Abstract
Although the rates of response to first-line pharmacological treatments (serotonin reuptake inhibitors – SRIs) are generally twice that of placebo, only 40-60% of patients respond ...sufficiently or are able to tolerate traditional first-line pharmacotherapy. Augmentation with dopamine antagonist medications is associated with the strongest evidence, yet dopamine antagonists benefit only a minority of those who try them and carry elevated risks of adverse effects. Based on evolving pathophysiologic models of OCD, a variety of agents targeting serotonin, dopamine, norepinephrine, glutamate, and anti-inflammatory pathways have been explored as alternative or adjunctive therapies for treatment-resistant OCD and have at least preliminary evidence of efficacy. Similarly, approximately 50% of patients do not respond optimally to first psychotherapeutic treatments including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP), even when combined with pharmacotherapy. The psychotherapy outcome literature is heterogeneous and very few psychological strategies have been developed specifically to treat treatment resistant OCD. However, a recent systematic review concluded that CBT improved treatment response in individuals with pharmacotherapy resistance. This presentation will present an update on the pharmacological and psychotherapeutic treatment of refractory OCD including novel strategies such as the use of psychedelics.
Disclosure of Interest
M. Van Ameringen Grant / Research support from: Elvium, CIHR,Hamilton Academic Health Sciences Organization, Consultant of: Abbvie, Bausch Health, Boehringer Ingelheim, Elvium, Jazz, Vistagen, Speakers bureau of: Abbvie, Elvium (Purdue), Lundbeck, Otsuka, Sunovion, and Takeda
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.
Objective
To compare the gut microbiome profile (by way of taxon analysis and indices of β‐ and α‐diversity) and inflammatory markers (C‐reactive protein CRP, interleukin‐6IL‐6 and tumour necrosis ...factor‐α TNF‐α) of obsessive‐compulsive disorder (OCD) outpatients and non‐psychiatric community controls.
Methods
We collected morning stool and blood samples from 21 non‐depressed, medication‐free OCD patients and 22 age‐ and sex‐matched non‐psychiatric community controls. Microbiota analysis was performed using Illumina sequencing of the V3 region of 16S rRNA; serum CRP samples were analysed using immunoturbidimetry and plasma IL‐6/TNF‐α were examined by high‐sensitivity ELISA. Multiple comparisons were corrected for using the false discovery rate (α = 0.05).
Results
Compared to controls, the OCD group presented lower species richness/evenness (α‐diversity, Inverse Simpson) and lower relative abundance of three butyrate producing genera (Oscillospira, Odoribacter and Anaerostipes). Compared to controls, mean CRP, but not IL‐6 and TNF‐α, was elevated OCD patients. CRP revealed moderate to strong associations with psychiatric symptomatology.
Conclusion
To our knowledge, this is the first investigation of the gut microbiome in OCD. In addition, our findings lend further support for the potential association of inflammation and OCD. These results suggest the gut microbiome may be a potential pathway of interest for future OCD research.
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.
The objective of this study was to evaluate the anxiolytic efficacy, and speed of onset of efficacy, of pregabalin (PGB) and venlafaxine-XR (VXR) in patients with generalized anxiety disorder (GAD). ...In this double-blind trial, outpatients, ages 18–65 years, who met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for GAD were randomized to 8 weeks of flexible-dose treatment with PGB (300–600 mg/day), VXR (75–225 mg/day), or placebo (PBO). The intent-to-treat sample consisted of 121 patients on PGB least square (LS) mean±SE baseline Hamilton Anxiety Rating Scale (HAM-A), 27.6±0.4, 125 patients on VXR (baseline HAM-A, 27.4±0.4), and 128 patients on PBO (baseline HAM-A, 26.8±0.4). Treatment with PGB was associated with a significantly greater LS mean change in the HAM-A total score at last observation carried forward endpoint versus PBO (−14.5±0.9 vs. −11.7±0.9; P=0.028). Treatment with VXR was not significant versus PBO at endpoint (−12.0±0.9; −11.7±0.9; P=0.968). Treatment with PGB showed an early onset of improvement, with significantly greater LS mean change in the HAM-A by day 4 versus both PBO (−5.3±0.5 vs. −3.4±0.5; P=0.008) and VXR (−2.9±0.5; P=0.0012). The proportion of patients reporting a severe adverse event was similar for PGB (9.1%) and PBO (7.8%), but higher for VXR (20.0%; P<0.05). In conclusion, PGB was a safe and effective treatment of GAD, with a significantly earlier onset of anxiolytic activity than VXR.
