[Show abstract][Hide abstract] ABSTRACT: Obsessive compulsive disorder (OCD) showed a lower prevalence of cigarette smoking compared to other psychiatric disorders in previous and recent reports. We assessed the prevalence and clinical correlates of the phenomenon in an international sample of 504 OCD patients recruited through the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) network. Cigarette smoking showed a cross-sectional prevalence of 24.4% in the sample, with significant differences across countries. Females were more represented among smoking patients (16% vs 7%; p<.001). Patients with comorbid Tourette's syndrome (p<.05) and tic disorder (p<.05) were also more represented among smoking subjects. Former smokers reported a higher number of suicide attempts (p<.05). We found a lower cross-sectional prevalence of smoking among OCD patients compared to findings from previous studies in patients with other psychiatric disorders but higher compared to previous and more recent OCD studies. Geographic differences were found and smoking was more common in females and comorbid Tourette's syndrome/tic disorder.
[Show abstract][Hide abstract] ABSTRACT: Comments on the original articles "Rapid-response impulsivity: Definitions, measurement issues, and clinical implications" (see record 2015-14753-004) and "Choice impulsivity: Definitions, measurement issues, and clinical implications" (see record 2015-14753-005) by Hamilton, Mitchell, et al. and Hamilton, Littlefield, et al., respectively. The present authors note that research has made important steps toward understanding impulsivity. Rapid-Response Impulsivity and Choice Impulsivity appear to be dissociable in terms of underlying neural circuitry and associated neurochemical modulation. Although various cognitive paradigms have been developed that tap these two functions, as Hamilton and colleagues correctly argue, there is a need for standardized measurements to be validated and agreed on, and for academics and clinicians to work together in order to tackle several pressing and related questions. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: Obsessive compulsive personality disorder (OCPD) is characterized by perfectionism, need for control, and cognitive rigidity. Currently, little neuropsychological data exist on this condition, though emerging evidence does suggest that disorders marked by compulsivity, including obsessive-compulsive disorder (OCD), are associated with impairment in cognitive flexibility and executive planning on neurocognitive tasks. Aim The current study investigated the neurocognitive profile in a nonclinical community-based sample of people fulfilling diagnostic criteria for OCPD in the absence of major psychiatric comorbidity.
Twenty-one nonclinical subjects who fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCPD were compared with 15 healthy controls on selected clinical and neurocognitive tasks. OCPD was measured using the Compulsive Personality Assessment Scale (CPAS). Participants completed tests from the Cambridge Automated Neuropsychological Test Battery including tests of set shifting (Intra-Extra Dimensional [IED] Set Shifting) executive planning (Stockings of Cambridge [SOC]), and decision making (Cambridge Gamble Task [CGT]).
The OCPD group made significantly more IED-ED shift errors and total shift errors, and also showed longer mean initial thinking time on the SOC at moderate levels of difficulty. No differences emerged on the CGT.
Nonclinical cases of OCPD showed significant cognitive inflexibility coupled with executive planning deficits, whereas decision-making remained intact. This profile of impairment overlaps with that of OCD and implies that common neuropsychological changes affect individuals with these disorders.
[Show abstract][Hide abstract] ABSTRACT: Serotonin reuptake inhibiting drugs (SRI) have been used in the treatment of paediatric obsessive-compulsive disorder over the past thirty years.We performed a systematic review and meta-analysis of the literature to discuss the place of and evidence for the use of SRI in paediatric OCD, based on fourteen publications of methodologically sound, randomized and controlled studies. Both SRI and specific SRIs were examined and comparisons of SRI, placebo, cognitive behaviour therapy (CBT), combined (COMBO) treatments (SRI+CBT) made to investigate their relative efficacy.
