Obsessive-compulsive Research Articles

The Role of the Orbitofrontal Cortex in the Regulation of Fear Coping Strategies.

Under threats, individuals exhibit freezing behavior and prepare for active coping. The ability to flexibly shift between freezing and active coping increases survival chances in animals and decreases susceptibility to mental disorders among human beings. For example, patients with psychiatric disorders, such as obsessive-compulsive disorder and posttraumatic stress disorder, often show maladaptive coping behaviors. The orbitofrontal cortex (OFC) is a critical hub to process higher cognitive functions, sensory inputs, reward learning, and decision-making. It also regulates negative emotions and its aberrant activation level often correlates with numerous mental disorders. The rodent OFC comprises different subdivisions with varying connections to cortical and subcortical regions. Among these subdivisions, the medial orbital area (MO) and the lateral orbital area (LO) have distinct functions in the regulation of fear. Here, we updated the existing rodent literature studying the function of the OFC, with a particular focus on the MO and the LO in different coping strategies of animals. By examining the role of the OFC in the mediation of defensive coping strategies, we aim to deepen the understanding of its functional importance on mental health.

Retrospective evaluation of stuttering cases with and without PANDAS comorbidity

Purpose: The aim of this study is to evaluate the clinical, demographic, and autoimmune characteristics of stuttering cases with and without Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) comorbidity. Materials and Methods: The study included 271 children and adolescents aged 2-17 years who were brought to our outpatient clinic between 2012 and 2022 and diagnosed with stuttering. The demographic information and medical characteristics of the patients and their families, such as infections, allergies, rheumatic diseases, and tonsillectomy or penicillin prophylaxis, were evaluated retrospectively. Their routine laboratory test results were also documented. Results: In total, 55 girls (20.3%) and 216 (79.7%) boys at a mean age of 7.6±3.6 years were included. Forty-eight cases (17%) were in the PANDAS group, and 223 (82.3%) were in the non-PANDAS group. The comparison of the PANDAS and non-PANDAS groups showed that the PANDAS group had significantly higher rates of history of tonsillectomy, history of adenoidectomy, and history of frequent infections. The rates of psychiatric, autoimmune, and allergic diseases in the families of the cases in the PANDAS group were significantly higher. The PANDAS group had a significantly greater frequency of comorbid conditions such as obsessive-compulsive disorder, tics, attention-deficit/hyperactivity disorder, and anxiety, as well as a greater mean number of comorbid conditions with at least one diagnosis. Additionally, the age at onset of psychiatric symptoms and the mean age of cases were higher in the PANDAS group. The mean initial anti-streptolysin O level of the PANDAS group was 326.5±335.3 IU/mL, while the mean level in the non-PANDAS group was 155.6±215.1 IU/mL. Conclusion: Both the individuals in the PANDAS group and their families had high rates of comorbidities and inflammatory and autoimmune disorders. In cases of stuttering, there is a need to evaluate these conditions, determine the required methodologies, and explain the relevant pathophysiological mechanisms.

Universal personality dimensions and dysfunctional obsessional beliefs in the DSM-5’s OCD and related disorders (OCRDs)

ABSTRACT This study aimed to determine the extent to which personality and cognitive factors contribute to the identification of shared associations between the DSM-5’s OCD and Related Disorders (OCRDs). Participants (n = 239) were treatment-seeking outpatients with a principal diagnosis of obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (TTM), or excoriation disorder (EXC), as compared to healthy community controls (n = 100). Analyses examined the relationships between diagnostic group, personality dimensions, and obsessive beliefs. Results demonstrated that compared to non-clinical controls, all diagnostic groups scored significantly higher on neuroticism and lower on extraversion and conscientiousness. Few significant differences were found across diagnostic groups: extraversion was higher in the TTM group (vs. all OCRDs), conscientiousness was lower in the HD group (vs. OCD, TTM, EXC), and openness to experience was higher in the TTM and EXC groups (vs. OCD, HD). Obsessional beliefs were significantly elevated in all clinical conditions (vs. controls) except for beliefs surrounding responsibility and threat estimation, which were only significantly higher in OCD and BDD groups. These results highlight shared personality and cognitive vulnerability in the OCRDs as well as unique disorder-specific vulnerabilities related to OCD.

