Impairment In Obsessive-compulsive Disorder Research Articles

Feed-forward motor control impairment in obsessive-compulsive disorder: a study of fMRI and GABA spectroscopy

Feed-forward motor control impairment in obsessive-compulsive disorder: a study of fMRI and GABA spectroscopy

Cortical gyrification differences between early- and late-onset obsessive-compulsive disorder: neurobiological evidence for neurodevelopmentally distinct subtypes.

Identifying more homogenous subtypes of patients with obsessive-compulsive disorder (OCD) using biological evidence is critical for understanding complexities of the disorder in this heterogeneous population. Age of onset serves as a useful subtyping scheme for distinguishing OCD into two subgroups that aligns with neurodevelopmental perspectives. The underlying neurobiological markers for these distinct neurodevelopmental differences can be identified by investigating gyrification changes to establish biological evidence-based homogeneous subtypes. We compared whole-brain cortical gyrification in 84 patients with early-onset OCD, 84 patients with late-onset OCD, and 152 healthy controls (HCs) to identify potential markers for early neurodevelopmental deficits using the local gyrification index (lGI). Then, the relationships between lGI in clusters showing significant differences and performance in visuospatial memory and verbal fluency, which are considered trait-related neurocognitive impairments in OCD, were further examined in early-onset OCD patients. The early-onset OCD patients exhibited significantly greater gyrification than those with late-onset OCD patients and HCs in frontoparietal and cingulate regions, including the bilateral precentral, postcentral, precuneus, paracentral, posterior cingulate, superior frontal, and caudal anterior cingulate gyri. Moreover, impaired neurocognitive functions in early-onset OCD patients were correlated with increased gyrification. Our findings provide a neurobiological marker to distinguish the OCD population into more neurodevelopmentally homogeneous subtypes, which may contribute to the understanding of the neurodevelopmental underpinnings of an etiology in early-onset OCD consistent with the accumulated phenotypic evidence of greater neurodevelopmental deficits in early-onset OCD than in late-onset OCD.

Impaired test performance yet spared neurocognitive functioning in individuals with obsessive-compulsive disorder: the role of performance mediators

ABSTRACT Introduction Although most studies report neurocognitive deficits in patients with obsessive-compulsive disorder (OCD), important exceptions exist, highlighting the possible role of mediators (e.g., poor motivation). This study investigated neurocognitive functioning and potential influences affecting performance in OCD. Methods Forty-three participants (13 OCD patients, 30 healthy controls) were assessed using a battery of neurocognitive tests. During the assessment, the examiner completed the Impact on Performance Scale (IPS) which measures variables that may impact neurocognitive performance. Results Pooled neurocognitive performance was lower in OCD patients versus healthy controls at a moderate effect size. Patients performed more poorly on the IPS, particularly the Well-Being During Assessment subscale. Performance differences across the two groups were attenuated to a non-significant small-to-medium effect when the IPS was entered as a covariate. A total of 34% of patients showed scores greater than one standard deviation below the mean compared to 9.63% in healthy individuals. Yet, when a conservative impairment criterion (≥2 standard deviations below the mean) was applied, less than 10% of patients displayed deficits. Conclusions Neurocognitive impairment in OCD is likely exaggerated. In addition to considering important mediators researchers should report the percentage of participants displaying performance deficits rather than mean group differences alone; the latter obscures the high percentage of patients without impairment and thus may unduly foster stigma in this population.

A pilot study examining the use of Goal Management Training in individuals with obsessive-compulsive disorder

BackgroundRecent meta-analyses point towards cognitive impairments in obsessive-compulsive disorder (OCD), particularly in such executive function subdomains as planning and organization. Scant attention has focused on cognitive remediation strategies that may reduce cognitive dysfunction, with a possible corresponding decrease in symptoms of OCD.ObjectiveThe aim of this study was to assess the implementation of a standardized cognitive remediation program, Goal Management Training (GMT), in a pilot sample of individuals with OCD.MethodNineteen individuals with a primary DSM-5 diagnosis of OCD were randomized to receive either the 9-week GMT program (active group; n = 10) or to complete a 9-week waiting period (waitlist control; n = 9). Groups were assessed at baseline, post-treatment, and 3-month follow-up. The assessment comprised neuropsychological tasks assessing a variety of cognitive domains, and subjective measures of functioning and of symptom severity.ResultsThe active condition showed significant improvements from baseline to post-treatment on measures of inattention, impulsivity, problem-solving, and organization compared to controls. Moreover, whereas the active group reported a significant improvement in subjective cognition over the course of treatment, no such improvement emerged in the waitlist group over this same period. Neither group showed improvement on indices of depressive, anxiety, or OCD-related symptom severity.DiscussionThe results of this small pilot investigation indicate that, although promising, this protocol requires several modifications to be best suited for this population. Replication of these findings is awaited, with current results potentially limited by sample characteristics including motivation to seek and complete treatment, and high attrition at 3-month follow-up (n = 6 completers).Trial RegistrationNCT02502604. (December 7, 2018)

