-1262-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a chronic mental health condition recognized as one of the most serious causes of disability and impaired quality of life. In the literature, there is no review about sexual dysfunction and satisfaction in OCD. The current paper presents the protocol for a systematic review and meta-analysis aimed to summarize data (1) comparing the presence of sexual dysfunction between groups with OCD and non-clinical groups, (2) investigating prevalence of each one of the sexual dysfunctions in patients with OCD, (3) comparing risk for sexual dysfunction in OCD groups with the prevalence in control groups, (4) comparing sexual satisfaction between OCD groups and non-clinical groups, and (5) investigating moderators of sexual dysfunction in OCD groups as compared with control groups. Gender, age, marital status, OCD symptom severity and subtypes, comorbid depressive disorders, comorbid anxiety disorders, concurrent psychiatric medications, comorbid general medical disease, and study quality will be investigated as moderators. METHODS The protocol is reported according to PRISMA-P guidelines. The search will be conducted by independent reviewers during the second week of December 2019 by using electronic databases (Scopus, PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Library), by contacting the authors of the included studies to identify further data, by examining the references of the included studies, and by handsearching conference proceedings and theses/doctoral dissertations. The study quality will be independently evaluated using the Newcastle-Ottawa Quality Assessment Scale. Random-effect meta-analyses will be computed. If there is insufficient data for a specific outcome, only a systematic review will be performed. DISCUSSION This review may support clinical practice highlighting the importance of the assessment of sexuality in patients with OCD and suggesting the use of therapeutic strategies dedicated to sexuality in this clinical population with the aim of improving patients' quality of life. Potential limitations will regard the heterogeneity of the studies in terms of the instruments used to assess sexual dysfunction/satisfaction and of the definitions used to conceptualize sexual dysfunction. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42019132264.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - David Veale
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
- South London and Maudsley, NHS Trust, London, UK
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Davide Prestia
- Department of Neuroscience, Rehabilitation, Opthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa IRCCS San Martino, Genoa, Italy
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, Florence, Italy
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20
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Pozza A, Ferretti F, Coluccia A. The Perception of Physical Health Status in Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Clin Pract Epidemiol Ment Health 2019; 15:75-93. [PMID: 31819755 PMCID: PMC6882187 DOI: 10.2174/1745017901915010075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/22/2022]
Abstract
Background: Physical Health Status is a neglected outcome in clinical practice with Obsessive-Compulsive Disorder (OCD) and a systematic review is lacking. Objective: The current study presents the first systematic review and meta-analysis summarizing the evidence on (a) perceived Physical Health Status, Bodily Pain and Role Limitations due to Physical Problems in patients with OCD compared with controls, (b) age, gender, severity of OCD symptoms, study publication date, study methodological quality as moderators of perceived Physical Health Status. Methods: Case-control studies were included if they (a) compared OCD patients with healthy/general population participants as controls, and (b) used validated self-report instruments. Two reviewers searched electronic databases, contacted corresponding authors, and examined reference lists/conference proceedings/theses. Results: Fourteen studies were included. A large significant negative effect size without publication bias showed that controls reported higher perceived Physical Health Status than patients with OCD. Medium and small effect sizes favouring controls emerged for Role Limitations due to Physical Problems and Bodily Pain, respectively. Higher age, females percentage, and publication date were associated with larger effect sizes; higher OCD severity and methodological quality were associated with smaller effect sizes. Conclusion: Perceived Physical Health should be evaluated and addressed by clinicians during treatment, particularly with older, female and less severe patients. Lifestyle interventions might be implemented.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, viale Bracci 16, 53100 Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, viale Bracci 16, 53100 Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital of Siena, viale Bracci 16, 53100 Siena, Italy
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21
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Pozza A, Marazziti D, Mucci F, Dèttore D. Propensity to Sexual Response among Adults with Obsessive-Compulsive Disorder. Clin Pract Epidemiol Ment Health 2019; 15:126-133. [PMID: 31819761 PMCID: PMC6882137 DOI: 10.2174/1745017901915010126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022]
Abstract
Background: Propensity to sexual excitation and inhibition is one of the key dimensions of sexuality. Clinicians working with Obsessive-Compulsive Disorder (OCD) patients rarely assess this and other aspects of sexuality, since treatment targets generally symptom reduction. Literature on sexual functioning in OCD patients is scarce and no study has focused on symptom subtypes, nor investigated the psychological processes related to sexual response. Objective: In the present short report, we describe an exploratory study investigating the association between symptom subtypes and propensity towards sexual excitation/inhibition in OCD patients, controlling for gender, age and antidepressant treatment. Methods: Seventy-two OCD patients (mean age = 34.50 years, 37.50% women) completed the Obsessive-Compulsive Inventory-Revised and the Sexual Inhibition/Sexual Excitation Scales. Results: Patients with more severe compulsive washing habit had a lower propensity towards excitation and a higher one towards inhibition due to threat of performance consequences (i.e., contamination with sexually transmitted diseases/having an unwanted pregnancy). Patients with more severe symptoms of checking showed a higher propensity towards inhibition due to the threat of performance consequences. Gender, age and antidepressant treatment were not related to sexual functioning. Conclusion: Specific OCD symptom subtypes may be associated with some psychological processes involved in sexual response. Sexual well-being should be carefully evaluated by practitioners and should be regarded as a treatment target. Future studies should investigate more comprehensively the processes involved in sexuality.
