Are neuropsychological deficits trait markers in OCD?
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.
Available from: Armagan Ozdemir
- "We could not confirm previous findings demonstrating greater Stroop interference among patients with OCD (Abramovitch et al., 2011;Penades et al., 2005), suggesting normal anterior cingulate function. In contrast to these previous studies, we found that patients with OCD performed similarly to healthy controls, replicating the findings of others (Moritz et al., 2002;Rao, Reddy, Kumar, Kandavel, & Chandrashekar, 2008). A number of limitations of the present study exist. "
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ABSTRACT: This study examined whether patients with obsessive-compulsive disorder (OCD) have deficits in executive functioning and memory, as well as the specificity of any OCD-related neuropsychological dysfunction. Previous studies have indicated poorer performance among individuals with OCD compared to healthy controls across the majority of neuropsychological domains, however, findings are very inconsistent. We included 34 individuals with bipolar-I disorder (BP-I), 35 untreated patients with OCD, and 33 healthy controls matched for age, gender, and education. Participants completed the Rey Auditory Verbal Learning Test (RAVLT), the Wechsler Memory Scale-Revised (WMS-R) visual-reproduction subscale, and Stroop Color-Word Interference Test (SCWIT). Compared to both healthy controls and participants with OCD, patients with BP-I showed poorer performance in long-delay verbal recall. Although participants with OCD performed more poorly in visual recall than both BP-I patients and healthy controls, their scores were within the normative range. In pairwise comparisons, OCD did not differ from either BP-I or controls. No significant differences were found in verbal memory or Stroop performance between OCD and healthy controls. Overall, we found no significant differences in neuropsychological performance between patients with OCD and healthy controls that could potentially contribute to functional impairment.
Available from: Clarissa Marceli Trentini
- "50 On the other hand, two other studies used the same instrument and indicated that OCD patients and their relatives performed as well as healthy controls. 51,55 It should be noted, however, that different versions of the Wisconsin Card Sorting Test were used by the different studies, for example, Viswanath et al. (2009) 51 assessed their sample with a computerized version, while Zhang et al. (2015) 55 and Rao et al. (2008) 50 used a non-computerized version. A meta-analysis previously revealed that the use of different forms of this test might explain a significant proportion of the heterogeneity in the estimated effects for the test and that the computerized version appears to be more sensitive than the classical method in identifying deficits in patients with OCD. 31 Thus, according to the results of this review, there is evidence that set-shifting/cognitive flexibility could be considered endophenotype candidate markers in OCD and the Wisconsin Card Sorting Test appears to be the most sensitive test for investigating these abilities . "
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ABSTRACT: Evidence in the literature indicates that neurocognitive impairments may represent endophenotypes in psychiatric disorders. Objective: This study aimed to conduct a systematic review on executive functions as a potential neurocognitive endophenotype in anxiety disorder diagnosis according to the DSM-IV and DSM-5 classifications. Methods: A literature search of the LILACS, Cochrane Library, Index Psi Periódicos Técnico-Científicos, PubMed and PsycInfo databases was conducted, with no time limits. Of the 259 studies found, 14 were included in this review. Results: Only studies on obsessive-compulsive disorder (OCD) were found. The executive function components of decision-making, planning, response inhibition, behavioral reversal/alternation, reversal learning and set-shifting/cognitive flexibility were considered to be a neurocognitive endophenotypes in OCD. Conclusion: Further studies on executive functions as a neurocognitive endophenotype in other anxiety disorders are needed since these may have different neurocognitive endophenotypes and require other prevention and treatment approaches. © 2015, Academia Brasileira de Neurologia. All rights reserved.
Available from: Adam Reid
- "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. "
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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.
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