Yale-Brown Research Articles

Effects of Videogaming on Attention and Conduct in Adolescents with Tourette’s Syndrome (P12-11.010)

<h3>Objective:</h3> To assess the association between time spent playing videogames on attention and behavior in adolescents with Tourette’s Syndrome (TS). <h3>Background:</h3> As adolescents spend more time playing videogames, the effects of gaming on cognitive and behavioral function remain heavily debated. There is literature emphasizing the negative effects of gaming on conduct, but there is also literature showing improvement in attention skills. This may be dependent on the amount of time spent on gaming. The effects of videogaming on attention and conduct in adolescents with TS have not been investigated yet. <h3>Design/Methods:</h3> Patients with TS, age 12–19, seen at the Rush Movement Disorders Clinic were invited to participate in the study. They completed questionnaires including demographics and number of hours spent playing video games per day (0–1, 1–3, more than 3 hours). The primary outcome measures included the Continuous Performance Test, 3rd Edition (CPT-3) and the Behavioral Assessment System for Children, 3rd Edition (BASC). Other assessments included the Yale Global Total Tic Severity Scale (YGTTSS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Revised Children’s Manifest Anxiety Scale (RCMAS). Demographics were summarized with descriptive statistics. CPT-3 (detectability, omissions, commissions, hit reaction, variability) and BASC (externalizing, internalizing, behavioral problems) T-scores were compared between groups of time spent gaming using the ANOVA model. <h3>Results:</h3> 19 subjects were included in the study, 11 male, mean age 14.8 (SD 1.9), mean YGTTSS 53.4 (SD 14.2), median YBOCS 8 (range 0–42), and median RCMAS 14 (range 4–38). 47.4% of subjects carried the diagnosis of ADHD, 5.3% learning disorder, 36.8% obsessive compulsive disorder, 26.3% depression, and 68.4% anxiety. There was no significant association between time spent playing video games and CPT-3 or BASC. <h3>Conclusions:</h3> In this cohort, time spent videogaming did not affect attention or behavior in TS patients. We will continue to recruit patients to adequately characterize this in a larger cohort. <b>Disclosure:</b> Mr. Colgan has nothing to disclose. Bichum Ouyang has nothing to disclose. Dr. Gera has nothing to disclose. Dr. Kompoliti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Kompoliti has received personal compensation in the range of $0-$499 for serving as a Consultant for Sunovion. Dr. Kompoliti has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. Dr. Kompoliti has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Scion. Dr. Kompoliti has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Kompoliti has received research support from Emalex. The institution of Dr. Kompoliti has received research support from Aeon. The institution of Dr. Kompoliti has received research support from Sun Pharma. The institution of Dr. Kompoliti has received research support from Revance. The institution of Dr. Kompoliti has received research support from Restore. The institution of Dr. Kompoliti has received research support from Theravance.

Self-compassion and cognitive flexibility in people with body dysmorphic disorder syndrome

Introduction: Negative body image and its adverse behavioral consequences are important public health concerns, and studying effective psychological factors in its formation is very important. Aim: The present research aimed to compare Self-compassion and Cognitive flexibility in people with and without body dysmorphic disorder syndrome. Method: The present study had a descriptive and causal-comparative design. The research population consisted of all women and men aged 18 to 40 of Tehran in 2022, from which a sample of 62 people was selected by available and purposeful sampling method (31 people as a sample group with symptoms of body dysmorphic disorder and 31 people as a sample group without symptoms of body dysmorphic disorder). Participants answered the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder: BDD-YBOCS (1997), Self-compassion Scale-Short Form (2011), and Cognitive Flexibility Inventory (2010). Data were analyzed using multivariate analysis of variance, by SPSS-25 software. Results: The results showed that the mean scores of self-compassion (F=31.16, P=0.001, Eta=0.34) and cognitive flexibility (F=31.24, P=0.001, Eta=0.18) were significantly lower in the group with symptoms of body dysmorphic disorder than the group without symptoms of body dysmorphic disorder and there was a statistically significant difference between the two groups (P&lt;0.01). Conclusion: The present study highlighted the importance of psychological mechanisms in the symptoms of body dysmorphic disorder. These findings indicated that psychotherapists should pay essential attention to the special psychological attributes of people with symptoms of body dysmorphic disorder at the time of prevention and treatment.

Safety, tolerability, and clinical and neural effects of single-dose psilocybin in obsessive-compulsive disorder: protocol for a randomized, double-blind, placebo-controlled, non-crossover trial.