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Affiliation(s)
- Andrea Pozza
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, Florence, Italy
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Turna J, Grosman Kaplan K, Patterson B, Bercik P, Anglin R, Soreni N, Van Ameringen M. Higher prevalence of irritable bowel syndrome and greater gastrointestinal symptoms in obsessive-compulsive disorder. J Psychiatr Res 2019; 118:1-6. [PMID: 31437616 DOI: 10.1016/j.jpsychires.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/02/2019] [Accepted: 08/08/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anxiety and mood symptoms often co-occur with gastrointestinal problems, such as irritable bowel syndrome (IBS). The extent to which these relate to Obsessive-Compulsive Disorder (OCD) is unclear, despite anxiety being a prominent symptom of this disorder. The purpose of this analysis was to examine gastrointestinal symptoms in unmedicated, non-depressed adult OCD patients compared to age- and sex-matched community controls. METHODS Twenty-one OCD patients and 22 controls were recruited from the community (Hamilton, ON, Canada) and enrolled in this cross-sectional study. In addition to a standardized psychiatric assessment, participants completed clinician- and self-rated psychiatric and gastrointestinal symptom severity measures. Presence of IBS was assessed using Rome III criteria. RESULTS Gastrointestinal symptom severity (GSRS total; OCD = 8.67 ± 6.72 vs. controls = 2.32 ± 2.12) and prevalence of IBS (OCD = 47.6%; Controls = 4.5%) was higher in OCD patients than in controls. A comparison of OCD patients based on IBS status revealed greater depressive symptom severity (total MADRS: 12.60 ± 1.89 vs 6.91 ± 2.77), p < 0.001) among those with IBS. CONCLUSIONS High prevalence and severity of gastrointestinal symptoms may be an important clinical consideration when treating OCD patients. More specifically, assessment of IBS and gastrointestinal symptoms may be useful when considering pharmacotherapeutic treatments options for patients. Given the high comorbidity noted with IBS, a disorder of the "gut-brain axis", results may suggest a shared pathophysiological mechanism between psychiatric and gastrointestinal disorders which should be explored in future research.
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Affiliation(s)
- Jasmine Turna
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada; MacAnxiety Research Centre, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Keren Grosman Kaplan
- MacAnxiety Research Centre, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Beth Patterson
- MacAnxiety Research Centre, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Premysl Bercik
- Farncombe Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Anglin
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Farncombe Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Noam Soreni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Van Ameringen
- MacAnxiety Research Centre, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
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Pozza A, Ferretti F, Coluccia A. Perceived physical health in obsessive-compulsive disorder: a protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e026261. [PMID: 31175195 PMCID: PMC6561448 DOI: 10.1136/bmjopen-2018-026261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a mental health condition associated with severe impairment in a variety of quality of life domains, an increased physical health burden, and a higher risk of general medical conditions and mortality compared with the general population. While there is a large amount of literature on psychological quality of life, a systematic review of perceived physical health in OCD is lacking. A quantitative summary might suggest that policy makers also focus the evaluation on perceived physical health and develop new strategies also aimed at this outcome. The current paper presents a protocol for the first systematic review and meta-analysis aimed at summarising perceived physical health in OCD by specifically examining perceived physical health status, bodily pain and role limitations due to physical problems in patients with OCD compared with controls. The review will also investigate potential demographic and clinical moderators of perceived physical health status (age, gender, OCD severity, publication date, methodological quality). METHODS AND ANALYSIS A systematic review and meta-analysis will be conducted according to PRISMA guidelines. Studies will be included if using a clinical group with a current primary diagnosis of OCD established by international standardised criteria, if measuring perceived physical health status, and if using screened or community participants as controls. No publication date or language restriction will be applied. An online systematic search of electronic databases (Scopus, PubMed, PsycINFO, EMBASE, Cochrane Library), and examination of conference proceedings and theses/dissertations will be conducted by independent reviewers. Risk of bias will be assessed through the Newcastle-Ottawa Scale. ETHICS AND DISSEMINATION The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER 2018 CRD42018106194.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, Siena, Italy
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Early intervention for obsessive compulsive disorder: An expert consensus statement. Eur Neuropsychopharmacol 2019; 29:549-565. [PMID: 30773387 DOI: 10.1016/j.euroneuro.2019.02.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/04/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.
