Intrusive Thoughts Research Articles

The Promise of MDMA in the Future Treatment of Severe Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an often debilitating condition caused by a person’s exposure to traumatic events. Symptoms of PTSD include intrusive thoughts, suicidal ideation, and highly negative and distressing emotional states. Current treatments for PTSD such as cognitive behavioral therapy, EMDR, and SSRIs and SNRIs are ineffective for a large chunk of patients who seek out treatment. A majority of patients with PTSD do not respond to talking therapy, and the remission rate for patients on SSRIs and SNRIs is low. The ineffectiveness of recommended treatments has led to experimentation with drugs like MDMA. MDMA increases levels of chemicals in the brain that induce happy and calm states. This drug also decreases fear states in patients, allowing them to more comfortably discuss traumatic events without the possible side effects of extreme emotional numbness or high levels of anxiety. Research conducted in the last decade on MDMA in addition to psychotherapy in a clinical setting has yielded impressive results. A majority of patients in all three conducted trials experienced a long-term reduction in PTSD symptoms. MDMA in a clinical setting was also proven to be safe, with no serious drug-related side effects on patients. With such high rates of symptom reduction, these studies provide hope for the future of effective and safe PTSD treatment.

Young widowhood: A qualitative study of sexuality after partner loss

Partner loss deprives young widows of physical contact, emotional intimacy, and the fulfillment of sexual desire. Although disenfranchised and oppressed, sexuality is a core piece of women’s identity, and sexual bereavement may compel widows to reconstruct their sexual identities. This existential phenomenological study seeks to illuminate the sexual loss and coping of young widows aged 45 and under. Qualitative findings from 21 women indicated three findings: a) young widows felt profound loss regarding their sexual relationships, leading to deep physical loneliness and an initial disinterest in sex; b) some subsequently experienced widows’ fire, an involuntary and often distressing intense sexual desire marked by cravings, obsessive thoughts, and a longing for connection; c) widows’ fire complicated their struggle to understand their post-loss identities as sexual beings. These findings highlight the neglected and significant repercussions of sexual loss for young widows and point to a need for heightened support, psychoeducation, and research.

Treatment for OCD and Their Effectiveness

This research looks at a variety of aspects related to obsessive-compulsive disorder (OCD), such as symptoms, possible factors diagnosis, and treatment methods. OCD's distinctive ritualistic compulsions, which frequently manifest as uncontrollable thought and behavior patterns, are brought on by distressing obsessions. According to this study neurotransmitter and Corticostriatal circuits abnormalities have been linked to this disorder, although the exact cause is still unknown. Increased susceptibility among blood relations of sick individuals suggests a role for genetics. Obsessions and compulsions are diagnosed based on predetermined criteria that highlight their irrationality and disruptive nature. The connection between obsessive thoughts and anxiety can be broken by a number of treatments, the foundation of which is behavioral therapy. By gradually confronting anxiety-inducing circumstances, exposure and response prevention (ERP) has proven successful. According to this paper the main objectives of cognitive therapy are to address dysfunctional thought processes, such as overestimating threats or taking on excessive responsibility. This paper contends that by cognitive-behavioral therapy (CBT) combining behavioral and cognitive elements is both economical and efficient. The studies under review in this paper demonstrate differences in treatment effectiveness, accentuating the necessity for more studies with larger sample sizes in making definitive judgments on treatment outcomes.

Altered neural anticipation of reward and loss but not receipt in adolescents with obsessive-compulsive disorder

BackgroundObsessive-compulsive disorder (OCD) is characterized by persistent, unwanted thoughts and repetitive actions. Such repetitive thoughts and/or behaviors may be reinforced either by reducing anxiety or by avoiding a potential threat or harm, and thus may be rewarding to the individual. The possible involvement of the reward system in the symptomatology of OCD is supported by studies showing altered reward processing in reward-related regions, such as the ventral striatum (VS) and the orbitofrontal cortex (OFC), in adults with OCD. However, it is not clear whether this also applies to adolescents with OCD.MethodsUsing functional magnetic resonance imaging, two sessions were conducted focusing on the anticipation and receipt of monetary reward (1) or loss (2), each contrasted to a verbal (control) condition. In each session, adolescents with OCD (n1=31/n2=26) were compared with typically developing (TD) controls (n1=33/ n2=31), all aged 10-19 years, during the anticipation and feedback phase of an adapted Monetary Incentive Delay task.ResultsData revealed a hyperactivation of the VS, but not the OFC, when anticipating both monetary reward and loss in the OCD compared to the TD group.ConclusionsThese findings suggest that aberrant neural reward and loss processing in OCD is associated with greater motivation to gain or maintain a reward but not with the actual receipt. The greater degree of reward ‘wanting’ may contribute to adolescents with OCD repeating certain actions more and more frequently, which then become habits (i.e., OCD symptomatology).