Psilocybin may help treat obsessive-compulsive disorder (OCD). To date, only one open-label study of psilocybin for OCD exists, necessitating further investigation with a randomized controlled design. The neural correlates of psilocybin's effects on OCD have also not been studied. This first-of-its-kind trial aims to evaluate the feasibility, safety, and tolerability of psilocybin in the treatment of OCD, provide preliminary evidence on the effects of psilocybin on OCD symptoms, and elucidate neural mechanisms that may mediate psilocybin's effects on OCD. We use a randomized (1:1), double-blind, placebo-controlled, non-crossover design to examine the clinical and neural effects of either a single dose of oral psilocybin (0.25 mg/kg) or active placebo-control agent (250 mg of niacin) on OCD symptoms. We are enrolling 30 adult participants at a single site in Connecticut, USA who have failed at least one trial of standard care treatment (medication/psychotherapy) for OCD. All participants will also receive unstructured, non-directive psychological support during visits. Aside from safety, primary outcomes include OCD symptoms over the past 24 h, assessed by the Acute Yale-Brown Obsessive-Compulsive Scale and Visual Analog Scale ratings. These are collected by blinded, independent raters at baseline and the primary endpoint of 48 h post-dosing. Total follow-up is 12 weeks post-dosing. Resting state neuroimaging data will be collected at baseline and primary endpoint. Participants randomized to placebo will be offered the chance to return for an open-label dose of 0.25 mg/kg. All participants will be required to provide written informed consent. The trial (protocol v. 5.2) was approved by the institutional review board (HIC #2000020355) and registered with ClinicalTrials.gov (NCT03356483). This study may represent an advance in our ability to treat refractory OCD, and pave the way for future studies of neurobiological mechanisms of OCD that may respond to psilocybin.

Moderating Role of Depression on the Association of Tic Severity With Functional Impairment in Children

BackgroundChronic tic disorders (CTDs) commonly co-occur with other psychiatric disorders. CTDs have been linked to functional impairment and reduction in quality of life. Insufficient research is available on depressive symptoms in patients with CTD, especially children and adolescents, yielding conflicting findings. To investigate the presence of depressive symptoms in a cohort of children and young adolescents with CTD and to test whether they moderate the link between tic severity and functional impairment. MethodsThe sample consisted of 85 children and adolescents (six to 18 years) with a CTD who were treated in a large referral center. Participants were evaluated using gold-standard self- and clinician-reporting instruments to measure tic symptom severity and tic-related functional impairment (Yale Global Tic Severity Scale), depression (Child Depression Inventory), and obsessive-compulsive symptoms (Children Yale Brown Obsessive Compulsive Scale). ResultsDepressive symptoms (mild to severe) were exhibited by 21% of our sample. Study participants with CTD and comorbid obsessive-compulsive disorder (OCD) and/or attention-deficit/hyperactivity disorder had higher rates of depressive symptoms compared with those without comorbidities. Significant correlations were found within and among all tic-related and OCD-related measures, yet depressive symptoms only correlated to tic-related functional impairment. Depression significantly and positively moderated the correlation between tic severity and tic-related functional impairment. ConclusionsFindings suggest that depression plays an important part as a moderator in the link between tic severity and functional impairment in children and adolescents. Our study highlights the importance of screening for and treating depression in patients with CTD.

The Effect of Female Genital Cosmetic and Reconstructive Procedures on Body and Genital Self-Image: A Systematic Review and Meta-Analysis.

Performance of female genital cosmetic and reconstructive procedures (FGCRP) has been increasing over the past decades. Appearance and functional concerns are the most common reasons for seeking FGCRP. Poor body and genital self-image may contribute to the increase in demand for surgery. The aim of this systematic review is to explore outcomes of FGCRP in the domains of body and genital self-image. A systematic literature review of PubMed (National Institutes of Health, Bethesda, MD), Web of Science (Clarivate, London, UK), Scopus (Elsevier, Amsterdam, the Netherlands), PsycINFO (American Psychological Association, Washington, DC), Embase (Elsevier, Amsterdam, the Netherlands), and the Cochrane Library (Wiley, Hoboken, NJ) was conducted to identify articles that measured body and genital self-image in women after FGCRP. The authors identified 5 articles for a systematic review of body image and 8 studies for a systematic review of genital self-image. The most common procedure performed was labia minora labiaplasty. Instruments for body image evaluation were Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS), and the Body Image Quality of Life Inventory (BIQLI). Genital image was assessed with the Female Genital Self-Image Scale (FGSIS) and Genital Appearance Satisfaction (GAS) scale. Most of the studies indicated that FGCRP can improve both body image and genital self-image; meta-analysis revealed that FGCRP improved GAS scores by 17.96 (range: 0-33) (p < 0.001). It appeared that FGCRP led to improvements in women's body and genital self-image. Inconsistencies in study design and measures however limit this conclusion. Future research should involve more rigorous study designs (for example randomized clinical trials with large sample sizes) for a more accurate assessment of FGCRP's consequences.

