Obsessive-compulsive Research Articles

Persistent threat avoidance following negative reinforcement is not associated with elevated state anxiety.

Obsessive-Compulsive Disorder (OCD) is a debilitating illness consisting of obsessions and compulsions. OCD severity and treatment response are correlated with avoidant behaviors thought be performed to alleviate obsession-related anxiety. However, little is known about either the role of avoidance in the development of OCD or the interplay between anxiety states and avoidance behaviors. We have developed an instrumental negative reinforcement (i.e. active avoidance) paradigm in which mice must lever-press to avoid upcoming foot shocks. We show that mice (both sexes) can learn this task with high acquisition rates (75%) and that this behavior is largely stable when introducing uncertainty and modifying task structure. Furthermore, mice continue to perform avoidance responses on trials where lever pressing is not reinforced and increase response rates as they are maintained on this paradigm. With this paradigm, we did not find a relationship between negative reinforcement history and anxiety-related behaviors in well-established anxiety assays. Finally, we performed exploratory analyses to identify candidate regions involved in well-trained negative reinforcement using expression of the immediate early gene c-Fos. We detected correlated c-Fos expression in 1) cortico-striatal regions which regulate active avoidance in other paradigms and 2) amygdala circuits known to regulate conditioned defensive behaviors.Significance Statement Studies in patients with OCD suggest that compulsions are performed to avoid perceived threats and modulate anxiety tied to obsessions and/or compulsions. The negative reinforcement of avoidance and alleviated anxiety could therefore be a key driver of compulsive behaviors. However, there are still outstanding questions concerning the relationship between these two behaviors and the neural circuits involved in mediating negative reinforcement. We have developed an operant negative reinforcement paradigm in mice with discrete avoid and escape behaviors that can be learned without prior reward training with high throughput (75% acquisition) with responding that persists during nonreinforced trials. However, no differences were observed between negative reinforcement vs. unshocked and inescapably shocked controls, suggesting that continued negative reinforcement did not impact anxiety.

Atlas of gray matter volume differences across psychiatric conditions: A systematic review with a novel meta-analysis that considers co-occurring disorders

Regional gray matter volume (GMV) differences between individuals with mental disorders and comparison subjects may be confounded by co-occurring disorders. To disentangle the disorder-specific GMV correlates, we conducted a large-scale multi-disorder meta-analysis using a novel approach that explicitly models co-occurring disorders. We systematically reviewed voxel-based morphometry studies indexed in PubMed and Scopus up to January 2023 comparing adults with major mental disorders (anorexia nervosa, schizophrenia-spectrum, anxiety, bipolar, major depressive, obsessive-compulsive, and post-traumatic stress disorders, plus attention-deficit/hyperactivity, autism spectrum, and borderline personality disorders) to comparison subjects. Two authors independently extracted data and assessed quality using the Newcastle-Ottawa Scale. We derived GMV correlates for each disorder using: a) a multi-disorder meta-analysis accounting for all co-occurring mental disorders simultaneously; b) separate standard meta-analyses for each disorder ignoring co-occurring disorders. We assessed the alterations' extent, intensity (effect size), and specificity (inter-disorder correlations and transdiagnostic alterations) for both approaches. We included 433 studies (499 datasets) involving 19,718 patients and 16,441 comparison subjects (51% females, aged 20-67 years). We provide GMV correlate maps for each disorder using both approaches. The novel approach, which accounted for co-occurring disorders, produced GMV correlates that were more focal and disorder-specific (less correlated across disorders and fewer transdiagnostic abnormalities). This work offers the most comprehensive atlas of GMV correlates across major mental disorders. Modeling co-occurring disorders yielded more specific correlates, supporting this approach's validity. The atlas NIfTI maps are available online.