Obsessive-compulsive disorder from a cognitive-behavioural point of view

The prevalence of obsessive-compulsive disorder in the adult population is estimated at about 2–3%, while in children the prevalence of this disorder is higher, and it is considered to be one of the most common neuropsychiatric diseases in paediatric populations. Symptoms from the obsessive-compulsive disorder spectrum can vary in severity or occur with varying frequency. In severe cases, they are time-consuming and disorganise functioning, causing psychological stress not only to patients but often to those around them. The level of insight differentiates individuals with obsessive-compulsive disorder, affecting the course of treatment. Low insight often accompanies poor susceptibility to pharmacotherapeutic and psychotherapeutic interactions, while high levels of criticism may inhibit the motivation to seek help, out of fear of social judgement. Obsessive-compulsive disorder deserves the attention of clinicians because, without appropriate treatment, the disorder can take a chronic form, often becoming a trigger for depression, social phobia, or addiction. American data show that 90% of respondents meeting the criteria for obsessive-compulsive disorder also suffer from another Axis I disorder. Cognitive-behavioural therapy is a method with proven effectiveness in the treatment of Axis I disorders, including obsessive-compulsive disorder. The first goal of this paper is to present cognitive models of obsessive-compulsive disorder that will allow clinicians to understand the nature of this condition. The second goal is to describe the possibilities and tools used in cognitive-behavioural psychotherapy of patients.

Patterns of Child and Adolescent Psychiatric Admissions Before and After the Onset of the COVID-19 Pandemic: Take Home Messages from a Clinical Population.

: This study from Istanbul aimed to compare the child and adolescent psychiatric admissions and diagnosis rates between the first 3 months of the pandemic, the previous 3 months in the same year, and the same months in the previous year. : Children and adolescents were grouped according to the admission dates. Group A, between March 11 and June 1, 2020; Group B, between January 1 and March 11, 2020; and Group C, between March 11 and June 1, 2019. Only clinical interviews and diagnoses according to Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) interview were included. : Autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD)/tic disorder, and intellectual disability (ID) diagnoses were higher in group A than in groups B and C (for ASD, 6.4%, 4.3%, and 3.6%; for OCD/tic disorder, 2.9%, 1.8%, 1.7%; for ID, 3.7%, 2.5%, and 2.1%, respectively) (P < .001). Attention-deficit hyperactivity disorder (ADHD) diagnosis was higher in group A than in only group B (59.8% and 49.7%, respectively) (P < 0.001). Depression was higher in group A than in only group C (4.1% and 2.2%, respectively) (P < .001). Conduct disorder (CD) diagnosis was lower in group A than in only group B (3.6% and 6.4%, respectively) (P < .05). : Child psychiatry diagnosis rates were found to change significantly during the initial phase of the pandemic period. Among the referrals, ASD, OCD, Tic disorder, ID, ADHD, and depression admissions were significantly higher. The rate of pediatric neurodevelopmental disorders, particularly ASD, increased during the initial phase of the COVID-19 pandemic.

Changes in Child Psychiatry Presentations in the Second Wave of Coronavirus Disease 2019 Pandemic Compared to the Pre-pandemic Period and the First Wave: A Follow-up Study.

