Male Obsessive-compulsive Disorder Patients Research Articles

Anti-Androgen Drugs in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review.

This study aimed to systematically investigate whether anti-androgens could significantly reduce Obsessive-Compulsive Disorder (OCD) symptoms compared to placebo or usual care in OCD patients. PubMed, EMBASE, CENTRAL and International Clinical Trials Registry Platform (ICTRP) databases were searched up to October 2018 using relevant keywords. All randomized and if not available non-randomized studies conducted on a population including OCD patients who were administered with anti-androgen, which reported changes in their symptoms, were included. The studies on compulsive hypersexuality were excluded. Required data were extracted from full-text of the included articles by two independent authors. One randomized and four non-randomized trials were found. The only randomized trial showed that flutamide, an anti-androgen agent, was effective in reducing compulsion scores in male OCD patients with comorbid Tourette syndrome, compared to placebo. Three out of four non-randomized trials showed that different anti-androgens including finasteride, cyproterone acetate and triptorelin were effective in reducing OCD symptoms. The only study, which failed to show the efficacy of an anti-androgen agent, administered OCD patients with flutamide. Despite the positive results, available studies provide the evidence with low quality based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach. Available studies are not sufficient for a precise answer to our study question. There is still a need for further large randomized blinded clinical trials to evaluate the effectiveness of antiandrogens in OCD patients. It is recommended that gender, comorbidities and subscales of Yale- Brown Obsessive-Compulsive Score (Y-BOCS) should be considered in designing the studies and interpreting their results.

Sociodemographic Determinants of Personality Disorder In Patients of Obsessive-compulsive Disorder

Background & objective: Obsessive Compulsive Disorder (OCD) is the 4th most prevalent psychiatric disorder in Epidemiological Catchment Area (ECA) Survey and most individuals with OCD have co-morbid personality disorders (PD). The present study was undertaken to find the prevalence of PD among patients with OCD and the sociodemographic determinants that influence the development PD in patients with OCD.
 Methods:The cross-sectional analytical study was conducted in OCD clinic of Bangabandhu Sheikh Mujib Medical University from January 2015 to September 2016. Respondents were recruited from the OCD patients diagnosed on the basis of DSM-IV criteria and face to face interview was conducted with the help of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II questionnaire). The main outcome variable was PD in patients of OCD and the exposure variables (determinants) were selected sociodemographic characteristics.
 Result: The mean age of the OCD patients was (28 ± 8.7) years. Almost half (49%) of OCD patients belonged to the age group 20-30 years. Female respondents were 53.6%. Among the respondents, 62% had co-morbid PD. The mean age of the OCD patients with PD was observed to be significantly higher (29.1 ± 9.1 years) than those without PD (26.2 ± 7.8 years) (p = 0.047). Male OCD patients were 2.4 (95% CI of OR: 1.2 – 4.7) times more likely to have PD than their female counterparts (p = 0.012). Ethnic groups other than Muslims tend to be associated with PD more often and carry more than 8-fold (95% CI of OR: 8.4 – 37.2) higher risk of having the condition (p = 0.001). Likewise, other occupants were nearly 2(95% CI of OR: 0.98 – 3.74) times more prone to have PD than the students (p = 0.056).
 Conclusion: Personality Disorders are highly prevalent among people with OCD which remains underdiagnosed & under-addressed. Male OCD patients, non-Muslims and occupants other than students are more prone to have PD. Persons with Personality Disorders are far more likely to refuse psychiatric help and deny their problems.
 Ibrahim Card Med J 2017; 7 (1&2): 44-50

Peripheral SLC6A4 Gene Expression in Obsessive-Compulsive Disorder in the Han Chinese Population.

