Or Obsessive-compulsive Disorder Research Articles

Intensive Exposure Therapy for an Individual With History of Self-Harm and Suicidality

Practitioners may hesitate to treat patients with a history of nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs) using exposure therapy due to concerns that exposures will increase these risk-related behaviors. However, when NSSI/STBs are exacerbated by distress associated with anxiety disorders or obsessive-compulsive disorder (OCD), lack of treatment can worsen disability. This case report describes the treatment of a 14-year-old gender-fluid individual with symptoms of multiple anxiety disorders, OCD, and borderline personality disorder (including emotion dysregulation, chronic suicidality, and NSSI). Treatment involved dialectical behavioral therapy (DBT) for “stage one” of treatment, including maintaining behavioral control over self-harm and suicidal behaviors, followed by intensive exposure and response prevention (ERP) during “stage two” of treatment. Upon discharge, the client had maintained an absence of NSSI/STBs, demonstrated reductions in anxiety and OC symptoms, observed further decreased familial accommodation, and improved daily functioning. In addition, the client’s parents exhibited an improved capacity to regulate their own emotions (before responding to the client), more validating responses, and reduction in familial accommodation. This case report supports the feasibility, efficacy, and safety of exposure therapy for individuals in “stage two” of DBT and highlights the role of exposure as an important emotion regulation strategy to reduce OCD and anxiety symptoms in patients with a history of self-harm and suicidality. Challenges, successes, and future directions are discussed.

Suicidal Risk in People with Obsessive Compulsive Disorder

Obsessive compulsive disorder or Obsessive Compulsive Disorder (OCD) is a psychiatric disorder characterized by excessive anxiety, persistent thoughts (obsessions), and repetitive behaviors (compulsions). The prevalence of OCD in Europe ranges from 0.1-2.3% annually and more common in adults. The risk of suicide increases ten times more in OCD sufferers compared to the non-OCD sufferers with prevalence the OCD sufferers who has thoughts of suicide is 23.3%. This literature review aims to determine the risk factors for suicide in OCD patients so that prevention can be carried out in individuals who have risk factors. In this literature review we conducted a search on the PubMed, Google Schoolar, and Researchgate database using the search keyword “Obsessive Compulsive Disorder”, “Obsessive Compulsive Symptoms”, “Suicide”, “Self-murder”, and “Risk Factor”. OCD is a disease with genetic and non-genetic risk factors, can manifest clinically as obsessions and compulsions that occur due to failure in responding to yedasantience signals so that the security motivation system (SMS) will be activated longer than normal. The longer SMS activated, the more depressive symptoms can develop, which tends to give rise to suicidal thoughts. In conclusion, risk factors for suicide in OCD that can be identified earlier will not only help the patient's prognosis but also help them choose treatment steps that are appropriate with the severity of the OCD symptoms.

Transformers for autonomous recognition of psychiatric dysfunction via raw and imbalanced EEG signals

Early identification of mental disorders, based on subjective interviews, is extremely challenging in the clinical setting. There is a growing interest in developing automated screening tools for potential mental health problems based on biological markers. Here, we demonstrate the feasibility of an AI-powered diagnosis of different mental disorders using EEG data. Specifically, this work aims to classify different mental disorders in the following ecological context accurately: (1) using raw EEG data, (2) collected during rest, (3) during both eye open, and eye closed conditions, (4) at short 2-min duration, (5) on participants with different psychiatric conditions, (6) with some overlapping symptoms, and (7) with strongly imbalanced classes. To tackle this challenge, we designed and optimized a transformer-based architecture, where class imbalance is addressed through focal loss and class weight balancing. Using the recently released TDBRAIN dataset (n= 1274 participants), our method classifies each participant as either a neurotypical or suffering from major depressive disorder (MDD), attention deficit hyperactivity disorder (ADHD), subjective memory complaints (SMC), or obsessive–compulsive disorder (OCD). We evaluate the performance of the proposed architecture on both the window-level and the patient-level. The classification of the 2-min raw EEG data into five classes achieved a window-level accuracy of 63.2% and 65.8% for open and closed eye conditions, respectively. When the classification is limited to three main classes (MDD, ADHD, SMC), window level accuracy improved to 75.1% and 69.9% for eye open and eye closed conditions, respectively. Our work paves the way for developing novel AI-based methods for accurately diagnosing mental disorders using raw resting-state EEG data.

