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Khenavandi ZA. Treatment and Family Involvement for Young Children with Obsessive-Compulsive Disorder: An Experimental Study. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2699-2700. [PMID: 38435766 PMCID: PMC10903322 DOI: 10.18502/ijph.v52i12.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 03/05/2024]
Abstract
The Article Abstract is not available.
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Affiliation(s)
- Zeynab Amini Khenavandi
- Department of Counseling, Faculty of Counseling and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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2
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Early Identification and Intervention in Pediatric Obsessive-Compulsive Disorder. Brain Sci 2023; 13:brainsci13030399. [PMID: 36979207 PMCID: PMC10046131 DOI: 10.3390/brainsci13030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and course from adult OCD. Delayed and inadequate treatment is associated with a worse prognosis, making the need for early identification and intervention in pediatric OCD very urgent. In this paper, we reflected on the current constraints that make early interventions for pediatric OCD unpromoted and reviewed the approaches with potential application for early identification and early intervention in pediatric OCD, categorized by three-level prevention stages corresponding to a clinical staging model. Since the etiology of pediatric OCD is still unclear, primary prevention is most lacking, and early interventions for pediatric OCD are currently focused on the secondary prevention stage, which aims to prevent the conversion of obsessive-compulsive symptoms into full-blown OCD; tertiary prevention mostly focuses on the alleviation of mild to moderate OCD, while interventions for co-morbidities are still in their infancy. We closed by considering the important research questions on this topic.
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Body Dysmorphic Symptoms in Youth with Obsessive-compulsive Disorder: Prevalence, Clinical Correlates, and Cognitive Behavioral Therapy Outcome. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01298-0. [PMID: 35013848 DOI: 10.1007/s10578-021-01298-0] [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] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
The aims of the study were to estimate the prevalence of body dysmorphic symptoms in a sample of children and adolescents with obsessive-compulsive disorder, possible clinical correlates and whether BDD symptoms predict poorer treatment outcomes after cognitive behavioral therapy. The study included 269 children and adolescents with OCD, aged 7-17 years, from Denmark, Sweden, and Norway, who were treated with 14 weekly sessions of manualized, exposure-based CBT. Twenty-one patients (7.8%) had BDD symptoms. BDD symptoms were associated with older age (p = 0.003) and a higher prevalence of comorbid anxiety disorders (p = 0.025). In addition, patients with BDD symptoms endorsed a greater number of OCD symptoms than did those without BDD symptoms. Having symptoms of BDD did not affect the CBT outcome on OCD. The results of the study suggest that CBT for OCD is equally effective for those with and without comorbid BDD symptoms.
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4
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Efe A, Açıkel SB, Uygun SD, Canlı M, Temeltürk RD, Gürel Y, Çetinkaya M, Çakmak FH. A Retrospective Evaluation on Demographic, Phenomenological, and Comorbidity Features of Pediatric Obsessive-Compulsive Disorder. J Nerv Ment Dis 2022; 210:6-25. [PMID: 34417423 DOI: 10.1097/nmd.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The impacts of sex, age of onset, phenotype, and comorbidity on clinical features were explored in a large clinical sample with pediatric obsessive-compulsive disorder (p-OCD) (n = 457), along with concomitant specific features in the framework of different symptom dimensions/phenotypes, by a retrospective cross-sectional evaluation design. The most prevalent phenotype was obsession/checking (almost half), and the clinical features belonging to different phenotypes varied among sexes, age of onset, severity, and comorbidities. The contamination and aggressive obsessions, along with the compulsions such as cleaning and repeating routine activities, were the most prevalent symptoms, which were prevalently accompanied by generalized anxiety disorder, attention deficit hyperactivity disorder, and depression. Females with OCD were likely prone to exhibit comorbid internalizing disorders, whereas males were prone to externalizing. This recent study on a large Turkish clinical sample of p-OCD followed up within 5 years, highlighting separate evidence on subtyping of p-OCD in phenotype and comorbidity frame.
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Affiliation(s)
- Ayşegül Efe
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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5
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Straathof M, Blezer ELA, Smeele CE, van Heijningen C, van der Toorn A, Buitelaar JK, Glennon JC, Otte WM, Dijkhuizen RM. Memantine treatment does not affect compulsive behavior or frontostriatal connectivity in an adolescent rat model for quinpirole-induced compulsive checking behavior. Psychopharmacology (Berl) 2022; 239:2457-2470. [PMID: 35419637 PMCID: PMC9293859 DOI: 10.1007/s00213-022-06139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE Compulsivity often develops during childhood and is associated with elevated glutamate levels within the frontostriatal system. This suggests that anti-glutamatergic drugs, like memantine, may be an effective treatment. OBJECTIVE Our goal was to characterize the acute and chronic effect of memantine treatment on compulsive behavior and frontostriatal network structure and function in an adolescent rat model of compulsivity. METHODS Juvenile Sprague-Dawley rats received repeated quinpirole, resulting in compulsive checking behavior (n = 32; compulsive) or saline injections (n = 32; control). Eight compulsive and control rats received chronic memantine treatment, and eight compulsive and control rats received saline treatment for seven consecutive days between the 10th and 12th quinpirole/saline injection. Compulsive checking behavior was assessed, and structural and functional brain connectivity was measured with diffusion MRI and resting-state fMRI before and after treatment. The other rats received an acute single memantine (compulsive: n = 12; control: n = 12) or saline injection (compulsive: n = 4; control: n = 4) during pharmacological MRI after the 12th quinpirole/saline injection. An additional group of rats received a single memantine injection after a single quinpirole injection (n = 8). RESULTS Memantine treatment did not affect compulsive checking nor frontostriatal structural and functional connectivity in the quinpirole-induced adolescent rat model. While memantine activated the frontal cortex in control rats, no significant activation responses were measured after single or repeated quinpirole injections. CONCLUSIONS The lack of a memantine treatment effect in quinpirole-induced compulsive adolescent rats may be partly explained by the interaction between glutamatergic and dopaminergic receptors in the brain, which can be evaluated with functional MRI.