Using the Cochrane methodology, and as measures of effect size mean difference and Hedge’s g, SRIs proved to be superior to drug placebo, with a modest effect size. From direct comparisons of CBT and SRI treatments, we conclude that CBT has the superior efficacy. COMBO versus CBT shows that SRI treatment adds little to concomitant CBT, while COMBO shows favourable outcome versus SRI alone. In pre-trial partial treatment responders, those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI. Those who failed CBT treatment did as well with continued CBT as with switching to a SRI.
The studies of combinations and sequences of treatments need to be developed further.
Psychiatry Research 01/2015; 227(1). DOI:10.1016/j.psychres.2015.01.015 · 2.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
The purpose of this study was to determine the neural correlates of excessive habit formation in obsessive-compulsive disorder (OCD). The authors aimed to test for neurobiological convergence with the known pathophysiology of OCD and to infer, based on abnormalities in brain activation, whether these habits arise from dysfunction in the goal-directed or habit system.
Thirty-seven OCD patients and 33 healthy comparison subjects learned to avoid shocks while undergoing a functional MRI scan. Following four blocks of training, the authors tested whether the avoidance response had become a habit by removing the threat of shock and measuring continued avoidance. Task-related differences in brain activity in three regions of interest (the caudate, the putamen, and the medial orbitofrontal cortex) were tested at a statistical threshold set at <0.05 (family-wise-error corrected).
Excessive habit formation in OCD patients, which was associated with hyperactivation in the caudate, was observed. Activation in this region was also associated with subjective ratings of increased urge to perform habits. The OCD group, as a whole, showed hyperactivation in the medial orbitofrontal cortex during the acquisition of avoidance; however, this did not relate directly to habit formation.
OCD patients exhibited excessive habits that were associated with hyperactivation in a key region implicated in the pathophysiology of OCD, the caudate nucleus. Previous studies indicate that this region is important for goal-directed behavior, suggesting that habit-forming biases in OCD may be a result of impairments in this system, rather than differences in the buildup of stimulus-response habits themselves.
American Journal of Psychiatry 12/2014; 172(3):appiajp201414040525. DOI:10.1176/appi.ajp.2014.14040525 · 12.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Obsessive-compulsive personality disorder (OCPD) is an early-onset disorder characterized by perfectionism, need for control, and cognitive rigidity. Its nosological status is currently under review. Historically, OCPD has been conceptualized as bearing a close relationship with obsessive-compulsive disorder (OCD). In this article, we discuss the diagnosis of OCPD in anticipation of its review for the ICD-11, from the perspective of clinical utility, global applicability, and research planning. Considering the recent establishment of an obsessive-compulsive and related disorders (OCRD) category in DSM-5, we focus on the relationship between OCPD and the disorders that are currently thought to bear a close relationship with OCD, including DSM-5 OCRD, and other compulsive disorders such as eating disorder and autistic spectrum disorder (that were not included in the DSM-5 OCRD category), as well as with the personality disorders, focusing on nosological determinants such as phenomenology, course of illness, heritability, environmental risk factors, comorbidity, neurocognitive endophenotypes, and treatment response. Based on this analysis, we attempt to draw conclusions as to its optimal placement in diagnostic systems and draw attention to key research questions that could be explored in field trials.
Revista Brasileira de Psiquiatria 11/2014; 36 Suppl 1:40-50. DOI:10.1590/1516-4446-2013-1282 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Obsessive-compulsive disorder (OCD) is often associated with significant psychiatric comorbidity. Comorbid disorders include mood and anxiety disorders as well as obsessive-compulsive spectrum disorders (OCSDs). This paper aims to investigate comorbidity of DSM Axis I-disorders, including OCSDs, in patients with OCD from 10 centers affiliated with the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS).
This is a cross-sectional study of comorbidity of Axis I disorders including OCSDs in 457 outpatients with primary OCD (37% male; 63% female), with ages ranging from 12 to 88years (mean: 39.8±13). Treating clinicians assessed Axis I disorders using the Mini International Neuropsychiatric Interview and assessed OCSDs using the Structured Clinical Interview for OCD related/spectrum disorders (SCID-OCSD).