Investigating the relationship between the anxiety of contracting corona virus and the symptoms of obsessive-compulsive disorder with the mediating role of mental confusion and emotion regulation in health care center employees

Introduction: anxiety caused by the Corona virus transmission are highly prevalent among medical staff, so this study aims to determine the relationship between the anxiety of affected by infectious diseases and the symptoms of obsessive-compulsive disorder with the mediating role of mental confusion and emotion regulation. MethodS and Materials: This study was carried out based on correlational method in the form of modeling of structural equations, in which 350 male and female employees working in the health and treatment centers of Neyshabur city were selected through available sampling. Data collection tools included Madsley Practical Obsession Scale, Corona Alipour Anxiety Questionnaire, Criver, Solly and Esomil's Deliberate and Automatic Disorientation Questionnaire, and Gross and John's Emotion Regulation Questionnaire. After completing the questionnaires, data analysis using Modeling of structural equations was done with Lisrel and SPSS softwares. Results: between the anxiety and obsessive symptoms with r = 0.576, between mental confusion and obsessive symptoms with r = 0.553, between mental confusion and anxiety with r = 0.481, There is a significant direct relationship at the level p>0.01. But between emotional regulation and obsessive symptoms with r = -0.643, between emotional regulation and anxiety with r = -0.495, between emotional regulation and mental confusion with r = -0.611 there is an inverse significant relationship. Also, the results showed the role of two mediating variables of mental confusion and emotional regulation in the relationship between corona anxiety and obsessive symptoms. Conclusion: The model of the relationship between the anxiety caused by the transmission of the corona virus and the symptoms of obsessive-compulsive disorder according to the mediation of mental disorientation and emotion regulation has a good fit that with the increase in the number of emotions and defeat in regulating one's emotions, the symptoms of obsessive-compulsive disorder and confusion mental health also increases in the treatment staff. According to these findings, it is expected that health managers and medical centers will pay special attention to the psychological well-being of the personnel working in different parts of this profession.

The role of feared possible selves in the relationship between inferential confusion and obsessive-compulsive symptoms: A replication and extension in a clinical sample.

The feared possible self refers to an imagined version of self that one is afraid of being or becoming. Previous evidence has shown that dysfunctional reasoning (i.e., inferential confusion) is associated with obsessive-compulsive disorder (OCD) symptoms, which is partially mediated by a feared self. However, the evidence is reliant on non-clinical samples and a general measure of the feared self. Using a cross-sectional design, the current study attempted to replicate and extend this literature in a sample clinically diagnosed with OCD (n = 350) to assess the pathway from inferential confusion to OCD symptoms when feared self is accounted for as a mediator, particularly the individual dimensions of feared self (i.e., corrupted, culpable, and malformed feared selves). Participants completed a structured clinical interview for DSM-5, as well as measures of inferential confusion (Dysfunctional Reasoning Processes Task), obsessive beliefs, feared self, OCD symptoms, and psychological distress. Inferential confusion directly, and indirectly through the feared corrupted self, affected OCD symptoms, even after adjusting for obsessive beliefs, psychological distress, and comorbidity. However, the feared culpable and malformed selves did not play a role in this pathway. The study underscores that the feared corrupted self links inferential confusion to OCD symptoms, translating to the need to consider both dysfunctional reasoning processes and this specific feared self in clinical settings when treating OCD. Furthermore, the study provides more support for the inference-based approach (IBA) to OCD.

Neuro-pharmacological Assessment of Coleus forskohlii for Anti-compulsive Activity in Swiss Albino Mice

Background: Obsessive-Compulsive Disorder (OCD) is a common psychiatric illness characterized by obsessions or compulsions that significantly disrupt or impair daily functioning. Coleus forskohlii, a significant medicinal crop, has forskolin in its roots. It is utilized extensively as food and medicine all over the world. Coleus forskohlii has reputed medicinal uses, which include antidepressant, antiaggregant, cAMP-genic, anticancer, etc. Objective: This study used mice models of marble burying and nestlet shredding to assess the potential efficacy of Coleus forskohlii against obsessive-compulsive disorder. 8-hydroxy-2-(di-npropylamino) tetralin (8-OH-DPAT) induced compulsive checking can demonstrate OCD-like repetitive and obsessive behavior as well as neurotransmitter imbalance (serotonin). Methods: Each group had six mice, and the therapy was administered to the animals for a total of 15 days. On days 1, 7, and 14, the marble burying test was assessed for 30 minutes, and on days 2, 8 and 15, the nestlet shredding test was assessed for 30 minutes. The T-maze paradigm was used to assess anti-OCD activity. The brain histology and morphometry were also performed. Results: When compared to the control group, treatments with Coleus forskohlii (50 and 100 mg/kg, p.o.) significantly enhanced performance on both behavior tests. The SAB score is dramatically increased following the administration of the 8-OH-DPAT (2 mg/kg, i.p.) group. Coleus forskohlii (50 and 100 mg/kg, p.o.) and fluoxetine (15 mg/kg, p.o.) groups showed significantly lowered results. Animals treated with 8-OH-DPAT showed a considerable reduction in serotonin levels. Following Coleus forskohlii administration, the histology of the brain tissues showed normal morphological structure with no toxicity or abnormalities. Conclusion: The combination of all these findings points to Coleus forskohlii delivering a possible therapeutic option for the treatment of OCD. The identification and anticompulsive properties of the components from Coleus forskohlii should be the main aim of future studies.

