Objective Previous studies link lower body mass index(BMI)with increased obsessive-compulsive disorder(OCD)risk,yet other body mass indicators may be more etioloically relevant.We dissected the causal association betw...Objective Previous studies link lower body mass index(BMI)with increased obsessive-compulsive disorder(OCD)risk,yet other body mass indicators may be more etioloically relevant.We dissected the causal association between body fat mass(FM)and OCD.Methods Summary statistics from genome-wide association studies of European ancestry were utilized to conduct two-sample Mendelian randomization analysis.Heterogeneity,horizontal pleiotropy,and sensitivity analyses were performed to assess the robustness.Results The inverse variance weighting method demonstrated that a genetically predicted decrease in FM was causally associated with an increased OCD risk[odds ratio(OR)=0.680,95%confidence interval(CI):0.528–0.875,P=0.003].Similar estimates were obtained using the weighted median approach(OR=0.633,95%CI:0.438–0.915,P=0.015).Each standard deviation increases in genetically predicted body fat percentage corresponded to a reduced OCD risk(OR=0.638,95%CI:0.455–0.896,P=0.009).The sensitivity analysis confirmed the robustness of these findings with no outlier instrument variables identified.Conclusion The negative causal association between FM and the risk of OCD suggests that the prevention or treatment of mental disorders should include not only the control of BMI but also fat distribution and body composition.展开更多
Psychoeducation is a structured but straightforward and effective treatment,which consists of educating patients and family members about psychiatric disorders,teaching them to cope with the illness,and supporting the...Psychoeducation is a structured but straightforward and effective treatment,which consists of educating patients and family members about psychiatric disorders,teaching them to cope with the illness,and supporting them during treatment.Psychoeducation as an independent treatment is effective in schizophrenia and bipolar disorder.Psychoeducation is a core component of cognitivebehavioural therapy(CBT)or exposure and response prevention(ERP)treatment,which are the standard psychotherapeutic treatments for obsessive-compulsive disorder(OCD).However,research on the benefits of psychoeducational treatments in OCD is limited compared to schizophrenia and bipolar disorders.Very few studies have examined psychoeducation as an independent treatment for OCD,and its efficacy is not proven.The effectiveness of CBT or ERP for OCD is well established,but the contribution of psychoeducation to the efficacy of these treatments is unclear.Recently,there has been a greater understanding of maladaptive family responses,such as accommodation and antagonism,that worsen the outcome and treatment response in OCD.Family-based psychoeducational treatments targeting inappropriate family responses are effective in reducing obsessional symptoms,attenuating the negative family impact of OCD,and improving patient and family functioning.Family-based psychoeducation is a promising treatment for OCD,but there are methodological issues with the evidence,and trials among adult patients are limited compared to children and adolescents.The other obstacles to the implementation of psychoeducational treatments of OCD are the large treatment gap,lack of research from low-and middle-income countries,and the limited attempts to develop culturally adapted treatments in these countries.Thus,further research should focus on optimising psychoeducational treatments for OCD and efficiently delivering these treatments in routine clinical settings.展开更多
Obsessive-Compulsive Disorder(OCD)is a chronic and debilitating mental health condition that affects~2%to 3%of the global population[1],leading to significant functional impairment and reduced quality of life.Characte...Obsessive-Compulsive Disorder(OCD)is a chronic and debilitating mental health condition that affects~2%to 3%of the global population[1],leading to significant functional impairment and reduced quality of life.Characterized by intrusive thoughts and repetitive behaviors,OCD is typically managed with selective serotonin reuptake inhibitors(SSRIs)and cognitive-behavioral therapy,particularly exposure and response prevention.However,~25%to 40%of patients do not respond adequately to these firstline treatments,and many who do respond continue to experience residual symptoms[2].展开更多
The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disord...The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disorder （GAD） and obsessive-compulsive disorder （OCD）. We carried out a prospective uncontrolled intervention study with a 8-weeks of ARGT on sixty three outpatients with MDD, GAD or OCD. Hamilton rating scale for depression, Hamilton rating scale for anxiety, Yale-Brown obsessive-compulsive scale, attribution style questionnaire, self-esteem scale, index of well-being, and social disability screening schedule were administered before and after treatment. Significant improvement in symptoms and psychological and social functions from pre- to posttreatment occurred for all participants. The changes favored MDD patients. Our study suggested that ARGT may improve the symptoms and psychological-social functions of MDD, GAD, and OCD patients. MDD patients showed the best response.展开更多
Objective The existence of neuropsychological deficits has been implicated in obsessive-compulsive disorder （OCD）, particularly memory, attention, and executive functions. However, few studies have focused on neurop...Objective The existence of neuropsychological deficits has been implicated in obsessive-compulsive disorder （OCD）, particularly memory, attention, and executive functions. However, few studies have focused on neuropsychological deficits in the relatives of OCD patients. The aim of this study was to investigate cognitive deficits in OCD patients and their parents. Methods Forty patients with OCD, 48 parents of these patients, and 87 healthy controls completed a neuropsychological testing battery. Results Both OCD patients and their parents showed impairments in delayed verbal memory and delayed visual memory. Furthermore, they performed worse than healthy controls in problem-solving ability. Conclusion Our study demonstrated familial aggregation of delayed memory deficits and impaired problem-solving ability, which may be the potential neuropsychological endophenotypes of hereditary susceptibility to OCD.展开更多