Socratic Questioning Sebagai Solusi Masalah Waswas: Pendekatan Hadis Terpilih

Several hadiths reported by the Prophet Muhammad ﷺ contain several questions and answers about a topic. It discusses a lot about all the issues that occur, as well as answers to the issues that are provided. However, questions and answers from hadiths on mental issues have long been employed as one of the therapies used by psychiatrists and clinical psychologists today, known as Socratic inquiry. This technique is significant in the process of mental health therapy, particularly for waswas or obsessive-compulsive disorder (OCD), as well as for other mental disorders such as anxiety disorder. Based on a knowledge of Hadith jurisprudence, the purpose of this research is to compile those hadiths linked to waswas that contain features of Socratic inquiry. A total of four hadiths have been recognised as being associated with misgiving and the use of Socratic inquiry as a problem-solving technique. As a result, three forms of Socratic inquiry have been developed based on four hadiths linked to misgiving, namely Questions of Clarification, Questions About the Question, and Questions that Probe Assumptions. This study is anticipated to emphasise the chosen hadith method as one component of treatment in mental health, specifically the waswas issue.

Mice lacking Ptprd exhibit deficits in goal-directed behavior and female-specific impairments in sensorimotor gating.

Protein Tyrosine Phosphatase receptor type D (PTPRD) is a member of the protein tyrosine phosphatase family that mediates cell adhesion and synaptic specification. Genetic studies have linked Ptprd to several neuropsychiatric phenotypes, including Restless Leg Syndrome (RLS), opioid abuse disorder, and antipsychotic-induced weight gain. Genome-wide association studies (GWAS) of either pediatric obsessive-compulsive traits, or Obsessive-Compulsive Disorder (OCD), have identified loci near PTPRD as genome-wide significant, or strongly suggestive for this trait. We assessed Ptprd wild-type (WT), heterozygous (HT), and knockout (KO) mice for behavioral dimensions that are altered in OCD, including anxiety and exploration (open field test, dig test), perseverative behavior (splash-induced grooming, spatial d), sensorimotor gating (prepulse inhibition), and home cage goal-directed behavior (nest building). No effect of genotype was observed in any measure of the open field test, dig test, or splash test. However, Ptprd KO mice of both sexes showed impairments in nest building behavior. Finally, female, but not male, Ptprd KO mice showed deficits in prepulse inhibition, an operational measure of sensorimotor gating that is reduced in female, but not male, OCD patients. Our results indicate that constitutive lack of Ptprd may contribute to the development of certain domains that are altered OCD, including goal-directed behavior, and reduced sensorimotor gating specifically in females.

Asceticism of the Mind: Forms of Attention and Self-Transformation in Late Antique Monasticism

Asceticism of the Mind: Forms of Attention and Self-Transformation in Late Antique Monasticism

The gut microbiome in children with mood, anxiety, and neurodevelopmental disorders: An umbrella review

Abstract Research on the gut microbiome and mental health among children and adolescents is growing. This umbrella review provides a high-level overview of current evidence syntheses to amalgamate current research and inform future directions. Searches were conducted across seven databases for peer-reviewed pediatric (<18 years) review literature. Studies reporting gut microbiome composition and/or biotic supplementation on depression, bipolar disorder, anxiety, attention deficit hyperactivity disorder, autism spectrum disorder (ASD), or obsessive-compulsive disorder (OCD) were included. Deduplication and screening took place in Covidence. A sensitivity analysis was conducted to assess the degree of primary study overlap. Among the 39 included review studies, 23 (59%) were observational and 16 (41%) were interventional. Most reviews (92%) focused on ASD. Over half (56%) of the observational and interventional reviews scored low or critically low for methodological quality. A higher abundance of Clostridium clusters and a lower abundance of Bifidobacterium were consistently observed in ASD studies. Biotic supplementation was associated with ASD symptom improvement. Gut microbiome-mental health evidence syntheses in child and youth depression, anxiety, bipolar disorder, and OCD are lacking. Preliminary evidence suggests an association between specific microbiota and ASD symptoms, with some evidence supporting a role for probiotic supplementation ASD therapy.