BackgroundSerotonergic system dysfunction has been implicated in obsessive-compulsive disorder (OCD). This study examined peripheral SLC6A4 gene expression in OCD patients and healthy controls to explore the relationship between SLC6A4 and OCD.MethodsParticipants included 50 first episode OCD patients and 60 age and gender-matched healthy controls. Relative SLC6A4 gene expression were examined by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) in peripheral leukocytes of all the subjects. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess the severity and subtype of OCD.ResultsSLC6A4 gene expression, normalized by glyceraldehyde-3-phosphate dehydrogenase (GAPDH), were not significantly different between the OCD patients and healthy controls(z=-0.79, p=0.428). Male OCD patients showed a tendency of low gene expression of SLC6A4 in peripheral blood (z=-1.66, p=0.096). We did not find a significant correlation between SLC6A4 expression and the severity and subtype of OCD.ConclusionThere is no correlation between SLC6A4 expression levels and the severity and subtype of OCD, but male OCD patients showed a tendency of low gene expression of SLC6A4 in peripheral blood. These results suggest that gene expression of SLC6A4 in peripheral blood may not be a useful biomarker of OCD in the Han Chinese population.

Plasma Oxytocin Levels in Untreated Adult Obsessive-Compulsive Disorder Patients

Background and Aim: Given the paucity of information on the possible role of oxytocin (OT) in the pathophysiology of obsessive-compulsive disorder (OCD), our study aimed at evaluating plasma OT levels in a group of 44 OCD outpatients, as compared with a similar group of healthy control subjects. At the same time, the relationships between OT and clinical features and romantic attachment characteristics were examined as well. Methods: Diagnosis was assessed according to DSM-IV-TR criteria, while the OCD severity was measured by means of the Y-BOCS rating scale. All patients were drug free and not depressed. The romantic attachment was assessed by means of the Italian version of the ‘Experiences in Close Relationships' questionnaire. Plasma OT levels were evaluated by means of a standard RIA kit. Results: The main findings of our study showed that OT levels were increased in OCD patients, as compared with healthy subjects, and negatively related to symptom severity. Positive relationships were detected between OT levels and the fearful-avoidant and dismissing styles of romantic attachments, but only in male OCD patients. Conclusion: Taken together, these findings suggest that OT may play a role in OCD pathophysiology and also in the romantic attachment of patients with gender specificity.

Salivary alpha-amylase and cortisol responsiveness following electrical stimulation stress in obsessive–compulsive disorder patients

Salivary α-amylase (sAA) serves as a marker of sympathoadrenal medullary system (SAM) activity. Salivary AA has not been extensively studied in obsessive–compulsive disorder (OCD) patients. In the current study, 45 OCD patients and 75 healthy volunteers were assessed with the Yale–Brown Obsessive–Compulsive Scale (Y–BOCS), the Profile of Mood State (POMS), and the State-Trait Anxiety Inventory (STAI). Measures of heart rate variability (HRV), sAA, and salivary cortisol were also obtained following the application of electrical stimulation stress. The Y–BOCS and POMS Tension–Anxiety, Depression–Dejection, Anger–Hostility, Fatigue, and Confusion scores were significantly increased in patients with OCD compared with healthy controls. In contrast, Vigor scores were significantly decreased in patients with OCD relative to scores in healthy controls. There was no difference in HRV between the patients and the controls. Salivary AA levels in female and male OCD patients were significantly elevated relative to controls both before and after electrical stimulation. In contrast, there were no differences in salivary cortisol levels between OCD patients and controls. The elevated secretion of sAA before and after stimulation may suggest an increased responsiveness to novel and uncontrollable situations in patients with OCD. An increase in sAA might be a characteristic change of OCD.

Midsagittal structural differences and sexual dimorphism of the corpus callosum in obsessive-compulsive disorder

Neurobiological abnormalities in various brain regions, including the orbitofrontal cortex, basal ganglia, and thalamus, have been found in patients with obsessive–compulsive disorder (OCD), and impairment in white matter connectivity in these regions has recently been suggested. To investigate structural connectivity in OCD, we used the midsagittal area and thickness to assess the morphology of the corpus callosum (CC), the largest connecting fiber tract in the human brain. Midsagittal magnetic resonance images of the CC were acquired from 69 adult patients with OCD and 69 matched normal controls. We calculated and compared the total area and the areas of five subregions of the CC as well as the distances between 200 equidistant points on the top and bottom of lines on the surface of the CC in the two groups. The absolute total area of the CC was significantly larger in OCD patients than in controls when brain size, age, gender, and IQ were controlled. Significant enlargements in CC1, CC2, and CC5 were seen in OCD patients before correction for multiple comparisons. The thickness of the caudal part of the splenium was greater in OCD patients than in controls. The analysis according to gender showed that only male OCD patients differed from male controls with respect to the area of the CC. These findings reflect structural abnormalities in the CC, and especially in the splenium, in adult patients with OCD. Abnormal interhemispheric connectivity, including the parietotemporal and occipital areas, may affect the pathophysiology of OCD. Sexual dimorphism in the CC of OCD patients should be considered.

