Obsessive-compulsive Research Articles

Experiences of imagery in obsessive-compulsive disorder: An interpretative phenomenological analysis.

Mental imagery is a defining criterion within current OCD diagnoses, and yet little has been written about how this is experienced. This study aimed to investigate how people with a diagnosis of OCD experience imagery, to better understand how this might contribute to the condition. This research employed Interpretative Phenomenological Analysis (IPA) and used semi-structured interviews. An expert-by-experience was involved in the study design. Eight adults with an OCD diagnosis were purposively sampled from NHS mental health services and interviewed about their experience of imagery. Interviews were transcribed and analysed in accordance with IPA guidelines. A reflexive log and audit trail were maintained during the research process to enhance quality control and to support the analytical process. Six superordinate themes were found: Submersion in intense and multifaceted imagery; Overwhelming, uncontrollable imagery; Imagery is explosive and expansive; Imagery involves past memories and future fears; People respond to imagery as if it is real; Therapy shifts imagery. This study highlights the intensity of OCD-related imagery experienced by people with OCD and the significance of this imagery in their everyday lives. All participants experienced imagery related to their OCD, demonstrating its importance in the phenomenology of the condition. Images relating to past experiences and images of future fears were identified. Clinicians should routinely seek to include imagery in assessment, formulation, and individual treatment plans for those with OCD.

Cognitive behavioral therapy for pediatric obsessive-compulsive disorder delivered via internet videoconferencing: a manualized sensor-assisted feasibility approach

BackgroundBetween 1 and 4% of children and adolescents suffer from obsessive-compulsive disorder (OCD) worldwide, but the majority of these young people do not have access to cognitive behavioral therapy (CBT) as a first-line treatment. CBT delivered via online videoconferencing (vCBT) offers a new way to provide young people with therapy, especially in the home environment where symptoms usually occur.MethodsIn this study, we investigated the feasibility of a newly revised vCBT manual, symptom change during treatment, and effects on family life and social functioning. 20 patients with OCD, aged 12–18 years, were treated during 14 weekly sessions while using a multimodal sensor system that assessed their physiological and behavioral responses during therapy. Treatment was delivered in real time via an online videoconferencing platform. Measurements of feasibility, acceptance, and implementation were evaluated descriptively, and clinical measures were assessed with t tests.ResultsThe primary results showed that patients and parents perceived the manual-based vCBT as feasible and easy to understand. According to the therapists’ ratings, all treatment modules and the content could be carried out in accordance with the manual. As a secondary outcome, OCD symptoms improved significantly during treatment (p <.001, d = 1.87), revealed by an average decrease of more than half in the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score. As the psychotherapy could be implemented directly in the patients’ home environment, low barriers to participation were reported, and the majority of participants reported improvements in family life after treatment.ConclusionsIn summary, the results of this feasibility study indicated a successful application of manual-based psychotherapy delivered via videoconferencing for pediatric OCD supported by a sensor system. This method should be further investigated in future randomized controlled trials with larger patient samples.Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT05291611], first submission: 2021-12-10.

Abnormal nonlinear features of EEG microstate sequence in obsessive–compulsive disorder

BackgroundAt present, only a few studies have explored electroencephalography (EEG) microstates of patients with obsessive–compulsive disorder (OCD) and the results are inconsistent. Additionally, the nonlinear features of EEG microstate sequences contain rich information about the brain, yet how the nonlinear features of EEG microstate sequences abnormally change in patients with OCD is still unknown.MethodsResting-state EEG data were collected from 48 OCD patients and macheted 48 healthy controls (HC). Subsequently, EEG microstate analysis was used to extract the microstate temporal parameters (duration, occurrence, coverage) and nonlinear features of EEG microstate sequences (sample entropy, Lempel–Ziv complexity, Hurst index). Finally, the temporal parameters and nonlinear features of EEG microstate sequences were sent to three kinds of machine learning models to classify OCD patients.ResultsBoth groups obtained four typical EEG microstate topographies. The duration of microstates A, B, and C in OCD patients decreased significantly, while the occurrence of microstate D increased significantly compared to HC. Sample entropy and Lempel–Ziv complexity of microstate sequences in OCD patients increased significantly, while Hurst index decreased significantly compared to HC. The classification accuracy using the nonlinear features of microstate sequences reached up to 85%, significantly higher than that based on microstate temporal parameter models.ConclusionThis study provides supplementary findings on EEG microstates in OCD patients with a larger sample size. We found that the nonlinear features of EEG microstate sequences in OCD patients can serve as potential electrophysiological biomarkers for distinguishing OCD patients.

