In response to the emerging crisis and growing calls from patients and clinicians for guidance 5, a working group of clinical experts from the International College of Obsessive Compulsive Spectrum ...Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network of the European College of Neuropsychopharmacology (OCRN) have produced this consensus statement with the aim of delivering pragmatic guidance at the earliest opportunity to clinicians for managing this complex challenge. Based on the risks associated with exposure and response prevention (ERP) in the pandemic (see below), and uncertainty as to which of the two evidence-based treatments, pharmacotherapy or cognitive behaviour therapy (CBT), represents the most efficacious first line treatment modality 11, pharmacotherapy should be the first option for adults and children with OCD with contamination, washing or cleaning symptoms during the COVID-19 pandemic. Consider A) type of medication; most patients should receive an SSRI, or if not responsive, another SSRI and as a third choice clomipramine (for which an ECG may be required in certain patient groups); Note US Food and Drug Administration "black box" warnings or advice from equivalent national regulatory authorities regarding increased risk in young people and other vulnerable patient groups. Check for adverse effects and be available for any concerns related to "activation" or newly emergent or increased suicidal ideation, which in the young can be mitigated by starting treatment at a low dose and titrating more gradually; B) dosage; if the patient is on a suboptimal dose, consider increasing it, paying attention to any contraindications; C) SSRI-resistance; consider a low dose of adjunctive antipsychotic (aripiprazole, risperidone, quetiapine, olanzapine), especially if a tic is present; D) adherence; ensure the patient is able to obtain an adequate supply and is taking the treatment regularly.
The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the ...Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.
Well-functioning error monitoring of the inner and outer environments is essential for adaptively altering behavior, while malfunction characterizes conditions such as obsessive–compulsive disorder ...(OCD). The underlying brain processing is manifested as Error-Related Negativity (ERN) signal elicited following error comission, and Perceived Error Related Theta Activity (PERTA) signal elicited following detection of discrepancy in the environment. Yet, while enhanced ERN was repeatedly demonstrated in OCD patients and was found to be potentiated among their unaffected first degree relatives, no comparable observations were reported with regard to PERTA. We recorded EEG activity while OCD patients, OCD patients’ siblings (Family), and healthy controls (HC) performed computerized tasks. For the examination of ERN we used the Stroop task and for the examination of PERTA we presented correct and incorrect mathematical equations. Increased ERN (0–120 ms post response) was observed in both the OCD and Family groups, but only the OCD patients’ signal significantly differed from that of HC's. Similarly, modified PERTA activity was observed in both the OCD and Family groups in the N1 peak (65–125 ms post perceived error), but only for the OCD group this activity significantly differed from that of HC. Both ERN and PERTA's N1 are fast occurring peaks, which suggests that OCD is associate with a constantly over-activated detection system that monitors the inner and outer environment and reacts promptly following detection of a mistake. Furthermore, the modified but non-significantly different activity of the Family group suggests that the pathological condition evolves in vulnerable individuals with neuronal predisposition.
Abstract Recruitment for clinical studies presents a serious challenge in terms of meeting both time and budget constraints. The internet offers a potentially powerful means for quick and effective ...recruitment—either as an add-on or as alternative to traditional methods. We developed a Google search based solution which enhances patient recruitment. Recruitment via internet was associated with greater exposure to relevant applicants and better response to treatment as compared to traditional printed ads.
Abstract Characterized by compulsive rituals and Obsessive thoughts, OCD is a chronic and disabling disorder. Despite converging evidence pointing towards the involvement of dysfunctional ...cortico-striato-thalamo-cortical circuit in OCD, the neurophysiological pathology of OCD is still not well characterized. Indeed, 40%-60% of patients do not respond adequately to standard treatments. TMS is a noninvasive therapeutic technique, recently applied to treat and investigate OCD. However, lacking the ability to target the CSTC circuit directly, standard TMS treatment protocols for OCD showed diversified results. The use of special deep TMS (dTMS) coils allows direct stimulation of deeper neuronal pathways relative to those affected by standard TMS coils. Here we evaluated whether dTMS targeting the medial prefrontal and the anterior cingulate cortices may influence symptom severity. Method 40 patients were treated with either dTMS or a sham coil for five weeks in a double-blind controlled study. The patients were divided into groups receiving either high (20Hz) or low (1Hz) stimulation frequencies, and were simultaneously administrated with symptom provocation. EEG measurements were taken at baseline and at the end of treatment. Results The active 20Hz dTMS group improved significantly in YBOCS score compared to the 1Hz and placebo groups (28% vs. 6% reduction), {t (93) = -2.29 (p=0.0243)}. Moreover, follow-up assessments revealed 3 months stability in improvements as measured by YBOCS scores. EEG evoked responses measured over the ACC correlated with clinical response. Conclusions High frequency dTMS treatment, targeting the medial prefrontal and the anterior cingulate cortices is a promising therapeutic intervention in OCD.
Unreconciled Cobb, Daniel M.; Carmi, Marissa L.
Hungarian journal of English and American studies,
11/2023, Letnik:
29, Številka:
2
Journal Article
Recenzirano
Odprti dostop
This essay explores race, racism, history, and popular memory from the vantage point of the Indigenous world, and, specifically, Native peoples colonized within the present-day United States. Over ...the course of the past decade, Indigenous movements for land and life have shed light on the incomplete nature of conquest in Native North America and the instability of settler colonialism. “Unreconciled” explores the ongoing tension between Indigenous presence and the settler colonial “logic of elimination” in the context of land acknowledgments, commemoration, popular culture, and federal policy. We show that, despite changes with regard to the ways in which non-Indigenous people in settler states collectively remember or imagine community, elements of settler memory continue to reside within and limit public conversations on race, remembrance, reconciliation, and reparation. (DMC and MLC)
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