Decision Impairments in Obsessive-Compulsive Disorder are Explained by Acute Symptoms and Thought-Focused Attention

Obsessive-compulsive disorder is an illness characterized by intrusive thoughts and a heightened focus on thought experiences (i.e., cognitive self-consciousness; CSC). Individuals with obsessive-compulsive symptoms demonstrate broad deficits in executive functioning, including impairments in basic decision processes. Yet, it is unclear whether individual differences in such impairments are greater accounted for at the trait-level or state-level of OCD symptomatology and the extent to which CSC contributes.

Exploring response inhibition and error monitoring in obsessive-compulsive disorder

Behavioral evidence of impaired response inhibition (RI) and hyperactive error monitoring (EM) in obsessive-compulsive disorder (OCD) is inconsistent. Recent neuroimaging work suggests that EM plays a role in RI impairments in OCD, but this has rarely been investigated using behavioral measures. The aims of this study were to (1) compare RI and EM performance between adults with OCD and non-psychiatric controls (NPC) while investigating possible moderators, and (2) assess whether excessive EM influences RI in OCD. We compared RI and EM performance on the Stop-Signal Task (SST) between 92 adults with OCD and 65 NPC from two Brazilian sites. We used linear regression to investigate which variables (group, age, medication use, clinical symptomatology) influenced performance, as well as to examine possible associations between RI and EM. OCD and NPC did not differ in RI and EM. However, age moderated RI performance in OCD with a medium effect size, reflecting differential effects of age on RI between groups: age was positively associated with RI in OCD but not NPC. Further, OCD severity predicted EM with a medium to large effect size, suggesting that more symptomatic patients showed greater monitoring of their mistakes. Finally, group moderated the relationship between RI and EM with a small effect size. Our findings suggest that demographic factors may influence RI, whereas clinical factors may influence EM. Further, we found preliminary behavioral evidence to indicate that impaired RI and excessive EM are related in OCD.

Executive impairments in Obsessive Compulsive Disorder: A systematic review with emotional and non-emotional paradigms.

we reviewed research published in PubMed, Web of Science, PsychInfo, Scopus, Scielo, and ProQuest Psychology databases, from January 2008 to April 2019. The review followed a two-stage process. In the first stage, we selected only studies using neutral stimuli paradigms, while in the second we selected executive-emotional paradigms. The first stage of the review provided 16 final results, while the second stage, with emotional stimuli, provided 3 results. There is some initial evidence for the existence of executive impairments in OCD, as expressed in the performance and/or processing of working memory inhibitory control and cognitive flexibility. There is also initial evidence that these latter two could be modulated by the presentation or mental representation of negative valence stimuli or images, as well as the presence of aversive contingencies.

Dissociable source-monitoring impairments in obsessive-compulsive disorder and schizophrenia.

Based on the observed clinical overlap between obsessive-compulsive disorder (OCD) and schizophrenia (SCZ), both conditions may share, at least in part, common cognitive underpinnings. Among the cognitive deficits that could be involved, it has been hypothesized that patients share a failure in their abilities to monitor their own thoughts (source monitoring), leading to confusion between what they actually did or perceived and what they imagined. Although little is known regarding source-monitoring performances in patients with OCD, numerous studies in patients with SCZ have observed a relationship between delusions and/or hallucinations and deficits in both internal source- and reality-monitoring abilities. The present work compared source-monitoring performances (internal source and reality monitoring) between patients with OCD (n = 32), patients with SCZ (n = 38), and healthy controls (HC; n = 29). We observed that patients with OCD and patients with SCZ displayed abnormal internal source-monitoring abilities compared to HC. Only patients with SCZ displayed abnormalities in reality monitoring compared to both patients with OCD and HC. Internal source-monitoring deficits are shared by patients with OCD and SCZ and may contribute to the shared cognitive deficits that lead to obsessions and delusions. In contrast, reality-monitoring performance seems to differentiate patients with OCD from patients with SCZ.