Going beyond trauma: A scoping review on the prevalence of symptom-relevant negative autobiographical memories in anxiety disorders and obsessive-compulsive disorder.

Going beyond trauma: A scoping review on the prevalence of symptom-relevant negative autobiographical memories in anxiety disorders and obsessive-compulsive disorder.

Emotion dysregulation in youths with obsessive-compulsive disorder and its implication for treatment - an exploratory study from the TECTO trial: A protocol and statistical analysis plan

BackgroundResearch on improving psychotherapy for youths with obsessive-compulsive disorder (OCD), including cognitive behavioral therapy (CBT), should explore what works for whom and how by examining baseline moderators and potential mechanisms of change. Emotion dysregulation is proposed as an intermediate therapy factor in a transdiagnostic framework. This study investigates emotion dysregulation as an outcome, mechanism, and moderator of psychotherapy in youths aged 8-17 years with OCD. MethodsData are from a randomized clinical trial and a parallel prospective study of healthy controls. Participants with OCD (n=130; 121 in this study) were randomized to 14 sessions of either family-based CBT with exposure and response prevention versus family-based psychoeducation and relaxation training. We will; 1) assess if emotion dysregulation, measured by the Difficulties in Emotion Regulation Scale (DERS), decreases from baseline to end-of-treatment; 2) compare the proportion of participants with normative emotion regulation to a 90% reference interval from healthy controls (n=90); 3) use linear regression to examine if baseline emotion dysregulation moderates treatment effects measured by the Children’s Yale-Brown Obsessive-Compulsive Scale; 4) investigate if changes in emotion dysregulation mediate treatment effects; and 5) investigate the stability of emotion regulation over time in the healthy controls. Analyses 1-4 will be conducted for all OCD participants and separately for the two treatment groups. Two independent investigators will perform the analyses. ConclusionThis protocol and statistical analysis plan are presented to enhance analytical transparency and limit bias.

Obsessive-compulsive Disorder: Exposure Treatment and special Features of concentrated Treatment

Obsessive-compulsive disorder (OCD) is often associated with great suffering for both the affected individual as well as their relatives. The treatment of choice for OCD is cognitive behavioural therapy (CBT) with exposure and response prevention. Exposurebased treatment is offered in a concentrated, high-frequency format over four consecutive days in the Bergen 4-Day Treatment (B4DT). This article presents the procedure and effectiveness of this concentrated exposure treatment.

The Lived Experience of the Elderly with Obsessive-Compulsive Disorder: A Qualitative Study

The Lived Experience of the Elderly with Obsessive-Compulsive Disorder: A Qualitative Study

Schema-Therapeutic Exposure for Treatment Resistant Anxiety and Obsessive-Compulsive Disorders: A Multiple Baseline Case Series Design Study

Exposure is effective for patients with anxiety disorders or obsessive-compulsive disorders (OCD). Yet, a significant minority does not recover with current guideline treatments due to comorbid personality disorder symptoms. For these patients, no further guideline treatments exist. Schema therapy (ST) is an evidence-based treatment for personality disorders and integrating ST and exposure could provide a solution. We tested a new schema-therapeutic exposure treatment in patients with treatment-resistant anxiety or OCD. Using the latest methodological and statistical insights in a well-powered single-case experimental design (SCED; N = 6), we administered weekly measures of psychological malfunctioning, anxiety/OCD symptoms, and schema modes over the course of treatment (29-32 weeks). Schema-therapeutic exposure was effective for 33.33% of our sample, with improvement on all or most outcome measures. Another 33.33% demonstrated partial improvements, and 33.33% remained stable. Given the historical chronicity of symptoms in our sample, these effects are highly encouraging. Secondary findings showed that changes in schema modes did not precede changes in anxiety/OCD symptoms or psychological malfunctioning, and that 66.66% of the sample continued to improve in the second half of the treatment. Future research is wanted to unravel the interactive and additive effects of schema-therapeutic exposure to further optimize treatment.

CREB: A Promising Therapeutic Target for Treating Psychiatric Disorders.

