Naomi A Fineberg

The Queen Elizabeth Hospital, Tarndarnya, South Australia, Australia

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Publications (150)667.04 Total impact

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    ABSTRACT: Background The prevalence of depression in people receiving haemodialysis is high with estimates varying between 20 and 40 %. There is little research on the effectiveness of antidepressants in dialysis patients with the few clinical trials suffering significant methodological issues. We plan to carry out a study to evaluate the feasibility of conducting a randomised controlled trial in patients on haemodialysis who have diagnosed Major Depressive Disorder. Methods/Design The study has two phases, a screening phase and the randomised controlled trial. Patients will be screened initially with the Beck Depression Inventory to estimate the number of patients who score 16 or above. These patients will be invited to an interview with a psychiatrist who will invite those with a diagnosis of Major Depressive Disorder to take part in the trial. Consenting patients will be randomised to either Sertraline or placebo. Patients will be followed-up for 6 months. Demographic and clinical data will be collected at screening interview, baseline interview and 2 weeks, and every month (up to 6 months) after baseline. The primary outcome is to evaluate the feasibility of conducting a randomised, double blind, placebo pilot trial in haemodialysis patients with depression. Secondary outcomes include estimation of the variability in the outcome measures for the treatment and placebo arms, which will allow for a future adequately powered definitive trial. Analysis will primarily be descriptive, including the number of patients eligible for the trial, drug exposure of Sertraline in haemodialysis patients and the patient experience of participating in this trial. Discussion There is an urgent need for this research in the dialysis population because of the dearth of good quality and adequately powered studies. Research with renal patients is particularly difficult as they often have complex medical needs. This research will therefore not only assess the outcome of anti-depressants in haemodialysis patients with depression but also the process of running a randomised controlled trial in this population. Hence, the outputs of this feasibility study will be used to inform the design and methodology of a definitive study, adequately powered to determine the efficacy of anti-depressants in patient on haemodialysis with depression. Trial registration ISRCTN registry ISRCTN06146268 and EudraCT reference: 2012-000547-27.
    BMC Nephrology 12/2015; 16(1). DOI:10.1186/s12882-015-0170-x · 1.69 Impact Factor

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    ABSTRACT: Background: To present the rationale for the new Obsessive-Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping. Methods: Review of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity. Results: The rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing. Limitations: Alternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability. Conclusion: It is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.
    Journal of Affective Disorders 11/2015; 190. DOI:10.1016/j.jad.2015.10.061 · 3.38 Impact Factor
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    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.
    CNS spectrums 09/2015; 20:1-5. DOI:10.1017/S1092852915000565 · 2.71 Impact Factor
  • Samuel R Chamberlain · Naomi A Fineberg ·
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    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).
    Personality Disorders: Theory, Research, and Treatment 04/2015; 6(2):201-203. DOI:10.1037/per0000122 · 3.54 Impact Factor
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    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.
    CNS spectrums 03/2015; -1(5):1-10. DOI:10.1017/S1092852914000662 · 2.71 Impact Factor

  • International Conference on Behavioural Addiction, Budapest; 03/2015
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    ABSTRACT: This narrative review gathers together a range of international experts to critically appraise the existing trial-based evidence relating to the efficacy and tolerability of pharmacotherapy for obsessive compulsive disorder in adults. We discuss the diagnostic evaluation and clinical characteristics followed by treatment options suitable for the clinician working from primary through to specialist psychiatric care. Robust data supports the effectiveness of treatment with selective serotonin reuptake inhibitors (SSRIs) and clomipramine in the short-term and the longer-term treatment and for relapse prevention. Owing to better tolerability, SSRIs are acknowledged as the first-line pharmacological treatment of choice. For those patients for whom first line treatments have been ineffective, evidence supports the use of adjunctive antipsychotic medication, and some evidence supports the use of high-dose SSRIs. Novel compounds are also the subject of active investigation. Neurosurgical treatments, including ablative lesion neurosurgery and deep brain stimulation, are reserved for severely symptomatic individuals who have not experienced sustained response to both pharmacological and cognitive behavior therapies. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Psychiatry Research 02/2015; 227(1). DOI:10.1016/j.psychres.2014.12.003 · 2.47 Impact Factor
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    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
  • N. Fineberg · S. Reghunandanan · A. Brown ·