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Affiliation(s)
- Milou Straathof
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Erwin L. A. Blezer
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Christel E. Smeele
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Caroline van Heijningen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Annette van der Toorn
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands ,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Jeffrey C. Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands ,Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Willem M. Otte
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands ,Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Rick M. Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht & Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
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Zhu S, Zhang X, Zhou M, Kendrick KM, Zhao W. Therapeutic applications of transcutaneous auricular vagus nerve stimulation with potential for application in neurodevelopmental or other pediatric disorders. Front Endocrinol (Lausanne) 2022; 13:1000758. [PMID: 36313768 PMCID: PMC9596914 DOI: 10.3389/fendo.2022.1000758] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) as a newly developed technique involves stimulating the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear, with resulting activation of vagal connections to central and peripheral nervous systems. Increasing evidence indicates that maladaptive neural plasticity may underlie the pathology of several pediatric neurodevelopmental and psychiatric disorders, such as autism spectrum disorder, attention deficit hyperactivity disorder, disruptive behavioral disorder and stress-related disorder. Vagal stimulation may therefore provide a useful intervention for treating maladaptive neural plasticity. In the current review we summarize the current literature primarily on therapeutic use in adults and discuss the prospects of applying taVNS as a therapeutic intervention in specific pediatric neurodevelopmental and other psychiatric disorders. Furthermore, we also briefly discuss factors that would help optimize taVNS protocols in future clinical applications. We conclude from these initial findings that taVNS may be a promising alternative treatment for pediatric disorders which do not respond to other interventions.
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Affiliation(s)
- Siyu Zhu
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaolu Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Menghan Zhou
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M. Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Zhao
- The Clinical Hospital of Chengdu Brain Science Institute, Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Institute of Electronic and Information Engineering of University of Electronic Science and Technology of China (UESTC) in Guangdong, Dongguan, China
- *Correspondence: Weihua Zhao,
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7
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Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P, Lu C, Garg K, Thomas TL, Au ACL, Selles RR, Højgaard DRMA, Skarphedinsson G, Stewart SE. Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:703701. [PMID: 34858219 PMCID: PMC8631971 DOI: 10.3389/fpsyt.2021.703701] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs. Systematic Review Registration: Unique Identifier: CRD42020215904.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lavanya P. Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Srinivas Balachander
- Obsessive-Compulsive Disorders (OCD) Clinic, Accelerator Program for Discovery in Brain Disorders Using Stem Cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Boyee Lin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Harshini Manohar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Puneet Khanna
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Cynthia Lu
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kabir Garg
- Oxleas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Tony Lazar Thomas
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anthony Chun Lam Au
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Robert R. Selles
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Davíð R. M. A. Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Skejby, Denmark
| | | | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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8
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Irritability, Defiant and Obsessive-Compulsive Problems Development from Childhood to Adolescence. J Youth Adolesc 2021; 51:1089-1105. [PMID: 34727300 PMCID: PMC9090682 DOI: 10.1007/s10964-021-01528-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/16/2021] [Indexed: 11/07/2022]
Abstract
Little is known about the coexistence of oppositionality and obsessive-compulsive problems (OCP) in community children and how it affects their development until adolescence to prevent possible dysfunctions. The co-development of oppositional defiant dimensions and OCP is studied in 563 children (49.7% female) from ages 6 to 13 years, assessed yearly with measures answered by parents and teachers. A 4-class model based on Latent Class Growth Analysis for three parallel processes (irritability, defiant, and OCP) was selected, which showed adequate fitting indexes. Class 1 (n = 349, 62.0%) children scored low on all the measures. Class 2 (n = 53, 9.4%) contained children with high OCP and low irritability and defiant. Class 3 (n = 108, 19.2%) clustered children with high irritability and defiant and low OCP. Class 4 (n = 53, 9.4%) clustered comorbid irritability, defiant, and OCP characteristics. The classes showed different clinical characteristics through development. The developmental co-occurrence of irritability and defiant plus obsessive-compulsive behaviors is frequent and adds severity through development regarding comorbidity, peer problems, executive functioning difficulties, and daily functioning. The identification of different classes when combining oppositional problems and OCP may be informative to prevent developmental dysfunctions and to promote good adjustment through development.
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9
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Mitra S, Bult-Ito A. Bidirectional Behavioral Selection in Mice: A Novel Pre-clinical Approach to Examining Compulsivity. Front Psychiatry 2021; 12:716619. [PMID: 34566718 PMCID: PMC8458042 DOI: 10.3389/fpsyt.2021.716619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) and related disorders (OCRD) is one of the most prevalent neuropsychiatric disorders with no definitive etiology. The pathophysiological attributes of OCD are driven by a multitude of factors that involve polygenic mechanisms, gender, neurochemistry, physiological status, environmental exposures and complex interactions among these factors. Such complex intertwining of contributing factors imparts clinical heterogeneity to the disorder making it challenging for therapeutic intervention. Mouse strains selected for excessive levels of nest- building behavior exhibit a spontaneous, stable and predictable compulsive-like behavioral phenotype. These compulsive-like mice exhibit heterogeneity in expression of compulsive-like and other adjunct behaviors that might serve as a valuable animal equivalent for examining the interactions of genetics, sex and environmental factors in influencing the pathophysiology of OCD. The current review summarizes the existing findings on the compulsive-like mice that bolster their face, construct and predictive validity for studying various dimensions of compulsive and associated behaviors often reported in clinical OCD and OCRD.