It is to examine how child psychiatry admissions, diagnosis and treatment trends in the second wave (September-December 2020/SD20) of the coronavirus disease 2019 (COVID-19) pandemic change compared to the pre-pandemic (SD19) and the first wave (March-June 2020/MJ20). Our study was planned as a multicenter, retrospective cross-sectional. Data were obtained from hospital computer systems databases. All patients admitted to the child psychiatry clinic on SD19 and SD20 constituted the study sample. In total, 5244 admissions were assessed. Of the admissions, 1459 were repeat exams, and 3785 were cases. 50.9% (n = 1927) of the cases came in SD19 and 49.1% (n = 1858) in SD20. In 2019, 37% (n = 825) of cases were girls, compared to 41.6% (n = 646) in 2020 (P = .004). The mean age of those who came in 2019 was 9.61 ± 4.08; The mean age of those who came in 2020 was 10.15 ± 5.38 (P = .002). In 2020, oppositional defiant conduct disorder, major depressive disorder, social anxiety disorder, obsessive-compulsive disorder, sleep-wake disorder, and dysthymia were significantly higher, while specific learning disorders, separation anxiety disorder, and intellectual disability were found to be lower. The decrease in second-wave admissions is less than in the first wave. In the second wave, externalizing and internalizing problems have increased. Drug therapy was prioritized. Postponing admissions was less in the second wave.

Assessment of Children and Adolescents’ Admissions to Pediatric Psychiatric Emergency Department

Objective Emergencies in child and adolescent psychiatry are prevalent, and pediatric psychiatric emergency departments play a crucial role in acute intervention during mental health-related crises. This retrospective cross-sectional study aimed to analyze the characteristics of children and adolescents who were admitted to a pediatric psychiatric emergency department. Method The data were collected from the records of 8803 patients (females 56.6%, Mage = 15.07 ± 2.6) admitted to our pediatric psychiatry emergency department between 2014 and 2021. Diagnoses were made using the International Statistical Classification of Diseases, 10th Revision. We used descriptive statistics to determine patient characteristics and conducted a regression analysis to compare the changes in the admissions numbers by the year. Results It was found that depressive disorder was the highest psychiatric diagnosis, with a percentage of 21.4%. Depressive disorder, autism spectrum disorder, and obsessive-compulsive disorder have shown an increase over the years. In 2020, with the onset of the COVID-19 pandemic, psychiatric admissions reached their lowest level. The percentage of hospitalizations was 21.1% for the total of all years. No significant change was found in the total number of admissions, sex, and age. Conclusions The number of admissions for female adolescents who were diagnosed with depressive disorder to our pediatric psychiatry emergency department is shown to be high. The fact that these patients seek help more frequently should be taken into consideration during the planning of mental health services for outpatient and inpatient clinics as well as pediatric psychiatry emergency services.

Association of air pollutants with psychiatric disorders: a two-sample Mendelian randomization

BackgroundThe link between air pollution and increased risk of psychiatric disorders has been growing in evidence. However, the causal relationship between air pollution and psychiatric disorders remains poorly understood. MethodsSingle-nucleotide polymorphisms associated with air pollutants (including NOx, NO2, PM2.5, PM2.5–10, and PM10) from the UK Biobank were used as instrumental variables. Summary-level data for psychiatric disorders (major depressive disorder, anxiety, bipolar disorder, schizophrenia, post-traumatic stress disorder, attention deficit hyperactivity disorder, autism spectrum disorder, anorexia nervosa, and obsessive-compulsive disorder) were procured from the Psychiatric Genomics Consortium and FinnGen consortium. Two-sample Mendelian randomization (MR) analysis was conducted to analyze the causal associations. ResultsThe MR analysis revealed significant associations between certain air pollutants and specific types of psychiatric disorders. The inverse-variance weighted model of preliminary analysis indicated that genetically predicted NO2 was associated with increased risks of major depressive disorder (odds ratio [OR]: 1.13, 95 % confidence intervals [CI]: 1.00–1.28, P = 0.041), bipolar disorder (OR: 1.26, 95 % CI: 1.00–1.58, P = 0.0497), schizophrenia (OR: 1.57, 95 % CI: 1.23–2.00, P < 0.001), attention deficit hyperactivity disorder (OR: 1.61, 95 % CI: 1.25–2.09, P < 0.001) and autism spectrum disorder (OR: 1.39, 95 % CI: 1.01–1.91, P = 0.044). Genetically predicted PM2.5 showed a positive association with the risk of major depressive disorder (OR: 1.21, 95 % CI: 1.06–1.39, P = 0.006), bipolar disorder (OR: 1.32, 95 % CI: 1.03–1.69, P = 0.030) and attention deficit hyperactivity disorder (OR: 1.57, 95 % CI: 1.16–2.12, P = 0.004). In addition, our results also indicated that NOx (OR: 1.64, 95 % CI: 1.21–2.21, P = 0.0012) and PM10 (OR: 1.70, 95 % CI: 1.23–2.36, P = 0.0014) could increase the risk of attention deficit hyperactivity disorder. ConclusionsThe MR analysis provides evidence for the causality of different air pollutants on specific psychiatric disorders, underscoring the importance of mitigating air pollution to reduce the risk of psychiatric disorders.