Low expression of catecholamine-O-methyl-transferase gene in obsessive-compulsive disorder

This study examined peripheral catecholamine-O-methyl-transferase (COMT) gene expression in obsessive-compulsive disorder (OCD) patients and healthy controls. Participants included 35 first episode OCD patients and 31 age- and sex-matched healthy controls. Relative COMT gene expression levels were examined by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) in peripheral blood of all the subjects. COMT gene expression levels, normalized by glyceraldehyde-3-phosphate dehydrogenase (GAPDH), were significantly decreased in the OCD group compared with healthy controls ( F = 6.244, p = 0.015). OCD patients showed a 32% down-regulation. We also found lower COMT gene expression levels in female in comparison to male participants ( F = 5.366, p = 0.024) in the sample as a whole. COMT gene expression down-regulation of male OCD patients relative to male controls is 38%, and that of female OCD patients relative to female controls is 27%. These results suggest that COMT gene expression down-regulation might play an important role in the development of OCD and that there may be gender differences in this alteration.

Association between the dopamine D 2 receptor TaqI A2 allele and low activity COMT allele with obsessive–compulsive disorder in males

Background Mounting evidence suggests the involvement of the dopamine system in the pathophysiology of obsessive–compulsive disorder. Method The relationship of the dopamine D 2 receptor (DRD2) TaqI A, and catechol- O-methyl-transferase (COMT) NlaIII High/Low activity polymorphism to obsessive–compulsive disorder (OCD) was examined in a sample of 150 patients and 150 controls. Results OCD patients did not show significant differences in genotype distribution and allele frequency for polymorphisms investigated relative to controls. However, when the sample was stratified by gender, there was a trend to a significant predominance of the DRD2 A2A2 genotype ( p = 0.049), and a higher frequency of the DRD2 A2 allele ( p = 0.020) and low-activity COMT allele ( p = 0.035) in male OCD patients compared to male controls. In addition, we observed an association of the DRD2 A2A2 genotype in patients with an early onset of disease (≤ 15 years) ( p = 0.033). Conclusions Our findings replicate previous reports and provide support for a potential role of the COMT and DRD2 locus in subgroup of male, early onset patients with OCD.

Sexually dimorphic relationship of a 5-HT 2A promoter polymorphism with obsessive-compulsive disorder

Background: In an earlier analysis of 73 subjects from this study, the reduced activity catechol O-methyltransferase variant was shown to be associated with obsessive–compulsive disorder in men only. We hypothesized that the 5-HT 2A promoter polymorphism, -1438G>A, previously associated with anorexia nervosa, would be more abundant in women with obsessive-compulsive disorder. Methods: One hundred and one Caucasian obsessive–compulsive disorder patients (48 women, 53 men) and 138 control subjects (77 women, 61 men), were genotyped. DSM-III-R psychiatric diagnoses were assigned based on the SCID-I. Results: As hypothesized, the -1438A allele frequency was higher in obsessive-compulsive disorder women (.57) than female control subjects (.42) ( p = .015). The genotype frequencies were also significantly different ( p = .020). Allele frequencies did not differ between male obsessive-compulsive disorder patients (.44) and male control subjects (.41). Conclusions: We have found that a 5-HT 2A promoter polymorphism is associated with obsessive-compulsive disorder in women but not in men, strengthening the argument that there may be fundamental gender differences in the genetic susceptibility to obsessive-compulsive disorder.

Orbitofrontal cortex dysfunction in obsessive–compulsive disorder?: I. Alternation learning in obsessive–compulsive disorder: male–female comparisons

Background: We have previously reported a significant negative correlation between severity of symptoms and performance of an alternation learning task in female obsessive–compulsive disorder (OCD) patients. The present study was aimed at exploring this relationship between alternation learning and OCD symptom severity in male OCD patients. Methods and results: Eighteen female obsessive–compulsive disorder patients and 14 male non-depressed, drug free, OCD patients participated in the study. Measures of dorsolateral prefrontal function (Wisconsin Card Sorting Test) and orbitofrontal cortex function (object alternation learning) showed no significant differences between the sexes. The relationship between orbitofrontal cortex function and severity of OC symptoms was significantly different between the sexes ( z=2.44, P=0.007). While this correlation was negative in the females it was positive in the males. Conclusions: These results may indicate sexual dimorphism in OCD.