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Prevalence of Obsessive-Compulsive Disorder in Patients With Schizophrenia and Outcome on Positive and Negative Symptoms, Cognition, and Quality of Life. J Nerv Ment Dis 2019; 207:239-245. [PMID: 30865076 DOI: 10.1097/nmd.0000000000000956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objectives were to examine the prevalence of obsessive-compulsive disorder (OCD) in hospitalized patients with schizophrenia and to compare the clinical, cognitive, and functional characteristics of schizophrenia patients with and without OCD. This cross-sectional study, performed between May and August 2018, enrolled 308 patients (200 men and 108 women). The prevalence of OCD in patients with schizophrenia was 3.2%. An increase in patients having a mild β was significantly associated with higher social relationship score (β = 1.68) and the Memory Functioning Scale-Informant (MFS-I) version (β = 5.67). OCD did not affect the positive and negative symptoms of these patients. The prevalence of OCD in these patients was low (3.2%). Schizophrenia patients with and without OCD have comparable clinical profiles with few exceptions. The existence of OCD may affect the social relationship quality of life and the MFS-I version.
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Duration of untreated illness and response to SRI treatment in Obsessive-Compulsive Disorder. Eur Psychiatry 2019; 58:19-26. [PMID: 30763828 DOI: 10.1016/j.eurpsy.2019.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/27/2018] [Accepted: 01/19/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The duration of untreated illness (DUI) is a potentially modifiable parameter associated with worst prognosis in several psychiatric disorders, but poorly investigated in Obsessive-Compulsive Disorder (OCD). Our aims were to estimate the mean DUI in a large sample of individuals with OCD and its impact on response to the first ever adequate SRI treatment. METHODS We retrospectively examined records of 251 patients with OCD (SCID-I, DSM-IV) who referred to our Department and were prospectively and naturalistically treated according to International Guidelines. The DUI was defined as the interval between age at onset and age at which patients received their first adequate pharmacological treatment. Response rates were compared in subjects with brief (≤24 months) versus long DUI. Logistic regression models predicting response and 12-week Y-BOCS score were run with DUI (among others) as independent variable. RESULTS The mean DUI was 106.19 ± 118.14 months, with a mean interval between onset of the disorder and when patients sought professional help of 82.27 ± 112.30 months. Response rates were significantly reduced in subjects with a long DUI, using both the cut-off of 24 months and the median value of 60 months. Regression analyses confirmed that a long (>24 months) DUI predicts poorer response and higher Y-BOCS scores at 12 weeks. CONCLUSIONS Our results, although preliminary, seem to suggest that a longer duration of untreated illness in OCD is associated with poorer outcome in terms of response to SRI treatments. It is imperative to do all the possible to shorten the DUI, both by improving access to mental health services, improving the ability of primary care physicians and mental health professionals to recognize OCD, and disseminate best-practice prescription guidelines.
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Fontenelle LF, Yücel M. A Clinical Staging Model for Obsessive-Compulsive Disorder: Is It Ready for Prime Time? EClinicalMedicine 2019; 7:65-72. [PMID: 31193644 PMCID: PMC6537549 DOI: 10.1016/j.eclinm.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/02/2023] Open
Abstract
Recent changes to the diagnostic classification of obsessive-compulsive disorder (OCD), including its removal from the anxiety/neurotic, stress-related and somatoform disorders chapters of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases 11th Revision (ICD-11), are based on growing evidence of unique pathogenic signatures and linked diagnostic and treatment approaches. In this review, we build on these recent developments and propose a 'clinical staging model' of OCD that integrates the severity of symptoms and phase of illness for personalised case management. A clinical staging model is especially relevant for the early identification and management of subthreshold OCD - a substantial and largely neglected portion of the population who, despite having milder symptoms, experience harms that may impact personal relationships, work-related functioning and productivity. Research on the pathogenesis, classification and management of such cases is needed, including the development of new outcomes measures that prove sensitive to changes in future clinical trials. Early intervention strategies in OCD are likely to yield better long-term outcomes.
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Affiliation(s)
- Leonardo F. Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Brain & Mental Health Research Hub, Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
- Corresponding author at: Rua Visconde de Pirajá, 547, 617, Ipanema, Rio de Janeiro-RJ, CEP: 22410-003, Brazil.
| | - Murat Yücel
- Brain & Mental Health Research Hub, Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
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