Direct changes of neurometabolic concentrations in the pregenual anterior cingulate cortex among obsessive-compulsive patients after repetitive transcranial magnetic stimulation treatment

Background and aimAlthough Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising new noninvasive brain stimulation therapy, its underlying mechanisms of action remain unknown. OCD patients exhibit impaired response control and attention shifting, which is linked to some brain areas such as anterior cingulate cortex and basal ganglia. OCD patients also display altered neurometabolic concentrations in cortical cortical-striatal-thalamic-cortical (CSTC). In this study, we aimed to elucidate efficacy of rTMS treatment in alleviating related symptoms and pregenual anterior cingulate cortex (pACC) neurometabolites. MethodsOCD patients were randomly divided into either drug (n = 23) or drug + rTMS (n = 29) groups, and those in the latter group subjected to 4-week rTMS treatment. All participants were visited twice, at baseline and follow-up after four weeks. During both visits, all patients were subjected to 1H-MRS, then Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Global Assessment Function (GAF) used to assess severity of obsessive-compulsive symptoms. We also evaluated synchronous anxiety and depression by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D). ResultsAfter 4 weeks of treatment, patients in the Drug + rTMS group displayed significantly lower Y-BOCS (p = 0.038), BDI (p = 0.009), HAM-D (p = 0.013), HAM-A (p = 0.012) scores than their counterparts in the Drug group. Conversely, patients in the Drug + rTMS group had significantly higher tNAA concentrations (p = 0.030) than those in the Drug group. Notably, the Drug + rTMS group exhibited higher, but insignificant Glu (p = 0.055) and Glx (p = 0.068) concentrations compared to the Drug group. Partial correlation analysis revealed a significant negative correlation between post HAM-A scores and 4-week change of pACC glutamate levels in the Drug + rTMS group (r = −0.434, p = 0.02). ConclusionrTMS treatment is an efficacious treatment therapy for OCD, mainly by inducing changes in neurometabolites.

Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial

Many patients with obsessive-compulsive disorder (OCD) do not receive cognitive behavioral therapy with exposure and response prevention (first line treatment for OCD), for example, due to patients’ fear of the exposure and reservations of the therapists. Technology-supported exposure (e.g., exposure therapy with response prevention in mixed reality [MERP]) for patients with OCD may help to overcome this obstacle. Building upon findings of our pilot study objectives of this study are to evaluate the efficacy, expectations of treatment success, feasibility, and acceptance of MERP as well as to identify possible limitations. In total, 64 outpatients with contamination-related OCD will be recruited and randomized to one of two conditions: MERP (six sessions in six weeks) and self-guided exposure therapy (six exercises in six weeks). Participants will be assessed before (baseline), after the six-week intervention period (post), as well as three months after post assessment (follow-up) regarding symptomatology (Yale-Brown Obsessive Compulsive Scale; Y-BOCS), their subjective evaluation of MERP (acceptance) and sense of presence. The planned study is the first to investigate MERP in patients with OCD.

Reduced olfactory bulb volume and olfactory sulcus depth in obsessive compulsive disorder

Many studies have shown that limbic system abnormalities are seen in obsessive-compulsive disorder (OCD), but the neurobiological changes in OCD are still unclear. Moreover, olfactory bulb volume (OBV) and its association with symptom severity have not been yet investigated in patients with OCD. This is the first study on OBV and olfactory sulcus depth (OSD) values in OCD patients, to the best of our knowledge. Between January 2018 and March 2022, 25 patients with OCD and 26 healthy controls with brain magnetic resonance imaging (MRI) were included. Detailed disease history of OCD patients was taken, and Yale-Brown obsessive-compulsive scale (YBOCS) was applied. The mean age of the patient group was 33.40±9.58, the mean age of the control group was 32.84±8.01. LOBV, ROBV, TOBV, and LOSD in the patient group were significantly lower than in the control group (p=.013, p=.005, p=.001, p=.015, respectively). ROBV and TOBV were negatively correlated with YBOCS total and subscale scores. A negative correlation was found between ROBV and TOBV and disease duration (r=-0.749 and r=-0.640, respectively). The negative correlation of ROBV and TOBV values with disease duration and disease severity can be used to monitor the neurodegenerative process of OCD disease.