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Affiliation(s)
- Swarup Mitra
- Department of Pharmacology and Toxicology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Abel Bult-Ito
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, United States
- OCRD Biomed LLC, Fairbanks, AK, United States
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10
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Mazo GE, Kasyanov ED, Nikolishin AE, Rukavishnikov GV, Shmukler AB, Golimbet VE, Neznanov NG, Kibitov AO. [Family history of affective disorders, the gender factor and clinical characteristics of depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:75-83. [PMID: 34405661 DOI: 10.17116/jnevro202112105275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Analysis of clinical features of development and course of depression in patients with FH of mood disorders taking into account sex differences. MATERIAL AND METHODS This multicenter cross-sectional study included patients over 18 years of age with depressive episode/recurrent depressive disorder. Clinical characteristics of depression, presence of comorbid mental illness and family history (FH) information were obtained in a structured clinical interview. RESULTS One hundred and seventy-one patients (mean age (M (SD)) 40.87 (15.86) y.o.), including 64.5% of women, were enrolled in the study. FH was revealed in 30.2% of patients. The proportion of FH did not differ in men and women (p=0.375). Generalized anxiety disorder (GAD) was more frequent in FH positive patients (p=0.016). Logistic regression also revealed that FH is a risk factor for concomitant GAD (p=0.019, OR=2.4). The GLM demonstrated a significant joint effect of FH and sex on the maximum duration of a depressive episode (p=0.044), as well on the number of suicide attempts (p=0.055) and the number of depressive episodes as a trend (p=0.072). CONCLUSION We have demonstrated the specific interaction of FH of mood disorders with sex on clinical course of depression. Thus, the manifestation of a genetic influence on the clinical phenotype of depression can be significantly moderated by sex.
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Affiliation(s)
- G E Mazo
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia
| | - E D Kasyanov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Saint-Petersburg State University Pirogov Clinic of High Medical Technologies, St. Petersburg, Russia
| | - A E Nikolishin
- Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
| | - G V Rukavishnikov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia
| | - A B Shmukler
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
| | - V E Golimbet
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Mental Health Research Center, Moscow, Russia
| | - N G Neznanov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia
| | - A O Kibitov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
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Kazemi F, Vosough I, Sepahi S, Mohajeri SA. Effect of crocin versus fluoxetine in treatment of mild to moderate obsessive-compulsive disorder: A double blind randomized clinical trial. Hum Psychopharmacol 2021; 36:e2780. [PMID: 33599345 DOI: 10.1002/hup.2780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a common disabling disorder. Crocin, the active component of the saffron plant (Crocus Sativus L.) has various pharmacological activities. The present study compared the efficacy and safety of crocin and fluoxetine in treatment of mild to moderate OCD. METHODS & MATERIALS Fifty patients with OCD, aged 18 to 60 years, were randomized to receive either crocin (15 mg) or fluoxetine (20 mg) capsules for 8 weeks. Eligible participants received one capsule/day in the first month, which followed by two capsules daily in the second month. The patients were evaluated using Yale-Brown Obsessive-compulsive scale (Y-BOCS) and Hamilton Anxiety Rating scale (HARS). RESULTS The mean Y-BOCS score in both groups decreased significantly during 2 months (p-value = 0.0001). Also, HARS score in the crocin group was changed from 17.16 to 13.04 whereas, in the fluoxetine group was decreased from 18.28 to 12.34. The results indicated no difference between the two groups in Y-BOCS and HARS score changes after 2-month trial (p-value >0.5). Also, fewer adverse effects were reported in the crocin group compared to the fluoxetine group. CONCLUSION According to our study, it seems that crocin is effective in treatment of patients with mild to moderate OCD with possibly fewer adverse effects compared to fluoxetine.
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Affiliation(s)
- Fatemeh Kazemi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iraj Vosough
- Department of Psychiatry, Ibn-e-Sina Psychiatric Hospital, Mashhad, Iran
| | - Samaneh Sepahi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Mohajeri
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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12
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Mennies RJ, Birk SL, Norris LA, Olino TM. The Main and Interactive Associations between Demographic Factors and Psychopathology and Treatment Utilization in Youth: A Test of Intersectionality in the ABCD Study. Res Child Adolesc Psychopathol 2020; 49:5-17. [PMID: 32737734 DOI: 10.1007/s10802-020-00687-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Demographic factors may be associated with youth psychopathology due to social-contextual factors that may also pose barriers to intervention. Further, in line with intersectionality theory, youth with multiple non-dominant identities may be most likely to experience psychopathology and face barriers to care. This study examined rates of parent-reported psychopathology and mental health treatment utilization as a function of several demographic characteristics (in isolation and in concert) in a population-based, demographically diverse sample of 11,875 9- to 10-year-old youth. Results indicated most consistently that lower SES was associated with greater rates of psychopathology and greater likelihood of treatment utilization; that Asian American youth (relative to all other racial groups) and Hispanic/Latinx (relative to non-Hispanic/Latinx) youth were less likely to have a history of psychopathology or to have utilized treatment; and that male youth had greater rates of lifetime Obsessive Compulsive Disorder (OCD) and Oppositional Defiant Disorder (ODD) and were more likely to have utilized treatment. There was more modest support for interactive effects between demographic factors on psychopathology, which are discussed. The present study provides some support for differential rates of parent-reported psychopathology and treatment utilization as a function of demographic identities in youth. Potential explanations for these differences (e.g., cultural differences in symptom presentation; underreporting of symptoms) are discussed.
