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Wu X, Yu G, Zhang K, Feng J, Zhang J, Sahakian BJ, Robbins TW. Symptom-Based Profiling and Multimodal Neuroimaging of a Large Preteenage Population Identifies Distinct Obsessive-Compulsive Disorder-like Subtypes With Neurocognitive Differences. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:1078-1089. [PMID: 34224907 DOI: 10.1016/j.bpsc.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by both internalizing (anxiety) and externalizing (compulsivity) symptoms. Currently, little is known about their interrelationships and their relative contributions to disease heterogeneity. Our goal is to resolve affective and cognitive symptom heterogeneity related to internalized and externalized symptom dimensions by determining subtypes of children with OCD symptoms, and to identify any corresponding neural differences. METHODS A total of 1269 children with OCD symptoms screened using the Child Behavior Checklist Obsessive-Compulsive Symptom scale and 3987 matched control subjects were obtained from the Adolescent Brain Cognitive Development (ABCD) Study. Consensus hierarchical clustering was used to cluster children with OCD symptoms into distinct subtypes. Ten neurocognitive task scores and 20 Child Behavior Checklist syndrome scales were used to characterize cognitive/behavioral differences. Gray matter volume, fractional anisotropy of major white matter fiber tracts, and functional connectivity among networks were used in case-control studies. RESULTS We identified two subgroups with contrasting patterns in internalized and externalized dimensions. Group 1 showed compulsive thoughts and repeated acts but relatively low anxiety symptoms, whereas group 2 exhibited higher anxiety and perfectionism and relatively low repetitive behavior. Only group 1 had significant cognitive impairments and gray matter volume reductions in the bilateral inferior parietal lobe, precentral gyrus, and precuneus gyrus, and had white matter tract fractional anisotropy reductions in the corticostriatal fasciculus. CONCLUSIONS Children with OCD symptoms are heterogeneous at the level of symptom clustering and its underlying neural basis. Two subgroups represent distinct patterns of externalizing and internalizing symptoms, suggesting that anxiety is not its major predisposing factor. These results may have implications for the nosology and treatment of preteenage OCD.
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Affiliation(s)
- Xinran Wu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Gechang Yu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Kai Zhang
- School of Computer Science and Technology, East China Normal University, Shanghai, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Shanghai Center for Mathematical Sciences, Shanghai, China; Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Jie Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.
| | - Barbara J Sahakian
- Departments of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Trevor W Robbins
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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Peris TS, Salgari G, Perez J, Jurgiel J, Vreeland A, O'Neill J, Chang S, Piacentini J, Loo SK. Shared and unique neural mechanisms underlying pediatric trichotillomania and obsessive compulsive disorder. Psychiatry Res 2021; 298:113653. [PMID: 33621723 DOI: 10.1016/j.psychres.2020.113653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/12/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC). METHODS Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition. RESULTS TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices. CONCLUSIONS Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.
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Affiliation(s)
- Tara S Peris
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States.
| | - Giulia Salgari
- Department of Psychology, University of Central Florida, United States
| | - Jocelyn Perez
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - Joseph Jurgiel
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | | | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - Susanna Chang
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - John Piacentini
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024, United States
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Rech M, Weinzimmer S, Geller D, McGuire JF, Schneider SC, Patyk KC, De Nadai AS, Cepeda SC, Small BJ, Murphy TK, Wilhelm S, Storch EA. Symptom Trajectories of Early Responders and Remitters among Youth with OCD. J Obsessive Compuls Relat Disord 2020; 27:100580. [PMID: 35990243 PMCID: PMC9390966 DOI: 10.1016/j.jocrd.2020.100580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT). METHODS One hundred and thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT augmented by either placebo or d-cycloserine (DCS) as part of a randomized double-blind multi-site clinical trial. Early response and remission status were determined by clinician-rated global symptom improvement (CGI-I) and severity (CGI-S), respectively. RESULTS At the mid-treatment assessment, 45.3% of youth were early responders, and 28.1% were early remitters. At post-treatment assessment, 79.1% of youth were responders and 67.6% were remitters. Early response predicted a higher likelihood of post-treatment response and remission; early remission significantly predicted a higher likelihood of post-treatment remission. Bivariate logistic regressions showed that early response was predicted by lower baseline clinician-rated global severity (CGI-S) and lower depression severity; however, only depression severity remained a significant predictor in the multivariable logistic regression model. Furthermore, bivariate logistic regressions showed that early remission was predicted by lower baseline clinician-rated global severity (CGI-S), lower depression severity, and lower obsessive-compulsive symptom severity (CY-BOCS); however, only global severity remained a significant predictor in the multivariable logistic regression model. CONCLUSIONS Lower OCD and depression symptom severity predicted a greater likelihood of early treatment response and remission to CBT. Findings suggest that low OCD and depression symptom severity could serve as baseline characteristics to identify potential candidates for lower-intensity initial interventions in a stepped care approach. The modest predictive value of the variables examined suggests that additional factors could add to prediction of treatment response and remission.