Assessment of “Incompleteness” and “Not-just-right Experiences” in Patients of Obsessive-compulsive Disorders: A Cross-sectional Study

Assessment of “Incompleteness” and “Not-just-right Experiences” in Patients of Obsessive-compulsive Disorders: A Cross-sectional Study

Reduced pineal gland volume in patients with obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder (OCD) can have hyperactivity of the hypothalamic-pituitary-adrenal axis and may have increased secretion of adrenocorticotropic hormone and cortisol and reduced secretion of melatonin. Examination of pineal gland volumes in patients with OCD compared to healthy controls, thus, is an important consideration and the focus of this study. A total of 20 patients with OCD and 20 healthy controls were enrolled. Demographic and clinical characteristics of participants were assessed, and structural magnetic resonance imaging was performed. Patients with OCD had a statistically significant smaller pineal gland volumes compared to healthy controls. In this initial small study, patients with OCD exhibited smaller pineal gland volumes compared to healthy control subjects. While this finding suggests a potential link between the pineal gland and OCD pathophysiology, further research with larger sample sizes and measurement of hormonal changes are necessary.

Lessons learned from a multimodal sensor-based eHealth approach for treating pediatric obsessive-compulsive disorder.

The present study investigates the feasibility and usability of a sensor-based eHealth treatment in psychotherapy for pediatric obsessive-compulsive disorder (OCD), and explores the promises and pitfalls of this novel approach. With eHealth interventions, therapy can be delivered in a patient's home environment, leading to a more ecologically valid symptom assessment and access to experts even in rural areas. Furthermore, sensors can help indicate a patient's emotional and physical state during treatment. Finally, using sensors during exposure with response prevention (E/RP) can help individualize therapy and prevent avoidance behavior. In this study, we developed and subsequently evaluated a multimodal sensor-based eHealth intervention during 14 video sessions of cognitive-behavioral therapy (CBT) in 20 patients with OCD aged 12-18. During E/RP, we recorded eye movements and gaze direction via eye trackers, and an ECG chest strap captured heart rate (HR) to identify stress responses. Additionally, motion sensors detected approach and avoidance behavior. The results indicate a promising application of sensor-supported therapy for pediatric OCD, such that the technology was well-accepted by the participants, and the therapeutic relationship was successfully established in the context of internet-based treatment. Patients, their parents, and the therapists all showed high levels of satisfaction with this form of therapy and rated the wearable approach in the home environment as helpful, with fewer OCD symptoms perceived at the end of the treatment. The goal of this study was to gain a better understanding of the psychological and physiological processes that occur in pediatric patients during exposure-based online treatment. In addition, 10 key considerations in preparing and conducting sensor-supported CBT for children and adolescents with OCD are explored at the end of the article. This approach has the potential to overcome limitations in eHealth interventions by allowing the real-time transmission of objective data to therapists, once challenges regarding technical support and hardware and software usability are addressed. www.ClinicalTrials.gov, identifier (NCT05291611).