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Affiliation(s)
- Rebekah J Mennies
- Department of Psychology, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, USA.
| | - Samantha L Birk
- Department of Psychology, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, USA
| | - Lesley A Norris
- Department of Psychology, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, USA
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, USA
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13
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Straathof M, Blezer ELA, van Heijningen C, Smeele CE, van der Toorn A, Buitelaar JK, Glennon JC, Otte WM, Dijkhuizen RM. Structural and functional MRI of altered brain development in a novel adolescent rat model of quinpirole-induced compulsive checking behavior. Eur Neuropsychopharmacol 2020; 33:58-70. [PMID: 32151497 DOI: 10.1016/j.euroneuro.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 01/31/2023]
Abstract
Obsessive-compulsive disorder (OCD) is increasingly considered to be a neurodevelopmental disorder. However, despite insights in neural substrates of OCD in adults, less is known about mechanisms underlying compulsivity during brain development in children and adolescents. Therefore, we developed an adolescent rat model of compulsive checking behavior and investigated developmental changes in structural and functional measures in the frontostriatal circuitry. Five-weeks old Sprague Dawley rats were subcutaneously injected with quinpirole (n = 21) or saline (n = 20) twice a week for five weeks. Each injection was followed by placement in the middle of an open field table, and compulsive behavior was quantified as repeated checking behavior. Anatomical, resting-state functional and diffusion MRI at 4.7T were conducted before the first and after the last quinpirole/saline injection to measure regional volumes, functional connectivity and structural integrity in the brain, respectively. After consecutive quinpirole injections, adolescent rats demonstrated clear checking behavior and repeated travelling between two open-field zones. MRI measurements revealed an increase of regional volumes within the frontostriatal circuits and an increase in fractional anisotropy (FA) in white matter areas during maturation in both experimental groups. Quinpirole-injected rats showed a larger developmental increase in FA values in the internal capsule and forceps minor compared to control rats. Our study points toward a link between development of compulsive behavior and altered white matter maturation in quinpirole-injected adolescent rats, in line with observations in pediatric patients with compulsive phenotypes. This novel animal model provides opportunities to investigate novel treatments and underlying mechanisms for patients with early-onset OCD specifically.
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Affiliation(s)
- Milou Straathof
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Erwin L A Blezer
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Caroline van Heijningen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Christel E Smeele
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annette van der Toorn
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem M Otte
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
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Kuygun Karcı C, Gül Celik G. Nutritional and herbal supplements in the treatment of obsessive compulsive disorder. Gen Psychiatr 2020; 33:e100159. [PMID: 32215361 PMCID: PMC7066598 DOI: 10.1136/gpsych-2019-100159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/02/2019] [Accepted: 12/19/2019] [Indexed: 01/25/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that is characterised by obsessions and compulsions. The recommended treatments for OCD are cognitive– behavioural therapy using exposure and response prevention and/or pharmacotherapy. On the other hand, some nutritional and herbal supplements may be effective in the treatment of OCD. Nutritional and herbal supplements in OCD treatment will be reviewed in this paper. PubMed (Medline), Cochrane Library and Google Scholar databases were reviewed for the topic. There are some supplements that have been researched in OCD treatment studies such as vitamin D, vitamin B12, folic acid, homocysteine, trace elements, N-acetyl cysteine, glycine, myoinositol, St John’s wort, milk thistle, valerian root, curcumin and borage. The effectiveness of herbal and nutritional supplements in the treatment of OCD should be supported with more conclusive evidence.
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Affiliation(s)
- Canan Kuygun Karcı
- Child and Adolescent Psychiatry, Dr. Ekrem Tok Psychiatry Hospital, Adana, Turkey
| | - Gonca Gül Celik
- Child and Adolescent Psychiatry, Cukurova University Medical Faculty, Adana, Turkey
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15
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Baj J, Sitarz E, Forma A, Wróblewska K, Karakuła-Juchnowicz H. Alterations in the Nervous System and Gut Microbiota after β-Hemolytic Streptococcus Group A Infection-Characteristics and Diagnostic Criteria of PANDAS Recognition. Int J Mol Sci 2020; 21:E1476. [PMID: 32098238 PMCID: PMC7073132 DOI: 10.3390/ijms21041476] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
The objective of this paper is to review and summarize conclusions from the available literature regarding Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The authors have independently reviewed articles from 1977 onwards, primarily focusing on the etiopathology, symptoms, differentiation between similar psychiatric conditions, immunological reactions, alterations in the nervous system and gut microbiota, genetics, and the available treatment for PANDAS. Recent research indicates that PANDAS patients show noticeable alterations within the structures of the central nervous system, including caudate, putamen, globus pallidus, and striatum, as well as bilateral and lentiform nuclei. Likewise, the presence of autoantibodies that interact with basal ganglia was observed in PANDAS patients. Several studies also suggest a relationship between the presence of obsessive-compulsive disorders like PANDAS and alterations to the gut microbiota. Further, genetic predispositions-including variations in the MBL gene and TNF-α-seem to be relevant regarding PANDAS syndrome. Even though the literature is still scarce, the authors have attempted to provide a thorough insight into the PANDAS syndrome, bearing in mind the diagnostic difficulties of this condition.