Identifying trajectories of symptom change in adults with obsessive compulsive disorder receiving exposure and response prevention therapy

Exposure and response prevention (EX/RP) is a recommended psychotherapy for obsessive-compulsive disorder (OCD). Yet, not all patients benefit equally from EX/RP. Prior studies have examined EX/RP predictors by predicting endpoint symptoms and/or pre-post symptom change, rather than accounting for trajectories of symptom change across treatment. We pooled data from four NIMH-funded clinical trials, yielding a large sample (N = 334) of adults who received a standard course of manualized EX/RP. Independent evaluators rated OCD severity using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Data were analyzed using growth mixture modeling (GMM) to detect subgroups of participants with similar trajectories of symptom change followed by multinomial logistic regression to identify baseline variables capable of predicting class membership. GMM revealed three distinct trajectory classes: 22.5% of the sample showed dramatic improvement (dramatic progress class), 52.1% showed moderate improvement (moderate progress class), and 25.4% showed little change (little to no progress class). Membership in the little to no progress class was predicted by baseline avoidance and transdiagnostic internalizing factor levels. These findings suggest that OCD symptom improvement with outpatient EX/RP occurs via distinct trajectories. These findings have implication regarding identifying treatment non-responders and personalizing treatment depending one’s baseline characteristics in order to optimize treatment effectiveness.

Effectiveness of Neuropsychoeducation, Intrinsic Motivation, and Metaphoric Content Integrated with Cognitive Behavioral Therapy in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study.

Obsessive-compulsive disorder (OCD) is considered frequent, unnecessary thoughts that lead to repetitive actions to lessen the apprehension provoked by thoughts; this repetitive sequence may further influence trouble in one's daily activities. The remedial procedure for OCD includes medication (such as SSRIs, anxiolytics, and antidepressants) with psychotherapy [such as cognitive behavioral therapy (CBT) and exposure response prevention (ERP)]. Previous investigations indicated that regardless of the trend of adopting CBT and ERP to treat OCD, only around half of the patients experienced a full reduction in symptoms. The ERP component in CBT has been termed as a challenging treatment as it contains threatening anxiety-provoking indications, and it has been reflected that between 25-30% of OCD patients reject the ERP treatment, and the refusal and dropout rates for ERP in OCD are higher than other interventions. Thus, in the present investigation, researchers developed a proposed therapy that includes neuropsychoeducation, intrinsic motivation, and metaphoric content integrated with CBT in addition to regular pharmacological management to treat OCD patients and validated the efficacy of the proposed therapy through psychometric ratings (Y-BOCS). In this pilot study, 10 cases of OCD received a 12-week proposed therapy program. The primary outcome was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), which was assessed at baseline and post-treatment. The present study's results revealed a significant decrease in scores on the obsessions and compulsions domains and overall total scores on Y-BOCS among OCD patients. The findings show that this proposed therapy, which includes neuropsychoeducation, intrinsic motivation, and metaphors contents integrated with CBT in combination with pharmacological management, is effective in the treatment of OCD. Therefore, the proposed therapy may be beneficial in the treatment of OCD. It has far-reaching implications in the areas of clinical, psychiatry, and mental health.

Polygenetic risk scores and phenotypic constellations of obsessive–compulsive disorder in clozapine-treated schizophrenia

Obsessive–compulsive symptoms (OCS) are frequently observed in individuals with schizophrenia (SCZ) treated with clozapine (CLZ). This study aimed to analyze prevalence of OCS and obsessive–compulsive disorder (OCD) in this subgroup and find possible correlations with different phenotypes. Additionally, this is the first study to examine polygenetic risk scores (PRS) in individuals with SCZ and OCS. A multicenter cohort of 91 individuals with SCZ who were treated with CLZ was recruited and clinically and genetically assessed. Symptom severity was examined using the Positive and Negative Symptom Scale (PANSS), Clinical Global Impression Scale (CGI), the Calgary Depression Scale for Schizophrenia (CDSS), Global Assessment of Functioning Scale (GAF) and Yale–Brown Obsessive–Compulsive Scale (Y-BOCS). Participants were divided into subgroups based on phenotypic OCS or OCD using Y-BOCS scores. Genomic-wide data were generated, and PRS analyses were performed to evaluate the association between either phenotypic OCD or OCS severity and genotype-predicted predisposition for OCD, SCZ, cross-disorder, and CLZ/norclozapine (NorCLZ) ratio, CLZ metabolism and NorCLZ metabolism. OCS and OCD were frequent comorbidities in our sample of CLZ-treated SCZ individuals, with a prevalence of 39.6% and 27.5%, respectively. Furthermore, the Y-BOCS total score correlated positively with the duration of CLZ treatment in years (r = 0.28; p = 0.008) and the PANSS general psychopathology subscale score (r = 0.23; p = 0.028). A significant correlation was found between OCD occurrence and PRS for CLZ metabolism. We found no correlation between OCS severity and PRS for CLZ metabolism. We found no correlation for either OCD or OCS and PRS for OCD, cross-disorder, SCZ, CLZ/NorCLZ ratio or NorCLZ metabolism. Our study was able to replicate previous findings on clinical characteristics of CLZ-treated SCZ individuals. OCS is a frequent comorbidity in this cohort and is correlated with CLZ treatment duration in years and PANSS general psychopathology subscale score. We found a correlation between OCD and PRS for CLZ metabolism, which should be interpreted as incidental for now. Future research is necessary to replicate significant findings and to assess possible genetic predisposition of CLZ-treated individuals with SCZ to OCS/OCD. Limitations attributed to the small sample size or the inclusion of subjects on co-medication must be considered. If the association between OCD and PRS for CLZ metabolism can be replicated, it should be further evaluated if CYP1A2 alteration, respectively lower CLZ plasma level, is relevant for OCD development.