Single-dose psilocybin alters resting state functional networks in patients with body dysmorphic disorder

Body dysmorphic disorder (BDD) is a severe psychiatric condition characterized by preoccupation with perceived flaws in one's appearance, which the individual views as defective or ugly. Psilocybin, a serotonin 2A receptor agonist with psychedelic properties, has emerged as a potential therapeutic agent for depression and other psychiatric disorders. This study aimed to identify subacute neural changes predicting symptomatic response to psilocybin treatment in adults with BDD. Eight adults with moderate-to-severe nondelusional BDD were administered a single oral 25 mg dose of psilocybin, accompanied by psychological support, and underwent resting state functional magnetic resonance imaging assessments 1 day before and 1 day after the dosing. Both a region of interest (ROI)-to-ROI analysis and multivariate pattern analysis (MVPA) were used to identify changes in resting state functional connectivity (rsFC) at day 1 after dosing that predicted treatment response at week 1, measured by change in Yale-Brown Obsessive Compulsive Disorder Scale Modified for BDD (BDD-YBOCS) score. All participants completed the dosing and follow-up assessments over 12 weeks. BDD-YBOCS scores decreased at week 1 and week 12 after dosing (p&lt;0.001 for both). MVPA revealed a significant increase in rsFC within the Executive Control Network (ECN) at day 1. Increased rsFC within the ECN (dlPFC – Superior Parietal Lobule [FPL]), between the ECN and Default Mode Network (dlPFC – Precuneus), and between the ECN and the Salience Network (dlPFC – insula) were predictive of improvement in BDD symptoms at week 1. These findings are the first report of subacute brain effects of psilocybin in patients with BDD. Given the small sample size and uncontrolled design of the study, larger controlled studies are necessary to validate these observations. Clinical Trials Registration: Clinicaltrials.gov ID: NCT04656301

The safety and efficacy of N-acetylcysteine as an augmentation in the treatment of obsessive-compulsive disorder in adults: a systematic review and meta-analysis of randomized clinical trials.

Obsessive-compulsive disorder (OCD) ranks as the fourth most prevalent psychiatric disorder, with selective serotonin reuptake inhibitors (SSRIs) as its mainstay pharmacological treatment. However, approximately 40 to 60% of patients do not adequately respond to initial treatment, highlighting the need for alternative options. N-acetylcysteine (NAC) is one of the several medications that have been used in augmentation with SSRIs to enhance their efficacy. We aimed to investigate the safety and efficacy of NAC, a glutamate-modulating agent, as an augmentation in the treatment of moderate to severe OCD. We conducted a thorough search across PubMed, Scopus, Web of science, and ProQuest to identify relevant trials published until December 2023. The primary outcome of interest was the mean difference between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores before and after administrating augmented NAC among patients with moderate to severe OCD. Furthermore, we compared the occurrence of adverse drug events between the experimental and control groups. We included six randomized controlled trials with 195 patients. The results of our study indicated a positive outcome for the experimental group in terms of the total Y-BOCS score when using the medication for a period of five to eight weeks (p-Value = 0.05). However, no significant difference was observed for durations shorter than five weeks or longer than 12 weeks. Additionally, no significant difference was found between the two groups in terms of the obsession and compulsion Y-BOCS scores. Furthermore, no significant differences were observed in terms of adverse events. Augmentation of NAC with SSRIs may benefit patients with moderate to severe OCD. However, it is necessary to conduct additional multi-center trials over extended periods to develop a comprehensive strategy for action. https://www.crd.york.ac.uk/prospero/, identifier CRD42023463683.