BACKGROUND： Previous studies have shown that lesions in the anterior limb of the internal capsule contribute to obsessive-compulsive symptoms in patients with refractory obsessive-compulsive disorder （OCD）. However...BACKGROUND： Previous studies have shown that lesions in the anterior limb of the internal capsule contribute to obsessive-compulsive symptoms in patients with refractory obsessive-compulsive disorder （OCD）. However, few reports have addressed the effects of lesions in the anterior limb of the internal capsule on cognition, learning, and memory functions in patients with refractory OCD. OBJECTIVE： To investigate the degree of damage to memory tasks in refractory OCD patients following lesions to the anterior limb of the internal capsule. DESIGN, TIME AND SETTING： A case-controlled, observational study was performed at the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008. PARTICIPANTS： A total of 10 refractory OCD patients were admitted to the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008 and were recruited for this study. The OCD patients were of equal gender, with an average age of （25.1 ± 9.6） years. An additional 10 healthy volunteers were enrolled from a community of Shanghai City as controls; they were of equal gender and aged （25.1 ± 8.6） years. METHODS： A total of 10 refractory OCD patients were subjected to lesions in the anterior limbs of the bilateral internal capsules. Wechsler Memory Scale-Chinese Revision （WMS-CR, as a task of explicit memory） and the Nissen Version （serial reaction time task） software （SRTT, as a task of implicit memory） were applied to determine memory functions and learning performance in pre- and post-operative OCD patients and controls. MAIN OUTCOME MEASURES： WMS scores, reaction time in SRTT, and Yale-Brown obsessive compulsive scale scores were measured in pre- and post-operative OCD patients and controls. RESULTS： Compared to controls, the pre-operative OCD patients exhibited reduced memory task scores （P = 0.005）, whereas scores for reciting numbers of backwards digits were greater （P = 0.000）. Figure recall and associative memory were less in OCD patients at 1 week following surgery than in the pre-operative OCD patients （P = 0.042, P = 0.002, respectively）. Reaction time in implicit SRTT was significantly longer in pre-operative OCD patients compared with controls and post-operative OCD patients （P = 0.01, P = 0.03, respectively）. These results suggested ameliorated SRTT following neurosurgery. Yale-Brown Obsessive Compulsive Scale results revealed significantly improved OCD following lesions in the internal capsule （P = 0.04）. Some post-operative OCD patients suffered from deficits in short-term memory and implicit memory. CONCLUSION： Lesions in anterior limbs of bilateral internal capsules improve obsessive- compulsive symptoms and implicit memory in OCD patients, but result in aggravated short-term memory deficits.展开更多
The neuropsychiatric disease named obsessive-compulsive disorder is composed by obsessions and/or compulsions.Obsessive-compulsive disorder etiologies are undefined.However,numerous mechanisms in several localizations...The neuropsychiatric disease named obsessive-compulsive disorder is composed by obsessions and/or compulsions.Obsessive-compulsive disorder etiologies are undefined.However,numerous mechanisms in several localizations are implicated.Some studies showed that both glutamate,inflammatory factors and oxidative stress could have main functions in obsessive-compulsive disorder.Glycogen synthase kinase-3β,the major negative controller of the WNT/β-catenin pathway is upregulated in obsessive-compulsive disorder.In obsessive-compulsive disorder,some studies presented the actions of the different circadian clock genes.WNT/β-catenin pathway and circadian clock genes appear to be intricate.Thus,this review focuses on the interaction between circadian clock genes and the WNT/β-catenin pathway in obsessive-compulsive disorder.展开更多
The aim of the current study was to use whole brain voxel-based morphometry（VBM）to assess the gray matter（GM）changes in unmedicated patients with obsessive-compulsive disorder（OCD）compared with normal controls.W...The aim of the current study was to use whole brain voxel-based morphometry（VBM）to assess the gray matter（GM）changes in unmedicated patients with obsessive-compulsive disorder（OCD）compared with normal controls.We compared the GM volumes in28 patients with 22 matched healthy controls using a1.5T MRI.Three-dimensional T1-weighted magnetic resonance images were obtained from all participants.VBM was performed to detect GM volume differences between the two groups.We detected increased regional GM volumes in the bilateral middle temporal gyri,bilateral middle occipital gyri,bilateral globus pallidus,right inferior parietal gyrus,left superior parietal gyrus,right parahippocampus,right supramarginal gyrus,right medial superior frontal gyrus,and left inferior frontal opercular cortex in the OCD patients relative to controls（P〈0.001,uncorrected,cluster size〉100 voxels）.No decreased GM volume was found in the OCD group compared with normal controls.Our findings suggest that structural changes in the GM are not limited to fronto-striato-thalamic circuits in the pathogenesis of OCD.Temporo-parietal cortex may also play an important role.展开更多
Objective: Anger attacks have been observed in patients with obsessive-compulsive disorder(OCD), often triggered by obsessional triggers. However, few studies have reported the clinical characteristics and correlates ...Objective: Anger attacks have been observed in patients with obsessive-compulsive disorder(OCD), often triggered by obsessional triggers. However, few studies have reported the clinical characteristics and correlates of anger attacks among Chinese patients with OCD. Methods: A total of 90 adults with a primary diagnosis of OCD, ranging from 15 to 78 years old, participated in the study. Participants were administered the Rage Outbursts and Anger Rating Scale(ROARS), Yale-Brown Obsessive-Compulsive Scale-Second Edition, and Brown Assessment of Beliefs Scale by a trained clinician. Patients completed the Obsessive-Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21. Results: A total of 31.3% of participants reported anger outbursts in the past week, and ROARS scores had no significant correlation with age, duration of illness, OCD severity, depression, or stress. However, ROARS scores were negatively related to education level, and positively related to obsessing symptoms and anxiety. Conclusions: These data suggest that anger attacks are relatively common in Chinese patients with OCD. The severity of anger attacks is related to educational level, obsessing symptoms, and anxiety, which may be a latent variable reflecting executive functioning and emotion regulation skills.展开更多
Stress might exaggerate the compulsion and impair the working memory of patients with obsessivecompulsive disorder(OCD). This study evaluated the effect of stress on the cognitive neural processing of working memory i...Stress might exaggerate the compulsion and impair the working memory of patients with obsessivecompulsive disorder(OCD). This study evaluated the effect of stress on the cognitive neural processing of working memory in OCD and its clinical significance using a ‘‘number calculation working memory'' task. Thirty-eight patients and 55 gender-and education-matched healthy controls were examined. Stress impaired the performance of the manipulation task in patients. Healthy controls showed less engagement of the medial prefrontal cortex and striatum during the task under stress versus less stress,which was absent in the patients with OCD. The diagnosis 9 stress interaction effect was significant in the right fusiform, supplementary motor area, precentral cortex and caudate. The failure of suppression of the medial prefrontal cortex and striatum and stress-related hyperactivation in the right fusiform, supplementary motor area, precentral cortex, and caudate might be an OCD-related psychopathological and neural response to stress.展开更多
BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms ...BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According to the results,the response in the first year predicts the extent to which an OCD patient will benefit from DBS,since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation.Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients;but it is still controversial whether this improvement persists,increases or decreases in the long term.Three different patterns of LT response emerged from the analysis:49.5% of patients had good and sustained response to DBS,26.6% were non responders,and 22.5% were partial responders,who might improve at some point but experience relapses during follow-up.A significant improvement in depressive symptoms and global functionality was observed in most studies,usually(although not always)in parallel with an improvement in obsessive symptoms.Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters;however,some severe adverse events including intracranial hemorrhages and infections were also described.Hypomania was the most frequently reported psychiatric side effect.The relationship between DBS and suicide risk is still controversial and requires further study.Finally,to date,no clear clinical or biological predictors of response can be established,probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD,providing both ST and LT evidence of efficacy.展开更多
Obsessive-compulsive disorder(OCD)is a severe mental illness characterized by persistent,intrusive and distressing obsessions and/or compulsions.Such symptoms have been conceptualized as resulting from a failure in so...Obsessive-compulsive disorder(OCD)is a severe mental illness characterized by persistent,intrusive and distressing obsessions and/or compulsions.Such symptoms have been conceptualized as resulting from a failure in sourcemonitoring processes,suggesting that patients with OCD fail to distinguish actions they perform from those they just imagine doing.In this study,we aimed to provide an updated and exhaustive review of the literature examining the relationship between source-monitoring and OCD.A systematic search in the literature through January 2019 allowed us to identify 13 relevant publications investigating source-monitoring abilities in patients with OCD or participants with subclinical compulsive symptoms.Most of the retrieved studies did not report any source-monitoring deficits in clinical and subclinical subjects compared with healthy volunteers.However,most of the studies reported that patients with OCD and subclinical subjects displayed reduced confidence in source-monitoring judgments or global cognitive confidence compared to controls.The present review highlighted some methodological and statistical limitations.Consequently,further studies are needed to explore source monitoring with regard to the subcategories of OCD symptoms(i.e.,symmetryordering,contamination-washing,hoarding,aggressive obsession-checking,sexual-religious thoughts)and to clarify the relationship between sourcemonitoring subtypes(i.e.,reality or internal source-monitoring)and confidence in these populations.展开更多
BACKGROUND Obsessive-compulsive disorder(OCD)is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology.It also displays several different characteristics in children compared to...BACKGROUND Obsessive-compulsive disorder(OCD)is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology.It also displays several different characteristics in children compared to adults.AIM To describe the socio-demographic and phenomenological features of children with OCD and to investigate the impact of these features on response to pharmacotherapy.METHODS This retrospective study was carried out with 150 children and adolescents who had been diagnosed with OCD between 2014 and 2018.Data was collected by examining the files of the patients with diagnosis of OCD and similar disorders from the hospital database.Yale-Brown Obsessive-Compulsive Scale for Children was used for the assessment of obsession-compulsion subtypes.The Clinical Global Impression(CGI)scale was used to evaluate the severity of the disease(CGI-S)and global improvement(CGI-I).The predictors of treatment response were evaluated using linear regression analysis.The level of significance for all statistic tests was set as P<0.05.RESULTS The sample was divided into prepubertal(44%)and adolescent(56%)age groups.The most prevalent obsessions were contamination and aggression obsessions,and the most frequent compulsions were washing and checking.While contamination was observed more commonly in the prepubertal age group,the religious obsession was seen more frequently in adolescents.Patients with aggression obsession presented a higher frequency of comorbid anxiety(P=0.022)and mood subgroups(P>0.05).A lower CGI-I score was linked to a lower CGI-S score(95%confidence interval 0.21-0.39,P<0.001)and the prepubertal age of admission(95%confidence interval 0.03-0.87,P=0.020).CONCLUSION The phenomenology of OCD shows differences depending on the age group and the comorbid psychiatric disorders.Earlier identification and treatment of OCD may help to prevent the impairment of the mental health of children and adolescents.展开更多
BACKGROUND Obsessive-compulsive disorder(OCD)is a common mental disorder that varies greatly in manifestation and causes much distress to individuals.We describe a case in which a Chinese woman with OCD became delusio...BACKGROUND Obsessive-compulsive disorder(OCD)is a common mental disorder that varies greatly in manifestation and causes much distress to individuals.We describe a case in which a Chinese woman with OCD became delusional after childbirth,and discuss the possible phenomenological and psychological alterations.CASE SUMMARY A 27-year-old woman presented to the Psychiatry Department of our hospital with obsessions and compulsions.After taking medication,her symptoms were alleviated.Three years later,during her pregnancy,the obsessions returned and even progressed into paranoid delusions after childbirth.After multiple adjustments of treatment along with several fluctuations,she finally achieved remission and gained reasonable insight.CONCLUSION This case suggests that the patient with OCD appeared to move along a continuum of beliefs,and highlights the importance of effective intervention during pregnancy,which would exert a significant impact on postpartum exacerbation outcomes.展开更多
Recent data suggest that obsessive-compulsive disorder(OCD)is driven by an imbalance among the habit learning system and the goal-directed system.The frontostriatal loop termed cortico-striatal-thalamo-cortical(CSTC)c...Recent data suggest that obsessive-compulsive disorder(OCD)is driven by an imbalance among the habit learning system and the goal-directed system.The frontostriatal loop termed cortico-striatal-thalamo-cortical(CSTC)circuitry loop is involved in habits and their dysfunction plays an important role in OCD.Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD.Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABA ergic transmission,and could represent the pathophysiology of OCD.Moreover,the dysregulation of glutamate levels can lead to neurotoxicity,acting as a neuronal excitotoxin.The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients.Indeed,some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission.Although robust data supporting a progression of such brain changes are not available so far,an early intervention could help interrupt damage from neurotoxicity.Moreover,agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients.展开更多
BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 p...BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment.Moreover,the pandemic forced a global switch to telemental health(TMH)services to maintain the standards and continuity of care.Consequently,clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD.However,several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.AIM To describe the formulation,implementation,feasibility,and usefulness of videoconferencing-based ERP(VC-ERP)treatment for OCD during the coronavirus disease 2019 pandemic.METHODS This prospective,observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo(July 2020-June 2021).All patients with OCD were assessed using the home-based TMH services of the department.The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment.After a systematic evaluation of the available treatment options,an initial protocol for delivering VC-ERP was developed.Guidelines for clinicians and educational materials for patients and their families were prepared.The protocol was implemented among patients with OCD attending the TMH services,and their progress was monitored.The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders.Feasibility and efficacy outcomes were examined.RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases,10th version criteria.Out of 115 patients who attended the services during the study period,37 were excluded from the final analysis.Of the remaining 78 patients,VC-ERP was initiated in 43 patients.Six patients dropped out,and three were hospitalized for inpatient ERP.Eleven patients have completed the full VC-ERP treatment.One patient completed the psychoeducation part of the protocol.VC-ERP is ongoing in 22 patients.The protocol for VC-ERP treatment was developed and upgraded online.A large proportion of the eligible patients(n=34/43;79%)actively engaged in the VC-ERP treatment.Drop-out rates were low(n=6/43;14%).Satisfaction with the treatment was adequate among patients,caregivers,and clinicians.Apart from hospitalization in 3 patients,there were no other adverse events.Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol.Therefore,the feasibility of VC-ERP treatment in terms of operational viability,service utilization,service engagement,need for additional in-person services,frequency of adverse events,and user satisfaction was adequate.The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment.Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD.The results suggest that VC-ERP can be a useful option in resource-constrained settings.展开更多
In the treatment of OCD, several therapeutic approaches have been developed, including individual, group and/or pharmacological therapeutic methods. However, group therapy on OCD has received little research attention...In the treatment of OCD, several therapeutic approaches have been developed, including individual, group and/or pharmacological therapeutic methods. However, group therapy on OCD has received little research attention in comparison with other therapeutic methods and some studies demonstrated that OCD can be treated in group settings. In the literature, mentioned group therapies to treat OCD involve behavioral therapy, cognitive therapy, ERP (exposure and response prevention), cognitive behavioral therapy, ACT (acceptance and commitment therapy), supportive groups and individual therapy with family member involvement. In relation to their effectiveness, research indicated inconsistent findings. Therefore, the aim of this study was to address and to review whether group treatments on OCD are efficacious. This review focused on cognitive-behavioral group therapy (CBGT), ERP, and ACT.展开更多
A role of lower brain-derived neurotrophic factor (BDNF) content in the pathogenesis of several mental illnesses has been suggested, especially in major depression. It is not known whether BDNF is involved in the path...A role of lower brain-derived neurotrophic factor (BDNF) content in the pathogenesis of several mental illnesses has been suggested, especially in major depression. It is not known whether BDNF is involved in the pathogenesis of obsessive-compulsive disorder (OCD). Herein, we assessed the serum BDNF content and its correlation with symptom severity in a Japanese population with OCD. The serum BDNF levels of OCD patients (n = 39) and healthy controls (n = 37) were measured by ELISA. The severity of OCD symptoms was assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Beck Depression Inventory (BDI). The OCD patients’ BDNF levels were significantly higher than those of the controls (17.5 ± 7.3 vs. 12.7 ± 4.7) (p < 0.01). No correlation was observed between the OCD patients’ BDNF levels and their OCD symptoms as scored by the Y-BOCS. For all 76 subjects, the BDI scores were significantly negatively correlated with the serum BDNF levels. Our findings revealed that contrary to previous reports, the serum BDNF content in OCD patients could be higher than that of healthy subjects.展开更多
Background: There is limited knowledge about obsessive-compulsive disorder (OCD) in people with intellectual disabilities (IDs). This paper describes the manifestation of compulsive behaviors associated with OCD at th...Background: There is limited knowledge about obsessive-compulsive disorder (OCD) in people with intellectual disabilities (IDs). This paper describes the manifestation of compulsive behaviors associated with OCD at the behavioral level in people with ID in institutionalized settings. The aim was to gain nuanced insight into appropriate understanding and classification in this specific context, and derive implications for research and practice. Methods: Individual cases of people with ID (n = 7) were studied to assess compulsive symptoms through two days of on-site observation of the person with ID within the institution, guided group discussions (n = 28), and semi-structured interviews with key informants and caregivers of the person with ID (n = 20). Caregiver ratings of the compulsive behavior checklist were compiled. Data were analyzed using qualitative content analysis. Results: All forms of OCD were present. Characteristics of compulsive behaviors in people with ID at the behavioral level included less complex and more obvious compulsive acts, immediate responses, signs of tension, motor restlessness, facial expression changes, repetition, need for predictability, time-consuming behaviors, and aggressive reactions when these acts were interrupted. Some of the compulsive behaviors corresponded to the ICD-11 OCD code 6B20, and others to compulsions as a psychological symptom (MB23.4). Conclusions: OCD may manifest atypically at the behavioral level in people with ID, posing significant challenges for accurate classification due to symptom ambiguity. Follow-up differential diagnostic studies are needed to more accurately identify and differentiate OCD symptoms in people with ID. Further, disorder-specific guidelines for recognizing OCD in people with ID are needed for institutionalized settings without psychiatric-psychotherapeutic expertise.展开更多
