Factors Associated with Depression in Obsessive-Compulsive Disorder: A Cross-Sectional Study

Correlates of depression in individuals with obsessive compulsive disorder

The existing literature examining the correlates of depression in individuals with obsessive compulsive disorder (OCD) is characterized by inconsistent results. The aim of the current study was to replicate and extend the literature by exploring whether various clinical and demographic factors are related to the occurrence of depression in a large sample (N = 243) of individuals with OCD (M age = 33.00; SD = 12.47; 74% female). Individuals with OCD who had elevated comorbid depressive symptoms [Patient Health Questionnaire-9 item (PHQ-9) ≥10] scored significantly higher on all OCD symptom subtypes (p range < .001-.048), had greater obsessive and compulsive severity (ps < .001), scored higher on perfectionism (p < .001), and had higher disgust sensitivity and propensity scores (ps < .001) compared with individuals who did not have comorbid depressive symptoms (PHQ-9 < 10). Of these variables, obsession severity (β = 0.22, p = .004), OCD contamination subtype (β = 0.16, p = .032) and perfectionism (β = 0.25, p < .001) were found to be associated with depressive symptoms on the PHQ-9. The findings of this study contribute to the understanding of factors which are associated with depression comorbidity in individuals with OCD.

Ketamine Infusion in a Resistant Obsessive-Compulsive Disorder Patient in Bangladesh with Severe Suicidal Ideation: A Case Report

Treatment of resistant obsessive-compulsive disorder (OCD) typically results in insufficient symptom alleviation, and even long-term medication often fails to have the intended effect. Ketamine is a potent non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Studies have shown that low-dose ketamine infusion results in a considerable reduction in obsessive-compulsive symptoms and a rapid resolution of suicidal ideation. This is a case report on the effect of intravenous ketamine infusion on a patient with resistant OCD and severe suicidal ideation. Intravenous (IV) ketamine was given once a week over consecutive three weeks with necessary precautions. Psychometric tools such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impressions Scale (CGI-S), the Beck Scale for Suicidal Ideations (BSSI), and Depression Anxiety and Stress Scale 21 (DASS-21) were applied before and after infusions. Obsessive-compulsive symptoms and suicidal severity started to decrease rapidly after the first infusion. However, after a transient improvement, these symptoms again began to increase after a stressful incident on the second day of the first infusion. All the symptoms measured by validated rating scales showed continued improvement after the following two infusions. The improvement was sustained until discharge (one week after the last infusion) and subsequent follow-up in the sixth and 12th weeks. The role of ketamine in reducing suicidal thoughts and behavior is already established. Very few studies emphasized its effectiveness in improving severe/resistant obsessive-compulsive symptoms. This pioneering work may offer scope for similar research in the relevant field.

Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment

Obsessive-compulsive disorder (OCD) is a chronic disabling disease with often unsatisfactory therapeutic outcomes. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the diagnostic criteria for OCD, acknowledging that some OCD patients may lack insight into their symptoms. Previous studies have demonstrated that insight can impact therapeutic efficacy and prognosis, underscoring its importance in the treatment of mental disorders, including OCD. In recent years, there has been a growing interest in understanding the influence of insight on mental disorders, leading to advancements in related research. However, to the best of our knowledge, there is dearth of comprehensive reviews on the topic of insight in OCD. In this review article, we aim to fill this gap by providing a concise overview of the concept of insight and its multifaceted role in clinical characteristics, neuroimaging mechanisms, and treatment for OCD.

The relationship between obsessive-compulsive symptoms and depressive symptoms in patients with obsessive-compulsive disorder: A network analysis

Aim

The network model suggests that the comorbidity of obsessive-compulsive disorder (OCD) and depression is due to direct interactions between OCD and depression symptoms. The study investigates the network structure of OCD and depressive symptoms in patients with OCD and explores the pathways that connect the OCD and depression symptoms.

Materials and Methods

The items of Yale-Brown Obsessive-Compulsive Symptom (Y-BOCS) Scale and the Depression Self-Rating Scale of 445 patients with OCD were analyzed by network model. Statistical analysis and visualization of the network were conducted using R software.

Results

Two bridge edges "uneasiness" and "time consumed by obsessions" and "low spirit" and "distress caused by obsessions" connected the OCD symptoms to depressive symptoms. Two closely related edges were between "interference due to obsessions" and "interference due to compulsions" and between "difficulty resisting obsessions" and "difficulty resisting compulsions." The symptoms "interference due to compulsions," "distress caused by obsessions," "time consumed by compulsions," and "uneasiness" had the highest expected influence centrality.

