On Obsessive-compulsive Disorder Research Articles

Tryptophan hydroxylase gene polymorphism in patients with obsessive-compulsive disorder

Objective: There is limited number of studies on the effects of tryptophan hydroxylase-1 (TPH-1) A218C gene polymorphism on obsessive-compulsive disorder (OCD) etiology. This study aims to scrutinize the role of TPH-1 A218C gene polymorphism on OCD etiology. Methodology: Sixty patients diagnosed with OCD, applied to our clinic and fitting the study criteria were accepted as patient group. A group of 60 healthy individuals matching the patient group in age and gender were selected as the control group. In the study the Clinical Interview Scale Structured for DSM-IV Axis-I Disorders, Sociodemographic and Clinical Data Form, Yale-Brown Obsessive Compulsive Rating Scale (Y-BOCS) and Hamilton Depression Rating Scale were applied to participants initially. Consequently, they were classified into two groups of ‘responsive to therapy’ and ‘resistant to therapy’ based on their therapy histories and Y-BOCS points. For DNA isolation 300 μl blood samples were used in compliance with standard methods. Restriction Fragment Length Polymorphism method was used to evaluate A218C polymorphism in TPH-1 gene within the blood samples. Results: No significant difference was observed between patient and control groups related to TPH-1 genotypes. However, a significant increase was observed in AA genotype frequency for TPH-1 gene in the patient group resistant to therapy and in CC genotype frequency in the patient group responsive to therapy. The difference of the allele type ratios in this polymorphism between each patient group could be related to the response to therapy. To confirm the findings of the study, more research on the same gene polymorphisms is required with OCD patients in different societies.

Executive functions as a potential neurocognitive endophenotype in anxiety disorders: A systematic review considering DSM-IV and DSM-5 diagnostic criteria classification

Evidence in the literature indicates that neurocognitive impairments may represent endophenotypes in psychiatric disorders.ObjectiveThis study aimed to conduct a systematic review on executive functions as a potential neurocognitive endophenotype in anxiety disorder diagnosis according to the DSM-IV and DSM-5 classifications.MethodsA literature search of the LILACS, Cochrane Library, Index Psi Periódicos Técnico-Científicos, PubMed and PsycInfo databases was conducted, with no time limits. Of the 259 studies found, 14 were included in this review.ResultsOnly studies on obsessive-compulsive disorder (OCD) were found. The executive function components of decision-making, planning, response inhibition, behavioral reversal/alternation, reversal learning and set-shifting/cognitive flexibility were considered to be a neurocognitive endophenotypes in OCD.ConclusionFurther studies on executive functions as a neurocognitive endophenotype in other anxiety disorders are needed since these may have different neurocognitive endophenotypes and require other prevention and treatment approaches.

Associations between obsessive–compulsive symptoms, revenge, and the perception of interpersonal transgressions

Anger and aggression have only recently gained center stage in research on obsessive–compulsive disorder (OCD). An investigation of obsessive–compulsive (OC) symptoms focusing on the outcome of unresolved anger (i.e., revenge), however, is absent from the literature. The objective of the present research was therefore to provide a first step towards filling this gap and, hence, to systematically examine the associations between OC symptoms and different aspects of revenge (i.e., attitudes, dispositions, motivations). In three independent studies with nonclinical participants (N=504), we tested the hypothesis that OC symptoms relate to greater revenge. Individuals high in OC symptoms reported more positive attitudes toward revenge (Study 1), scored higher on a measure of trait revenge (Study 2), and reported increased revenge motivation regarding a real-life transgressor (Study 3). Furthermore, Study 4 (N=175) demonstrated that individuals high in OC symptoms perceived interpersonal transgressions more frequently in their daily lives. OC symptoms were positively related to the number of transgressions that respondents disclosed. Our results suggest that revenge and interpersonal hurt play a significant role in OCD.