Neurosurgery for psychiatric disorders, notably for obsessive-compulsive disorder (OCD), was initiated in Venezuela in the decade of 1970, and consisted since that time in the classic stereotactic anterior cingulotomy...Neurosurgery for psychiatric disorders, notably for obsessive-compulsive disorder (OCD), was initiated in Venezuela in the decade of 1970, and consisted since that time in the classic stereotactic anterior cingulotomy. In order to know further about the physiopathology of this disorder, we performed intracerebral microdialysis in 2 patients who were operated on. The aim was to measure changes in extracellular neurotransmitters within the basal ganglia. The microdialysis probes were stereotactically placed in the right caudate nucleus and in the dorsomedial nucleus of the right thalamus. The microdialysis was done before the left cingulotomy, during the pause and after the right cingulotomy. Glutamate and gamma-aminobutyric acid (GABA) changes were similar in the caudate nucleus of both patients, whereas in the dorsomedial nucleus the changes were opposite among the 2 patients. Although this study does not bring enough data to explain such differences yet, the existence of dynamic changes in the neurochemistry of the basal ganglia during cingulotomy shows that intracerebral microdialysis can help in the understanding of the pathophysiology of OCD and eventually in the design of new surgeries with better results.展开更多
基金supported by the Yanzhao Gold Talent Project of Hebei Province(NO.HJZD202506)。
文摘Objective Previous studies link lower body mass index(BMI)with increased obsessive-compulsive disorder(OCD)risk,yet other body mass indicators may be more etioloically relevant.We dissected the causal association between body fat mass(FM)and OCD.Methods Summary statistics from genome-wide association studies of European ancestry were utilized to conduct two-sample Mendelian randomization analysis.Heterogeneity,horizontal pleiotropy,and sensitivity analyses were performed to assess the robustness.Results The inverse variance weighting method demonstrated that a genetically predicted decrease in FM was causally associated with an increased OCD risk[odds ratio(OR)=0.680,95%confidence interval(CI):0.528–0.875,P=0.003].Similar estimates were obtained using the weighted median approach(OR=0.633,95%CI:0.438–0.915,P=0.015).Each standard deviation increases in genetically predicted body fat percentage corresponded to a reduced OCD risk(OR=0.638,95%CI:0.455–0.896,P=0.009).The sensitivity analysis confirmed the robustness of these findings with no outlier instrument variables identified.Conclusion The negative causal association between FM and the risk of OCD suggests that the prevention or treatment of mental disorders should include not only the control of BMI but also fat distribution and body composition.
文摘Psychoeducation is a structured but straightforward and effective treatment,which consists of educating patients and family members about psychiatric disorders,teaching them to cope with the illness,and supporting them during treatment.Psychoeducation as an independent treatment is effective in schizophrenia and bipolar disorder.Psychoeducation is a core component of cognitivebehavioural therapy(CBT)or exposure and response prevention(ERP)treatment,which are the standard psychotherapeutic treatments for obsessive-compulsive disorder(OCD).However,research on the benefits of psychoeducational treatments in OCD is limited compared to schizophrenia and bipolar disorders.Very few studies have examined psychoeducation as an independent treatment for OCD,and its efficacy is not proven.The effectiveness of CBT or ERP for OCD is well established,but the contribution of psychoeducation to the efficacy of these treatments is unclear.Recently,there has been a greater understanding of maladaptive family responses,such as accommodation and antagonism,that worsen the outcome and treatment response in OCD.Family-based psychoeducational treatments targeting inappropriate family responses are effective in reducing obsessional symptoms,attenuating the negative family impact of OCD,and improving patient and family functioning.Family-based psychoeducation is a promising treatment for OCD,but there are methodological issues with the evidence,and trials among adult patients are limited compared to children and adolescents.The other obstacles to the implementation of psychoeducational treatments of OCD are the large treatment gap,lack of research from low-and middle-income countries,and the limited attempts to develop culturally adapted treatments in these countries.Thus,further research should focus on optimising psychoeducational treatments for OCD and efficiently delivering these treatments in routine clinical settings.
基金supported by the STI2030-Major Projects(2021ZD0203000(2021ZD0203003))the Chinese Academy of Sciences(CAS)Pioneer Hundred Talents Program,and the Open Research Fund of the State Key Laboratory of Brain-Machine Intelligence,Zhejiang University(BMI2400014).
文摘Obsessive-Compulsive Disorder(OCD)is a chronic and debilitating mental health condition that affects~2%to 3%of the global population[1],leading to significant functional impairment and reduced quality of life.Characterized by intrusive thoughts and repetitive behaviors,OCD is typically managed with selective serotonin reuptake inhibitors(SSRIs)and cognitive-behavioral therapy,particularly exposure and response prevention.However,~25%to 40%of patients do not respond adequately to these firstline treatments,and many who do respond continue to experience residual symptoms[2].
基金supported by national science and technology support projects (No.2009BA177B07)Natural Science Foundation of Jiangsu Province,China (No.PBBS1-102350)
文摘The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disorder （GAD） and obsessive-compulsive disorder （OCD）. We carried out a prospective uncontrolled intervention study with a 8-weeks of ARGT on sixty three outpatients with MDD, GAD or OCD. Hamilton rating scale for depression, Hamilton rating scale for anxiety, Yale-Brown obsessive-compulsive scale, attribution style questionnaire, self-esteem scale, index of well-being, and social disability screening schedule were administered before and after treatment. Significant improvement in symptoms and psychological and social functions from pre- to posttreatment occurred for all participants. The changes favored MDD patients. Our study suggested that ARGT may improve the symptoms and psychological-social functions of MDD, GAD, and OCD patients. MDD patients showed the best response.
基金supported by the National Natural Science Foundation for Distinguished Young Scholars of China (30125014)
文摘Objective The existence of neuropsychological deficits has been implicated in obsessive-compulsive disorder （OCD）, particularly memory, attention, and executive functions. However, few studies have focused on neuropsychological deficits in the relatives of OCD patients. The aim of this study was to investigate cognitive deficits in OCD patients and their parents. Methods Forty patients with OCD, 48 parents of these patients, and 87 healthy controls completed a neuropsychological testing battery. Results Both OCD patients and their parents showed impairments in delayed verbal memory and delayed visual memory. Furthermore, they performed worse than healthy controls in problem-solving ability. Conclusion Our study demonstrated familial aggregation of delayed memory deficits and impaired problem-solving ability, which may be the potential neuropsychological endophenotypes of hereditary susceptibility to OCD.