Conclusions

This study highlighted the relationship between "uneasiness" and "time consumed by obsessions" and between "low spirit" and "distress caused by obsessions." In addition, "interference due to compulsions" is found as the core symptom in the network. Targeting these symptoms may help prevent and treat the comorbidity of obsession-compulsion and depression in patients with OCD.

Poor insight in obsessive compulsive disorder (OCD): Associations with empathic concern and emotion recognition

PURPOSE

Insight is currently considered to be responsible for 20% to 40% of the cases of ineffective obsessive-compulsive disorder (OCD) treatment. As 15% to 36% of patients with OCD have reduced insight, we aimed to identify some of the clinical determinants of insight in OCD.

RESULTS

Our sample consisted of 57 OCD patients, of which 34 men (59%) and 23 women (41%). All individuals completed a two-phase interview consisting of a clinical assessment, emotional awareness evaluation and insight measurement, using the Brown Assessment of Beliefs Scale (BABS). The insight score correlated significantly with negative emotion recognition (p < 0.0001) and empathic concern (p = 0.003).

MAJOR CONCLUSIONS

Our results support the hypothesis that insight in OCD is related to emotional awareness, specifically emotion recognition and empathic concern. Future research should investigate the extent to which poor insight and impaired emotional awareness can be modified by psychological or pharmacological therapies and whether this will enhance treatment response.

Psychiatric comorbidities of obsessive-compulsive disorder: A series of systematic reviews and meta-analyses

OBJECTIVE

Although there is a growing number of studies on psychiatric comorbidities of obsessive-compulsive disorder (OCD), controversy remains about the strength of associations between some disorders. We present a series of systematic reviews and meta-analyses examining four psychiatric disorders frequently associated with OCD-depression, bipolar disorder, substance abuse disorder and psychosis.

METHODS

Three electronic databases were searched up to May 2017; PsycINFO, Medline, and Web of Science. Meta-analyses using random effects models were conducted.

RESULTS

The meta-analyses found strong associations between all comorbidities and OCD, particularly for depression. In addition, a series of systematic reviews were conducted giving information about the characteristics of these psychiatric associations.

CONCLUSION

It is probable that these disorders share common etiological factors, and thus trans-diagnostic processes must be addressed when offering treatment. Clinical implications of these findings are discussed with suggestions for further research in the area.

Association of insight, avoidance behavior, indecisiveness, and inflated responsibility with other clinical characteristics in children and adolescents with obsessive-compulsive disorder

Objectives:

Although the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) includes ancillary symptom dimensions – insight, avoidance, degree of indecisiveness, inflated sense of responsibility, pervasive slowness/disturbance of inertia, and pathological doubting –, we know little about their clinical/scientific utility. We examined these ancillary dimensions in childhood obsessive-compulsive disorder (OCD), and tested their associations with clinical characteristics.

Methods:

Treatment-seeking children and adolescents (n=173) with a DSM-5 OCD diagnosis were recruited from six centers in India and evaluated with a semi-structured proforma for sociodemographic/clinical details, the Structured Clinical Interview for DSM-5, the CY-BOCS, the Children’s Depression Rating Scale, and the Family Interview for Genetic Studies. Regression analysis was used to study the associations between ancillary dimensions (independent variables) and clinical variables (dependent variables).

Results:

87.9% of the sample reported at least a mild-moderate severity of ancillary dimensions, which were highly intercorrelated. Multiple ancillary dimensions were correlated with illness severity on the CY-BOCS. On regression analysis, only insight and avoidance retained significance. There were few differential associations between OCD symptom and ancillary dimensions.

Conclusion:

Ancillary dimensions are more a feature of illness severity than differentially associated with individual symptom dimensions in childhood OCD. Insight and avoidance should be considered for inclusion in the assessment of illness severity in childhood OCD.

Attention Deficit Hyperactivity Disorder, Impulsivity, Anxiety, and Depression Symptoms Mediating the Relationship Between Childhood Trauma and Symptoms Severity of Obsessive-Compulsive Disorder

Introduction

A growing body of research associates childhood trauma with obsessive-compulsive disorder (OCD). The aim of this study was to investigate the relationships between childhood trauma and OCD, including both its severity and OCD patients' comorbid impulsivity, ADHD, anxiety, and depressive symptoms.

Methods

A convenient sample consisting of 106 patients with OCD was given the Childhood Trauma Questionnaire (CTQ), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Wender Utah Rating Scale (WURS), Hamilton Rating Scale for Depression (HAM-D), Beck Anxiety Inventory (BAI), and Barratt Impulsivity Scale-11 (BIS-11).