In terms of the OCSDs, highest comorbidity rates were found for tic disorder (12.5%), BDD (8.71%) and self-injurious behavior (7.43%). In terms of the other Axis I-disorders, major depressive disorder (MDD; 15%), social anxiety disorder (SAD; 14%), generalized anxiety disorder (GAD; 13%) and dysthymic disorder (13%) were most prevalent.
High comorbidity of some OCSDs in OCD supports the formal recognition of these conditions in a separate chapter of the nosology. Rates of other Axis I disorders are high in both the general population and in OCSDs, indicating that these may often also need to be the focus of intervention in OCD.
[Show abstract][Hide abstract] ABSTRACT: Background / Purpose:
Depression is often unrecognized and undertreated in patients with chronic medical illness leading to negative outcomes. Recognition of depression is poor in patients with end-stage renal disease (ESRD) because symptoms of depression overlap with those of uraemia. Depressive symptoms in ESRD may negatively affect general health awareness, mortality rate, treatment adherence and inpatient hospitalisation. It is therefore an important health issue in this population.
Antidepressants are commonly prescribed. beck depression inventory (BDI-II) score was high despite antidepressant in a substantial proportion of patients. BDI-II screen positive patients receiving antidepressants appear to be more depressed, and younger than their untreated counterparts. This questions the role of antidepressants in this population.
7th Biennial Congress of The International Society of Affective Disorders 2014; 06/2014
[Show abstract][Hide abstract] ABSTRACT: Why do we repeat choices that we know are bad for us? Decision making is characterized by the parallel engagement of two distinct systems, goal-directed and habitual, thought to arise from two computational learning mechanisms, model-based and model-free. The habitual system is a candidate source of pathological fixedness. Using a decision task that measures the contribution to learning of either mechanism, we show a bias towards model-free (habit) acquisition in disorders involving both natural (binge eating) and artificial (methamphetamine) rewards, and obsessive-compulsive disorder. This favoring of model-free learning may underlie the repetitive behaviors that ultimately dominate in these disorders. Further, we show that the habit formation bias is associated with lower gray matter volumes in caudate and medial orbitofrontal cortex. Our findings suggest that the dysfunction in a common neurocomputational mechanism may underlie diverse disorders involving compulsion.Molecular Psychiatry advance online publication, 20 May 2014; doi:10.1038/mp.2014.44.
[Show abstract][Hide abstract] ABSTRACT: This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
Journal of Psychopharmacology 04/2014; 28(5). DOI:10.1177/0269881114525674 · 3.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It may be useful to consider the application of Huang & Bargh's (H&B's) theory of unconscious motivational processes to psychopathology. In disorders of compulsivity and impulsivity, an unconscious habit system may play a key role in explaining ego-dystonic or self-destructive behaviour. H&B's theory may provide some insights into understanding conditions such as obsessive-compulsive disorder (OCD) and drug addiction; however, additional work is needed to address the neurocircuitry and neurochemistry mediating their abnormal underlying motivational processes.
[Show abstract][Hide abstract] ABSTRACT: There is disagreement regarding the role of perceived control in obsessive-compulsive disorder (OCD). The present study used a traditional illusion of control paradigm (Alloy and Abramson, 1979) to empirically test control estimation in OCD. Twenty-six OCD patients and 26 matched comparison subjects completed an illusion of control task wherein their goal was to attempt to exert control over a light bulb. The density of reinforcement (high, low) and the valence of trials (gain, loss) were experimentally manipulated within subjects. Unbeknownst to participants, the illumination of the light bulb was predetermined and irrespective of their behavior. OCD patients exhibited lower estimates of control compared with healthy comparison subjects. There were no interactions between group and outcome density or group and valence. We found that OCD patients endorse lower estimates of control than comparison subjects. This finding highlights a potential role for contingency learning in the disorder.
Frontiers in Psychology 03/2014; 5:204. DOI:10.3389/fpsyg.2014.00204 · 2.80 Impact Factor