Loneliness in OCD and its determinants

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by intrusive thoughts and repetitive behaviors, affecting approximately 1.3 % of the population. Loneliness has serious consequences for future health outcomes. Although it has been extensively studied in depression, its prevalence in obsessive-compulsive disorder (OCD) has hardly been investigated. The current study sought to examine the association between loneliness and OCD, through an exploratory investigation of their demographic and clinical correlates. This cross-sectional study utilized data from the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study, designed to investigate determinants, course, and consequences of OCD in a large clinical sample. In this data base, a cohort of 363 OCD adult patients underwent assessment for loneliness severity, OCD symptomatology, comorbid conditions, and demographic variables. Findings reveal a high prevalence of loneliness among OCD patients, with nearly three-quarters (73.6 %) experiencing elevated levels. Loneliness was associated with greater depression severity and specific demographic factors such as gender, age, and education level. However, the relationship between OCD severity and loneliness was explained by depression severity. Clinical and theoretical implications are discussed as well as limitations and directions for future research.

Sadness and fear, but not happiness, motivate inhibitory behaviour: the influence of discrete emotions on the executive function of inhibition

ABSTRACT Inhibition, an executive function, is critical for achieving goals that require suppressing unwanted behaviours, thoughts, or distractions. One hypothesis of the emotion and goal compatibility theory is that emotions of sadness and fear enhance inhibitory control. Across Experiments 1–4, we tested this hypothesis by inducing a happy, sad, fearful, and neutral emotional state prior to completing an inhibition task that indexed a specific facet of inhibition (oculomotor, resisting interference, behavioural, and cognitive). In Experiment 4, we included an anger induction to examine whether valence or motivational-orientation best-predicted performance. We found support that fear and sadness enhanced inhibition except when inhibition required resisting interference. We argue that sadness and fear enhance inhibitory control aiding the detection and analysis of problems (i.e. sadness) or threats (i.e. fear) within one’s environment. In sum, this work highlights the importance of identifying how negative emotions can be beneficial for and interact with specific executive functions influencing down-stream processing including attention, cognition, and memory.

The Effectiveness of Spirituality-Centered Cognitive Therapy on Body Image, Sexual Function, Illness Perception and Intrusive Thoughts in Iranian Women after Mastectomy

Spirituality-centered cognitive therapy refers to the way in which people search for and express the meaning and purpose of their lives, as well as experience connection with themselves, others, nature, and spirituality. This study aimed to determine the effectiveness of spirituality-centered cognitive therapy on body image, sexual function, disease perception, and disturbing thoughts in women after mastectomy. This was semi-experimental research, which was conducted via a pre-test–post-test method and had a control group. The samples included 85 women with breast cancer who had undergone mastectomy, and, based on the inclusion criteria, 78 individuals were randomly selected and were then divided into two groups (39 individuals in the intervention group and 39 individuals in the control group). The intervention group received eight 120 min sessions of spirituality-centered cognitive therapy, and the control group did not receive any training. Data were collected using questionnaires on illness perception, body image, sexual function, and rumination and were then analyzed by multivariate analysis of variance with repeated measurements using SPSS-24. Before the training, there was no significant difference between the intervention and control groups in the scores obtained by the scales. After the intervention, the mean scores in all scales except sexual function were significantly different from the control group. Therefore, spirituality-centered cognitive therapy may be useful for improving negative psychological symptoms among women in Iran with breast cancer after mastectomy surgery.

Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design.

Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity. To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self. This was a four-phase ABC plus community follow-up (D) mixed methods n=1 single case experimental design. Four idiographic measures were collected daily across four phases; the baseline (A) was during PICU admission, the first treatment phase (B) was behavioural on the PICU, the second treatment phase (C) was cognitive on an acute ward and the follow-up phase (D) was conducted in the community. Four nomothetic measures were taken on admission, on discharge from the PICU, discharge from the acute ward and then at 4-week follow-up. The participant was also interviewed at follow-up using the Change Interview. Compared with baseline, the behavioural and the cognitive interventions appeared effective in terms of improving calmness, optimism and rumination, but the effects on sociability were poor. There was evidence across idiographic and nomothetic outcomes of a relapse during the follow-up phase in the community. Eleven idiographic changes were reported in the interview and these tended to be unexpected, related to the therapy and personally important. Single case methods can be responsive to tracking the progress of patients moving through in-patient pathways and differing modules of evidence-based interventions. There is a real need to implement robust outcome methodologies on PICUs to better evaluate the psychological aspects of care in this context.

Internet-Based Cognitive Behavioural Treatments for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis.

Obsessive-compulsive disorder (OCD) is a common mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing anxiety. Internet-based cognitive behavioural therapy (ICBT) has emerged as an effective treatment modality for various mental health disorders. This meta-analysis evaluates the efficacy of guided self-help ICBT (GSH ICBT) and unguided self-help ICBT (SH ICBT) against active and passive control conditions in adults with OCD. A comprehensive systematic literature search yielded 12 randomized controlled trials (RCTs) comprising 15 comparison arms (N = 1416) that met the inclusion criteria. Results indicate that GSH ICBT significantly reduced OCD symptomatology posttreatment compared to active controls (g = 0.378, k = 9), with no significant effects maintained at follow-up (g = 0.153, k = 4). GSH ICBT was also found to be as effective as active CBT interventions in reducing comorbid anxiety and depression symptoms posttreatment (g = 0.278, k = 6) and at follow-up (g = 0.124, k = 4). However, improvements in quality of life were not significant posttreatment (g = 0.115, k = 4) nor at follow-up (g = 0.179, k = 3). Combined GSH and SH ICBT demonstrated large effects on reducing OCD symptoms (g = 0.754, k = 6), medium effects on comorbid symptoms (g = 0.547, k = 6) and small effects on quality of life (g = 0.227, k = 2) when compared to inactive controls. No significant differences were found between GSH and SH ICBT in all measured outcomes posttreatment (OCD: g = 0.098, k = 3; AD: g = 0.070, k = 3; QoL: g = -0.030, k = 1) and at follow-up (OCD: g = 0.265, k = 2; AD: g = 0.084, k = 2; QoL: g = 0.00, k = 1). Sample size was identified as a significant moderator of treatment effects. This paper further explores clinical significance, treatment adherence, therapist time investment and moderator influences of the ICBT. The limitations of the study and recommendations for future research are thoroughly discussed.

Beyond symptom classification: Analyzing subjectivity of people diagnosed with obsessive compulsive disorder through Lacanian Discourse Analysis perspective

Intrusive thoughts and repetitive behaviors are manifested in numerous forms, however regarding the symptom-based system, people with such diverse forms of symptoms are diagnosed under the same category, named obsessive-compulsive disorder (OCD). The social constructivist approach, that have an increasingly substantial impact on psychotherapy research, emphasizes the subjectivity of individuals since the therapeutic field focuses on one-to-one work. Although studies on psychotherapy and the use of language are expanding, to the best knowledge of authors the subjectivity of people diagnosed with obsessive-compulsive disorder has not yet been studied using a combination of qualitative, discursive, critical, and language-based perspectives. The main purpose of this study was to critically evaluate the symptom-based diagnosis in the therapeutic process, with a particular emphasis on the subjectivity of people with OCD symptoms and their discursive practices. For this aim, interviews were conducted with six participants who were diagnosed with OCD and selected via the purposive sampling method. As for the qualitative analysis, critical and Lacanian Discourse Analysis perspectives were utilized. Considering the concepts of this perspective, the analysis revealed that though all participants were diagnosed under the same category, namely OCD, their basic signifiers, positioning, and relationships with the Other were quite distinct. Furthermore, differentiated patient discourses and gender differences emerged as crucial issues that were discussed in the light of Lacanian psychoanalytic literature. These findings suggested that individuals should be carefully listened to within their own subjectivity and psychological structures instead of being broadly categorized on the basis of symptom similarity. Based on the findings, the current study presents a diagnostic debate and key clinical implications.