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Affiliation(s)
- Megan Rech
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Saira Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Kevin C Patyk
- Department of Psychology, Texas State University, San Marcos, Texas
| | | | - Sandra C Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Brent J Small
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- University of South Florida School of Aging Studies, Tampa, Florida
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Torp NC, Weidle B, Thomsen PH, Skarphedinsson G, Aalberg M, Nissen JB, Melin KH, Dahl K, Valderhaug R, Ivarsson T. Is it time to rethink standard dosage of exposure-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder? Psychiatry Res 2019; 281:112600. [PMID: 31622874 DOI: 10.1016/j.psychres.2019.112600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identifying factors associated with early treatment response is important, because it can help allocate limited resources in psychiatric care more appropriately. This study examined baseline characteristics of participants with early response to exposure-based cognitive behavior therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). METHOD 269 participants with OCD, aged 7-17 years, were enrolled in a 14-weeks CBT program. We identified participants with early response to treatment, (CY-BOCS total score of ≤15), by the seventh session. RESULTS At week 7, 248 (92.2%) participants were assessed, 38.3% (95% CI 32.4-44.5%, n = 95) were identified as treatment responders. Univariate analyses showed that six baseline characteristics were significantly associated with early treatment response: young age, lower levels of symptom severity, functional impairment, internalizing- and externalizing problems, depressive symptoms, and family accommodation. CONCLUSIONS These results suggested that treatment plans for younger children with moderate OCD symptoms and no major comorbid disorder should include briefer and less resource demanding treatment formats than the commonly recommended and applied standard doses of 15 CBT sessions.
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Affiliation(s)
- Nor Christian Torp
- Department of Child and Adolescent Psychiatry. Division of Mental Health and Addiction. Vestre Viken Hospital, Drammen, Norway.
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Hove Thomsen
- Aarhus University Hospital, Regional Center for Child and Adolescent Psychiatry, Risskov, Aarhus, Denmark
| | | | | | - Judith Becker Nissen
- Aarhus University Hospital, Regional Center for Child and Adolescent Psychiatry, Risskov, Aarhus, Denmark
| | - Karin Holmgren Melin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kitty Dahl
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Robert Valderhaug
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tord Ivarsson
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Leon J, Hommer R, Grant P, Farmer C, D'Souza P, Kessler R, Williams K, Leckman JF, Swedo S. Longitudinal outcomes of children with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). Eur Child Adolesc Psychiatry 2018; 27:637-43. [PMID: 29119300 DOI: 10.1007/s00787-017-1077-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
Little is known about the natural history of children with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). This study prospectively followed 33 children with PANDAS for up to 4.8 years (mean 3.3 ± 0.7 years) after enrollment in a 24-week randomized, double-blind, placebo-controlled trial of intravenous immunoglobulin (IVIG) (N = 35). Fourteen of eighteen children randomized to placebo received open label IVIG 6 weeks after the blinded infusion, so follow-up results reported below largely reflect outcomes in a population of children who received at least one dose of IVIG. Telephone interviews with the parents of participants found that at the time of phone follow-up, 29 (88%) were not experiencing clinically significant obsessive-compulsive symptoms. During the interim period (6-57 months after entering the clinical trial), 24 (72%) had experienced at least one exacerbation of PANDAS symptoms, with a median of one exacerbation per child (range 1-12; interquartile range 0-3). A variety of treatment modalities, including antibiotics, IVIG, psychiatric medications, cognitive behavioral therapy, and others, were used to treat these exacerbations, and were often used in combination. The outcomes of this cohort are better than those previously reported for childhood-onset OCD, which may support conceptualization of PANDAS as a subacute illness similar to Sydenham chorea. However, some children developed a chronic course of illness, highlighting the need for research that identifies specific symptoms or biomarkers that can be used to predict the longitudinal course of symptoms in PANDAS.
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Turner C, O'Gorman B, Nair A, O'Kearney R. Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review. Psychiatry Res 2018; 261:50-60. [PMID: 29287236 DOI: 10.1016/j.psychres.2017.12.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022]
Abstract
We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations.
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Affiliation(s)
- Cynthia Turner
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia; Department of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Beth O'Gorman
- Department of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Archana Nair
- Research School of Psychology, Australian National University, Canberra, ACT 0020, Australia
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, ACT 0020, Australia.
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Abstract
Purpose of review This review examines emerging neuroimaging research in pediatric obsessive compulsive disorder (OCD) and explores the possibility that developmentally sensitive mechanisms may underlie OCD across the lifespan. Recent findings Diffusion tensor imaging (DTI) studies of pediatric OCD reveal abnormal structural connectivity within frontal-striato-thalamic circuity (FSTC). Resting-state functional magnetic resonance imaging (fMRI) studies further support atypical FSTC connectivity in young patients, but also suggest altered connectivity within cortical networks for task-control. Task-based fMRI studies show that hyper- and hypo-activation of task control networks may depend on task difficulty in pediatric patients similar to recent findings in adults. Summary This review suggests that atypical neurodevelopmental trajectories may underlie the emergence and early course of OCD. Abnormalities of structural and functional connectivity may vary with age, while functional engagement during task may vary with age and task complexity. Future research should combine DTI, resting-state fMRI and task-based fMRI methods and incorporate longitudinal designs to reveal developmentally sensitive targets for intervention.
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Anderson LM, Freeman JB, Franklin ME, Sapyta JJ. Family-Based Treatment of Pediatric Obsessive-Compulsive Disorder: Clinical Considerations and Application. Child Adolesc Psychiatr Clin N Am 2015; 24:535-55. [PMID: 26092738 DOI: 10.1016/j.chc.2015.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pediatric obsessive-compulsive disorder (OCD) can be effectively treated with family-based intervention by expanding and enhancing family members' behavioral repertoire to more effectively manage OCD symptoms and affected family interactions. This article provides an overview and practical understanding of the implementation of family-based treatment of pediatric OCD. Special attention is given to relevant contextual family processes that influence symptom presentation, current empirical support for family-based treatment, and the clinical application of family-based cognitive-behavioral therapy. Case vignettes illustrate important clinical considerations for providers.
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Affiliation(s)
- Lindsay M Anderson
- Department of Psychology & Neuroscience, Duke University, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Jennifer B Freeman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Martin E Franklin
- Department of Psychiatry, University of Pennsylvania Medical School, 3535 Market Street, 6th Floor Philadelphia, PA 19104, USA
| | - Jeffrey J Sapyta
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA.
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