Speech graph analysis in obsessive-compulsive disorder: The relevance of dream reports

Obsessive-compulsive disorder (OCD) is a distressing disorder characterized by the presence of intrusive thoughts, images or urges (obsessions) and/or behavioral efforts to reduce the anxiety (compulsions). OCD lifetime prevalence varies between 1% and 3% in the general population and there are no reliable markers that support the diagnosis. In order to fill this gap, Computational Psychiatry employs multiple types of quantitative analyses to improve the understanding, diagnosis, prediction, and treatment of mental illnesses including OCD. One of these computational tools is speech graphs analysis. A graph represents a network of nodes connected by edges: in non-semantic speech graphs, nodes correspond to words and edges correspond to the directed link between consecutive words. Using non-semantic speech graphs, we compared free speech samples from OCD patients and healthy controls (HC), to test whether speech graphs analysis can grasp structural differences in speech between these groups. To this end, 39 OCD patients and 37 HC were interviewed and recorded during six types of speech reports: yesterday, dream, old memory, positive image, negative image and neutral image. Also, the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Yale Brown Obsessive-Compulsive Scale (Y-BOCS) were used to assess symptom severity. The graph-theoretical structural analysis of dream reports showed that OCD patients have significantly smaller lexical diversity, lower speech connectedness and a higher recurrence of words in comparison with HC. The other five report types failed to show differences between the groups, adding to the notion that dream reports are especially informative of speech structure in different psychiatric states. Further investigation is necessary to completely assess the potential of this tool in OCD.

Pilot study of single-dose psilocybin for serotonin reuptake inhibitor-resistant body dysmorphic disorder

ObjectiveBody dysmorphic disorder (BDD) is an often-severe condition in which individuals are preoccupied by misperceptions of their appearance as defective or ugly. Only serotonin reuptake inhibitors and cognitive-behavioral therapy have been demonstrated efficacious in randomized controlled trials. Psilocybin is a psychedelic drug with growing evidence for safety and efficacy in treatment of depression. This study aimed to pilot test the feasibility, tolerability, safety, and efficacy of psilocybin treatment of adults with BDD. Methods: In this open-label trial, 12 adults (8 women, 4 men) with moderate-to-severe non-delusional BDD that had been unresponsive to at least one serotonin reuptake inhibitor trial received a single oral dose of psilocybin 25 mg. There was no control group. Psychological support was provided before, during, and after the dosing session. The primary outcome measure for efficacy was the Yale-Brown Obsessive Compulsive Disorder Scale Modified for BDD (BDD-YBOCS) score during 12 weeks of assessments after dosing. Results: All participants completed dosing and all follow-up assessments. BDD-YBOCS scores decreased significantly over 12 weeks of follow-up (p < .001) with a large effect size (partial eta squared = 0.54), and significant changes from baseline were present at week 1 and persisted through week 12. Secondary efficacy measures of BDD symptoms, conviction of belief, negative affect, and disability also improved significantly, and no serious adverse events occurred. At week 12, seven participants (58%) were rated responders, based on ≥30% decrease in BDD-YBOCS. Conclusion: This study provides promising preliminary support for psilocybin as a treatment of BDD, warranting future controlled studies.

Embitterment and metacognition in obsessive–compulsive disorder

ObjectiveEmbitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive–compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics.MethodFollowing a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive–compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive–Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory.ResultsPatients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; p < 0.001), but the cut-off of < 2.5 for a clinically relevant embitterment disorder was not reached. Dysfunctionally distorted metacognition (MCQ-30), which is a consistent finding in OCD, as well as a generally high degree of clinical impairment were significantly cor related to the degree of embitterment.ConclusionOur findings suggest that embitterment as measured by PTEDq is important in patients with OCD, who are characterized by metacognitive distortions with an injustice of fate as well as a mortification of their self-image. In future, it would be necessary to screen patients with OCD not only for depressive symptoms but also specifically for feelings of embitterment in order to be able to initiate appropriate psychotherapeutic measures at an early stage.