Machine learning in obsessive-compulsive disorder medications

Obsessive-compulsive disorder (OCD) is the fourth most common psychiatric disorder with a significant morbidity rate. Despite various treatment modalities and medications, some patients show no definitive response. The aim of this study is to classify the medications of OCD with machine learning (ML) methods and to compare the classification performances of the decision tree (DT), chi-square automatic interaction detection (CHAID) algorithm, and linear model in ML methods. This research is a descriptive analytical study based on co-word and artificial intelligence methods. The DT models were created with a target (total weight link strength). For hyperparameter optimization, the Gini index was used as the weight total link strength. The performance of the DT model was evaluated based on the prediction model. A total of 116 drugs were extracted from 6574 articles based on co-word analysis, and 56 drugs were classified as the DT's root. These drugs were categorized into six groups in the EWKM diagram. The DT was constructed using the weight.total.link index, with 7 items in Label 3 and 42 items in Label 5 serving as DT leaves. The ML analysis provided valuable insights into the efficacy of various medications such as clomipramine, duloxetine, and pindolol, as well as supplements such as folate, in the treatment of OCD. Treating concomitant diseases, namely hypothyroidism and streptococcal infection could improve the efficacy of treatment.

Concurrent Oculomotor Hyperactivity and Deficient Anti-saccade Performance in Obsessive-compulsive Disorder

Concurrent Oculomotor Hyperactivity and Deficient Anti-saccade Performance in Obsessive-compulsive Disorder

Intercalated amygdala dysfunction drives avoidance extinction deficits in the Sapap3 mouse model of obsessive-compulsive disorder

The avoidance of aversive stimuli through negative reinforcement learning is critical for survival in real-world environments, which demand dynamic responding to both positive and negative stimuli that often conflict with each other. Individuals with obsessive-compulsive disorder (OCD) commonly exhibit impaired negative reinforcement and extinction, perhaps involving deficits in amygdala functioning. An amygdala subregion of particular interest is the intercalated nuclei of the amygdala (ITC) which has been linked to negative reinforcement and extinction, with distinct clusters mediating separate aspects of behavior. This study focuses on the dorsal ITC cluster (ITCd) and its role in negative reinforcement during a complex behavior that models real-world dynamic decision making. We investigated the impact of ITCd function on negative reinforcement and extinction by applying fiber photometry measurement of GCamp6f signals and optogenetic manipulations during a platform-mediated avoidance task in a mouse model of OCD-like behavior: the Sapap3-null mouse. We find impaired neural activity in the ITCd of male and female Sapap3-null mice to the encoding of negative stimuli during platform-mediated avoidance. Sapap3-null mice also exhibit deficits in extinction of avoidant behavior, which is modulated by ITCd neural activity. Sapap3-null mice fail to extinguish avoidant behavior in platform-mediated avoidance, due to heightened ITCd activity. This deficit can be rescued by optogenetically inhibiting ITCd during extinction. Together, our results provide insight into the neural mechanisms underpinning negative reinforcement deficits in the context of OCD, emphasizing the necessity of ITCd in responding to negative stimuli in complex environments.