Psychiatric disorders are complex, multifactorial illnesses. It is challenging for us to understand the underlying mechanism of psychiatric disorders. In recent years, the morbidity of psychiatric disorders has increased yearly, causing huge economic losses to the society. Although some progress, such as psychotherapy drugs and electroconvulsive therapy, has been made in the treatment of psychiatric disorders, including depression, anxiety, bipolar disorder, obsessive-compulsive and autism spectrum disorders, antidepressants and psychotropic drugs have the characteristics of negative effects and high rate of relapse. Therefore, researchers continue to seek suitable interventions. cAMP response element binding protein (CREB) belongs to a protein family and is widely distributed in the majority of brain cells that function as a transcription factor. It has been demonstrated that CREB plays an important role in neurogenesis, synaptic plasticity, and neuronal growth. This review provides a 10-year update of the 2013 systematic review on the multidimensional roles of CREB-mediated transcriptional signaling in psychiatric disorders. We also summarize the classification of psychiatric disorders and elucidate the involvement of CREB and related downstream signalling pathways in psychiatric disorders. Importantly, we analyse the CREB-related signal pathways involving antidepressants and antipsychotics to relieve the pathological process of psychiatric disorders. This review emphasizes that CREB signalling may have a vast potential to treat psychiatric disorders like depression. Furthermore, it would be helpful for the development of potential medicine to make up for the imperfection of current antidepressants and antipsychotics.

Psychometric properties of the OCI-4: a brief screening tool for perinatal obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) has an elevated prevalence among pregnant and postpartum women, with negative impacts on both mother and child. There is a need for brief, efficient screening tools for OCD in perinatal care because OCD is underrecognized. We evaluated the psychometric properties of the 4-item Obsessive Compulsive Inventory (OCI-4), and investigated it as a screening measure, in a perinatal sample. Pregnant women were assessed at 20- and 34-weeks' gestation, 6 weeks postpartum, and 6 months postpartum. Reliability was assessed via test-retest analyses, and validity was examined through correlations with established measures. Criterion-related validity and diagnostic sensitivity were also examined. The OCI-4 demonstrated good test-retest reliability, convergent and discriminant validity, and criterion-related validity. The measure also showed moderate to high diagnostic sensitivity. A score of 3 provided the best balance of sensitivity and specificity for screening. The OCI-4 is an effective screener that should be used for identifying OCD symptoms in perinatal settings. Despite the need for further study, its ease of use and quick administration make it a valuable tool for early detection and referral for assessment intervention.

Altered brain network stability in OCD following rTMS intervention: Insights from structural balance theory

Repetitive Transcranial Magnetic Stimulation (rTMS) is a promising intervention for Obsessive-Compulsive Disorder (OCD). However, understanding brain network changes following rTMS remains limited, despite its potential to enhance treatment efficacy. In this retrospective study, we investigated brain network reorganization in OCD patients after rTMS, using structural balance theory as a framework. We hypothesized that rTMS-induced functional plasticity would alter brain network topology, particularly affecting triadic associations, and leading to increased balance energy levels, indicative of a less stable network state. Brain functional networks were constructed from resting-state EEGs of OCD patients, with phase lag indexes calculated both before and after rTMS treatment. These networks were analyzed by comparing global parameters, including positive and negative links, triadic interactions (balanced/unbalanced), hub formation tendencies, and balance energy levels. We observed a significant decrease in weak-balanced triads and an increase in strong-unbalanced triads within the Beta І frequency band (12–15 Hz). Additionally, there was a notable reduction in the tendency of negative links to form hubs across certain frequency bands. These changes led to an increase in the network's balanced energy level, pushing it toward a less stable state. We hope these findings will refine rTMS strategies by facilitating brain network reorganization.

Examining the Relationship Among Parental-Reported Problems, Self-Reported Problems, and Psychiatric Diagnosis in Children and Adolescents