Clinician- versus caregiver-rated scales as outcome measures of repetitive-restricted behaviors in clinical trials of autism: A systematic review and meta-analysis

The agreement between treatment effects measured by clinician- and caregiver-ratings of repetitive-restricted behaviors (RRBs) is important for clinical practice and research but is still unclear.Therefore, we conducted a post-hoc meta-analysis of placebo-controlled randomized-controlled trials (RCTs) investigating pharmacological and dietary-supplement treatments for autism that reported both clinician- and caregiver-ratings of RRBs. Treatment effects between medications and placebo were quantified with standardized mean differences (SMDs). The agreement between clinician- and caregiver-rated SMDs was investigated with an intraclass correlation coefficient (ICC) and random-effects meta-analysis of their difference (Δg). A meta-regression investigated the association between clinician (dependent) and caregiver-rated SMDs (independent variable). Certainty in the evidence was evaluated using the GRADE approach.We identified 15 eligible placebo-controlled RCTs with 1567 participants, from which 13 included children/adolescents and 9 reported data for the pair of the clinician-rated Yale-Brown Obsessive Compulsive Scale (YBOCS) and the caregiver-rated Aberrant Behavior Checklist-Stereotypic Behavior (ABC-S). There was on average a good agreement between clinician- and caregiver-rated SMDs (ICC=0.84, 95% confidence intervals [0.55, 0.95]), no clear difference between them (Δg=0.08, 95%CI[-0.06, 0.21], 95% prediction intervals [-0.16, 0.31]), and the beta of the meta-regression was 0.62, 95%CI[0.27, 0.97]. The certainty of the evidence was low due to concerns in imprecision and inconsistency.Our analysis showed on average a good agreement between clinician- and caregiver-rated treatment effects in RRBs, yet discordance could be expected in future RCTs, given the wide prediction intervals. It is also not certain that these results could be generalizable to other rating scales and intervention modalities.Ethics committee approval: Not applicable as a meta-analysis of previously published studies..

Memantine augmentation of sertraline in the treatment of symptoms and executive function among patients with obsessive-compulsive disorder: A double-blind placebo-controlled, randomized clinical trial

IntroductionMedications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually decrease the severity of the symptoms by 20–30%; however, 40–60% of OCD patients do not achieve a satisfactory response. Our main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder.ObjectivesOur main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder.MethodsSeventy patients with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of more than 21 were recruited to the study. They received sertraline (100 mg daily initially followed by 200 mg daily after week 4) and either memantine (10 mg twice daily) or placebo in a placebo controlled, double-blinded, parallel-group, clinical trial of 12 weeks. The primary outcome was OCD symptoms measured by the Y-BOCS. Moreover, executive function of participants was measured by the Wisconsin Card Sorting Test (WCST).ResultsThe total score, and obsession and compulsion subscales of Y-BOCS significantly dropped in both groups with no significant difference between the two groups. However, memantine group showed a greater response in the number of completed categories subscale of the WCST (p value&lt;0.001). We did not observe any major adverse effects in any of the groups.Image:Image 2:Image 3:ConclusionsMemantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD.Memantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD.Disclosure of InterestNone Declared

Rituximab for treatment-resistant schizophrenia and/or obsessive-compulsive disorder (OCD): functional connectivity and cytokines associated with symptomatic improvements

IntroductionImmunological mechanisms may contribute to the causation of mental illness. Autoimmunity is most convincingly shown for anti-NMDA-R encephalitis and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS); disorders that overlap clinically with schizophrenia and OCD. Altered inflammatory cytokine production, glial activation and auto-antibodies have also been associated with schizophrenia and OCD. In these disorders, however, the treatment results with anti-inflammatory or immunomodulating drugs have hitherto been limited and inconsistent. Yet other targets within the immune system may still be effective and new options are warranted for treatment-resistant patients. Rituximab targets B-lymphocytes and is often used in autoimmune disorders such as rheumatoid arthritis, multiple sclerosis and anti-NMDA-R encephalitis.ObjectivesWe aimed to investigate whether rituximab is clinically effective, safe and tolerable as add-on therapy in markedly ill, treatment-resistant adult psychiatric patients with schizophrenia or OCD. We also wanted to identify putative mediating mechanisms in treatment responders, such as cytokine changes and functional connectivity (FC).MethodsIn an open pilot study, adults (18-39 years) with treatment-resistant schizophrenia and/or OCD were included. They received an intravenous infusion of rituximab 1000 mg, once at baseline, in addition to their regular psychiatric medication and were followed for 1 year. The main outcome measures were the Positive and Negative Syndrome Scale (PANSS) or Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impression-Improvement scale (CGI-I) and the Personal and Social Performance scale (PSP). Treatment response was defined as ≥ 40 % decrease in PANSS or ≥ 35 % decrease in Y-BOCS, and much improved according to CGI-I. Resting-state fMRI was applied at baseline and after 5 months. Plasma cytokines were measured at 0, 3 and 5 months. Cognitive tests and the recently developed PsychoNeuroinflammatory Related Signs and Symptoms Inventory (PNISSI) were used to identify and measure symptoms related to neuro-inflammation and cognitive function.ResultsNineteen patients were treated with rituximab. 3-5 months after treatment, 6/9 patients with schizophrenia and 1/10 with OCD responded. One schizophrenia patient continues with rituximab every 6 months and has reportedly done well for almost 3 years. No severe side effects were reported apart from recurrent abdominal pain in a schizophrenia patient and one case of post-COVID-19 syndrome. Significant changes of FC were detected in responders only and correlated with PSP changes.ConclusionsAberrant B-cell activities may contribute to treatment-resistant schizophrenia and be amenable to treatment with rituximab. However, the results of this pilot study need confirmation in placebo-controlled trials.Disclosure of InterestNone Declared