Circulating lymphocyte subsets in obsessive compulsive disorder, major depression and normal controls

Background: Obsessive compulsive disorder (OCD) shares several features with depressive illness (e.g., comorbidity, early escape from dexamethasone suppression, effectiveness of serotonergic pharmacotherapy). It was of interest to establish whether OCD, like major depression, was also associated with immune alterations, notably elevations of circulating natural killer (NK) cells. Method: Circulating lymphocytes were determined from morning blood samples taken from OCD and major depressive patients, as well as from age- and sex-matched controls. Stress perception and coping styles were evaluated in order to assess whether such variables accompanied the NK alterations. Finally, in a subset of patients, symptoms of the illness, stress/coping, and circulating lymphocytes, were also evaluated following 12 weeks of antidepressant medication (serotonergic reuptake inhibitor). Results: The major depressive and OCD patients reported increased perception of day-to-day stresses, coupled with reliance on emotion focused coping styles. Moreover, circulating NK cells were elevated among male OCD and major depressive patients, whereas only a modest increase of NK cells was seen in female major depressives. Twelve weeks of medication alleviated depressive and OCD symptoms, and resulted in normalization of NK cells in the major depressives. However, in OCD patients the reduction of symptoms was not accompanied by significant variations of circulating NK cells. Conclusions: Although major depression and OCD are both accompanied by elevated circulating NK cells, at least in males, normalization of NK cells following treatment was only evident in depression. The persistent elevations of NK cells among male OCD patients may reflect either a trait characteristic of the illness, or symptom reduction and not true remission. Limitations: Although elevations of lymphocyte subsets in major depressive and OCD patients were observed, conclusions concerning immune status in OCD ought to be held in abeyance pending assessment of other indices of immune and cytokine functioning.

Cerebrospinal fluid corticotropin-releasing factor concentrations in patients with anxiety disorders and normal comparison subjects

Cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRF) were measured in a group of patients with anxiety disorders and normal comparison subjects (NC) to explore the hypothesis that abnormalities in CRF neuronal regulation occur in patients with anxiety disorders. Analysis of variance (ANOVA) revealed no differences in CSF CRF concentrations between the four diagnostic categories: panic disorder (PD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and NCs. Male OCD patients had higher CSF CRF concentrations than men with PD and GAD and male NCs. CSF CRF concentration was positively correlated with age in women but not in men. These findings suggest that central neuronal CRF regulation may be affected by both age and gender.

Regional 133Xenon cerebral blood flow and cerebral 99mTc-HMPAO uptake in patients with obsessive-compulsive disorder before and during treatment

We previously reported increased regional cerebral cortical uptake and decreased caudate nucleus uptake of 99mTc-HMPAO in patients with obsessive-compulsive disorder(OCD) before treatment compared to matched normal controls. In the present study, we determined whether or not these changes persisted during treatment. Single-photon emission computed tomography was used to measure regional cerebral blood flow (rCBF) by 133Xe inhalation and cerebral uptake of 99mTc-HMPAO in eight adult male OCD patients before and during treatment with chlomipramine, and in eight age-matched normal male controls. With 133Xe, there were no significant differences in rCBF between patients with OCD and their matched controls, and no significant differences in rCBF in the patients before and during treatment. Significantly increased HMPAO uptake in the orbital frontal cortex, posterofrontal cortex, and high dorsal parietal cortex bilaterally occurred in the OCD patients before treatment compared to their matched controls, and there were significant reductions of HMPAO uptake, into the normal range, in all these areas in the patients during treatment. Significantly reduced HMPAO uptake in the caudate nucleus bilaterally occurred in the patients before treatment compared to their matched controls, and these reductions persisted during treatment. This study provides additional support for the involvement of both the orbital frontal cortex and the caudate nuclei in the pathophysiology of OCD.