The deer mouse (Peromyscus maniculatus bairdii) as a model organism to explore the naturalistic psychobiological mechanisms contributing to compulsive-like rigidity: A narrative overview of advances and opportunities

Deer mice (Peromyscus maniculatus bairdii), a wildtype species native to North America, have been investigated for their spontaneous compulsive-like behaviour. The repetitive and persistence nature of three unique compulsive-like phenotypes in deer mice, i.e., high stereotypy (HS), large nesting behaviour (LNB) and high marble burying (HMB), are characterized by behavioural and cognitive rigidity. In this narrative review, we summarize key advances in the model's application to obsessive-compulsive disorder (OCD), emphasizing how it may be used to study neurobiological and neurocognitive aspects of rigidity. Indeed, deer mice provide the field with a unique naturalistic and spontaneous model system of behavioural and cognitive rigidity, that is useful for investigating the psychobiological mechanisms that underpin a range of compulsive-like phenotypes. Throughout the review, we highlight new opportunities for future research.

Beyond Eyeball Tests: A Methodical Rebuttal to Fillon et al.'s Commentary.

In our original study, "Consumed by Creed" (Adam-Troian & Bélanger, 2024), we established significant and consistent associations between obsessive-compulsive disorder symptom severity and radical intentions across four distinct U.S. population samples-Environmentalists, Republicans, Democrats, and Muslims-partially or fully mediated by obsessive passion. Fillon et al. (2024) challenged our findings, alleging methodological errors and an excessive degree of researcher flexibility, which they claim could lead to false-positive results. In this response, we critically examine Fillon et al.'s commentary, arguing that it exemplifies flawed meta-scientific critique. We demonstrate that their approach relies on a series of unsupported and misleading claims, including a misinterpretation of the literature, unjustified reliance on visual data inspection, speculative assumptions about religious influences on our findings, and a shifting of the burden of proof. Through rigorous re-analyses, we reaffirm the robustness of our original results and address the unfounded allegations regarding our methodological practices. We also critique Fillon et al.'s approach, highlighting the necessity of domain-specific expertize in meta-scientific evaluations and cautioning against the risks of speculative and defamatory criticism in academic discourse. This exchange underscores the importance of maintaining rigorous standards in both original research and its critique, ensuring that scientific debate remains grounded in evidence rather than conjecture.

Breast Cancer and Mental Health: Incidence and Influencing Factors—A Claims Data Analysis from Germany

Background/Objectives: With breast cancer (BC) survival improving due to optimized therapy, enhancing quality of life has become increasingly important. Both diagnosis and treatment, with their potential side effects, pose risks to mental well-being. Our study aimed to analyze the incidence and potential risk factors for mental disorders in BC patients. Methods: This retrospective analysis used claims data from AOK Baden-Wuerttemberg, including 11,553 BC patients diagnosed via ICD code C50 between 2010 and 2020 and 31,944 age-matched controls. Patients with mental disorders in the 12 months prior to diagnosis were excluded. Mental disorders were categorized into eight groups based on ICD codes: anxiety, obsessive compulsive disorder, adjustment disorder, dissociative disorder, hypochondriac disorder, affective disorder, mania, and other neuroses. Results: Mental disorders were significantly more common in BC patients than in controls (64.2% vs. 38.1%, p < 0.01, OR 2.91, 95%CI [2.79, 3.04]). In particular, hypochondriac, anxiety, affective, and adjustment disorders occurred significantly more often in BC patients. No differences were found for mania, bipolar disease, other neuroses, obsessive compulsive-, or dissociative disorders. Furthermore, endocrine therapy was associated with psychological comorbidities (OR 1.69, p < 0.001, 95%CI [1.53, 1.86]), while primarily metastasized patients (stage C) had a lower risk than adjuvant patients in stage A (OR 0.55, p < 0.0001, 95%CI [0.49, 0.61]). Regarding surgical treatment, mastectomy patients showed lower rates of mental illnesses (61.2%) than those with breast-conserving treatment (71.6%), or especially breast reconstruction (78.4%, p < 0.01). Breast reconstruction was also associated with more hypochondriac (p < 0.01) and adjustment disorders (p < 0.01). Conclusions: So, BC patients experience significantly more mental disorders than controls, particularly when treated with endocrine therapy and breast reconstructive surgery.

The Predictive Role of Personality Disorders and Personality Traits in Death Anxiety.

