Neuropsychological deficits are potential endophenotype markers. In obsessive-compulsive disorder (OCD), there is impairment in executive functions and nonverbal memory. However, studies have largely examined neuropsychological functioning in patients during the symptomatic phase. The state independent nature of neuropsychological deficits in OCD is not established. For neuropsychological deficits to be endophenotype markers, they have to be state-independent. We compared neuropsychological functions in recovered OCD patients with matched healthy controls.
We assessed 30 recovered DSM-IV OCD patients without any concurrent comorbidity or lifetime history of schizophrenia, bipolar disorder, tics and alcohol/substance abuse and 30 healthy controls individually matched for age, sex and education. They were assessed on different neuropsychological dimensions: attention, executive function, memory and intelligence. For between-group comparisons, we employed univariate analyses, and to identify neuropsychological variables that differentiate cases and controls, we used backward conditional logistic regression for matched case-control design.
Patients in the recovered phase of the illness had significant deficits in tests of set-shifting ability, alternation, response inhibition and nonverbal memory but had intact performance in other tests. In the logistic regression, scores on the Wisconsin Card Sorting Test 'categories completed' and the Rey's Complex Fig. Test 'delayed recall' were significant after controlling for the possible confounding effects of age and education. There was no correlation between illness-related variables and neuropsychological deficits.
Deficits in certain executive functions and nonverbal memory are possibly state independent. Neuropsychological deficits are possibly candidate endophenotype markers for OCD and may help clarify genetic contributions. Future studies should evaluate unaffected siblings to establish deficits are endophenotype markers. Prospective studies with serial measurements of cognitive deficits are also needed to assess whether these deficits are cumulative with the progression of illness.
"Theoretical arguments for how OCD relates to EF deficits in self-regulation and metacognition have been postulated (Eysenck and Calvo 1992; Olley et al. 2007) and supported by research with adult OCD samples. Adults with OCD have displayed marked difficulties in neuropsychological tasks assessing EF, such as working memory and inhibition (e.g., Bannon et al. 2006; Nakao et al. 2009; Purcell et al. 1998; Rao et al. 2008; Watkins et al. 2005). A few neurological and performance based studies have investigated and supported the relationship between EF presentation and obsessive-compulsive severity in pediatric populations, such as for difficulties with inhibition and planning or organizing (Abramovitch et al. 2012; Andrés et al. 2007; Ornstein et al. 2010), although the pediatric literature is much more sparse and discrepancies from the adult literature are notable. "
[Show abstract][Hide abstract] ABSTRACT: The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.
Journal of Psychopathology and Behavioral Assessment 09/2014; 36(3). DOI:10.1007/s10862-014-9408-3 · 1.55 Impact Factor
"Obsessive-compulsive disorder (OCD) is a highly debilitating neuropsychiatric condition characterized by intrusive unwanted thoughts and/or repetitive, compulsive behavior or mental rituals (American Psychiatric Association, 2000). The cognitive profile of the disorder is marked by the deficit of executive functions (Olley et al., 2007; Rao et al., 2008; Cavedini et al., 2010). However, some studies of OCD patients have found intact performance on traditional executive neuropsychological tasks (for reviews see Greisberg and McKay, 2003; Kuelz et al., 2004; Chamberlain et al., 2005; Abramovitch et al., 2013). "
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate the role of executive functions in resolving memory interference in a clinical sample of patients with obsessive-compulsive disorder (OCD). Retrieval of memories has been shown to involve some form of executive act that diminishes the accessibility of rival memory traces, leading to retrieval-induced forgetting (RIF). These executive control processes might suppress unwanted thoughts and irrelevant memories during competitive retrieval. We assessed RIF with the retrieval practice paradigm among 25 OCD patients and 25 healthy controls matched for age and education. Retrieval of target memories led to enhancement of target memory recall in both groups, but suppression of related memories (RIF) occurred only among controls. Our results suggest that suppression of irrelevant, interfering memories during competitive recall is impaired in OCD.
"Of the two child studies examining associations between OCD severity and neurocognitive functioning, neither identified significant relationships (Andres et al., 2007; Flessner et al., 2010). Findings with the present, and largest child sample published to date, support assertions that neuropsychological deficits are not epiphenomenon of present OCD symptoms (Andres et al., 2007; Rao et al., 2008; Schultz et al., 1999), but perhaps a trait marker of the underlying neurobiological substrates (Kuelz et al., 2004). That is, whereas neurocognitive impairment did not relate to the severity of OCD or global functioning, the presence of psychiatric comorbidity did impact cognitive performance. "
[Show abstract][Hide abstract] ABSTRACT: Preliminary research suggests neuropsychological deficits in youth with obsessive-compulsive disorder (OCD) similar to those in adults; however, small samples and methodological confounds limit interpretation. We aimed to examine the rates and clinical correlates of cognitive sequelae in youth with OCD, focusing on executive functioning and memory abilities. Youth ages 7–17 years with OCD (N=96) completed a hypothesis-driven neuropsychological battery (including the Rey-Osterreith Complex Figure, California Verbal Learning Test, and subtests of the Delis-Kaplan Executive Function System and Wide Range Assessment of Memory and Learning) that primarily assessed executive functioning, memory and processing speed. Cognitive sequelae were identified in 65% of youth (37% using a more stringent definition of impairment). Magnitude of cognitive sequelae was not associated with OCD severity or age; however, greater neuropsychological impairments were found amongst youth prescribed atypical neuroleptics and those diagnosed with comorbid tic disorders. Comorbidity burden was associated with presence of neuropsychological impairment, but was not specific to any single tests. Findings suggest that the presence of cognitive sequelae is prevalent amongst treatment-seeking youth with OCD. Deficits were found in executive functioning and non-verbal memory performance but these impairments were not associated with OCD severity.
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