基金the Key Program of International Communication Foundation of Psychiatry and Neurology Department of Shanghai Jiao-Tong University, No. 200901
文摘BACKGROUND： Previous studies have shown that lesions in the anterior limb of the internal capsule contribute to obsessive-compulsive symptoms in patients with refractory obsessive-compulsive disorder （OCD）. However, few reports have addressed the effects of lesions in the anterior limb of the internal capsule on cognition, learning, and memory functions in patients with refractory OCD. OBJECTIVE： To investigate the degree of damage to memory tasks in refractory OCD patients following lesions to the anterior limb of the internal capsule. DESIGN, TIME AND SETTING： A case-controlled, observational study was performed at the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008. PARTICIPANTS： A total of 10 refractory OCD patients were admitted to the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008 and were recruited for this study. The OCD patients were of equal gender, with an average age of （25.1 ± 9.6） years. An additional 10 healthy volunteers were enrolled from a community of Shanghai City as controls; they were of equal gender and aged （25.1 ± 8.6） years. METHODS： A total of 10 refractory OCD patients were subjected to lesions in the anterior limbs of the bilateral internal capsules. Wechsler Memory Scale-Chinese Revision （WMS-CR, as a task of explicit memory） and the Nissen Version （serial reaction time task） software （SRTT, as a task of implicit memory） were applied to determine memory functions and learning performance in pre- and post-operative OCD patients and controls. MAIN OUTCOME MEASURES： WMS scores, reaction time in SRTT, and Yale-Brown obsessive compulsive scale scores were measured in pre- and post-operative OCD patients and controls. RESULTS： Compared to controls, the pre-operative OCD patients exhibited reduced memory task scores （P = 0.005）, whereas scores for reciting numbers of backwards digits were greater （P = 0.000）. Figure recall and associative memory were less in OCD patients at 1 week following surgery than in the pre-operative OCD patients （P = 0.042, P = 0.002, respectively）. Reaction time in implicit SRTT was significantly longer in pre-operative OCD patients compared with controls and post-operative OCD patients （P = 0.01, P = 0.03, respectively）. These results suggested ameliorated SRTT following neurosurgery. Yale-Brown Obsessive Compulsive Scale results revealed significantly improved OCD following lesions in the internal capsule （P = 0.04）. Some post-operative OCD patients suffered from deficits in short-term memory and implicit memory. CONCLUSION： Lesions in anterior limbs of bilateral internal capsules improve obsessive- compulsive symptoms and implicit memory in OCD patients, but result in aggravated short-term memory deficits.
文摘The neuropsychiatric disease named obsessive-compulsive disorder is composed by obsessions and/or compulsions.Obsessive-compulsive disorder etiologies are undefined.However,numerous mechanisms in several localizations are implicated.Some studies showed that both glutamate,inflammatory factors and oxidative stress could have main functions in obsessive-compulsive disorder.Glycogen synthase kinase-3β,the major negative controller of the WNT/β-catenin pathway is upregulated in obsessive-compulsive disorder.In obsessive-compulsive disorder,some studies presented the actions of the different circadian clock genes.WNT/β-catenin pathway and circadian clock genes appear to be intricate.Thus,this review focuses on the interaction between circadian clock genes and the WNT/β-catenin pathway in obsessive-compulsive disorder.
基金supported by the National High Technology Research and Development Program (863 Program) of China (2007AA02Z420)a Key Project of the Science and Technology Commission of Shanghai Municipality (074119520)+4 种基金the Program for Shanghai Outstanding Academic Leader Plans (08XD14036)the National Key Clinical Disciplines at Shanghai Mental Health Center (Office of Medical Affairs, Ministry of Health, 2011873 OMA-MH, 2011-873)a Guidance Project of the Shanghai Science and Technology Commission, China (124119a8200)the Medical Engineering Crossover Research Fund Program of Shanghai Jiao Tong University (YG2012MS59)
文摘The aim of the current study was to use whole brain voxel-based morphometry（VBM）to assess the gray matter（GM）changes in unmedicated patients with obsessive-compulsive disorder（OCD）compared with normal controls.We compared the GM volumes in28 patients with 22 matched healthy controls using a1.5T MRI.Three-dimensional T1-weighted magnetic resonance images were obtained from all participants.VBM was performed to detect GM volume differences between the two groups.We detected increased regional GM volumes in the bilateral middle temporal gyri,bilateral middle occipital gyri,bilateral globus pallidus,right inferior parietal gyrus,left superior parietal gyrus,right parahippocampus,right supramarginal gyrus,right medial superior frontal gyrus,and left inferior frontal opercular cortex in the OCD patients relative to controls（P〈0.001,uncorrected,cluster size〉100 voxels）.No decreased GM volume was found in the OCD group compared with normal controls.Our findings suggest that structural changes in the GM are not limited to fronto-striato-thalamic circuits in the pathogenesis of OCD.Temporo-parietal cortex may also play an important role.
基金Project supported by the Shanghai Pudong New District Health and Family Planning Commission Key Discipline Construction Fund Project(No.PWZxk2017-29),China
文摘Objective: Anger attacks have been observed in patients with obsessive-compulsive disorder(OCD), often triggered by obsessional triggers. However, few studies have reported the clinical characteristics and correlates of anger attacks among Chinese patients with OCD. Methods: A total of 90 adults with a primary diagnosis of OCD, ranging from 15 to 78 years old, participated in the study. Participants were administered the Rage Outbursts and Anger Rating Scale(ROARS), Yale-Brown Obsessive-Compulsive Scale-Second Edition, and Brown Assessment of Beliefs Scale by a trained clinician. Patients completed the Obsessive-Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21. Results: A total of 31.3% of participants reported anger outbursts in the past week, and ROARS scores had no significant correlation with age, duration of illness, OCD severity, depression, or stress. However, ROARS scores were negatively related to education level, and positively related to obsessing symptoms and anxiety. Conclusions: These data suggest that anger attacks are relatively common in Chinese patients with OCD. The severity of anger attacks is related to educational level, obsessing symptoms, and anxiety, which may be a latent variable reflecting executive functioning and emotion regulation skills.