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Affiliation(s)
- Jacek Baj
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland
| | - Elżbieta Sitarz
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (E.S.); (A.F.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (E.S.); (A.F.)
| | - Katarzyna Wróblewska
- North London Forensic Service, Chase Farm Hospital, 127 The Ridgeway, Enfield, Middlesex EN2 8JL, UK;
| | - Hanna Karakuła-Juchnowicz
- Chair and 1st Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Gluska Street 1, 20-439 Lublin, Poland;
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Gluska Street 1, 20-439 Lublin, Poland
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16
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Yazici KU, Yazici IP. Decreased theory of mind skills, increased emotion dysregulation and insight levels in adolescents diagnosed with obsessive compulsive disorder. Nord J Psychiatry 2019; 73:462-469. [PMID: 31403840 DOI: 10.1080/08039488.2019.1652341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: An abnormal interaction between cognition and emotion may contribute to the development of obsessive-compulsive disorder (OCD). Aims: In this study, we aimed to evaluate theory of mind and emotion regulation skills in adolescents diagnosed with OCD. In addition, the results were evaluated in accordance with patients' insight levels. Methods: This study was conducted with 50 patients, who were aged between 11 and 16 and who were newly diagnosed with OCD and 50 healthy individuals. The Turkish version of the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime was used to diagnose OCD and other comorbidities. The Children's Yale-Brown Obsessive Compulsive Scale, the Children's Depression Inventory, and the State-Trait Anxiety Inventory for Children were used for clinical evaluation. The intelligence levels were assessed using the Wechsler Intelligence Scale for Children-Revised Short Form. Reading the Mind in the Eyes Test was used in patients. The Difficulties in Emotion Regulation Scale was also used to evaluate the skills of regulating emotions. Results: Patients with OCD had lower ability with regard to reading minds in the eyes and emotion regulation than the healthy individuals. Patients with OCD, who had a poor insight, had more difficulty in reading minds in the eyes and emotion regulation than those with good insight. Conclusions: This study supports the idea that OCD is related to deficits in theory of mind and emotion regulation skills. Thus, further studies are required to confirm the findings of this study.
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Affiliation(s)
- Kemal Utku Yazici
- Department of Child and Adolescent Psychiatry, Firat University Medical Faculty , Elazig , Turkey
| | - Ipek Percinel Yazici
- Department of Child and Adolescent Psychiatry, Firat University Medical Faculty , Elazig , Turkey
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17
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Khramtsova EA, Heldman R, Derks EM, Yu D, Davis LK, Stranger BE. Sex differences in the genetic architecture of obsessive-compulsive disorder. Am J Med Genet B Neuropsychiatr Genet 2019; 180:351-364. [PMID: 30456828 PMCID: PMC6527502 DOI: 10.1002/ajmg.b.32687] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly heritable complex phenotype that demonstrates sex differences in age of onset and clinical presentation, suggesting a possible sex difference in underlying genetic architecture. We present the first genome-wide characterization of the sex-specific genetic architecture of OCD, utilizing the largest set of OCD cases and controls available from the Psychiatric Genomics Consortium. We assessed evidence for several mechanisms that may contribute to sex differences including a sex-dependent liability threshold, the presence of individual sex-specific risk variants on the autosomes and the X chromosome, and sex-specific pleiotropic effects. Furthermore, we tested the hypothesis that genetic heterogeneity between the sexes may obscure associations in a sex-combined genome-wide association study. We observed a strong genetic correlation between male and female OCD and no evidence for a sex-dependent liability threshold model, suggesting that sex-combined analysis does not suffer from widespread loss of power because of genetic heterogeneity between the sexes. While we did not detect any significant sex-specific genome-wide single nucleotide polymorphisms (SNP) associations, we did identify two significant gene-based associations in females: GRID2 and GRP135, which showed no association in males. We observed that the SNPs with sexually differentiated effects showed an enrichment of regulatory variants influencing expression of genes in brain and immune tissues. These findings suggest that future studies with larger sample sizes hold great promise for the identification of sex-specific genetic risk factors for OCD.
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Affiliation(s)
- Ekaterina A Khramtsova
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
- Institute for Genomics and Systems Biology, University of Chicago, Chicago, Illinois
| | | | - Eske M Derks
- Queensland Institute of Medical Research, Brisbane, Australia
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Lea K Davis
- Vanderbilt Genetics Institute; Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Medical Genetics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Barbara E Stranger
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
- Institute for Genomics and Systems Biology, University of Chicago, Chicago, Illinois
- Center for Data Intensive Science, University of Chicago, Chicago, Illinois
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18
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Robbins TW, Vaghi MM, Banca P. Obsessive-Compulsive Disorder: Puzzles and Prospects. Neuron 2019; 102:27-47. [PMID: 30946823 DOI: 10.1016/j.neuron.2019.01.046] [Citation(s) in RCA: 252] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/02/2023]
Abstract
Obsessive-compulsive disorder is a severe and disabling psychiatric disorder that presents several challenges for neuroscience. Recent advances in its genetic and developmental causation, as well as its neuropsychological basis, are reviewed. Hypotheses concerning an imbalance between goal-directed and habitual behavior together with neural correlates in cortico-striatal circuitry are evaluated and contrasted with metacognitive theories. Treatments for obsessive-compulsive disorder (OCD) tend to be of mixed efficacy but include psychological, pharmacological, and surgical approaches, the underlying mechanisms of which are still under debate. Overall, the prospects for new animal models and an integrated understanding of the pathophysiology of OCD are considered in the context of dimensional psychiatry.
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Affiliation(s)
- Trevor W Robbins
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK.
| | - Matilde M Vaghi
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK.
| | - Paula Banca
- Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK.