Inflated Responsibility Beliefs in Paediatric OCD: Exploring the Role of Parental Rearing and Child Age.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) propose that inflated responsibility beliefs are central to the maintenance of the disorder and are proposed to originate during early childhood via experiences of harsh and/or controlling parenting. The current study aimed to examine the associations between perceived parental rearing behaviours, inflated responsibility/threat beliefs, and OCD severity and impairment in children (aged 7-12years) and adolescents (aged 13-17years) with OCD (n = 136). Results indicated that for younger children, greater child perceptions of overprotection and anxious rearing were each associated with increased inflated responsibility beliefs. For older children, these positive associations remained, and furthermore, inflated responsibility beliefs mediated the association between perceived maternal anxious rearing and OCD impairment. Results highlight the role of the family in the development of inflated responsibility bias and OCD-related impairment.

Cognitive training for neurocognitive and functional impairments in obsessive compulsive disorder: A case report

Obsessive-compulsive disorder (OCD) is associated with impairments in neurocognition, especially on executive functioning and visuospatial memory, which tend to persist despite clinical improvement. Impairments in social and occupational functioning are likely related to neurocognition but are rarely targeted by existing treatments for OCD. Previous studies of cognitive training in OCD have been limited by narrow transfer of effects. We report a case of an individual referred for cognitive training in view of persisting cognitive and functional difficulties despite clinical improvement. The intervention consisted of therapist-guided sessions along with homework practice. A smartphone application was developed for cognitive stimulation, and used with other techniques for cognitive stimulation, strategy use, and generalization to achieve transfer of effects. Following 12 weeks of intervention, changes were observed on executive functions including verbal fluency and planning, and smaller changes across measures of attention and working memory. Notably, there was simultaneous reduction on severity of anxiety, depression, and obsessive-compulsive symptoms. Further, there was improvement in subjectively perceived cognitive difficulties as well as work, family and social functioning. The cognitive training intervention has promising implications for individuals with OCD with persisting cognitive and functional impairments despite clinical improvement.

Novel Smartphone Interventions Improve Cognitive Flexibility and Obsessive-Compulsive Disorder Symptoms in Individuals with Contamination Fears

One type of obsessive–compulsive disorder (OCD) is characterized by contamination fears and compulsive cleansing. Few effective treatments are available for this debilitating condition. Compulsive symptoms, such as excessive washing, are believed to be mediated by cognitive inflexibility—arguably the most striking cognitive impairment in OCD. In this study, we investigated the effects of two novel smartphone interventions on cognitive flexibility and OCD symptoms in healthy individuals with OCD-like contamination fears. In the first intervention, participants watched a brief video recording of themselves engaging in handwashing on a smartphone, four times a day, for a total of one week (N = 31). The second intervention was similar except that participants watched themselves repeatedly touching a disgust-inducing object (N = 31). In a third (control) “intervention”, participants watched themselves performing sequential hand movements (N = 31). As hypothesized, the two smartphone interventions, unlike the control, improved cognitive flexibility; as assessed on the Intradimensional–Extradimensional Set Shifting task (a sensitive marker of cognitive flexibility). The two interventions, unlike the control, also improved OCD symptoms (measured with the Obsessive–Compulsive Inventory–Revised and Yale–Brown Obsessive–Compulsive Scale). Finally, we found high levels of adherence to the interventions. These findings have significant clinical implications for OCD.

Abnormalities of the neural function, morphometry and metabolism and its correlation with clinical symptom severity and recognition deficit in obsessive–compulsive disorder

Background: Obsessive–compulsive disorder (OCD) causes neural dysfunction associated with cognitive deficit and emotional dysregulation. Although a few studies have revealed working memory impairment in OCD using functional neuroimaging, the neural correlates among the brain functional change, anatomical deficit and metabolic abnormalities remain unknown.

Value-based decision making under uncertainty in hoarding and obsessive- compulsive disorders

Difficulties in decision making are a core impairment in a range of disease states. For instance, both obsessive- compulsive disorder (OCD) and hoarding disorder (HD) are associated with indecisiveness, inefficient planning, and enhanced uncertainty intolerance, even in contexts unrelated to their core symptomology. We examined decision-making patterns in 19 individuals with OCD, 19 individuals with HD, 19 individuals with comorbid OCD and HD, and 57 individuals from the general population, using a well-validated choice task grounded in behavioral economic theory. Our results suggest that difficulties in decision making in individuals with OCD (with or without comorbid HD) are linked to reduced fidelity of value-based decision making (i.e. increase in inconsistent choices). In contrast, we find that performance of individuals with HD on our laboratory task is largely intact. Overall, these results support our hypothesis that decision-making impairments in OCD and HD, which can appear quite similar clinically, have importantly different underpinnings. Systematic investigation of different aspects of decision making, under varying conditions, may shed new light on commonalities between and distinctions among clinical syndromes.