A comprehensive guide to research protocols for collecting and coding involuntary past and future thoughts

The paper presents a comprehensive guide for researchers investigating mind-wandering and related phenomena such as involuntary past and future thinking. Examining such spontaneous cognitions presents a challenge requiring not only the use of appropriate laboratory-based procedures, but also the coding of complex qualitative data. This guide outlines two main stages of existing research protocols: data acquisition and data coding. For the former, we introduce an easily modifiable computerized version of the vigilance task, designed for broad application in studies focusing on eliciting and measuring involuntary thoughts in controlled laboratory conditions. Regarding data preparation and coding, we provide a detailed step-by-step procedure for categorizing and coding different types of thoughts, involving both participants and competent judges. Additionally, we address some of the difficulties that may arise during this categorization and coding process. The guide is supplemented by a clip demonstrating the main part of the experimental procedure and a step-by-step example of the subsequent data processing stages. We anticipate that this research guide will not only assist a broader group of researchers interested in investigating spontaneous cognition, but will also inspire future studies on spontaneous cognition and related phenomena.•There is a need for standardized approaches to working with qualitative data when investigating spontaneous thoughts.•The paper outlines a comprehensive protocol for collecting and coding involuntary past and future-oriented thoughts.•The paper also presents a detailed step-by-step procedure for data preparation and coding to categorize different types of thoughts, involving both participants and competent judges.

Cognitive Impulsivity in Anorexia Nervosa in Correlation with Eating and Obsessive Symptoms: A Comparison with Healthy Controls.

Impulsivity in eating disorders (ED) has been historically focused on bingeing-purging symptoms, evidencing lower levels in restricting subtypes. In the recent literature, obsessive-compulsive disorder (OCD) has been described as characterized by high cognitive impulsivity. This specific impulsivity factor has been rarely studied in anorexia nervosa (AN). In this study, 53 inpatients with anorexia nervosa and 59 healthy controls completed the following questionnaires: the Barratt Impulsiveness Scale (BIS-11), the Obsessive-Compulsive Inventory (OCI), the Eating Disorders Inventory-2 (EDI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). AN individuals showed significantly increased levels of cognitive instability but no difference in global score and other subscales of impulsivity compared to the healthy controls. Among AN individuals, cognitive instability emerged as being associated with the global score and obsession subscale of the OCI. It was also significantly associated with interoceptive awareness and impulse regulation. Cognitive instability was the main predictor of obsessive thoughts and behaviors in AN. Our study supports the hypothesis of AN as being characterized by high cognitive instability and adds the result that the cognitive domain of impulsivity may be associated with the presence of obsessive symptoms, specifically obsessive thoughts.

Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial

BackgroundHigh rates of negative intrusive thoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors.MethodsData on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1 year after diagnosis, trial 2 had follow-up 2 years after diagnosis, baseline in both trials was 12 months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression.ResultsTrial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2.ConclusionsThe emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group.Trial registrationThe three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).

Secondary Trauma by Internet Content Moderation: a Case Report

Introduction In recent years, a global debate has emerged regarding the protection of Internet users from exposure to harmful content. Content moderation is defined as the organized practice of filtering user-generated content posted on internet, social networks, and media to determine the appropriateness of the content for a site, locality, or jurisdiction. The growing volume of this content along with the psychological impact of this activity have promoted the application of automated approaches based on artificial intelligence and machine-learning. However, the changing characteristics of content, as well as the cultural differences that influence its appropriateness, mean that human moderation of Internet content currently continues to exist. Psychological effects of this activity such as symptoms of post-traumatic stress disorder (PTSD) could represent an example of secondary trauma.Objectives Our aim is to describe a clinical case of post-traumatic stress disorder presenting with specific traumatic exposure idiosyncrasy that could lead to a better consequence characterization of a recent social phenomena such as internet content moderation.MethodsWe expose the clinical case of a woman with emotional distress who was reffered to our outpatient psychiatric unit in Barcelona in 2022 after five years working as an internet content moderator.ResultsWe describe the case of a 35-year-old woman without relevant medical, toxicologic or psychiatric record that presents to our out-patient psychiatric clinic with post-traumatic stress disorder after five years of working as an internet content moderator and being exposed to visual traumatic content such as sexual assault and paedophilia. The clinical presentation consisted with one year of recurrent daily panic attacks, intrusive images about the traumatic exposure, intrusive thoughts, insomnia, vivid nightmares, avoidance of exposure to her son, distrust of the environment and intense fear for her son security. The disorder interfered in her capacity to work. The patient received psychological treatment and ISRS (Sertraline) was prescribed, however only partial response was reached with persistence of the majority of symptoms.ConclusionsThe presented case suggests a temporal and symptom content relationship between the described work exposure and the appearance of emotional distress in a patient without PTSD history. Although previous evidence of secondary trauma in people exposed to indirect traumatic experiences has been reported, for example in healthcare professionals, the exposure to alien trauma through digital exposure as a workactivity is yet to be specifically examined. It is necessary to expand knowledge on the clinical expression of this phenomenon due to the observed recurrence of anxious and depressive symptomatology related to repeated exposure to traumatic content.Disclosure of InterestNone Declared