The study aims to investigate the relationship among psychiatric diagnosis, parental reported problems, and the Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) results of children. The sample of the study consisted of 78 children and adolescents (36 girls and 42 boys), and statistical analyses were made using the chi-square test and Fisher’s exact test. Relationships identified between the following pairs: worry problems with Generalized Anxiety Disorder (GAD), distraction problems with Attention Deficit and Hyperactivity Disorder (ADHD), hyperactivity problems with Tic and Tourette's Syndrome, obsession problems with Obsessive-Compulsive Disorder (OCD), unhappiness with Major Depressive Disorder or dysthymia, and avoidance of communication with autism spectrum disorder. Furthermore, when examining the relationship between psychiatric diagnoses and diagnoses according to the RCADS-CV, we found other connections, such as the psychiatric diagnosis of separation anxiety and RCADS-CV separation anxiety, as well as the psychiatric diagnosis of separation anxiety and RCADS-CV social phobia. Lastly, when investigating the relationship between parentally reported problems and RCADS-CV diagnoses, several associations emerged, including the connection between obsession problems and RCADS-CV OCD diagnosis, relationship problems and RCADS-CV’s OCD diagnosis, unhappiness problems, and RCADS-CV’s depression diagnosis. In conclusion, our findings demonstrate a substantial overlap among parentally reported problems, psychiatric diagnoses, and diagnoses based on RCADS-CV.

Polysomnographic changes of obsessive-compulsive disorder: evidence from case-control studies.

To explore the polysomnographic differences between patients with obsessive-compulsive disorder (OCD) and healthy controls. An electronic literature search was conducted in MEDLINE, EMBASE, All EBM databases, Web of Science, and CNKI from inception to Sep 2023. Pooled analyses revealed significant reductions in sleep efficiency, total sleep time, and rapid eye movement (REM) sleep latency, and increases in awakening time, REM density and REM intensity in patients with OCD compared with healthy controls. Meta-regression analyses reveal no significant influence of OCD severity and disease duration on polysomnographic changes of patients with OCD. Significant polysomnographic changes are present in OCD. Our findings underscore the need for a comprehensive PSG assessment of sleep changes in patients with OCD.

Psychedelics for the Treatment of Obsessive Compulsive Disorder: Efficacy and Proposed Mechanisms.

Psychedelics are emerging as potential treatments for a range of mental health conditions, including anxiety and depression, treatment-resistant depression, and substance use disorders. Recent studies have also suggested that the psychedelic psilocybin may be able to treat obsessive compulsive disorder (OCD). Since the 1960s, case studies have reported improvements to obsessive and compulsive behaviours in patients taking psychedelics recreationally. The effects of psilocybin were then systematically assessed in a small, open-label trial in 2006, which found that psilocybin significantly reduced the symptoms of OCD. Reduced compulsive behaviours have also been seen in rodent models of OCD after administration of psilocybin. Nonetheless, the mechanisms underlying the effects of psychedelics for OCD are unclear, with hypotheses including their acute pharmacological effects, changes in neuroplasticity and resting state neural networks, and their psychological effects. This review will evaluate the evidence supporting the theory that psychedelics can be used for the treatment of OCD, as well as the data regarding claims about their mechanisms. It will also discuss issues with the current evidence and the ongoing trials of psilocybin that aim to address these knowledge gaps.

Anxiety, Obsessive-Compulsive, and Depressive Symptom Presentation and Change Throughout Routine Eating Disorder Treatment.

The present study examined whether patients with binge/purge and restricting anorexia nervosa (AN-BP and AN-R), bulimia nervosa (BN), binge eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding and eating disorder (OSFED) differ in generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and depression symptom patterns and overall comorbid symptom severity at admission. We also assessed between-group differences in the patterns of change and overall comorbid symptom severity change from admission to discharge from routine eating disorder (ED) treatment at higher levels of care (HLOC). The initial sample included 3730 adults routinely assessed for GAD, depression, and OCD at admission and discharge from treatment. ED diagnostic groups exhibited somewhat different symptom patterns (e.g., AN-R and ARFID were more prone to GAD and OCD than depression symptoms; BED exhibited the opposite pattern) and overall symptom severity at admission (i.e., AN-BP and OSFED had the highest overall comorbid symptom severity; BED had the lowest). Although the overall symptom improvement was significantly greater in ARFID and BED than in AN-BP, AN-R, and OSFED, ED patients collectively and within each diagnostic group improved significantly in GAD, OCD, and depression symptoms following routine ED treatment at HLOC.

Ketamine for treatment-resistant obsessive-compulsive disorder: Double-blind active-controlled crossover study.