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19
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Karacaoğlan G, Lüleyap Ü, Tahiroğlu AY, Pazarcı P, Yaman A, Çetiner S, Sertdemir Y, Lüleyap D. Streptokok enfeksiyonu ile ilişkili pediatrik otoimmün nöropsikiyatrik hastalık (PANDAS) ile insan lököksit antijen (HLA) ilişkisi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.426378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Burchi E, Pallanti S. Diagnostic Issues in Early-Onset Obsessive-Compulsive Disorder and their Treatment Implications. Curr Neuropharmacol 2019; 17:672-680. [PMID: 29701156 PMCID: PMC7059152 DOI: 10.2174/1570159x16666180426151746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/16/2018] [Accepted: 04/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The lifespan approach and recent shift in the conceptualization of Obsessive- Compulsive Disorder (OCD) promoted by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM5) along with novel insights into the pathogenesis of this heterogeneous disorder are driving the development of new outcome measures and new treatments for a disease that, on the other hand, is characterized by high rates of refractoriness. OBJECTIVE AND METHODS The aim of this review is to provide a discussion of the translational evidence about Early Onset OCD (EO) in compliance with a neurodevelopmental and RdoC perspective. RESULTS AND CONCLUSION EO might be considered the neurodevelopmental subtype of OCD. Indeed there is evidence that different clusters of symptoms and dimensions at an early stage predict different trajectories in phenotype and that distinct neurocircuit pathways underpin the progression of the disorder. Despite the development of high refractoriness in the course of the disorder, evidence suggests that EO may be particularly treatment responsive in the early stages, thus showing the need for early recognition and additional recovery oriented studies in this subgroup. Consistent with the neurodevelopmental perspective, immunity and glutamate neurotransmission are emerging as novel pathways for parsing out the neurobiology of OCD, the EO form, in particular, supporting the implementation of new multisystemic models of the OCD phenotype. Brain connectivity patterns, immune and microbiome profiles are standing out as promising areas for biomarkers with the potential for targeted personalized therapies in EO.
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Affiliation(s)
- Elisabetta Burchi
- Address correspondence to this author at the Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center 111 East 210th street, Bronx, NY, 10467, USA;, Tel: 929-308-6669; E mail:
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21
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Amemori KI, Amemori S, Gibson DJ, Graybiel AM. Striatal Microstimulation Induces Persistent and Repetitive Negative Decision-Making Predicted by Striatal Beta-Band Oscillation. Neuron 2018; 99:829-841.e6. [PMID: 30100255 DOI: 10.1016/j.neuron.2018.07.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/24/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022]
Abstract
Persistent thoughts inducing irrationally pessimistic and repetitive decisions are often symptoms of mood and anxiety disorders. Regional neural hyperactivities have been associated with these disorders, but it remains unclear whether there is a specific brain region causally involved in these persistent valuations. Here, we identified potential sources of such persistent states by microstimulating the striatum of macaques performing a task by which we could quantitatively estimate their subjective pessimistic states using their choices to accept or reject conflicting offers. We found that this microstimulation induced irrationally repetitive choices with negative evaluations. Local field potentials recorded in the same microstimulation sessions exhibited modulations of beta-band oscillatory activity that paralleled the persistent negative states influencing repetitive decisions. These findings demonstrate that local striatal zones can causally affect subjective states influencing persistent negative valuation and that abnormal beta-band oscillations can be associated with persistency in valuation accompanied by an anxiety-like state.
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Affiliation(s)
- Ken-Ichi Amemori
- McGovern Institute for Brain Research and Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA; The Hakubi Center for Advanced Research and Primate Research Institute, Kyoto University, 41-2 Kanrin, Inuyama, Aichi 484-8506, Japan
| | - Satoko Amemori
- McGovern Institute for Brain Research and Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
| | - Daniel J Gibson
- McGovern Institute for Brain Research and Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA
| | - Ann M Graybiel
- McGovern Institute for Brain Research and Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar Street, Cambridge, MA 02139, USA.
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Yazici KU, Percinel Yazici I, Ustundag B. Vitamin D levels in children and adolescents with obsessive compulsive disorder. Nord J Psychiatry 2018; 72:173-178. [PMID: 29168423 DOI: 10.1080/08039488.2017.1406985] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent studies showed that vitamin D deficiency may lead to dysfunctional changes in the brain and may be associated with neuropsychiatric diseases. AIMS The present study aims to investigate vitamin D, calcium, phosphorus and alkaline phosphatase levels in children and adolescents diagnosed with obsessive-compulsive disorder (OCD) and compared them to healthy controls. Additionally, the correlation of OCD symptom severity with serum vitamin D level will be analyzed. METHODS A semi-structured interview form (K-SADS-PL) was used to diagnose OCD and other comorbidities in accordance with DSM-IV criteria. In addition, all participants were assessed with clinical interviews based on DSM-5 OCD diagnostic criteria. Children's Yale Brown Obsession Compulsion Scale (CY-BOCS) and Children's Depression Inventory were used in the clinical evaluation. RESULTS Vitamin D levels were lower in patients diagnosed with OCD (15.88 ± 6.96 ng/mL) when compared to healthy controls (18.21 ± 13.24 ng/mL), but the difference was not statistically significant (p = .234). Serum calcium, serum phosphate and serum alkaline phosphatase levels were not different between the groups. A negative correlation was found between serum 25OH-D3 levels and obsession scale scores in CY-BOCS. CONCLUSIONS To our knowledge this is the first study that evaluated vitamin D levels in OCD patients without comorbidity. The vitamin D levels of newly diagnosed OCD cases were lower but not statistically different than healthy controls. Furthermore, the study does also not support the presence of a significant association between serum vitamin D levels and OCD.