Does impairment in neuropsychological tests equal neuropsychological impairment in obsessive-compulsive disorder (OCD)? Momentary influences, testing attitude, and motivation are related to neuropsychological performance in OCD

Meta-analyses conclude that individuals with obsessive-compulsive disorder (OCD) share neurocognitive deficits. The aim of the present study was to examine the impact of attitude towards neuropsychological assessment, symptoms during assessment, and performance motivation on test results in OCD.Thirty OCD and 30 nonclinical individuals were assessed with a comprehensive battery of neuropsychological tests. Before and after testing, participants completed the newly developed Momentary Influences, Attitudes and Motivation Impact on Cognitive Performance Scale (MIAMI). The experimenter rated the patients’ momentary influences, attitude, motivation, and OC behavior during testing.Patients with OCD performed worse than controls on five out of ten outcome measures. Patients were more fearful about the test outcome and complained about more negative influences during testing than controls did. The MIAMI total score mediated the relationship between group and speed. When the MIAMI score was entered as a covariate, group differences for speed were nonsignificant. No group differences emerged between patients high on motivation and those with few negative momentary influences (as assessed by the experimenter) compared to controls.OCD patients and controls differ greatly with regard to attitude towards testing and momentary influences, which likely represents a substantial source of secondary malperformance in patients. Consequently, we call for greater caution when interpreting group differences in neuropsychological studies on OCD. Contextual and motivational variables need to be controlled for. It is also necessary to avoid general and potentially stigmatizing inferences if group differences are due to malperformance in only a subgroup of patients.

Trait-related decision making impairment in obsessive-compulsive disorder: evidence from decision making under ambiguity but not decision making under risk.

This study aimed to investigate whether deficits in decision making were potential endophenotype markers for OCD considering different phases of the disease. Fifty-seven non-medicated OCD patients (nmOCD), 77 medicated OCD patients (mOCD), 48 remitted patients with OCD (rOCD) and 115 healthy controls were assessed with the Iowa Gambling Task (IGT), which measured decision making under ambiguity, and the Game of Dice Task (GDT), which measured decision making under risk. While the three patients groups showed impaired performance on the IGT compared with healthy controls, all patients showed intact performance on the GDT. Furthermore, the rOCD patients showed a preference for deck B, indicating that they showed more sensitivity to the frequency of loss than to the magnitude of loss, whereas the mOCD patients showed a preference for deck A, indicating that they had more sensitivity to the magnitude of loss than to the frequency of loss. These data suggested that OCD patients had trait-related impairments in decision making under ambiguity but not under risk, and that dissociation of decision making under ambiguity and under risk is an appropriate potential neurocognitive endophenotype for OCD. The subtle but meaningful differences in decision making performance between the OCD groups require further study.

Divergent subcortical activity for distinct executive functions: stopping and shifting in obsessive compulsive disorder.

There is evidence of executive function impairment in obsessive compulsive disorder (OCD) that potentially contributes to symptom development and maintenance. Nevertheless, the precise nature of these executive impairments and their neural basis remains to be defined. We compared stopping and shifting, two key executive functions previously implicated in OCD, in the same task using functional magnetic resonance imaging, in patients with virtually no co-morbidities and age-, verbal IQ- and gender-matched healthy volunteers. The combined task allowed direct comparison of neural activity in stopping and shifting independent of patient sample characteristics and state variables such as arousal, learning, or current symptom expression. Both OCD patients and controls exhibited right inferior frontal cortex activation during stopping, and left inferior parietal cortex activation during shifting. However, widespread under-activation across frontal-parietal areas was found in OCD patients compared to controls for shifting but not stopping. Conservative, whole-brain analyses also indicated marked divergent abnormal activation in OCD in the caudate and thalamus for these two cognitive functions, with stopping-related over-activation contrasting with shift-related under-activation. OCD is associated with selective components of executive function, which engage similar common elements of cortico-striatal regions in different abnormal ways. The results implicate altered neural activation of subcortical origin in executive function abnormalities in OCD that are dependent on the precise cognitive and contextual requirements, informing current theories of symptom expression.

Neuropsychological assessment in obsessive-compulsive disorder.

