Adult Obsessive-compulsive Disorder Patients Research Articles

Psychometric Evaluation of the Chinese Version of the Family Accommodation Scale for Obsessive–Compulsive Disorder Patient Version

This study aimed to examine the psychometric properties of the Chinese version of the family accommodation scale for obsessive–compulsive disorder (OCD) patient version (FAS-PV). A total of 171 adult OCD patients and 145 family members were enrolled in the present study. The majority of the adult OCD patients (89.5%) reported engaging in at least one accommodating behavior in the past week. The FAS-PV comprised three components that included (a) direct participation and facilitation, (b) provision of reassurance and assumption, and (c) modification of routines and avoidance. The FAS-PV demonstrated excellent internal consistency. The correlation between the total FAS-PV score and the criteria measure demonstrated excellent convergent validity when assessing the OCD symptom severity, global functioning, family functioning, and functioning impairment. The findings supported that the FAS-PV could be used widely in evaluating and identifying the accommodating behavior both in clinical and in research settings, especially in adult OCD patients who usually present to the clinic alone.

Family Accommodation in Obsessive Compulsive Disorder and Its Association With Insight.

Family accommodation (FA) is defined as a family members' involvement by doing certain behavior in response to the daily rituals of patients with obsessive-compulsive disorder (OCD). FA is associated with more severe symptoms of OCD. Similarly, poor insight is associated with high severity of OCD symptoms. FA and insight are also related to each other, as more accommodative behavior of family members is associated with poor insight. This cross-sectional observational study assessed 103 adult OCD patients with an illness duration of at least one year. Participants were assessed using Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom checklist, Y-BOCS to assess severity, and Family Accommodation Scale-SR (Hindi) to evaluate FA. Insight was assessed with the 11th item of Y-BOCS. FA was common in the families of our participants. The mean±SD Y-BOCS score was 28.72±5.09, and the mean FAS-SR score was 44.1±12.03. A significant positive correlation existed between the FA and YBOCS scores, that is, with the increase in FA, YBOCS scores also significantly increased. A considerable number reported poor insight, and had high scores on YBOCS and their caregiver had high FA scores. FA is indicative of high symptom severity of OCD and higher FA is associated with poor insight, so FA needs further research for its interplay with OCD symptomatology and role in the maintenance of symptoms.

The thalamus and its subregions – a gateway to obsessive-compulsive disorder

IntroductionHigher thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population (Boedhoe et al. 2017, Weeland et al. 2021a). Functionally distinct thalamic nuclei are an integral part of OCD-relevant brain circuitry.ObjectivesWe aimed to study the thalamic nuclei volume in relation to subclinical and clinical OCD across different age ranges. Understanding the role of thalamic nuclei and their associated circuits in pediatric OCD could lead towards treatment strategies specifically targeting these circuits.MethodsWe studied the relationship between thalamic nuclei and obsessive-compulsive symptoms (OCS) in a large sample of school-aged children from the Generation R Study (N = 2500) (Weeland et al. 2021b). Using the data from the ENIGMA-OCD working group we conducted mega-analyses to study thalamic subregional volume in OCD across the lifespan in 2,649 OCD patients and 2,774 healthy controls across 29 sites (Weeland et al. 2021c). Thalamic nuclei were grouped into five subregions: anterior, ventral, intralaminar/medial, lateral and pulvinar (Figure 1).ResultsBoth children with subclinical and clinical OCD compared with controls show increased volume across multiple thalamic subregions. Adult OCD patients have decreased volume across all subregions (Figure 2), which was mostly driven by medicated and adult-onset patients.Conclusions Our results suggests that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status.DisclosureNo significant relationships.