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Affiliation(s)
- Kemal Utku Yazici
- a Department of Child and Adolescent Psychiatry , Firat University Medical Faculty , Elazig , Turkey
| | - Ipek Percinel Yazici
- a Department of Child and Adolescent Psychiatry , Firat University Medical Faculty , Elazig , Turkey
| | - Bilal Ustundag
- b Department of Biochemistry , Firat University Medical Faculty , Elazig , Turkey
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Geller DA, Abramovitch A, Mittelman A, Stark A, Ramsey K, Cooperman A, Baer L, Stewart SE. Neurocognitive function in paediatric obsessive-compulsive disorder. World J Biol Psychiatry 2018; 19:142-151. [PMID: 28090807 PMCID: PMC5555842 DOI: 10.1080/15622975.2017.1282173] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The small body of neuropsychological research in paediatric obsessive-compulsive disorder (OCD) yields inconsistent results. A recent meta-analysis found small effect sizes, concluding that paediatric OCD may not be associated with cognitive impairments, stressing the need for more research. We investigated neuropsychological performance in a large sample of youths with OCD, while assessing potential moderators. METHODS Participants with OCD (n = 102) and matched controls (n = 161) were thoroughly screened and blindly evaluated for comorbidities, and completed a neuropsychological battery assessing processing speed, visuospatial abilities (VSA), working memory (WM), non-verbal memory (NVM), and executive functions (EF). RESULTS Compared to controls, youths with OCD exhibited underperformance on tasks assessing processing speed. On tests of VSA and WM, underperformance was found only on timed tasks. There were no differences on NVM and EF tasks. Notably, the OCD group's standardised scores were in the normative range. Test performance was not associated with demographic or clinical variables. CONCLUSIONS Youths with OCD exhibited intact performance on memory and EF tests, but slower processing speed, and underperformance only on timed VSA and WM tasks. While the OCD group performed in the normative range, these findings reveal relative weaknesses that may be overlooked. Such an oversight may be of particular importance in clinical and school settings.
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Affiliation(s)
- Daniel A. Geller
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Amitai Abramovitch
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766,Department of Psychology, Texas State University, UAC 253, San Marcos, TX, 78666, USA; phone +1(512)245-2526,Address for correspondence: Amitai Abramovitch, Department of Psychology, Texas State University, San Marcos, Texas 78666, USA; Phone: +1(512)245-2526, Fax: +1(512)245-3153;
| | - Andrew Mittelman
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Abigail Stark
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Kesley Ramsey
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Allison Cooperman
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - Lee Baer
- Department of Psychiatry Massachusetts General Hospital & Harvard Medical School, 185 Cambridge St. Boston, MA, 02114, US A; phone:+1(617)726-6766
| | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, BC Children's Hospital, A3-118, 950 West 28th Av., Vancouver, BC, V5Z4H4, Canada; phone:+1(604)-875-2000
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Højgaard DRMA, Hybel KA, Ivarsson T, Skarphedinsson G, Becker Nissen J, Weidle B, Melin K, Torp NC, Valderhaug R, Dahl K, Mortensen EL, Compton S, Jensen S, Lenhard F, Thomsen PH. One-Year Outcome for Responders of Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2017; 56:940-947.e1. [PMID: 29096776 DOI: 10.1016/j.jaac.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/23/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study describes 1-year treatment outcomes from a large sample of cognitive-behavioral therapy (CBT) responders, investigates age as a possible moderator of these treatment outcomes, and evaluates clinical relapse at the 1-year follow-up. METHOD This study is the planned follow-up to the Nordic Long-term OCD [obsessive-compulsive disorder] Treatment Study (NordLOTS), which included 177 children and adolescents who were rated as treatment responders following CBT for OCD. Participants were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at 6- and 12-month follow-up. Treatment response and remission were defined as CY-BOCS total scores ≤15 and ≤10, respectively. Linear mixed-effects models were used to analyze all outcomes. RESULTS At 1 year, a total of 155 children and adolescents (87.6%) were available for follow-up assessment, with 142 of these (91.6%) rated below a total score of ≤15 on the CY-BOCS. At 1-year follow-up, 121 (78.1%) were in remission. On average, CY-BOCS total scores dropped by 1.72 points during the first year after terminating treatment (p = .001). A total of 28 participants (15.8%) relapsed (CY-BOCS ≥ 16) at either the 6- or 12-month assessment; only 2 patients required additional CBT. CONCLUSION Results suggest that manualized CBT in a community setting for pediatric OCD has durable effects for those who respond to an initial course of treatment; children and adolescents who respond to such treatment can be expected to maintain their treatment gains for at least 1 year following acute care. Clinical trial registration information- Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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Affiliation(s)
- Davíð R M A Højgaard
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.
| | - Katja A Hybel
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Tord Ivarsson
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo
| | | | - Judith Becker Nissen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Bernhard Weidle
- Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin Melin
- Queen Silvia's Children's Hospital, Sahlgrenska, University Hospital, Gothenburg, Sweden
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - Robert Valderhaug
- Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Hospital of Aalesund, Norway
| | - Kitty Dahl
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo
| | | | | | - Sanne Jensen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Fabian Lenhard
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden and the Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Per Hove Thomsen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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Leung A, Bleakley C, Loh A, Saran K, Stewart SE. Pediatric Obsessive-Compulsive Disorder Exacerbation and Obstructive Hydrocephalus: A Case Report. Pediatrics 2016; 138:peds.2016-0558. [PMID: 27609824 DOI: 10.1542/peds.2016-0558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
We present the case of an 11 year-old boy with a previous history of obsessive-compulsive disorder (OCD), who experienced a dramatic and acute worsening of OCD symptoms in temporal association with obstructive hydrocephalus secondary to a tectal low-grade glioma. Management and resolution of the hydrocephalus was temporally associated with an improvement in his OCD compulsion symptoms. The present case does not establish proof of cause and effect, but highlights potential multifactorial influences on OCD onset and clinical course. Cortico-striatal-thalamic-cortical pathways, physically distorted by hydrocephalus in this case, have long been implicated in OCD etiology. Clinical implications include the importance of conducting an appropriate neurologic work-up to rule out biological causes for acute and dramatic OCD exacerbations with neurologic signs, even in the context of preexisting OCD. Given that neurologic lesions may exist in the absence of typical signs and symptoms, that they may further disrupt OCD circuitry, and that treatment may lead to resolution of associated psychiatric symptoms, it is important to remain cognizant of these differential diagnoses.