    European Psychiatry 12/2014; 29:1. DOI:10.1016/S0924-9338(14)77642-4 · 3.44 Impact Factor
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    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. Method: 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). Results: 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. Conclusions: 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
  • Debbie Sookman · Naomi A Fineberg ·
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    ABSTRACT: The World Health Organization ranks obsessive compulsive disorder (OCD) among the leading causes of worldwide medical disability. Affecting approximately 3% of the population, OCD, with its damaging effect on psychosocial function, is among the most severe and impairing of mental disorders. In Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), OCD and related disorders form a separate classification, consistent with convergent research that indicates OCD is distinct from anxiety disorders in psychopathology and treatment requirements. Although evidence-based treatments have been developed for OCD, these are not accessible to many sufferers. Timely evidence-based treatment is recommended to avoid unnecessary progression to chronicity, disability, and intransigence of symptoms. Improvement in existing training models is needed to disseminate advanced specialty clinical skills to optimize illness recovery. This special series by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) Accreditation Task Force (ATF) critically reviews evidence-based psychological and pharmacological treatments for OCD throughout the lifespan. The ATF mandate is to establish specialty OCD certification and accreditation standards and competencies. The ATF mandate is to operationalize specialty OCD certification and accreditation standards and competencies. This pioneering initiative aims to achieve transformational change in accessibility to evidence-based clinical care so urgently needed for young people and adults suffering from OCD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 12/2014; 227(1). DOI:10.1016/j.psychres.2014.12.002 · 2.47 Impact Factor
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    Naomi A Fineberg · Samar Reghunandanan · Sangeetha Kolli · Murad Atmaca ·
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    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
  • Haroon Rashid · Akif A Khan · Naomi A Fineberg ·
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    ABSTRACT: Objectives: A retrospective naturalistic case note study to determine the frequency, co-morbidity and treatment-response of body dysmorphic disorder (BDD). Methods: Records from 280 patients attending a highly specialised obsessive-compulsive disorder (OCD)/BDD service were analysed. The clinical outcome was measured either through scoring of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD/BDD, or textual analysis of case notes for evidence of symptomatic improvement, treatment tolerability, and premature disengagement. Results: A total of 32 patients (11.43%) were diagnosed with BDD. Of these, 28 (87.5%) had at least one co-morbidity. All patients were offered cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitor (SSRI). Adjunctive low-dose antipsychotic was prescribed for 21 (66%) patients. Overall, 18/32 (56%) responded, and 7/32 (22%) disengaged prematurely. Patients offered antipsychotic, SSRI and CBT (n = 21) were compared with those offered SSRI and CBT only (n = 11). The treatment was well-tolerated. Whereas there was no significant inter-group difference in the clinical response rate, premature disengagement occurred less frequently in the antipsychotic-treated patients (9.5% versus 45%; Fisher's Exact Test P = 0.0318). Conclusions: BDD frequently presents with co-morbidity, treatment-resistance and premature disengagement. Adjunctive antipsychotic was associated with significantly better treatment adherence, but responder rates did not differ significantly, possibly related to the small sample-size. A well-powered randomised controlled study is warranted, to determine clinical outcomes with adjunctive antipsychotic in BDD.
    International Journal of Psychiatry in Clinical Practice 11/2014; 19(2):1-15. DOI:10.3109/13651501.2014.981546 · 1.39 Impact Factor

  • N. Fineberg · A. Brown · S. Reghunandanan · I. Pampaloni ·

  • European Neuropsychopharmacology 10/2014; 24:S122–S123. DOI:10.1016/S0924-977X(14)70153-1 · 4.37 Impact Factor
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    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). Methods: 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). Results: 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. Discussion: 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.
    Comprehensive Psychiatry 06/2014; 55(7). DOI:10.1016/j.comppsych.2014.05.020 · 2.25 Impact Factor
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    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. Main conclusion: 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
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    World psychiatry: official journal of the World Psychiatric Association (WPA) 06/2014; 13(2):125-7. DOI:10.1002/wps.20115 · 14.23 Impact Factor

Publication Stats

4k Citations
667.04 Total Impact Points


  • 2005-2015
    • The Queen Elizabeth Hospital
      Tarndarnya, South Australia, Australia
  • 1999-2015
    • University of Hertfordshire
      • • Department of Postgraduate Medicine
      • • Department of Psychology
      Hatfield, England, United Kingdom
  • 2005-2014
    • University of Cambridge
      • • School of Clinical Medicine
      • • Behavioural and Clinical Neurosciences Institute (BCNI)
      • • Brain Mapping Unit
      • • Department of Psychiatry
      Cambridge, England, United Kingdom
  • 2010
    • University Hospital "St. Anna", Sofia, Bulgaria
      Ulpia Serdica, Sofia-Capital, Bulgaria
    • Tel Aviv University
      • Department of Zoology
      Tell Afif, Tel Aviv, Israel
  • 2004
    • St George's, University of London
      Londinium, England, United Kingdom
    • Royal College of Psychiatrists
      Londinium, England, United Kingdom