Static and temporal dynamic changes of intrinsic brain activity in pediatric and adults OCD

Epidemiological and clinical age differences in obsessive-compulsive disorder (OCD) have been reported in clinical symptoms and morphometry changes; however, age differences in amplitude of low-frequency fluctuation and the relationship between ALFF imaging and clinical symptoms has not been thoroughly studied in OCD. Age may be an important feature associated with distinct subtypes of OCD. To examine the effect of age on OCD, the current study enrolled 92 OCD patients (32 pediatrics and 60 adults) and matched HCs (33 pediatrics and 84 adults), undergoing resting-state functional magnetic resonance imaging. The spontaneous brain activity was measured by static and dynamic amplitude of low-frequency fluctuation (ALFF) followed by two-way ANOVA. In pediatric OCD patients versus adult patients, we observed a significantly higher ALFF in the default mode network (DMN), including posterior cingulate, precuneus and superior frontal gyrus, and extending to cuneus, lingual gyrus. Additionally, the increased ALFF and dynamic ALFF in the precentral gyrus were found in pediatric patients. In OCD patients compared with controls, we found a significantly increased ALFF in hippocampal gyrus, cerebellum network (CN), and the dALFF in middle and inferior occipital gyrus, bilateral paracentral lobule and sensorimotor network. The findings emphasized the different patterns of static and dynamic intrinsic brain activity alterations associated with pediatric and adult OCD patients. These results provide unique insights into constructing evidenced-based distinct OCD subtypes based on brain activity and point the need of specified management for pediatric and adult OCD patients in clinical setting.

The thalamus and its subnuclei\u2014a gateway to obsessive-compulsive disorder

Larger thalamic volume has been found in children with obsessive-compulsive disorder (OCD) and children with clinical-level symptoms within the general population. Particular thalamic subregions may drive these differences. The ENIGMA-OCD working group conducted mega- and meta-analyses to study thalamic subregional volume in OCD across the lifespan. Structural T1-weighted brain magnetic resonance imaging (MRI) scans from 2649 OCD patients and 2774 healthy controls across 29 sites (50 datasets) were processed using the FreeSurfer built-in ThalamicNuclei pipeline to extract five thalamic subregions. Volume measures were harmonized for site effects using ComBat before running separate multiple linear regression models for children, adolescents, and adults to estimate volumetric group differences. All analyses were pre-registered (https://osf.io/73dvy) and adjusted for age, sex and intracranial volume. Unmedicated pediatric OCD patients (<12 years) had larger lateral (d = 0.46), pulvinar (d = 0.33), ventral (d = 0.35) and whole thalamus (d = 0.40) volumes at unadjusted p-values <0.05. Adolescent patients showed no volumetric differences. Adult OCD patients compared with controls had smaller volumes across all subregions (anterior, lateral, pulvinar, medial, and ventral) and smaller whole thalamic volume (d = −0.15 to −0.07) after multiple comparisons correction, mostly driven by medicated patients and associated with symptom severity. The anterior thalamus was also significantly smaller in patients after adjusting for thalamus size. Our results suggest that OCD-related thalamic volume differences are global and not driven by particular subregions and that the direction of effects are driven by both age and medication status.

Disorder-specific cingulo-opercular network hyperconnectivity in pediatric OCD relative to pediatric anxiety.

Prior investigation of adult patients with obsessive compulsive disorder (OCD) has found greater functional connectivity within orbitofrontal-striatal-thalamic (OST) circuitry, as well as altered connectivity within and between large-scale brain networks such as the cingulo-opercular network (CON) and default mode network (DMN), relative to controls. However, as adult OCD patients often have high rates of co-morbid anxiety and long durations of illness, little is known about the functional connectivity of these networks in relation to OCD specifically, or in young patients near illness onset. In this study, unmedicated female patients with OCD (ages 8-21 years, n = 23) were compared to age-matched female patients with anxiety disorders (n = 26), and healthy female youth (n = 44). Resting-state functional connectivity was used to determine the strength of functional connectivity within and between OST, CON, and DMN. Functional connectivity within the CON was significantly greater in the OCD group as compared to the anxiety and healthy control groups. Additionally, the OCD group displayed greater functional connectivity between OST and CON compared to the other two groups, which did not differ significantly from each other. Our findings indicate that previously noted network connectivity differences in pediatric patients with OCD were likely not attributable to co-morbid anxiety disorders. Moreover, these results suggest that specific patterns of hyperconnectivity within CON and between CON and OST circuitry may characterize OCD relative to non-OCD anxiety disorders in youth. This study improves understanding of network dysfunction underlying pediatric OCD as compared to pediatric anxiety.