From Circuit Activity to Network Connectivity and Back: The Case of Obsessive-Compulsive Disorder

From Circuit Activity to Network Connectivity and Back: The Case of Obsessive-Compulsive Disorder

Obsessive–compulsive-like behaviors in house mice are attenuated by a probiotic (Lactobacillus rhamnosus GG)

Two experiments examined probiotic pretreatment (Lactobacillus rhamnosus GG) on obsessive-compulsive disorder (OCD)-like behavior induction by RU 24969 in BALB/cJ house mice. In the first experiment, two groups were defined by their daily pretreatment by oral gavage of either (a) L. rhamnosus (1×10⁹ CFU/day) or (b) the saline vehicle. Both a 2- and 4-week probiotic pretreatment attenuated OCD-like behavior induction (increased perseverative open-field locomotion, stereotypic turning, and marble burying) relative to saline pretreatment. Experiment 2 re-examined the 2-week probiotic pretreatment while also comparing it to a 4-week fluoxetine pretreatment. Again, groups were defined by daily pretreatment of either (a) L. rhamnosus for 2 weeks, (b) the saline vehicle for 2 weeks, or (c) fluoxetine (10 mg/kg) for 4 weeks. Pretreatment by either L. rhamnosus or fluoxetine blocked the induction of OCD-like behavior compared with saline pretreatment. Thus the 2-week probiotic pretreatment was again effective. Although side effects of fluoxetine or L. rhamnosus on androgen-dependent behaviors could not be demonstrated, L. rhamnosus treatment appeared comparable to fluoxetine treatment in attenuating mouse OCD-like behaviors.

Obsessive-compulsive disorder for ICD-11: proposed changes to the diagnostic guidelines and specifiers.

Since the approval of the ICD-10 by the World Health Organization (WHO) in 1990, global research on obsessive-compulsive disorder (OCD) has expanded dramatically. This article evaluates what changes may be needed to enhance the scientific validity, clinical utility, and global applicability of OCD diagnostic guidelines in preparation for ICD-11. Existing diagnostic guidelines for OCD were compared. Key issues pertaining to clinical description, differential diagnosis, and specifiers were identified and critically reviewed on the basis of the current literature. Specific modifications to ICD guidelines are recommended, including: clarifying the definition of obsessions (i.e., that obsessions can be thoughts, images, or impulses/urges) and compulsions (i.e., clarifying that these can be behaviors or mental acts and not calling these "stereotyped"); stating that compulsions are often associated with obsessions; and removing the ICD-10 duration requirement of at least 2 weeks. In addition, a diagnosis of OCD should no longer be excluded if comorbid with Tourette syndrome, schizophrenia, or depressive disorders. Moreover, the ICD-10 specifiers (i.e., predominantly obsessional thoughts, compulsive acts, or mixed) should be replaced with a specifier for insight. Based on new research, modifications to the ICD-10 diagnostic guidelines for OCD are recommended for ICD-11.

Review Finds 2007 OCD Guideline ‘Substantially Correct and Current’

There are new rating scales in the APA practice guideline that clinicians can use, and augmentation strategies have better evidence than was available in 2007.

Lifetime comorbidity of obsessive-compulsive disorder and sub-threshold obsessive-compulsive symptomatology in the community: impact, prevalence, socio-demographic and clinical characteristics

Objective. This study aims to expand the available knowledge on Obsessive Compulsive Disorder (OCD)-comorbidity by investigating the prevalence and clinical impact on a group of individuals with OCD or subthreshold OC syndrome (OCS), prospectively followed-up over an extended period. Methods. A stratified sample of the general population of the canton of Zurich, Switzerland (n = 591), participated in a series of seven interviews over a 30-year period. Clinically significant comorbid subgroups of OCD/OCS were compared to cases of OCD/OCS without respective comorbidity, in order to determine differences in socio-demographic and other clinical characteristics. Results. Lifetime rates of psychiatric comorbidity were high and increased in prevalence across the OC severity spectrum. Bipolar affective disorder was significantly associated with OCD whereas unipolar major depression and both alcohol and drug misuse disorders were not. Most forms of comorbidity increased distress and impacted negatively on family and work relationships, though disorder-specific effects were observed. Thus, agoraphobia and GAD were associated with increased OCD-severity; bipolar disorder was associated with suicidal acts and panic disorder increased treatment-seeking behaviour. Conclusions. Despite the statistical limitations imposed by the small sample-size, our findings highlight the negative impact of psychiatric comorbidity on health and psychosocial function.

Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-Vedited by HollanderEric, M.D., ZoharJoseph, M.D., SirovatkaPaul J., M.S., and RegierDarrel A., M.D., M.P.H. Washington, DC, American Psychiatric Publishing, 2011, 257 pp., $67.00 (paper).

Obsessive-Compulsive Spectrum Disorders: Refining the Research Agenda for DSM-Vedited by HollanderEric, M.D., ZoharJoseph, M.D., SirovatkaPaul J., M.S., and RegierDarrel A., M.D., M.P.H. Washington, DC, American Psychiatric Publishing, 2011, 257 pp., $67.00 (paper).

Editorial: Categories and dimensions: reflections on obsessive-compulsive disorder (OCD)

Editorial: Categories and dimensions: reflections on obsessive-compulsive disorder (OCD)

Serotonin transporter gene polymorphism implicates reduced orbito-frontal cortex in obsessive–compulsive disorder

Although a number of magnetic resonance imaging (MRI) and genetic studies have been performed on obsessive–compulsive disorder (OCD), only limited studies in which genetic and neuroanatomical variables are evaluated concurrently have been performed. Therefore, the aim of our present study is (to understand) better understanding how genetic variation in the promoter region of the 5-HTT gene (5-HTTLPR) is associated with key brain structures in OCD, orbito-frontal cortex (OFC), thalamus and anterior cingulate. 5-HTT genotypes (SS, SL, LL) were determined for 40 patients with OCD and the same number of healthy controls. MRI-derived volumes of the OFC, thalamus, and anterior cingulate were determined by reliable tracing techniques. Volumetric measurements were made with T1-weighted coronal MRI images, with 1.5-mm-thick slices, at 1.5 T, and were done blindly. In comparison with controls, OCD patients demonstrated volumes reduction in OFC, increased volumes of thalamus and total white matter volumes, but no difference in total brain volume, total gray matter volumes and anterior cingulate volumes. No significant difference was observed in allelic frequencies between the patients and controls. The stronger effects of 5-HTT polymorphism on brain morphology in OCD than those in controls were determined in the both OFC and thalamus. On the other hand, for the OCD patients, ANCOVA revealed a significant main effect of genotype for both the OFC and thalamus and a significant genotype-by-side interaction for the OFC, demonstrating that the short variants had a smaller right OFC than the long variants. In conclusion, we found a significant genotype-diagnosis interaction effects on key brain structures, with a stronger effects of 5-HTT polymorphism in OFC and thalamus of OCD patients, whereas no morphological changes related to the polymorphism were found in normal individuals.

Obsessive Compulsive Disorder with Bipolar Mood Disorder: A Rare Comorbidity in India

Obsessive compulsive features occurring in mania have been well documented. Though there have been some studies on obsessive compulsive disorder (OCD) comorbid with mania in the western countries, there are very few case reports and studies in India. Our aim is to report one such case here, who presented with OC features which are not typical of the symptom cluster of the OCD commonly seen with mania in earlier reports. Also, the comorbidities in OCD should be recognized as this can have important diagnostic and therapeutic implications.