Results

The results showed that childhood trauma indirectly predicts the severity of OCD and directly predicts comorbidities in OCD patients, including anxiety, ADHD, WURS, and impulsivity. Patients with childhood trauma had higher WURS, BAI, and BIS-11 scores and fewer years of education. Ongoing adult ADHD was more common in individuals with childhood trauma.

Conclusion

A history of childhood trauma in OCD patients has indirect effects on the severity of OCD and depressive symptoms and is associated with more severe anxiety, higher levels of impulsivity, higher prevalence of ADHD, and lower levels of education. More research is needed to clarify the effects of childhood trauma on OCD severity and comorbidity.

Level of Insight in Patients With Obsessive-Compulsive Disorder: An Exploratory Comparative Study Between Patients With "Good Insight" and "Poor Insight"

Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive-compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight (n = 148), and those with scores above the 75% percentile composed the group with poor insight (n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics (p = 0.05); higher untreated time interval (p < 0.001); higher total Yale-Brown obsessive-compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale-Brown obsessive-compulsive scale total and dimensional scores (p from 0.04 to 0.001); higher prevalence of contamination/cleaning (p = 0.006) and hoarding (p < 0.001) symptoms dimensions; more prevalent sensory phenomena (p = 0.023); higher levels of depression (p = 0.007); and more prevalent comorbidity with bipolar affective disorder (p = 0.05) and post-traumatic stress disorder (PTSD) (p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to conventional OCD treatments. Studies based on neurobiological aspects such as neuroimaging and neuropsychology may help to elucidate more consistently the role of insight in patients with OCD and the repercussions concerning available treatments.

Are Mentalizing Abilities and Insight Related to the Severity of Obsessive-Compulsive Disorder

OBJECTIVE

The aim of this study is to investigate whether insight and mentalizing abilities are related to the severity of Obsessive Compulsive Disorder (OCD) in treatment resistant OCD. We look at the association between treatment resistance, insight, and mentalizing ability.

METHODS

The study was conducted with 71 OCD patients; 30 of them met the criteria for treatment resistant OCD, whereas the other 41 (57.7%) were labeled as responder group. All patients were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Reading the Mind in the Eyes Test (RMET), Brown Assessment of Beliefs Scale (BABS), Mini International Neuropsychiatric Interview, Beck Depression Inventory, and Beck Anxiety Inventory.

RESULTS

The resistant group received higher depression and anxiety mean scores and had significantly longer illness duration. The RMET score was significantly higher for responders. The Y-BOCS insight score and the BABS score were significantly higher for the resistant group. BABS scores were negatively correlated with RMET total scores. RMET scores were found to be significant predictor of insight even when other potential factors were controlled for.

RESULTS

suggest that better mentalizing abilities may be a predictor of better treatment outcome in patients with OCD.

Strain and sex based characterization of behavioral expressions in non-induced compulsive-like mice

There is currently a lack of understanding how genetic background and sex differences attribute to the heterogeneity of obsessive-compulsive disorder (OCD). An animal model of compulsive-like behaviors has been developed through bidirectional selection of house mice (Mus musculus) for high (big cotton nests; BIG mice) and low levels (small nests; SMALL mice) of nest-building behavior. The BIG male strains have predictive and face validity as a spontaneous animal model of OCD. Here, we evaluated compulsive-, anxiety-, cognitive-, and depression-like behaviors among male and proestrus female replicate strains each of BIG (BIG1, BIG2) and SMALL (SML1, SML2) nest-builders, and randomly-bred Controls (C1, C2). BIG1 and BIG2 males and females had higher nesting scores when compared to SMALL and Control strains. Male BIG1 and BIG2 strains showed more compulsive-like nesting than BIG1 and BIG2 proestrus females, which was not observed among the other strains. Nesting scores were also different between BIG replicate male strains. A similar pattern was observed in the compulsive-like marble burying behavior with BIG strains burying more marbles than SMALL and Control strains. Significant replicate and sex differences were also observed in marble burying among the BIG strains. The open field test revealed replicate effects while the BIG strains showed less anxiety-like behavior in the elevated plus maze test compared to the SMALL strains. For novel object recognition only the Control strains showed replicate and sex differences. In the depression-like forced swim test proestrus females demonstrated less depression-like behavior than males. BIG and SMALL nest-building strains had a higher corticosterone stress response than the Control strains. Together these results indicate a strong interplay of genetic background and sex in influencing expression of behaviors in our compulsive-like mouse model. These results are in congruence with the clinical heterogeneity of OCD.