Background:Neuropsychological deficits in obsessive-compulsive disorder (OCD) have been encouraged by brain imaging studies suggesting a putative fron to- striatial biological basis of the condition. Studies of neuropsychological functions in OCD have documented deficits in several cognitive domains, particularly with regard to visuospatial abilities, executive functioning, motor speed and memory. The Aim of the present study was to assess neuropsychological profile of patients with OCD. Objectives of the study were to assess and compare the neuropsychological profile of patients with OCD and matched healthy controls.Materials and Methods:Twenty clinically stable outpatients with ICD-10 diagnosis of OCD and equal number of normal controls matched for age, education, gender and handedness were studied using a battery of neuropsychological tests. The tests consisted of verbal and performance tests of intelligence, memory, perceptual motor functions, set test and Wisconsin Card Sorting Test (WCST).Results:On perceptual-motor functions, verbal fluency, executive functions (WCST), intelligence and memory patients with OCD did not show impairments comparable to healthy controls. An attempt to correlate the test findings with the duration of illness, stability of illness and the average drug dose was made and it was found that there was no correlation between the two.Conclusion:The present study does not provide evidence for a localized neuropsychological/cognitive impairment in OCD in cases that are stable for at least three months. Absence of impairments in perceptual-motor functions, verbal fluency, executive functions (WCST), intelligence, and memory does not agree with the results of other studies using these tests.

Cognitive deficits are a matter of emotional context: Inflexible strategy use mediates context-specific learning impairments in OCD

The present study examines the interplay between cognitive deficits and emotional context in obsessive-compulsive disorder (OCD) and social phobia (SP). Specifically, this study examines whether the inflexible use of efficient learning strategies in an emotional context underlies impairments in probabilistic classification learning (PCL) in OCD, and whether PCL impairments are specific to OCD. Twenty-three participants with OCD, 30 participants with SP and 30 healthy controls completed a neutral and an OCD-specific PCL task. OCD participants failed to adopt efficient learning strategies and showed fewer beneficial strategy switches than controls only in an OCD-specific context, but not in a neutral context. Additionally, OCD participants did not show any explicit memory impairments. Number of beneficial strategy switches in the OCD-specific task mediated the difference in PCL performance between OCD and control participants. Individuals with SP were impaired in both PCL tasks. In contrast to neuropsychological models postulating general cognitive impairments in OCD, the present findings suggest that it is the interaction between cognition and emotion that is impaired in OCD. Specifically, activated disorder-specific fears may impair the flexible adoption of efficient learning strategies and compromise otherwise unimpaired PCL. Impairments in PCL are not specific to OCD.

Predictors of quality of life and functional impairment in Obsessive–Compulsive Disorder

Obsessive–compulsive disorder (OCD) is the 10th leading cause of disability among health conditions; yet, relatively little research has focused on quality of life (QOL) and functional impairment in OCD. The present study extended existing work by examining correlates and predictors of QOL and functional impairment in 96 treatment-seeking OCD patients (in intensive outpatient and residential settings). In a model including OCD symptoms and related phenomena, and symptoms of depression and anxiety, two main findings emerged: (a) depressive symptoms predicted both QOL and functional impairment, and (b) contamination symptoms predicted functional impairment. These findings are discussed in terms of the implications for studying QOL and functional impairment in OCD. Future research should investigate the factors that predict changes in QOL and functional impairment following treatment.

EPA-1342 – Reduced loss avoidance and overconfidence in obsessive-compuslive disorder: a neuroeconomic perspective.

The aim of the study was to evaluate decision-making process and probabilistic bias in patients with obsessive-compulsive disorder (OCD). Our sample consisted of 80 subjects (40 diagnosed with OCD and 40 healthy controls). To assess the clinical characteristic of the sample we performed a clinical interview and a psychometric assessement using the Barrat Impulsiveness Scale (BIS-11) and the Cloniger's Temperamnt and Character Inventory (TCI-125). To assess decision making processes and probabilistic reasoning we used the Iowa Gambling Task (IGT) and the Beads Task. OCD group had a significantly lower IGT final netscore (p 0.032). Moreover, controls showed a significant improvement between netscore 1 and netscore 5 (p 0.014) while patients did not (p 0.700). Patients also showed significantly less draws till decision on the Beads Task (p 0.000). We performed four regression analysis to evaluate the influence of clinical variables (duration of illness, treatment resistance, Y-BOCS Score, presence of tics, Barratt Score) and personality traits (TCI sub-scales) on IGT netscore and Beads Task. The results indicated that the four overall models were not statistically significant. Our data show the presence of a decision making and probabilistic reasoning impairment in OCD. These data could be intareptated in a neurocognitive perspective as executive dysfunction and in a neuroeconomic perspective as a reduced loss avoidance and overconfidence during decision making processes.