An analysis of the prevalence and impact of obsessive-compulsive personality disorder on the course of obsessive-compulsive disorder

Introduction Obsessive-compulsive disorder (OCD) is a disorder diagnosed on the basis of the presence of obsessions (persistently recurring, intrusive thoughts, images, impulses) and compulsions (compulsive and transiently satisfying actions performed in response to obsessions). A separate clinical phenomenon in the broadly understood anankastic spectrum is obsessive-compulsive disorder (OCPD). OCPD is characterized by scrupulousness, over-normative morality, perfectionism and an inability to make concessions in terms of cooperation. It is assumed that the incidence of OCPD in the course of OCD is 25-32% and it is a report with an unfavorable course and a more difficult therapeutic prognosis. It also means an early onset of OCD with a greater intensity of compulsions and a predominance of symptoms related to the sphere of purity, symmetry and gathering. Objectives The main aims of the study were as follows: 1. To assess the prevalence of OCPD in OCD patients. 2. To compare both groups of patients for the severity, level of insight, aggression, impulsiveness and affective symptoms. 3. To verify whether the presence of OCPD depend on factors such as age, gender, treatment duration and delay in starting treatment. Methods The study was conducted in a group of 78 patients diagnosed with and treated for OCD. The patients were divided into two groups: patients with OCD and OCPD (group 1, n=43) and patients with OCD without OCPD (group 2, n=35). The groups were subsequently compared for the severity of anankastic symptoms, the level of insight, aggression, impulsiveness and its components and affective symptoms (depression, mania). The following tools were used for the diagnosis: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression-Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Brown Assessment of Beliefs Scale (BABS) and DSM 5 criteria for OCPD. Results Our results confirmed that OCPD is common in OCD and occurred in 55,12% of patients with OCD (n=43; m=21; f=22). The study shows that the presence of OCPD in the course of OCD negatively affects the severity of obsessive-compulsive symptoms, the level of insight, the level of aggression and impulsiveness, and affective disorders. Patients with OCPD obtained higher scores on the YBOCS, BABS, HDRS, and YMRS scales compared to patients with OCD without OCPD. The occurrence of OCPD in the study group did not depend on gender, duration of OCD treatment, or delay in starting it. Conclusions The occurrence of OCPD is common in OCD and can cause delay of treatment, worse course, greater intensity of egosyntonic symptoms, and thus worse insight. The presence of OCPD can lead to more hostility and more affective disorders. Screening for OCPD in patients with OCD should be an integral part of an OCD diagnostic process. Disclosure of Interest None Declared

Open-label: the clinical effects of adding cannbidiol to usual care of patients with residual symptoms in the diagnosis of Obsessive Compulsive Disorder