The forbidden thoughts dimension and psychiatric comorbidities in a large sample of OCD patients: A possible link to bipolar I comorbid disorder

ObjectiveMany theoretical models have been proposed to identify groups of patients affected by Obsessive Compulsive Disorder (OCD) and the most studied model categorized OCD into different classes according to symptom dimensions. The aims of this study were to evaluate the association between the lifetime presence of Forbidden Thoughts (FT) symptoms and lifetime psychiatric comorbidities and to examine socio-demographic and other clinical features related to the lifetime presence of FT in a large naturalistic sample. MethodsThe sample is composed of adult OCD patients from a tertiary center. The sample was divided into two subgroups according to the lifetime presence/absence of the FT. Differences between groups were analyzed with Student's t-test and χ2 tests. Subsequently we performed multivariate logistic regression. Results and conclusionsData regarding 601 subjects were collected. The 65.9% Experienced lifetime FT. Higher level of education, lower age at symptoms onset, abrupt onset type and bipolar I comorbid disorder were associated with the likelihood of having FT. Our findings confirm a high prevalence of the FT dimension and suggest that OCD with aggressive, sexual, religious obsessions could represent a specific endophenotype of this disorder. The specific relation between FT and comorbid bipolar disorder type I seems particularly interesting.

White matter microstructure and its relation to clinical features of obsessive\u2013compulsive disorder: findings from the ENIGMA OCD Working Group

Microstructural alterations in cortico-subcortical connections are thought to be present in obsessive–compulsive disorder (OCD). However, prior studies have yielded inconsistent findings, perhaps because small sample sizes provided insufficient power to detect subtle abnormalities. Here we investigated microstructural white matter alterations and their relation to clinical features in the largest dataset of adult and pediatric OCD to date. We analyzed diffusion tensor imaging metrics from 700 adult patients and 645 adult controls, as well as 174 pediatric patients and 144 pediatric controls across 19 sites participating in the ENIGMA OCD Working Group, in a cross-sectional case-control magnetic resonance study. We extracted measures of fractional anisotropy (FA) as main outcome, and mean diffusivity, radial diffusivity, and axial diffusivity as secondary outcomes for 25 white matter regions. We meta-analyzed patient-control group differences (Cohen’s d) across sites, after adjusting for age and sex, and investigated associations with clinical characteristics. Adult OCD patients showed significant FA reduction in the sagittal stratum (d = −0.21, z = −3.21, p = 0.001) and posterior thalamic radiation (d = −0.26, z = −4.57, p < 0.0001). In the sagittal stratum, lower FA was associated with a younger age of onset (z = 2.71, p = 0.006), longer duration of illness (z = −2.086, p = 0.036), and a higher percentage of medicated patients in the cohorts studied (z = −1.98, p = 0.047). No significant association with symptom severity was found. Pediatric OCD patients did not show any detectable microstructural abnormalities compared to controls. Our findings of microstructural alterations in projection and association fibers to posterior brain regions in OCD are consistent with models emphasizing deficits in connectivity as an important feature of this disorder.

Maintained Visual-, Auditory-, and Multisensory-Guided Associative Learning Functions in Children With Obsessive-Compulsive Disorder.

Sensory-guided acquired equivalence learning, a specific kind of non-verbal associative learning, is associated with the frontal cortex–basal ganglia loops and hippocampi, which seem to be involved in the pathogenesis of obsessive–compulsive disorder (OCD). In this study, we asked whether visual-, auditory-, and multisensory-guided associative acquired equivalence learning is affected in children with OCD. The first part of the applied learning paradigm investigated association building between two different sensory stimuli (where feedback was given about the correctness of the choices), a task that critically depends upon the basal ganglia. During the test phases, which primarily depended upon the hippocampi, the earlier learned and hitherto not shown but predictable associations were asked about without feedback. This study involved 31 children diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria and 31 matched healthy control participants. The children suffering from OCD had the same performance as the control children in all phases of the applied visual-, auditory-, and multisensory-guided associative learning paradigms. Thus, both the acquisition and test phases were not negatively affected by OCD. The reaction times did not differ between the two groups, and the applied medication had no effect on the performances of the OCD patients. Our results support the findings that the structural changes of basal ganglia and hippocampi detected in adult OCD patients are not as pronounced in children, which could be the explanation of the maintained associative equivalence learning functions in children suffering from OCD.