The current study investigates the interplay between personality traits, personality disorders, and death anxiety in a sample of 2331 participants (49% males; 51% females) across two phases. The Death Anxiety Scale, the Psychosocial Personality Inventory, and the Personality Diagnostic Questionnaire were utilized. The findings revealed significant predictive relationships between personality disorders and death anxiety. Positive correlations were observed between death anxiety and nine personality disorders, including avoidant (r = .227), borderline (r = .123), dependent (r = .157), depressive (r = .098), histrionic (r = .074), narcissistic (r = .111), negativistic (r = .103), obsessive-compulsive (r = .126), and schizotypal (r = .078) personality disorders (p < .001). Death anxiety had significant inverse correlations with leadership (r = -.101) and spirituality (r = -.099) traits (p < .005). Avoidant personality disorder projected the highest prediction for death anxiety (β = .227; p = .000). Leadership as a personality trait demonstrated an outstanding ability to prevent death anxiety (β = -.101; p = .013). These findings make a unique contribution to the literature of death anxiety, personality disorders, and personality traits.

Assessing the Pharmacotherapy and Clinical Outcomes After Deep Brain Stimulation for Treatment-Refractory Obsessive–Compulsive Disorder: A Case–Cohort Study

Assessing the Pharmacotherapy and Clinical Outcomes After Deep Brain Stimulation for Treatment-Refractory Obsessive–Compulsive Disorder: A Case–Cohort Study

Analysis of the Characteristics and Influencing Factors of Perinatal Obsessive-Compulsive Symptoms in Elderly Parturients.

Aims/Background Perinatal obsessive-compulsive symptoms are significant predictors of increased postpartum anxiety, depression, and bipolar disorder. These symptoms have persistent adverse effects on both mothers and children. Currently, there are few reports in the literature on obsessive-compulsive disorder in elderly parturient women in China. This study primarily discusses the clinical characteristics of perinatal obsessive-compulsive symptoms in elderly parturient women and analyzes their influencing factors, aiming to provide references for clinical prevention and treatment. Methods This research employed a cross-sectional design, utilizing a convenience sampling method to select elderly parturients who delivered at Panjin Central Hospital from September 2022 to August 2023. The assessment instruments included a general data questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the self-rating anxiety scale (SAS), the edinburgh postpartum depression scale (EPDS), and the sense of coherence scale (SOC-13). The relationship between the severity of obsessive-compulsive symptoms and negative emotions and psychological burden was examined through Pearson correlation analysis. Additionally, the influencing factors of perinatal obsessive-compulsive symptoms were analyzed using multivariate logistic regression. Results In this study, a total of 124 questionnaires were distributed, and 122 valid questionnaires were recovered, yielding an effective recovery rate of 98.39%. Among the 122 elderly parturients, 37 were positive for perinatal obsessive-compulsive disorder, accounting for 30.33% (37/122). Among the 37 elderly parturients with perinatal obsessive-compulsive symptoms, 64.86% had both obsessive-compulsive thoughts and behaviors, 21.62% had obsessive-compulsive thoughts as the main symptom (8/37), and 13.51% had obsessive-compulsive behaviors (5/37). Multivariate logistic regression analysis showed that pregnancy history, pregnancy complications, fetal health, SOC-13 score, SAS score, and EPDS score were independent risk factors for positive perinatal obsessive-compulsive symptoms (p < 0.05). Conclusion The incidence of perinatal obsessive-compulsive symptoms in elderly parturient women is high. Obsessive-compulsive thoughts primarily involve fears of injury and contamination, while obsessive-compulsive behaviors mainly consist of compulsive checking and cleaning. The occurrence of perinatal obsessive-compulsive disorder is associated with factors such as pregnancy and childbirth history, pregnancy complications, fetal health, negative emotions, and stress resistance.

Medical Psychiatric Challenges in the Treatment of Obsessive-Compulsive Disorder and Eating Disorders

This paper examines the intricate relationship between Obsessive-Compulsive Disorder (OCD) and eating disorders (EDs), focusing on their diagnostic criteria, comorbidity, shared characteristics, and the profound medical and psychiatric complications that arise from these conditions. OCD is characterized by intrusive obsessions and compulsions that significantly impact daily functioning, while EDs, including Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder, involve severe disturbances in eating behaviors and body image. These disorders often co-occur, with up to 41% of individuals with EDs also suffering from OCD. The shared symptoms, such as obsessions, compulsions, avoidance behaviors, and perfectionism, highlight the complex interplay between OCD and EDs, complicating diagnosis and treatment. The medical complications associated with this comorbidity are severe and varied, affecting multiple organ systems. Gastrointestinal issues, proctological problems, oral health deterioration, cardiological dysfunction, electrolyte imbalances, kidney disorders, and hormonal dysregulation are common. Additionally, sleep disorders are prevalent, further exacerbating both psychiatric and physical health outcomes. Effective treatment requires a holistic approach that addresses the unique needs of each individual, with integrated care involving specialists across medical and mental health fields. This comprehensive approach is crucial to mitigating the devastating impact of OCD and EDs, improving overall well-being and quality of life for affected individuals.