The Epidemic of Non-Suicidal Self-Harm in Adolescents and Young Adults in the Kyrgyz Republic

Introduction During the last two years, many young people and adolescents in the Kyrgyz Republic started to visit specialists due to Non-suicidal self-harm. A significant rise in the amount of such cases allowed specialists from the Republican Center of Psychiatry in Bishkek to think about an “epidemic “of self-harming behavior. Non-suicidal self-harm (NSSH) is defined as repeated, deliberate, direct injury to the body without suicidal intent that is not socially acceptable (Nixon et al., 2002) to reduce psychological discomfort in the absence of a conscious intention to take one’s life (ICD-10 codes X60-X84, and ICD-11 codes PB80-PD3Z).ObjectivesTo determine the causes of NSSH among adolescents and young adults who approached specialists in mental health sphere at Institute of Behavioral Health at the American University of Central Asia.MethodsOver two years, forty-five adolescents and young adults under twenty-five who had committed self-harm visited specialists from the Behavioral Health Institute at the American University of Central Asia.All the patients received either dialectical behavioral treatment or cognitive processing treatment, medication (paroxetine) was used in three cases.ResultsThirty patients were girls under twenty-one, and fifteen were boys and young male adults. The overwhelming majority (40 people) had self-inflicted cuts, two had imposed burns with matches and cigarettes, and one had used self-suffocation without a bond. Reasons for self-harm were the following: releasing internal tension and anxiety, getting some rest from intrusive thoughts, relieving the inner pain, and a desire to “feel as a whole person.” All the patients underlined that they did not want to attract attention from their family members; moreover, they tried to hide the consequences of self-harm. Teens and young adults (twelve patients) from Kyrgyz traditional families visited a consultant or psychiatrist after a long drive through conventional or religious healers. All of the patients knew that they were addicted to self-harm, wanted to stop a problematic behavior, and could not stop it on their own. Ten patients have been diagnosed with borderline personality disorder. Two of them also had eating disorders. Five patients had PTSD, and five had social phobia. The others had recognizable anxiety symptoms.ConclusionsThe enormous rise of non-suicidal self-harm is a phenomenon that needs further research. Those cases often resist treatment due to the “addictive” component in the pathogenesis.Disclosure of InterestNone Declared

Experimental use of self-affirmation to manage self-concept threat in a simulated intrusive thought paradigm

Introduction: Based on the commonality in cognitive clinical theories of OCD and cognitive dissonance theory regarding threat to self (Wright & Riskind, 2021), this preliminary study investigated whether (1) OCD-related distress catalyzed by ego-dystonic intrusive unwanted thoughts is akin to cognitive dissonance, and (2) distress and negative appraisals of the simulated intrusive thoughts can be alleviated by a values-based self-affirmation exercise developed in the dissonance literature. Methods: Nonclinical college students (N = 93) were presented with a simulated intrusive thought induction. After rating their distress from writing the simulated intrusion, they were randomly assigned to one of four conditions: neutralization used in the clinical literature, a values-based self-affirmation task, a combination of neutralization followed by self-affirmation, or a control condition. Results: The results revealed that the group that combined a neutralizing exercise followed by a self-affirmation exercise displayed a significantly greater decrease in dissonance-like distress and negative appraisals of the simulated intrusion than the other three groups. The groups that received self-affirmation alone or neutralization alone did not appear to reduce distress on their own. The combined group and other groups did not show rebound distress. Discussion: These novel analogue study findings help to bring cognitive clinical models of OCD and cognitive dissonance theory closer together. Moreover, they introduce the possibility that self-affirmation procedures could provide useful secondary ways to augment current OCD treatment protocols.