Analysis of magnetic resonance spectroscopy in patients with obsessive-compulsive disorder comorbid skin-picking disorder.

To investigate the neurobiochemical characteristics of the anterior cingulate cortex (ACC) in patients with obsessive-compulsive disorder (OCD) comorbid skin-picking disorder (SPD), and to provide reference for the pathophysiological basis for OCD. We examined the levels of glutamate and other neurochemicals in ACC of 30 adult OCD patients (13 with comorbid SPD, 17 without SPD), using proton magnetic resonance spectroscopy (1H-MRS) at 3T. The clinical evaluation and the quantitative analysis of metabolites were carried out in the two groups. OCD patients with comorbid SPD showed significantly lower ACC glutamate than the patients without SPD (P=0.001). In all OCD patients, glutamate was negatively correlated with scores of Hamilton Anxiety Rating Scale (r=-0.55, P=0.002). Moreover, the ACC glutamate of female patients was correlated with the total score of Yale-Brown Obsessive Compulsive Scale (r=0.69, P=0.041) in the OCD with comorbid SPD patients. Alterations of the glutamate content in the ACC are involved in the pathophysiological process of OCD with comorbid SPD, which provides evidence for the study on the pathogenesis of OCD and SPD.

Prevalence and predictors of family accommodation in obsessive-compulsive disorder in an Indian setting.

Background:Family accommodation (FA) is a phenomenon whereby caregivers assist/facilitate rituals or behaviors related to obsessive–compulsive disorder (OCD). FA, however, has been explored primarily in the Western population, and it is unclear to what extent it might be present in diverse cultural settings. At present, little is known about the extent and predictors of FA among caregivers of adult OCD patients in India.Aims:The study aims to assess the extent, clinical correlates, and predictors of FA in the caregivers of adults with OCD.Settings and Design:Cross-sectional study conducted in an outpatient setting in a tertiary-care hospital.Materials and Methods:Hundred and one adult patients of either gender with Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis of OCD and 101 caregivers were included. The patients were assessed using Yale–Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), World Health Organization Disability Assessment Schedule Version 2.0 12-item version (WHO-DAS 2.0.12), Clinical Global Impressions Scale for Severity (CGI-S), and Clinical Global Impressions Scale for Improvement. The FA Scale-Self Rated Version (FAS-SR) was applied on caregivers after Hindi translation.Statistical Analysis:Descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Multiple linear regression modeling was performed with the total FAS-SR score as the dependent variable.Results:About 92% of caregivers displayed at least some form of FA. Higher scores on HAM-D, YBOCS, WHODAS, and CGI-S were associated with higher scores on FAS-SR scale, which reached statistical significance (P < 0.01).Conclusions:FA in OCD appears to be a frequent phenomenon. Higher FA is associated with higher symptom severity and disability, emphasizing its clinical and research relevance for future studies.

Predictors of treatment outcome in OCD: An interpersonal perspective

Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.

Perfectionism in Intensive Residential Treatment of Obsessive–Compulsive Disorder

Perfectionism is frequently noted in obsessive–compulsive disorder (OCD) and some data suggest that treatment outcomes with cognitive behavioral therapy (CBT) are poorer for OCD patients with higher levels of perfectionism. However, this literature includes inconsistent findings and has thus far been limited to outpatient samples. Existing studies have also not utilized measures of perfectionism in-line with the multidimensional nature of this construct, which includes both adaptive and maladaptive forms of perfectionism. This study administered measures of multidimensional perfectionism and OCD severity at admission and discharge in a large sample (N = 154) of adult OCD patients undergoing intensive residential treatment (IRT). Results indicated that more perfectionistic patients had slightly longer treatment duration. Adjusting for treatment duration and baseline severity, pre-treatment perfectionism did not significantly predict OCD outcomes. However, all domains of perfectionism significantly improved following treatment, and changes in perfectionism significantly predicted OCD outcomes. In particular, greater reduction in maladaptive perfectionism uniquely predicted better OCD symptom outcomes. These results suggest that high initial levels of perfectionism may not prevent OCD patients from benefitting from IRT, and that reduction in perfectionism significantly accounts for OCD treatment gains. Limitations and avenues for future research are discussed.