Characteristics of incident benzodiazepine recipients among US veterans with posttraumatic stress disorder.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. While benzodiazepine prescribing among veterans with posttraumatic stress disorder (PTSD) declined substantially in the Veterans Health Administration over the past decade, little is known about current incident prescribing. Our objective was therefore to describe patient, provider, facility, and prescribing characteristics among veterans with PTSD who were incident benzodiazepine recipients in 2022 and contrast these to the characteristics for incident recipients in 2012. This retrospective observational study included all veterans with PTSD who received an incident benzodiazepine prescription during calendar year 2022 and separately for 2012. The distribution of patient, provider, facility, and benzodiazepine prescribing characteristics was contrasted between years. Stratified subanalyses were conducted by potential non-PTSD benzodiazepine indication, including anxiety and sleep disorders. A total of 28,310 (6.6%) incident benzodiazepine recipients were identified in 2012, which decreased to 16,776 (1.9%) incident recipients in 2022. The proportion of initial prescriptions written for a days' supply of 30 or more days decreased from 75.6% to 51.7%, and the proportion who received a second prescription within 6 months decreased from 68.7% to 53.5%. The proportion of patients with diagnoses for potential benzodiazepine indications also increased, including for generalized anxiety disorder (15.1% increase), obsessive compulsive disorders (0.6% increase), panic disorder (6.7% increase), and sleep disorders (22.9% increase). As incident benzodiazepine prescribing among veterans with PTSD decreased over the past decade, so did the volume of drug dispensed and duration of therapy, while the prevalence of documented prescriptions for non-PTSD indications increased.

Deprescribing Antidepressants in Children and Adolescents: A Systematic Review of Discontinuation Approaches, Cross-Titration, and Withdrawal Symptoms.

Background: Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly used to treat depressive, anxiety, and obsessive-compulsive disorders in youth. Yet, data on discontinuing these medications, withdrawal symptoms, and strategies to switch between them are limited. Methods: We searched PubMed and ClinicalTrials.gov through June 1, 2024, to identify randomized controlled trials assessing antidepressant discontinuation in youth. We summarized pediatric pharmacokinetic data to inform tapering and cross-titration strategies for antidepressants and synthesized these data with reports of antidepressant withdrawal. Results: Our search identified 528 published articles, of which 28 were included. In addition, 19 records were obtained through other methods, with 14 included. The corpus of records included 13 randomized, double-blind, placebo-controlled trials (3026 patients), including SSRIs (K = 10), SNRIs (K = 4), andTCAs (K = 1), ranging from 4 to 35 weeks. Deprescribing antidepressants requires considering clinical status, treatment response, and, in cross-titration cases, the pharmacokinetics and pharmacodynamics of both medications. Antidepressant withdrawal symptoms are related to the pharmacokinetics of the medication, which vary across antidepressants and may include irritability, palpitations, anxiety, nausea, sweating, headaches, insomnia, paresthesia, and dizziness. These symptoms putatively involve changes in serotonin transporter expression and receptor sensitivity, impacting the serotonin, dopamine, and norepinephrine pathways. Conclusions: Although approaches to deprescribing antidepressants in pediatric patients are frequently empirically guided, accumulating data related to the course of relapse and withdrawal symptoms, as well as the pharmacokinetic and pharmacodynamic properties of medications, should inform these approaches. Recommendations within this review support data-informed discussions of deprescribing-including when and how-that are critically important in the clinician-family-patient relationship.