Use of vortioxetine in treating obsessive-compulsive disorder: a case report

Introduction Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.ObjectivesTo evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.MethodsClomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.ResultsThe dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.The pre and post results are summarized in tables 1 and 2. Table 1.Hamilton Depresion Rating Scale (0-52)BasalPost 10-week treatment214Dimensional Y-BOCS (0-15)BasalPost 10-week treatmentAggressive-related obsessions and compulsions102Religious-related obsessions and compulsions51Symmetry and order71Pollution and cleaning00Collecting and accumulation20Miscellaneous103ConclusionsVortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.Disclosure of InterestNone Declared

Intérêt de la psychothérapie d’acceptation et d’engagement et de la thérapie fondée sur la compassion pour soutenir le maintien de l’abstinence dans les polyaddictions

Introduction and objectivesAddiction concerns people suffering from great psychological vulnerability due to early trauma and attachment disorders. Although several forms of therapeutic management have been shown to be effective, the relapse rate remains high, and the effects are short-lived. Therefore, the first objective of this study was to integrate the tenets and concepts of compassion-based therapy with acceptance and commitment therapies for the treatment of patients with polyaddictions by conceptualizing a therapeutic program aimed at support for maintaining abstinence. The interest in such an integration has been raised by several authors. The central concept of that integrative approach was the “compassionate flexibility”. Our second objective was to explore the feasibility, acceptability, and therapeutic effects of this intervention for patients with polyaddictions and psychiatric comorbidities, who are particularly resistant to psychotherapies. Material and methodTwelve patients (8 men and 4 women) with polyaddictions (alcohol, cocaine, tobacco, cannabis) of the 24 referred for the study, followed the MyActaddiction program. The A-B multiple-case-series protocol combined qualitative and quantitative measures to monitor feasibility, acceptability, clinical (OCDS, EADS-21) and psychological (AAQ-II, EAC) progress, patient narrative feedback (perception, connection, sense of presence), complemented by follow-up observations on abstinence maintenance. ResultsResults show moderate feasibility, with only 50 % of study referrals accessing psychotherapy, good accessibility, with 66 % of patients completing all sessions, high satisfaction levels and positive qualitative feedback. Pre- and post-treatment assessments showed a significant clinical improvement in craving (obsessive thoughts and OCDS total score) at group level, and these changes were clinically significant at individual level by Reliable Change Index measures, for 70 % of participants. On the EDAS-21 scale, patients who had pathological scores prior to therapy improved their scores to non-pathological thresholds for anxiety, stress and depression. The Reliability Change Index (RCI) showed that the resulting change was clinically significant at the individual level for 83 % of patients on anxiety level, for 58.33 % of patients on depression, and 50 % of patients on the stress level. In terms of the psychological processes targeted by the therapeutic practices, we observed an improvement in psychological flexibility, with a clinically significant reduction in AAQ-II scores after the intervention compared to the pre-treatment score. The RCI indicated that the observed clinical change was significant. There was also a significant increase in post-test versus pre-test for two dimensions of self-compassion: “common humanity” and “mindfulness”, with a high Cohen's d. Regarding individual scores, the scores for “self-compassion” and “common humanity” were below the expected average scores usually observed in the general population. According to the RCI, the increase in post-test scores was robust for 41 % of the patients on “common humanity” dimension, for only on patient on the “mindfulness” dimension, and on patient on the “self-kindness” dimension. The RCI shows that changes are clinically reliable for 50 % of patients for the “common humanity” and “mindfulness” sub-dimensions of self-compassion. Follow-up showed that 66 % of patients-maintained abstinence at one year, while 25 % relapsed, while one patient experienced both variations in consumption and periods of abstinence. ConclusionThe present program combines TFC and ACT for abstinence maintenance in the treatment of addiction. This study could demonstrate the value of process-based approaches to the treatment of complex pathologies such as polyaddiction. These findings suggest that compassion-based psychological interventions and psychological flexibility could be a transdiagnostic protective factor encouraging abstinence maintenance in people with polyaddictions. These results call for further research to explore the active mechanisms of compassion-related components.

