An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations ...involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
Among patients with bipolar I disorder who had remission of depression, there was no significant difference in the incidence of relapse of any mood episode between 8 weeks and 52 weeks of ...antidepressant treatment.
Purpose of review
Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive–compulsive disorder (OCD) and related disorders such as body ...dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders.
Recent findings
Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating.
Summary
Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.
Abstract Objective Although several studies have examined neuropsychological functions in obsessive-compulsive disorder (OCD), findings are not conclusive, predominantly due to small samples and ...assessment of limited domains. We aim to map the neuropsychological profile of OCD in a large sample with a comprehensive battery of tests. Method Neuropsychological functions were tested in 150 subjects with DSM-IV OCD and 205 healthy control subjects. Results Subjects with OCD performed significantly worse than healthy control subjects on Colour Trails 1 time, Tower of Hanoi 3-disk time, Wisconsin Card Sorting Test categories completed, Iowa Gambling Task, Complex Figure Test immediate and delayed recall (p < 0.001). Conclusions Subjects with OCD evince deficits in scanning, planning time, concept formation, decision making and encoding of non-verbal memory after controlling for the effects of age, gender and education. The profile is suggestive of a predominantly executive dysfunction, with difficulties in strategizing and organizing stimuli and cognitive resources for maximum efficiency. The findings implicate dorsolateral prefrontal, superior medial prefrontal and anterior cingulate cortices, suggesting that OCD might not be a purely orbitofronto-striatal disorder as previously conceptualized.
Objective
To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing comorbid anxiety and depressive symptoms in patients with obsessive-compulsive ...disorder (OCD).
Methods
Three electronic databases were searched for randomized, sham-controlled clinical trials evaluating rTMS for the treatment of OCD. Hedge's g was calculated as the effect size for anxiety/depression symptom severity (primary outcome) and OCD severity (secondary outcome). Subgroup analyses and meta-regression analyses were carried out to evaluate the most promising target and whether a reduction in OCD severity moderates the change in anxiety or depression scores.
Results
Twenty studies (n = 688) were included in the meta-analysis. rTMS had small-medium effect size on OCD (Hedge's g = 0.43; 95% confidence interval CI: 0.20, 0.65; P < 0.001), anxiety (Hedge's g = 0.3; 95% CI: 0.11, 0.48; P = 0.001) and depression (Hedge's g = 0.24; 95% CI: 0.07, 0.40; P = 0.003) symptoms. Subgroup analysis showed that protocols targeting dorsolateral prefrontal cortex (DLPFC) were effective for 3 outcome measures. The change in anxiety, but not depression severity, was moderated by a change in OCD symptom scores. However, the findings are uncertain as a majority of the studies had some concerns or a high risk of bias.
Conclusions
Active rTMS protocol targeting DLPFC is effective in reducing the comorbid anxiety/depression symptoms along with OCD severity. The antidepressant effect is not moderated by the anti-obsessive effect of rTMS.
Abstract Accommodation of symptoms by families and expressed emotion (EE) may have a negative impact on the outcome of obsessive–compulsive disorder (OCD). The study examines the effect of family ...accommodation (FA) and EE on the 1-year naturalistic outcome of OCD. Patients with OCD who met the criteria for the Diagnostic and Statistical Manual of Mental Disorders -IV, text revision (DSM-IV TR; N =94) were followed up for 1 year and assessed every 3 months. Assessments included measurement of symptom severity, FA, EE and family burden. By the 12th month, the cumulative probability of remission was 58%. Non-remitters compared with remitters had a significantly higher FA, EE and family burden at the baseline and did not report significant reductions on any of the family variables over the year. In a Cox proportional hazard regression analysis, a higher FA at the baseline significantly predicted time to remission. FA of symptoms has a significant negative impact on the naturalistic outcome of OCD. This emphasises the need to design specific interventions to reduce FA for a better outcome.
Obsessive-compulsive disorder Stein, Dan J; Costa, Daniel L C; Lochner, Christine ...
Nature reviews. Disease primers,
08/2019, Letnik:
5, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related ...disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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