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Affiliation(s)
- Aldrich Leung
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Clare Bleakley
- Division of Psychiatry, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and
| | - Adrian Loh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Psychiatry, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and
| | - Kelly Saran
- Division of Psychiatry, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; .,Division of Psychiatry, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; and.,Harvard Medical School, Boston, Massachusetts
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Anticompulsive Activity of a New Pyrazolo[C]Pyridine Derivative GIZh-72 under Conditions of Unpredictable Chronic Mild Stress. Bull Exp Biol Med 2016; 161:377-80. [DOI: 10.1007/s10517-016-3418-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 10/21/2022]
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Guidi J, Poinso F. L’hallucination auditive isolée chez l’enfant pré-pubère : cadre diagnostique et valeur prédictive. Arch Pediatr 2015; 22:1302-8. [DOI: 10.1016/j.arcped.2015.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/25/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022]
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Murphy YE, Flessner CA. Family functioning in paediatric obsessive compulsive and related disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 54:414-34. [PMID: 26017183 DOI: 10.1111/bjc.12088] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 03/19/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among paediatric OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research. METHODS A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', 'paediatric OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting practices, family dynamics, family involvement with symptoms, and family emotional climate. RESULTS The literature reviewed demonstrated a strong relationship between paediatric OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in paediatric HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs. CONCLUSIONS This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed. PRACTITIONER POINTS The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in paediatric OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits in paediatric OCRDs may prove beneficial in developing or bolstering preventative and/or therapeutic interventions. Insufficient number of articles pertaining to family functioning in some paediatric OCRDs (i.e., hoarding, skin picking) inhibits formal conclusions. Magnitudes of family functioning effects were not calculated; therefore, future research should consider meta-analytic analyses.
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Arlen AM, Dewhurst LL, Kirsch SS, Dingle AD, Scherz HC, Kirsch AJ. Phantom urinary incontinence in children with bladder-bowel dysfunction. Urology 2014; 84:685-8. [PMID: 25168551 DOI: 10.1016/j.urology.2014.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a previously undescribed condition in which children present with the sensation of wetness because of presumed urinary incontinence when they are actually completely dry. We have termed this entity "phantom" urinary incontinence (PUI). MATERIALS AND METHODS Twenty children referred to our pediatric urology clinic were diagnosed with PUI between 2009 and 2013. Patient demographics, associated bladder and bowel symptoms, concomitant diagnoses, imaging, management, and treatment outcomes were evaluated. RESULTS Twenty children (18 females and 2 males) were diagnosed with PUI over a 5-year interval. Mean age at diagnosis was 6.9 ± 2.5 years (range, 4-12 years). Nineteen patients (95%) had concomitant lower urinary tract symptoms, and all were also diagnosed with constipation. Urgency (75%) and frequency (50%) were the most common associated bladder symptoms. Of the 18 girls, 13 (72%) had associated vaginitis. Fourteen children (70%) carried a parent-reported diagnosis of obsessive-compulsive disorder or obsessive-compulsive disorder personality traits. Patients were managed with timed voiding, dietary modifications, and a bowel regimen. Ninety percent children experienced improvement of bladder-bowel dysfunction and resolution of PUI at a mean follow-up of 14.4 months. CONCLUSION Children with PUI have a high incidence of obsessive-compulsive traits. Phantom incontinence as well as associated lower urinary tract symptoms resolve with adherence to a strict bladder-bowel regimen.
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Affiliation(s)
- Angela M Arlen
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Liisa L Dewhurst
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Susan S Kirsch
- Department of Psychiatry, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Arden D Dingle
- Department of Psychiatry, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Hal C Scherz
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Andrew J Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
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Keszler G, Kruk E, Kenezloi E, Tarnok Z, Sasvari-Szekely M, Nemoda Z. Association of the tumor necrosis factor -308 A/G promoter polymorphism with Tourette syndrome. Int J Immunogenet 2014; 41:493-8. [DOI: 10.1111/iji.12147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/21/2014] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- G. Keszler
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry; Semmelweis University; Budapest Hungary
| | - E. Kruk
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry; Semmelweis University; Budapest Hungary
| | - E. Kenezloi
- Vadaskert Child and Adolescent Psychiatric Clinic; Budapest Hungary
| | - Z. Tarnok
- Vadaskert Child and Adolescent Psychiatric Clinic; Budapest Hungary
| | - M. Sasvari-Szekely
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry; Semmelweis University; Budapest Hungary
| | - Z. Nemoda
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry; Semmelweis University; Budapest Hungary
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Transcranial Magnetic Stimulation (TMS) Clinical Applications: Therapeutics. TRANSCRANIAL MAGNETIC STIMULATION 2014. [DOI: 10.1007/978-1-4939-0879-0_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Vivan ADS, Rodrigues L, Wendt G, Bicca MG, Braga DT, Cordioli AV. Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study. ACTA ACUST UNITED AC 2013; 36:111-8. [PMID: 24165685 DOI: 10.1590/1516-4446-2013-1113] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/16/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender. METHODS Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring ≥ 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version - K-SADS-PL). RESULTS The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3 ± 3.8) and symmetry (85.3%; 5.9 ± 3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006). CONCLUSIONS OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD.
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Affiliation(s)
- Analise de Souza Vivan
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lidiane Rodrigues
- School of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Guilherme Wendt
- School of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mônica Giaretton Bicca
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniela Tusi Braga
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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