OBJECTIVE: The authors evaluated the efficacy, safety, and tolerability of sertraline, a selective serotonin reuptake inhibitor, in the treatment of generalized social phobia. METHOD: Adult ...outpatients with generalized social phobia (N=204) from 10 Canadian centers were randomly assigned to receive sertraline or placebo in a 2:1 ratio for a 20-week double-blind study following a 1-week, single-blind, placebo run-in. The initial dose of sertraline was 50 mg day with increases of 50 mg day every 3 weeks permitted after the fourth week of treatment (dosing was flexible up to a maximum of 200 mg day). Primary efficacy assessments were the percentage of patients rated much or very much improved on the Clinical Global Impression (CGI) improvement item and the mean changes from baseline to study endpoint in total score on the social phobia subscale of the Marks Fear Questionnaire and total score on the Brief Social Phobia Scale. RESULTS: In intent-to-treat endpoint analyses of 203 of the patients, significantly more of the 134 patients given sertraline (N=71 53%) than of the 69 patients receiving placebo (N=20 29%) were considered responders according to their CGI improvement scores at the end of treatment. The mean reductions in the social phobia subscale of the Marks Fear Questionnaire and in the total score on the Brief Social Phobia Scale were 32.6% and 34.3% in the sertraline group and 10.8% and 18.6% in the placebo group, respectively. Analysis of covariance showed superiority of sertraline over placebo on all primary and secondary efficacy measures. Sertraline was well tolerated: 103 (76%) of the 135 sertraline-treated patients and 54 (78%) of the 69 placebo-treated patients completed the study. CONCLUSIONS: Sertraline is an effective treatment for patients with generalized social phobia.
The importance of scientific evidence to guide nutrition policy and programme design is well established.1 Nevertheless, there are still critical gaps in the evidence to inform nutrition programme ...priorities and achievements,2 and strong pleas have been made for improving the collection and use of evidence in the nutrition sector.3 Nutrition interventions are founded on a strong evidence base from clinical trials, the systematic review of those trials and the translation of this evidence into global guidance.1 However, we have far less evidence, particularly for functional outcomes,4 on the impact of nutrition programmes that incorporate - but often go beyond - single interventions. ...the World Health Organization, as part of the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition,7 has called for renewed and coordinated efforts to better track programme coverage and to build systems for data-driven decision-making. Fortification of staple foods by the addition of vitamins and/ or minerals to food at processing is widely recognized to be a cost-effective public health intervention that can reach large segments of the population.8 For example, goitre and other severe iodine deficiency disorders have been virtually eliminated in most countries around the world due to iodization of salt,9 and the contribution of wheat flour fortification with folic acid to reductions in the incidence of neural tube defects10 in several countries is well documented. Data about intakes are required to set appropriate levels of fortificants, as well as to assess the extent to which those in need are actually consuming the foods, with what frequency and quantity.8 Some efforts have been made to fill these gaps, via analysis of household income and expenditure data at the national level,13 but the lack of detail about the types of food consumed and individuals' consumption levels may limit the utility of these data to fully inform food fortification programmes.14 The Fortification Rapid Assessment Tool (FRAT)15 and more recently the Fortification Assessment Coverage Tool (FACT)16 were designed to provide more comprehensive information on consumption of fortified foods and foods that could potentially be fortified.
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