IntroductionObsessive-compulsive disorder (OCD) is a heterogeneous and debilitating neuropsychiatric disorder. First-line antidepressants with Selective Serotonin Reuptake Inhibitors (SSRIs) and Clomipramine (a tricyclic antidepressant) are unresponsive or partially responsive in 40% of treated patients. Preclinical studies have shown that cannabidiol (CBD) can reduce compulsive behavior in animals, and considering that the release of glutamate in the action of CBD can inhibit terminal axons of neurons in the corticostriatal-thalamo-cortical circuit, we chosefor testing CBD, a drug with few side effects and low toxicity, as an adjuvant in treating OCD.ObjectivesTo evaluate the clinical effects of CBD add-on to the usual pharmacological treatment of outpatients diagnosed with OCD.MethodsMethods: This is an open-label study in which patients received CBD 300mg-day for 30 days in addition to their usual treatments and CBD 600mg-day for an additional 30 days if they have not reduced at least 25% of symptoms compared to the baseline evaluated by the Yale-brown obsessive-compulsive scale (Y-BOCS). Psychometric scales were used to assess the effects of CBD: Y-BOCS, General Anxiety Disorder 7 (GAD-7), Clinical Overall Impressions-Severity (CGI-S), Clinical Global Impressions-Improvement (CGI-I), Patient Health Questionnaire-9 (PHQ-9), Epworth Sleepiness Scale and Udvalg Scale for Kliniske Undersogelser (UKU) scale.Participants: We initially assessed 33 participants in the study. So far, 19 patients have completed the study. Eleven did not complete the study, and 03 patients are still in the study trial.ResultsMean (SD) Y-BOCS scores decreased from 28.0 (4.8) at baseline to 13.8 (8.6) at week 8, corresponding to a - 50.7% reduction (P&lt;.0001). Anxiety symptoms (GAD-7 scale) (P=0.001) and CGI-Severity scales scores (P&lt;0.001) improved significantly.MeasureBaseline, Mean (SD)Week 4, Mean (SD)Week 8, Mean (SD)Mean Change (Baseline to Week 4)Mean Change (Baseline to Week 8)Mean (SD)p-valuet-testY-Bocks28.0 (4.8)17.8 (7.3)13.8 (8.6)10.1 (6.5)&lt;0,0017.114.1 (7.9)&lt;0,0017.7GAD-713.8 (4.4)8.14 (4.9)8.0 (5.7)5.7 (6.4)0,0014.05.6 (5.8)0,0014.1CGI-I5.48 (0.9)3.9 (1.3)3.3 (1.5)1.5 (1.3)&lt;0,0015.282.1 (1.2)&lt;0,0017.4an=22;bn=19Image:Image 2:Image 3:ConclusionsWe concluded that there was an important reduction in the psychometric scales used with statistical significance. This is a partial analysis of the results as the study progresses. We believe that in the future we will be able to complete this study and have a better analysis of the results that are promising. At the end of the study, other psychometric scales such as CGI-I, epworth scale and UKU will be analyzed.Disclosure of InterestNone Declared

Apelin-13 and Asprosin in Adolescents with Anorexia Nervosa and Their Association with Psychometric and Metabolic Variables

IntroductionAnorexia nervosa (AN) is a widespread, metabo-psychiatric disorder with high relapse rates, comorbidity, and mortality. Many regulatory proteins and neurohormones studied to date play essential roles in the etiopathogenesis of eating disorders and the maintenance of psychopathological symptoms. Nevertheless, the regulatory and pathophysiological mechanisms of AN are still poorly understood.ObjectivesThe present study aimed to investigate the plasma levels of asprosin (ASP) and apelin-13 (APE-13) in malnourished (AN1) and partially cured (AN2) adolescent patients with AN. Correlations between protein levels and several dimensions of AN symptomatology, such as eating disorder, depressive, and obsessive compulsive symptoms, were investigated.MethodsSixty-four patients aged 11–18 years admitted to the Department of Child and Adolescent Psychiatry in the acute phase of AN participated in the study. Between the 1st and 3rd days of admission, patients with AN (AN1) underwent psychometric evaluation, height and weight assessment, and 15 mL of blood was drawn. The same procedures were repeated at a second time point about 11.2 ± 2.3 weeks later, after partial normalization of body weight on the day of discharge (AN2). The control group (CG) normal-weight girls with no history of psychiatric disorders, recruited from among the students of a local school. The Eating Attitudes Test (EAT-26), Beck Depression Inventory (BDI) Hamilton Depression Scale (HAMD) and Yale–Brown Obsessive Compulsive Scale (CYBOCS), were used to assess eating disorder symptoms, depression, obsessions and compulsions. Patients were included in a nutritional rehabilitation program. Daily caloric intake was 2000–2500 kcal and was gradually increased to 3500–4000 kcal depending on weight gain (1.0–1.5 kg per week).ResultsAPE-13 levels were higher in the AN1 group than in the post-realimentation and the CG group. APE-13 levels were independent of insulin and glucose levels. Plasma ASP levels increased with increasing body weight in patients with AN, correlating with the severity of eating disorder symptoms in emaciation.Image:Image 2:Image 3:ConclusionsThe presented data suggest that APE-13 and ASP may be AN’s biomarkers-regulation of eating behavior by APE-13 and ASP, the close relationship between them and emotional behavior, and changes in neurohormone levels in patients with eating and affective disorders seem to support these hypotheses. Moreover, their plasma levels seem to be related to the severity of psychopathological symptoms of eating disorders.Disclosure of InterestNone Declared