Theoretically grounded music therapy interventions for people with obsessive compulsive disorder

Over two percent of adults experience obsessive compulsive disorder (OCD) in their lifetime, and research on novel, effective treatments for this condition is needed. OCD is characterized by obsessions and compulsions spanning several domains including but not limited to cleanliness, evenness, and unacceptable or disturbing thoughts. Although there is a deficit of research on music therapy for people with OCD, preliminary research has indicated that music-based interventions and music therapy can help decrease anxiety, rigidity, obsessions, and compulsions in people with OCD. The purpose of this paper was to explore and develop music therapy interventions for people with OCD grounded in theories and concepts related to this diagnosis. The authors conducted a narrative literature review of interdisciplinary research on music therapy and OCD. In this manuscript, the authors reviewed three theories and concepts related to OCD and their applications to music therapy: evaluative conditioning, incompleteness and not just right experiences, and transdiagnostic theory. The authors used these theories to develop music therapy interventions to address areas of life that can be impacted by OCD identified in the Cognitive Assessment Instrument of Obsessions and Compulsions. Empirical research is needed to determine the efficacy, practicality, and generalizability of proposed music therapy interventions.

Safety and efficacy of targeting the supplementary motor area with double-cone deep transcranial magnetic stimulation vs figure-eight coil in treatment of obsessive-compulsive disorder with comorbid major depressive disorder

Background and objectiveThe Supplementary Motor Area (SMA), a relatively large brain structure predominantly located along the interhemispheric fissure, is an established target for repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Obsessive-Compulsive Disorder (OCD). We investigated the feasibility, safety, and efficacy of targeting SMA using a double-cone “deep” TMS coil compared to conventional figure-eight coil for treatment of OCD with comorbid Major Depressive Disorder (MDD). MethodsSixty-two patients with treatment-resistant OCD and comorbid MDD participated in the study. All patients received high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) with a figure-eight coil (MagVenture B70), followed by 1 Hz rTMS over the bilateral SMA using either the B70 (N = 25) or double-cone deep coil (MagVenture DB80) (n = 23) for 36 treatment sessions. Weekly clinical assessments were conducted. ResultsSubjects overall had significant reductions in OCD and depressive symptom severity at the primary endpoint. Subjects stimulated at SMA with the double-cone deep coil had statistically significantly lesser reductions in overall OCD and depression symptom severity compared to the figure-eight group. The intensity of stimulation at SMA was significantly greater with the double-cone deep than figure-eight coil and e-field modeling showed that it affected broader regions beyond SMA (off-target stimulation). There was no significant difference in reported tolerability between groups. ConclusionsSMA stimulation using either a double-cone deep or conventional figure-of-eight coil was safe and was associated with a significant reduction in comorbid OCD and depression symptoms, but the higher intensities of stimulation with the double-cone deep coil used in this study were significantly less clinically beneficial than figure-eight coil stimulation.

Severe Epilepsy in an Individual With a TSC2 R905Q Variant Prompting Late Diagnosis in Affected Family Members

BackgroundTuberous sclerosis complex (TSC) is a multisystemic disorder caused by inactivating variants in the mTOR pathway inhibitor genes TSC1 and TSC2. Individuals with TSC are predisposed to benign tumors in multiple organs as well as TSC-associated neuropsychiatric disorders (TAND) and epilepsy. Pathogenic variants in TSC2 are typically associated with a more severe phenotype compared with TSC1; the TSC2 R905Q variant has been shown to be an exception, where patients have been reported to present with unusually mild TSC features that may be undetected. MethodsWe studied the TSC phenotype of a 13-year-old individual and three family members with a TSC2 c.2714G>A (R905Q) pathogenic variant. ResultsPatient 1 presented with severe medically refractory epilepsy without tubers or subependymal nodules and only mild dermatologic features of TSC missed on virtual examinations. Her mother and maternal aunt (Patients 2 and 3–diagnosed after age 50 years) presented with a mild phenotype, with dermatologic features and TAND. Her maternal uncle (Patient 4–diagnosed at age 47 years) displayed the most severe phenotype, presenting with intellectual disability, medically refractory epilepsy, obsessive-compulsive disorder, post-traumatic stress disorder, and psychosis. ConclusionsThis study expands the possible phenotypic spectrum of TSC2 R905Q variant, demonstrating an association with severe epilepsy without associated neuroradiological stigmata. This presentation highlights the possibility of occult focal cortical dysplasia in TSC and emphasizes the importance of genetic testing in individuals with severe epilepsy. Moreover, a late adult diagnosis was subsequently made in other family members allowing for appropriate TSC surveillance to occur.