Obsessive-Compulsive Disorder (OCD) may respond to ketamine treatment. To examine the responsiveness and tolerability of treatment-refractory OCD to intramuscular (IM) ketamine compared to IM fentanyl. This was a randomised double-blind psychoactive-controlled study with single doses of racemic ketamine 0.5 mg/kg, 1.0 mg/kg or fentanyl 50 µg (psychoactive control). Pre-dosing with 4 mg oral ondansetron provided nausea prophylaxis. Eligible participants were aged between 18 and 50 years with severe treatment-resistant OCD. The primary efficacy measure was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Tolerability was measured with the Clinician-Administered Dissociative States Scale (CADSS). Repeated measures analysis of variance with orthogonal polynomial trends was used to assess the effect of drug treatment on Y-BOCS and CADSS scores. Twelve participants were randomised and 10 completed the study (7 females, 3 males, mean age 33 years). Two participants dropped out due to not tolerating dissociative effects associated with the study medication. The reductions in Y-BOCS scores were greater and statistically dose-related for both ketamine doses than fentanyl (dose [linear], F(1, 9) = 6.5, p = 0.031). Score changes for all treatments were maximal at 1-2 h with a steady separation of scores out to 168 h. Ketamine was associated with short-term dissociative and cardiovascular effects. We provide further preliminary evidence for the efficacy and tolerability of IM ketamine in an outpatient cohort of OCD. Additional work is required to establish the optimal dosing regimen and longer-term role of ketamine for OCD. These findings are encouraging given the well-known limitations that exist for treatments in this area.

Encapsulation of fluoxetine by cucurbit[7]uril: A computational and experimental study

Fluoxetine (FLX), a selective serotonin reuptake inhibitor, is widely prescribed for the treatment of depression and obsessive-compulsive disorders. However, the administration of FLX can lead to side effects, which may be mitigated by encapsulating the drug within a macrocyclic host. In this study, we explored the complexation of FLX with cucurbit[7]uril (CB7) using 19F and 1H NMR spectroscopy, fluorescence displacement titrations, and molecular dynamics (MD) simulations. Our fluorescence results indicate that CB7 forms a 1:1 complex with FLX, with a binding constant of 1.7 × 10³ M−1. Additionally, NMR data suggest that the (trifluoromethyl) phenyl moiety of FLX is encapsulated within the CB7 cavity. Molecular dynamics simulations revealed two binding modes for FLX with CB7: one involving the inclusion of the (trifluoromethyl) phenyl moiety and the other involving the phenyl moiety within the CB7 cavity. In both modes, the protonated amine group of FLX interacted with the CB7 portal. Binding free energy calculations using the MM-PBSA method suggested a preference for the inclusion of the phenyl moiety, which contrasts the NMR findings. The interactions between the host and guest were primarily driven by electrostatic forces, with van der Waals interactions playing a lesser, but still favorable, role. In contrast, DFT calculations produced similar binding free energy estimates for the two modes.

Examination of perception of threat from emotion as mechanisms underlying the relationship between obsessive compulsive symptom dimensions and anxiety symptoms

BackgroundThe present study examined the mediating role of perceived threats from anxiety in the relationships among trait anxiety, state anxiety, and the obsessive–compulsive symptom dimension in obsessive–compulsive disorder (OCD).MethodsPatients with OCD (N = 170) completed scales assessing trait and state anxiety, OCD dimensions symptom severity, and perceived threat from anxiety with mediation analyses.ResultsPerceived threat from anxiety appears to be a significant mediator between trait anxiety and harm and unacceptable thoughts symptom dimensions; perceived threat from anxiety had minimal power as a mediator in the relationship between trait anxiety and in the contamination or symmetry dimensions. However, there were no significant relationships between state anxiety and harm and mistakes, unacceptable thoughts or symmetry dimensions except for the contamination dimension.ConclusionsThe findings from our study indicate the significance of perceived threats of anxiety as a mediator function between trait anxiety and OCD symptom dimensions, which may be a maintenance factor. Enhancing the recognition of the role of cognitive mechanisms in the association between trait anxiety rather than state anxiety and different obsessive–compulsive symptom dimensions could contribute to the development of dimension-specific interventions.

Exploring the Role of Sleep Quality, Obsessive–Compulsive Disorder, Fear of Missing Out, and Psychological Resilience on Problematic Instagram Use

Exploring the Role of Sleep Quality, Obsessive–Compulsive Disorder, Fear of Missing Out, and Psychological Resilience on Problematic Instagram Use

Symptom Changes in Patients with Obsessive-Compulsive Disorder During the COVID-19 Pandemic: The Impact of Cognitive Flexibility

Symptom Changes in Patients with Obsessive-Compulsive Disorder During the COVID-19 Pandemic: The Impact of Cognitive Flexibility