基金supported by the National Natural Science Foundation of China (81771443, 81370032, 81601171, and 91432304)。
文摘Stress might exaggerate the compulsion and impair the working memory of patients with obsessivecompulsive disorder(OCD). This study evaluated the effect of stress on the cognitive neural processing of working memory in OCD and its clinical significance using a ‘‘number calculation working memory'' task. Thirty-eight patients and 55 gender-and education-matched healthy controls were examined. Stress impaired the performance of the manipulation task in patients. Healthy controls showed less engagement of the medial prefrontal cortex and striatum during the task under stress versus less stress,which was absent in the patients with OCD. The diagnosis 9 stress interaction effect was significant in the right fusiform, supplementary motor area, precentral cortex and caudate. The failure of suppression of the medial prefrontal cortex and striatum and stress-related hyperactivation in the right fusiform, supplementary motor area, precentral cortex, and caudate might be an OCD-related psychopathological and neural response to stress.
基金Supported by Carlos Ⅲ Health Institute,No.PI16/00950 and No.PI18/00856and FEDER funds(‘A way to build Europe’).
文摘BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According to the results,the response in the first year predicts the extent to which an OCD patient will benefit from DBS,since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation.Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients;but it is still controversial whether this improvement persists,increases or decreases in the long term.Three different patterns of LT response emerged from the analysis:49.5% of patients had good and sustained response to DBS,26.6% were non responders,and 22.5% were partial responders,who might improve at some point but experience relapses during follow-up.A significant improvement in depressive symptoms and global functionality was observed in most studies,usually(although not always)in parallel with an improvement in obsessive symptoms.Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters;however,some severe adverse events including intracranial hemorrhages and infections were also described.Hypomania was the most frequently reported psychiatric side effect.The relationship between DBS and suicide risk is still controversial and requires further study.Finally,to date,no clear clinical or biological predictors of response can be established,probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD,providing both ST and LT evidence of efficacy.
文摘Obsessive-compulsive disorder(OCD)is a severe mental illness characterized by persistent,intrusive and distressing obsessions and/or compulsions.Such symptoms have been conceptualized as resulting from a failure in sourcemonitoring processes,suggesting that patients with OCD fail to distinguish actions they perform from those they just imagine doing.In this study,we aimed to provide an updated and exhaustive review of the literature examining the relationship between source-monitoring and OCD.A systematic search in the literature through January 2019 allowed us to identify 13 relevant publications investigating source-monitoring abilities in patients with OCD or participants with subclinical compulsive symptoms.Most of the retrieved studies did not report any source-monitoring deficits in clinical and subclinical subjects compared with healthy volunteers.However,most of the studies reported that patients with OCD and subclinical subjects displayed reduced confidence in source-monitoring judgments or global cognitive confidence compared to controls.The present review highlighted some methodological and statistical limitations.Consequently,further studies are needed to explore source monitoring with regard to the subcategories of OCD symptoms(i.e.,symmetryordering,contamination-washing,hoarding,aggressive obsession-checking,sexual-religious thoughts)and to clarify the relationship between sourcemonitoring subtypes(i.e.,reality or internal source-monitoring)and confidence in these populations.
基金The study protocol was approved by the Marmara University School of Medicine Clinical Research Ethics Committee(Protocol No:09.2019.360,date:April 5,2019).
文摘BACKGROUND Obsessive-compulsive disorder(OCD)is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology.It also displays several different characteristics in children compared to adults.AIM To describe the socio-demographic and phenomenological features of children with OCD and to investigate the impact of these features on response to pharmacotherapy.METHODS This retrospective study was carried out with 150 children and adolescents who had been diagnosed with OCD between 2014 and 2018.Data was collected by examining the files of the patients with diagnosis of OCD and similar disorders from the hospital database.Yale-Brown Obsessive-Compulsive Scale for Children was used for the assessment of obsession-compulsion subtypes.The Clinical Global Impression(CGI)scale was used to evaluate the severity of the disease(CGI-S)and global improvement(CGI-I).The predictors of treatment response were evaluated using linear regression analysis.The level of significance for all statistic tests was set as P<0.05.RESULTS The sample was divided into prepubertal(44%)and adolescent(56%)age groups.The most prevalent obsessions were contamination and aggression obsessions,and the most frequent compulsions were washing and checking.While contamination was observed more commonly in the prepubertal age group,the religious obsession was seen more frequently in adolescents.Patients with aggression obsession presented a higher frequency of comorbid anxiety(P=0.022)and mood subgroups(P>0.05).A lower CGI-I score was linked to a lower CGI-S score(95%confidence interval 0.21-0.39,P<0.001)and the prepubertal age of admission(95%confidence interval 0.03-0.87,P=0.020).CONCLUSION The phenomenology of OCD shows differences depending on the age group and the comorbid psychiatric disorders.Earlier identification and treatment of OCD may help to prevent the impairment of the mental health of children and adolescents.
文摘BACKGROUND Obsessive-compulsive disorder(OCD)is a common mental disorder that varies greatly in manifestation and causes much distress to individuals.We describe a case in which a Chinese woman with OCD became delusional after childbirth,and discuss the possible phenomenological and psychological alterations.CASE SUMMARY A 27-year-old woman presented to the Psychiatry Department of our hospital with obsessions and compulsions.After taking medication,her symptoms were alleviated.Three years later,during her pregnancy,the obsessions returned and even progressed into paranoid delusions after childbirth.After multiple adjustments of treatment along with several fluctuations,she finally achieved remission and gained reasonable insight.CONCLUSION This case suggests that the patient with OCD appeared to move along a continuum of beliefs,and highlights the importance of effective intervention during pregnancy,which would exert a significant impact on postpartum exacerbation outcomes.
文摘Recent data suggest that obsessive-compulsive disorder(OCD)is driven by an imbalance among the habit learning system and the goal-directed system.The frontostriatal loop termed cortico-striatal-thalamo-cortical(CSTC)circuitry loop is involved in habits and their dysfunction plays an important role in OCD.Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD.Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABA ergic transmission,and could represent the pathophysiology of OCD.Moreover,the dysregulation of glutamate levels can lead to neurotoxicity,acting as a neuronal excitotoxin.The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients.Indeed,some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission.Although robust data supporting a progression of such brain changes are not available so far,an early intervention could help interrupt damage from neurotoxicity.Moreover,agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients.