Implicación del circuito corticoestriadotalámico en pacientes con trastorno obsesivo-compulsivo durante una tarea de control inhibitorio con contingencias de recompensa y castigo

Recent neuroimaging studies conducted on obsessive-compulsive disorder (OCD) show alterations in the fronto-thalamic-striatal circuit, which would give rise to an executive dysfunction. This could be the neurocognitive substrate underlying the main symptoms of OCD, i.e. obsessions and compulsions. Both brain activity and behavioural performance of a group of 13 patients with OCD were compared with a control group of 13 healthy subjects by means of functional magnetic resonance imaging while performing an inhibitory control task with reward and punishment contingencies. The effects of medication were also analysed. The intra-group analyses showed a longer reaction time during the go/no go condition in both groups, although there were no differences between the groups in the performance of the task. With regard to this task, significant activation of large areas of the cerebellum and the occipital, temporal and parietal lobes was observed in the healthy subjects. In comparison with the controls, the obsessive patients showed lower activation in the right-side frontal medial and superior gyri, the anterior cingulate cortex and the caudate nucleus, and greater activation in the inferior parietal convolution and the fusiform gyrus. The effects of medication were found in the frontal cortex and basal structures. These results agree with the argument claiming that the dysfunction in the corticostriatal system in OCD is associated to diminished brain activity in response to cognitive tasks.

Was Freud partly right on obsessive–compulsive disorder (OCD)? Investigation of latent aggression in OCD

Inflated responsibility is increasingly regarded a pathogenetic mechanism in obsessive–compulsive disorder (OCD). In seeming contrast, there is mounting evidence that latent aggression is also elevated in OCD. Building upon psychodynamic theories that an altruistic façade including exaggerated concerns for others is partly a defense against latent aggression, evidence was recently obtained for high interpersonal ambivalence in OCD patients relative to psychiatric and healthy controls using a newly developed instrument entitled the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). A total of 46 OCD patients and 23 healthy participants took part in the present study. OCD patients displayed a higher social responsibility than controls. At the same time, patients also disclosed more latent aggression/calculating behavior and interpersonal distrust. While the pathogenic role of latent aggression is still not fully uncovered, it may deserve more consideration in treatment in view of frequent tensions in the families of OCD patients. Longitudinal studies with at-risk sample are needed to assess the relationship between problems with anger expression as well as (exaggerated) moral standards in OCD.

Exposure-in-vivo containing interventions to improve work functioning of workers with anxiety disorder: a systematic review

BackgroundAnxiety disorders are associated with functional disability, sickness absence, and decreased productivity. Effective treatments of anxiety disorders can result in remission of symptoms. However the effects on work related outcomes are largely unknown. Exposure in vivo is potentially well fit to improve work-related outcomes. This study systematically reviews the effectiveness of exposure-in-vivo containing interventions in reducing work-related adverse outcomes in workers with anxiety disorders.MethodsA systematic study search was conducted in Medline, Cinahl, Embase and Psycinfo. Two reviewers independently extracted data and from each study assessed the quality of evidence by using the GRADE approach. We performed a meta-analysis if data showed sufficient clinical homogeneity.ResultsSeven studies containing 11 exposure-in-vivo interventions were included. Four studies were focused on Obsessive Compulsive Disorder (OCD), two on Post Traumatic Stress Disorder (PTSD), and one on a mixed group of OCD and severe phobias. The studies were grouped according to type of anxiety disorder and subsequently according to type of comparisons. For OCD, exposure-in-vivo containing interventions can yield better work-related outcomes compared to medication (SSRIs) and relaxation but not better compared to response prevention. The results on anxiety outcomes were similar. The net contribution of exposure in vivo in two OCD intervention programs is also presented as a meta-analysis and shows significant positive results on work role limitations. The calculated pooled effect size with 95% confidence interval was 0.72 (0.28, 1.15). For PTSD, exposure-in-vivo containing interventions can yield better work-related and anxiety-related outcomes compared to a waiting-list but not better compared to imaginal exposure.ConclusionsExposure in vivo as part of an anxiety treatment can reduce work-related adverse outcomes in workers with OCD and PTSD better than various other anxiety treatments or a waiting-list. We recommend that it should be studied how the results of these studies can be transferred to the practice of occupational health professionals and how clinicians can make better use of them to improve work-related outcomes. In future research, priority should be given to high-quality randomised controlled trials (RCTs) in which exposure-in-vivo containing interventions are applied to a variety of anxiety disorders and compared with other clinical anxiety treatments such as SSRIs. Work-related outcomes, in particular work functioning and sickness absence, need to be assessed with reliable and valid measures.