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

The minimal important difference in obsessive-compulsive disorder: An analysis of double-blind SSRI trials in adults.

The change in symptoms necessary to be clinically relevant in obsessive-compulsive disorder (OCD) is currently unknown. In this study, we aimed to create an empirically validated threshold for clinical significance or minimal important difference (MID). We analyzed individual participant data from short-term, double-blind, placebo-controlled registration trials of selective serotonin reuptake inhibitors in adult OCD patients. Data were collected from baseline to week 12. We used equipercentile linking to equate changes in the Clinical Global Impression (CGI) scale to changes in the Yale-Brown Obsessive-Compulsive Scale (YBOCS). We defined the MID as the YBOCS change linked to a CGI improvement of 3 (defined as "minimal improvement"). We included 7 trials with a total of 1216 patients. The CGI-scores and YBOCS were moderately to highly correlated. The MID corresponded to 4.9 YBOCS points (95% CI 4.4-5.4) for the full sample, or a 24% YBOCS-decrease compared to baseline. The MID varied with baseline severity, being lower in the group with mild symptoms and higher in the group with severe symptoms. By linking the YBOCS to the CGI-I, this is the first study to propose an MID in OCD trials. Having a clearly defined MID can guide future clinical research and help interpretation of efficacy of existing interventions. Our results are clinician-based; however, there is further need for patient-reported outcomes as anchor to the YBOCS.

Lifetime Prevalence of Obsessive-Compulsive Disorder (OCD) in Men With an Eating Disorder: A Meta-Analysis

Lifetime Prevalence of Obsessive-Compulsive Disorder (OCD) in Men With an Eating Disorder: A Meta-Analysis

Obsessive-compulsive disorder as a first manifestation of Ataxia with Oculomotor Apraxia type 2 due to a novel mutation of SETX gene.

Ataxia with oculomotor apraxia type 2 (AOA2) is an autosomal recessive disorder presenting with cerebellar ataxia, sensory-motor axonal neuropathy, oculomotor apraxia, cerebellar atrophy and high alpha-fetoprotein (AFP) serum level. AOA2 is due to coding mutations of the SETX gene, mapped to chromosome 9q34. Seldom noncoding mutations affecting RNA processing have been reported too. To date psychiatric symptoms have never been reported in AOA2. A 19 years-old man came to our attention for progressive gait ataxia debuted five years earlier. His past medical history was unremarkable, while his parents were consanguineous. On neurological examination, he had bilateral horizontal gaze-evoked nystagmus with hypometric saccades and saccadic horizontal smooth pursuit, appendicular ataxia, limbs and trunk myoclonic involuntary movements with hands' dystonic postures and dance of the tendons. Psychological evaluation described intrusive and obsessive thoughts experienced by the patient, then diagnosed as obsessive-compulsive disorder. Blood tests detected an elevated AFP level. Brain MRI showed cerebellar atrophy, while electroneuromyography revealed an axonal sensory-motor polyneuropathy. In the suspicion of a pathology belonging to the autosomal recessive cerebellar ataxias (ARCA) spectrum disorder, a direct search of point mutations by whole-exome sequencing was performed revealing a novel biallelic variant in SETX gene (c.6208+2dupT), which was classified as likely pathogenic. The present case expands the genotypic and phenotypic spectrum of AOA2, reporting a novel likely pathogenic SETX mutation (c.6208+2dupT) and highlighting an early psychiatric involvement in AOA2, suggesting the need for psychiatric assessment in these neurologic patients.