The Intersection of Anorexia Nervosa and Personality Disorders: A Comprehensive Review of Comorbidities, Influencing Factors, and Therapeutic Approaches

Complex eating disorders like anorexia nervosa (AN) and personality disorders (PDs), including obsessive-compulsive personality disorder (OCPD) and borderline personality disorder (BPD), often co-occur. The confluence of PDs and AN poses distinct difficulties in terms of diagnosis, prognosis, and therapy, complicating clinical management and producing less favorable results. To summarize the most recent findings on the co-occurrence of anorexia nervosa and personality disorders, this review will look at their prevalence, psychopathological relationships, effects on treatment results, and efficacy of different therapy modalities, with a thorough search conducted, concentrating on research published between 2000 and 2024, utilizing peer-reviewed publications from PubMed, PsycINFO, and Proquest. Past literature presents a substantial overlap between PDs and AN, and concomitant PDs have been linked to recurrence rates, treatment resistance, and more severe types of AN. The psychopathological relationships among these illnesses are complex, encompassing both common and unique etiological paths. Depending on the PD implicated, various therapy modalities, such as dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), have been investigated with varying degrees of success. This review emphasizes the need for more specialized, integrated treatment approaches targeting AN and concomitant PDs and appeals that future research should concentrate on creating tailored therapies and early detection techniques to enhance therapeutic results. The results emphasize the importance of considering personality pathology while managing AN to improve treatment efficacy and promote long-term recovery.

Effective deep brain stimulation for obsessive-compulsive disorder after failed anterior capsulotomy: illustrative cases.

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to relieve distress related to the obsessions. For patients with severe illness refractory to first-line pharmacotherapy and psychotherapy, neurosurgical treatments such as deep brain stimulation (DBS) and stereotactic lesioning are an option. The choice between DBS and lesioning is often driven by patient preference, but these options are not mutually exclusive. Here, the authors highlight the success of one surgical therapy (DBS) after the failure of another (lesioning). Two patients with severe, treatment-refractory OCD underwent DBS lead implantation targeting the ventral capsule/ventral striatum after they did not attain any worthwhile benefit from a previous anterior capsulotomy. Both patients showed significant improvement (≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale [YBOCS] score) of their OCD symptoms at the long-term follow-up after DBS. One patient experienced a 37% reduction in symptom severity as measured by the YBOCS, and the other patient experienced a 47% reduction. DBS and lesioning procedures are both effective surgical options for patients with intractable OCD. In these cases, the authors demonstrate that DBS can be utilized even after a lesioning procedure in nominally the same target (ventral portion of the anterior limb of the internal capsule). https://thejns.org/doi/10.3171/CASE24289.

Prevalence and severity of insomnia in adult outpatients attending Kasralainy Psychiatry and Addiction Treatment Hospital

BackgroundInsomnia is common among patients with psychiatric disorders and affects the clinical presentation and outcomes of the psychiatric disorder. The presentation of insomnia varies according to the type and severity of the psychiatric disorder.ObjectivesThis cross-sectional study aimed to assess the prevalence and severity of insomnia in adult psychiatric outpatients attending Psychiatry and Addiction Medicine Hospital, Faculty of Medicine, Cairo University. The study included 390 patients diagnosed with the following disorders: depressive disorders (n = 126 (32.2%)), anxiety disorders (n = 69 (17.6%)), psychotic spectrum disorders (n = 67 (17.1%)), bipolar and related disorders (n = 50 (12.8%)), trauma and stress-related disorders (n = 46 (11.8%)), obsessive–compulsive disorder (n = 30 (7.7%)), and somatic symptoms disorders (n = 2 (0.5%)). Patients were assessed using the Sleep Disorder Interview, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Global Assessment of Functioning Scale (GAF).ResultsAmong the assessed patients, 314 (80.5%) had insomnia, with a higher prevalence in females (91.5%) compared to males (67.2%). The prevalence of insomnia was 96% in depressive disorders, 97.1% in anxiety disorders, 49.3% in psychotic disorders, and 32% in bipolar and related disorders; while all patients with trauma and stress-related disorders, obsessive–compulsive disorders, and somatic symptoms disorders had insomnia.The severity of insomnia as measured by ISI was positively correlated with the global functioning score (r = 0.341, p = < 0.001) and negatively correlated with the duration of the psychiatric illness (r = − 0.285, p = < 0.001).ConclusionsInsomnia is highly prevalent in outpatients with psychiatric disorders.