Association Between Polymorphisms in GRIK2 Gene and Obsessive-Compulsive Disorder: A Family-Based Study

Several studies support a genetic influence on obsessive-compulsive disorder (OCD) etiology. The role of glutamate as an important neurotransmitter affecting OCD pathophysiology has been supported by neuroimaging, animal model, medication, and initial candidate gene studies. Genes involved in glutamatergic pathways, such as the glutamate receptor, ionotropic, kainate 2 (GRIK2), have been associated with OCD in previous studies. This study examines GRIK2 as a candidate gene for OCD susceptibility in a family-based approach. Probands had full DSM-IV diagnostic criteria for OCD. Forty-seven OCD probands and their parents were recruited from tertiary care OCD specialty clinics from France and USA. Genotypes of single nucleotide polymorphism (SNP) markers and related haplotypes were analyzed using Haploview and FBAT software. The polymorphism at rs1556995 (P= 0.0027; permuted P-value = 0.03) was significantly associated with the presence of OCD. Also, the two marker haplotype rs1556995/rs1417182, was significantly associated with OCD (P= 0.0019, permuted P-value = 0.01). This study supports previously reported findings of association between proximal GRIK2 SNPs and OCD in a comprehensive evaluation of the gene. Further study with independent samples and larger sample sizes is required.

Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V.

Since the publication of the DSM-IV in 1994, research on obsessive-compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses.

Role of dopamine in the pathophysiology and treatment of obsessive–compulsive disorder

The differential effects of serotonin-reuptake inhibitors on obsessive–compulsive disorder (OCD) were sufficient to presume that a serotonin regulatory disorder is the most essential part of the pathophysiology of OCD. In patients with OCD, however, a high-dose of serotonin-reuptake inhibitor monotherapy may not be sufficient, and approximately half of patients were noted to be treatment-resistant. As results from previous studies have shown, there have been positive treatment responses to the dopaminergic antagonists. This suggests that other neurotransmitter systems, such as dopamine, are involved in the pathophysiology of OCD. Preclinical, neuroimaging and neurochemical studies have provided evidence demonstrating that the dopaminergic system is involved in inducing or aggravating the symptoms that are indicative of OCD. In this article, we review the dopaminergic system in OCD pathophysiology as well as reviewing the effect of drugs that act on dopaminergic activity in OCD.

Obsessive-compulsive disorder and related disorders: a comprehensive survey

Our aim was to present a comprehensive, updated survey on obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders (OCRDs) and their clinical management via literature review, critical analysis and synthesis.Information on OCD and OCRD current nosography, clinical phenomenology and etiology, may lead to a better comprehension of their management. Clinicians should become familiar with the broad spectrum of OCD disorders, since it is a pivotal issue in current clinical psychiatry.

The Effects of a Mindfulness Intervention on Obsessive-Compulsive Symptoms in a Non-Clinical Student Population

This controlled pilot study tested the effects of a mindfulness intervention on obsessive compulsive disorder (OCD) symptoms and tested the psychological processes possibly mediating such effects. Participants with OCD symptoms (12 women, 5 men) received either mindfulness training (N=8) or formed a waiting-list control group (N = 9). Meditation included 8 group meetings teaching meditative breathing, body-scan, and mindful daily living, applied to OCD. The intervention had a significant and large effect on mindfulness, OCD symptoms, letting go, and thought-action fusion. Controlling for changes in "letting go," group effects on change in OCD symptoms disappeared, pointing at a mediating role for letting go. This may be the first controlled study demonstrating that a mindfulness intervention reduces OCD symptoms, possibly explained by increasing letting go capacity. If replicated in larger and clinical samples, mindfulness training may be an alternative therapy for OCD.