文摘BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment.Moreover,the pandemic forced a global switch to telemental health(TMH)services to maintain the standards and continuity of care.Consequently,clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD.However,several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.AIM To describe the formulation,implementation,feasibility,and usefulness of videoconferencing-based ERP(VC-ERP)treatment for OCD during the coronavirus disease 2019 pandemic.METHODS This prospective,observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo(July 2020-June 2021).All patients with OCD were assessed using the home-based TMH services of the department.The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment.After a systematic evaluation of the available treatment options,an initial protocol for delivering VC-ERP was developed.Guidelines for clinicians and educational materials for patients and their families were prepared.The protocol was implemented among patients with OCD attending the TMH services,and their progress was monitored.The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders.Feasibility and efficacy outcomes were examined.RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases,10th version criteria.Out of 115 patients who attended the services during the study period,37 were excluded from the final analysis.Of the remaining 78 patients,VC-ERP was initiated in 43 patients.Six patients dropped out,and three were hospitalized for inpatient ERP.Eleven patients have completed the full VC-ERP treatment.One patient completed the psychoeducation part of the protocol.VC-ERP is ongoing in 22 patients.The protocol for VC-ERP treatment was developed and upgraded online.A large proportion of the eligible patients(n=34/43;79%)actively engaged in the VC-ERP treatment.Drop-out rates were low(n=6/43;14%).Satisfaction with the treatment was adequate among patients,caregivers,and clinicians.Apart from hospitalization in 3 patients,there were no other adverse events.Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol.Therefore,the feasibility of VC-ERP treatment in terms of operational viability,service utilization,service engagement,need for additional in-person services,frequency of adverse events,and user satisfaction was adequate.The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment.Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD.The results suggest that VC-ERP can be a useful option in resource-constrained settings.
文摘In the treatment of OCD, several therapeutic approaches have been developed, including individual, group and/or pharmacological therapeutic methods. However, group therapy on OCD has received little research attention in comparison with other therapeutic methods and some studies demonstrated that OCD can be treated in group settings. In the literature, mentioned group therapies to treat OCD involve behavioral therapy, cognitive therapy, ERP (exposure and response prevention), cognitive behavioral therapy, ACT (acceptance and commitment therapy), supportive groups and individual therapy with family member involvement. In relation to their effectiveness, research indicated inconsistent findings. Therefore, the aim of this study was to address and to review whether group treatments on OCD are efficacious. This review focused on cognitive-behavioral group therapy (CBGT), ERP, and ACT.
文摘A role of lower brain-derived neurotrophic factor (BDNF) content in the pathogenesis of several mental illnesses has been suggested, especially in major depression. It is not known whether BDNF is involved in the pathogenesis of obsessive-compulsive disorder (OCD). Herein, we assessed the serum BDNF content and its correlation with symptom severity in a Japanese population with OCD. The serum BDNF levels of OCD patients (n = 39) and healthy controls (n = 37) were measured by ELISA. The severity of OCD symptoms was assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Beck Depression Inventory (BDI). The OCD patients’ BDNF levels were significantly higher than those of the controls (17.5 ± 7.3 vs. 12.7 ± 4.7) (p < 0.01). No correlation was observed between the OCD patients’ BDNF levels and their OCD symptoms as scored by the Y-BOCS. For all 76 subjects, the BDI scores were significantly negatively correlated with the serum BDNF levels. Our findings revealed that contrary to previous reports, the serum BDNF content in OCD patients could be higher than that of healthy subjects.
文摘Background: There is limited knowledge about obsessive-compulsive disorder (OCD) in people with intellectual disabilities (IDs). This paper describes the manifestation of compulsive behaviors associated with OCD at the behavioral level in people with ID in institutionalized settings. The aim was to gain nuanced insight into appropriate understanding and classification in this specific context, and derive implications for research and practice. Methods: Individual cases of people with ID (n = 7) were studied to assess compulsive symptoms through two days of on-site observation of the person with ID within the institution, guided group discussions (n = 28), and semi-structured interviews with key informants and caregivers of the person with ID (n = 20). Caregiver ratings of the compulsive behavior checklist were compiled. Data were analyzed using qualitative content analysis. Results: All forms of OCD were present. Characteristics of compulsive behaviors in people with ID at the behavioral level included less complex and more obvious compulsive acts, immediate responses, signs of tension, motor restlessness, facial expression changes, repetition, need for predictability, time-consuming behaviors, and aggressive reactions when these acts were interrupted. Some of the compulsive behaviors corresponded to the ICD-11 OCD code 6B20, and others to compulsions as a psychological symptom (MB23.4). Conclusions: OCD may manifest atypically at the behavioral level in people with ID, posing significant challenges for accurate classification due to symptom ambiguity. Follow-up differential diagnostic studies are needed to more accurately identify and differentiate OCD symptoms in people with ID. Further, disorder-specific guidelines for recognizing OCD in people with ID are needed for institutionalized settings without psychiatric-psychotherapeutic expertise.
文摘Neurosurgery for psychiatric disorders, notably for obsessive-compulsive disorder (OCD), was initiated in Venezuela in the decade of 1970, and consisted since that time in the classic stereotactic anterior cingulotomy. In order to know further about the physiopathology of this disorder, we performed intracerebral microdialysis in 2 patients who were operated on. The aim was to measure changes in extracellular neurotransmitters within the basal ganglia. The microdialysis probes were stereotactically placed in the right caudate nucleus and in the dorsomedial nucleus of the right thalamus. The microdialysis was done before the left cingulotomy, during the pause and after the right cingulotomy. Glutamate and gamma-aminobutyric acid (GABA) changes were similar in the caudate nucleus of both patients, whereas in the dorsomedial nucleus the changes were opposite among the 2 patients. Although this study does not bring enough data to explain such differences yet, the existence of dynamic changes in the neurochemistry of the basal ganglia during cingulotomy shows that intracerebral microdialysis can help in the understanding of the pathophysiology of OCD and eventually in the design of new surgeries with better results.