Cannabinoids Hyperemesis Syndrome – An Urgent Call for Timely Diagnosis, Management, and Future Directions– A Case Report and Review of the Updated Literature

IntroductionCannabinoid Hyperemesis Syndrome (CHS) is distinguished by a pathognomonic cyclic pattern of hyperemesis characterized by recurring episodes of severe vomiting every few weeks to months, as well as obsessive thoughts and compulsive behavior, such as a proclivity to take frequent hot baths or showers. It is largely accepted as the most commonly used illicit drug in the United States, with estimates ranging from 42% to 46% lifetime consumption. Despite greater awareness of CHS, practitioners continue to lack comprehension, resulting in an unfortunate delay in patient identification and treatment.ObjectivesThe aim of this article is to bring attention to CHS in order to enable clinicians, and more specifically, addiction medicine specialists and psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations and investigations. This will save the patient’s time, prevent financial burdens and mental health stresses, and increase their overall quality of life.MethodsA thorough screening and data extraction of the relevant articles was conducted using PubMed, Cochrane, and Embase. Databases were used to search for articles on CHS published between January 2021 and September 2023, yielding relevant articles. Keywords used were “hyperemesis”, “cyclical vomiting,” “cannabis” and “cannabinoid”.ResultsWe present a case of 20-year-old teens who came to emergency with severe dehydration and vomiting of more than 40 episodes at home. He had multiple admissions for abdominal pain, nausea, and vomiting in the past and was evaluated and diagnosed with gastritis, PUD, and H. pylori infection. A more detailed medical history revealed a frequent use of cannabis over the past few years and symptoms manifestation and worsening is associated with the use of cannabis. After the complete cessation of cannabis, there have been no new symptomatic episodes reported in the patient and the patient is stable clinically.ConclusionsCannabinoid Hyperemesis Syndrome (CHS) is a serious health hazard that requires immediate discovery and treatment. Despite the widespread use of cannabis, CHS is often misdiagnosed, resulting in unnecessary medical treatments and complications for patients. Given their special knowledge of linking chronic cannabis use to this syndrome, this case report and literature review highlight the critical role of addiction medicine experts and psychiatrists in quickly detecting and treating CHS. Early detection and treatment, particularly complete cannabis abstinence, are critical in alleviating symptoms, minimizing recurrent hospitalizations, and ultimately improving patients’ overall quality of life.Disclosure of InterestNone Declared

Obsessive-compulsive symptoms in professional tennis players

IntroductionEngaging in moderate physical activity holds a vital role in our daily lives, serving as both a means of social recreation and a fundamental contributor to physical and mental wellbeing. It is also worth noting that such activity can potentially produce mood-enhancing effects by promoting neurogenesis and neuronal adaptability. Intriguingly, certain individual psychological traits such as rituals, compulsions, obsessional thinking, and superstitious beliefs, as well as inflexibility in daily routines, appear to serve a purpose in competitive athletic endeavors.ObjectivesThe aim of our study was to investigate the possible presence of obsessive-compulsive symptoms or disorders, as well as of superstitions or magical thinking, in a group of professional tennis players, by means of standardized assessment scales, as compared with healthy subjects who did not professionally perform any kind of sport activity.MethodsTwenty-five current or former professional tennis were recruited within the Italian Tennis Federation during an international competition and during a master meeting of coaches. All of them underwent a psychiatric interview with a structured scale and a psychopathological assessment carried out with the Mini-International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Data were analyzed and compared.analysis was performed by means of contingency tables, χ² tests, group statistics, paired, independent and Mann Whitney’s tests.ResultsThe Y-BOCS total score was significantly higher in both current and retired athletes than control subjects (5.96 ± 5.76 versus 1.24 ± 2.65, p = 0.001, t = 3.72). Current athletes showed more frequently current aggressive obsessions (χ2 = 0.041, r = 5.24) and current miscellaneous compulsions (χ2 = 0.030, r = 5.94) than past athletes. The Y-BOCS (t = 3.4, p = 0.002) obsessions (t = 3.48, p = 0.002), and compulsions subscale (t = 3.11, p = 0.005) scores were higher in current players than in the other group.ConclusionsOur results support the hypothesis that high-level competitive sports activities, which suppose compliance with strict daily routines and extensive training, could constitute a risk factor for the onset of full-blown obsessive-compulsive disorder in more vulnerable subjects. Similarly, there is a growing demand for sport psychological support experts in order to prevent high stress in training and competitions.Disclosure of InterestNone Declared