Is glutamate associated with fear extinction and cognitive behavior therapy outcome in OCD? A pilot study.

Cognitive behavioral therapy (CBT) including exposure and response prevention is a well-established treatment for obsessive-compulsive disorder (OCD) and is based on the principles of fear extinction. Fear extinction is linked to structural and functional variability in the ventromedial prefrontal cortex (vmPFC) and has been consistently associated with glutamate neurotransmission. The relationship between vmPFC glutamate and fear extinction and its effects on CBT outcome have not yet been explored in adults with OCD. We assessed glutamate levels in the vmPFC using 3T magnetic resonance spectroscopy, and fear extinction (learning and recall) using skin conductance responses during a 2-day experimental paradigm in OCD patients (n = 17) and in healthy controls (HC; n = 13). Obsessive-compulsive patients (n = 12) then received manualized CBT. Glutamate in the vmPFC was negatively associated with fear extinction recall and positively associated with CBT outcome (with higher glutamate levels predicting a better outcome) in OCD patients. Glutamate levels in the vmPFC in OCD patients were not significantly different from those in HC, and were not associated with OCD severity. Our results suggest that glutamate in the vmPFC is associated with fear extinction recall and CBT outcome in adult OCD patients.

Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: Prevalence and predictors

BackgroundPatients with obsessive-compulsive disorder (OCD) often present with comorbidities, mainly anxiety and affective disorders, which may influence OCD course, help-seeking and treatment response. Some authors have studied bipolar disorder (BD) comorbidity in patients with OCD, but usually in small samples. The objective was to estimate the lifetime prevalence of BD in a large clinical sample of OCD patients, and to compare demographic and clinical features of patients with and without BD comorbidity. MethodThis cross-sectional study with 955 adult OCD patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC) used several assessment instruments, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Descriptive and bivariate analyses were followed by logistic regression. ResultsThe lifetime prevalence of BD was 7.75% (N = 74). The variables that were independently associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders, and suicide attempts. LimitationsThe cross-sectional design does not permit causal inferences; the external validity may be limited, as the participants were from tertiary services. Despite the large sample size, some analyses may have been underpowered due to the relatively low prevalence of the outcome and of some explanatory variables. ConclusionsPatients with OCD comorbid with BD have some clinical features indicative of greater severity, including higher suicide risk, and require a careful therapeutic approach for the appropriate treatment of both disorders.

The impact of attention deficit hyperactivity disorder in obsessive-compulsive disorder subjects.

Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients. A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinical characteristics in adult OCD patients with and without comorbid ADHD were compared using Fisher's exact test, t-tests or Mann-Whitney tests. Bivariate analyses were followed by logistic regression analysis to identify clinical characteristics independently associated with ADHD comorbidity. The lifetime prevalence of ADHD in adult OCD patients was 13.7%. The current results indicate that OCD + ADHD patients were more severe, had an earlier onset of the obsessive-compulsive symptoms, a higher history of rheumatic fever, with higher frequencies of sensory phenomena and comorbidity with Tourette syndrome. They also had an increased risk for academic impairment and suicide attempts. Adult OCD patients with ADHD present some specific clinical features and may represent a special subgroup of adult OCD. Future studies should focus on the development of interventions more tailored to the phenotype of this subgroup of patients.

Combining Drug and Psychological Treatments for Obsessive- Compulsive Disorder: What is the Evidence, When and for Whom.

Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral psychotherapy (CBT) are first-line treatments for obsessive-compulsive disorder (OCD). Since response is often inadequate, in recent years researchers investigated whether combining CBT and SRIs, either ab initio or sequentially, results in a greater reduction of obsessivecompulsive symptoms. The aims of the present paper are to assess if combination treatment seems adding benefits as compared to either monotherapy alone and if sequential strategies may be effective in converting partial or non responders to a first-line treatment into responders. We reviewed available literature on pharmacological and CBT combination and sequential treatments for adult and pediatric OCD patients and then we conducted a separate analysis for studies concerning these two promising strategies. Search results included openlabel trials and randomized controlled trials (RCTs). We identified ten controlled studies assessing the efficacy of combination treatments ab initio versus CBT alone and six evaluating combination strategies ab initio versus medications alone. Eleven studies, only two of which were RCTs, have been published on sequential treatments. The combination ab initio of CBT and SRIs has not been found to be clearly superior to either monotherapy alone in most studies conducted on this topic, except for patients with severe depression who might benefit more from the combination versus only CBT. A sequential administration of CBT after medications has been found useful in promoting remission in patients who partially responded to drugs and in promoting response in resistant patients. OCD patients with comorbid major depression should receive medication firstly, eventually associated with CBT; for all remaining patients there is clear evidence from the literature of no additive benefits of combining ab initio CBT and medication. Therefore, the routine use of a combination approach in all adult patients affected by OCD is not supported by the literature. The available evidence supports the effectiveness of the sequential addition of CBT to SRIs.

Does cognitive-behavioral therapy affect goal-directed planning in obsessive-compulsive disorder?

Cross-sectional studies have reported failures in goal-directed planning in obsessive-compulsive disorder (OCD). It remains unclear whether these deficits confer vulnerability to developing OCD, or are a consequence of symptoms. The present study examined goal-directed learning before and after cognitive behavioral therapy (CBT), using treatment as a tool to reduce symptoms. Eighteen adult OCD patients undergoing 17 sessions of CBT completed an established task of model-based (i.e., goal directed) versus model-free planning as well as measures of OCD and depression before and after treatment. We thus tested whether improvements in goal-directed performance accompany improvements in OCD symptoms or if instead task performance remains stable despite symptom improvement. Results showed prior to treatment, higher OCD severity was associated with greater deficits in model-based planning. OCD severity scores significantly improved from pre- to post-treatment. Inconsistent with the state-view, OCD symptom improvement was not accompanied by improvements in model-based performance. At post-treatment, OCD severity scores were no longer correlated with model-based performance. Together, these data suggest that reducing OCD symptoms with CBT does not affect goal-directed planning. This supports a trait model of the relationship between goal-directed planning and OCD symptoms, such that problems in goal-directed planning may be an OCD risk factor.

Study protocol for a single-blind, randomised controlled, non-inferiority trial of internet-based versus face-to-face cognitive behaviour therapy for obsessive–compulsive disorder

IntroductionExpert guidelines recommend cognitive–behavioural therapy (CBT) as a first-line treatment for obsessive–compulsive disorder (OCD), but the majority of patients with OCD do not have access to CBT. Internet-delivered CBT (ICBT)...

The detection of white matter alterations in obsessive-compulsive disorder revealed by TRActs Constrained by UnderLying Anatomy (TRACULA).

PurposeIn recent years, a large number of studies have investigated obsessive–compulsive disorder (OCD) using diffusion-weighted images (DWIs) and have reported microstructural abnormalities in various regions, mainly the corpus callosum and cingulum. In the present study, we aimed to detect microstructural changes in the white matter using whole-brain tractography.Patients and methodsWe obtained MRI data from 25 adult non-medicated OCD patients and 27 healthy controls. DWI data from MRI scans were analyzed by the automated probabilistic tractography method referred to as TRActs Constrained by UnderLying Anatomy (TRACULA). We investigated diffusivity parameters: fractional anisotropy, radial diffusivity (RD), axial diffusivity, and mean diffusivity in 18 major white matter tracts and examined indices to know which measurements in which fibers can predict the diagnosis of OCD.ResultsCompared to healthy controls, OCD patients had significantly increased RD in the forceps major and a reduction of RD in the right cingulum angular (infracallosal) bundle. There was no correlation between these values and the clinical features.ConclusionWe found RD alterations in the forceps major and the right cingulum angular (infracallosal) bundle, which might be associated with myelination changes in the temporal and occipital regions in OCD. Our results suggest that the pathogenesis of OCD may include abonormality of myelination status in not only the fronto-striato-thalamic circuit but also the posterior and temporal regions.