Any overlap between orthorexia nervosa and obsessive–compulsive disorder in Lebanese adults? Results of a cross-sectional study and validation of the 12-item and 4-item obsessive–compulsive inventory (OCI-12 and OCI-4)

BackgroundOrthorexia Nervosa (ON), a compulsive obsession with vigorous eating, has increasingly caught researchers' attention. Although Orthorexia Nervosa has not been labeled an eating disorder, research about ON highlighted a strong link with anorexia nervosa or obsessive–compulsive disorder (OCD). Therefore, this study aimed to (1) validate the Arabic version of the Obsession-Compulsion Inventory (OCI-12 and OCI-4) and (2) check if there is an overlap between ON and OCD among a sample of Lebanese adults.MethodsThis cross-sectional study involved 487 Lebanese participants between July and August 2021. The Dusseldorf Orthorexia Scale (DOS) was used to assess ON; scores between 25 and 29 indicate probable ON, whereas scores ≥ 30 indicate ON tendencies. A confirmatory factor analysis (CFA) was carried out using SPSS AMOS v.24 on the OCI-12 and OCI-4 scales’ items. The root mean square error of approximation (RMSEA) statistic, the Tucker Lewis Index (TLI) and the comparative fit index (CFI) were used to evaluate the goodness-of-fit of the model.ResultsThe CFA results indicated an excellent fit of the model: the Maximum Likelihood Chi-Square = 147.73 and Degrees of Freedom = 48, which gave a χ2/df = 3.08, TLI = 0.934, CFI = 0.952, and RMSEA = 0.065 [95% CI 0.054–0.078]. The fit indices of the one-factor structure of the OCI-4 were excellent as well: χ2/df = 6.15/2 = 3.08, TLI = 0.95, CFI = 0.98 and RMSEA = 0.065 [95% CI 0.007–0.127]. The Area Under the Curve was 0.600 [95% CI 0.524–0.674]. There was no cutoff value that showed good sensitivity or specificity at the same time. At the DOS cutoff of 25, sensitivity was 19.1%, whereas the specificity was 90.6%. The positive and negative predictive values (PPV and NPV) at this cutoff value were 24.4% and 88.7% respectively. At the DOS cutoff of 30, sensitivity was 8.8%, whereas the specificity was 94.3%. The PPV and NPV at this cutoff value were 10.6% and 92.5% respectively.The results showed that higher total OCD scores (Beta = 0.15) were significantly associated with more ON tendencies. Moreover, higher OCD washing scores (Beta = 0.52), physical activity index (Beta = 0.06), and Body Mass Index (Beta = 0.17) were significantly associated with more ON tendencies.ConclusionThe present results suggest that ON, as measured by the DOS, shares more common features with disordered eating and cannot adequately predict the presence of OCD symptoms.

FV 1 Segregating the prefrontal cortex by means of deep brain stimulation

Introduction: Neurocircuits are involved in the motor, cognitive, and affective dysfunctions of multiple brain disorders. Functional segregation into these domains has been widely defined on a fronto- cortical basis. However, despite considerable interaction, these functional domains remain partitioned to some extent at (sub)thalamic levels (1). To map the functional organization of the the frontal cortex (FC), we employ optimal connectivity profiles from successful deep brain stimulation (DBS) electrodes to the same target, which receives input from the entire FC, in four different disorders. Specifically, we identify cortical projection sites that, on a group level, associate with maximal improvements following subthalamic nucleus (STN) DBS in dystonia (DYT), Parkinson's disease (PD), Tourette syndrome (TS) or obsessive-compulsive disorder (OCD). Patients and Methods: Using Lead-DBS (2), stimulation volumes were estimated for six patient cohorts from six centers, each implanted with DBS to the STN for treatment of either DYT (N = 62), PD (N = 51), TS (N = 14), or OCD (N = 19). Via DBS Network Mapping (3) we derived disease-specific structural connections between cortex and STN from a normative connectome (4) that relate to optimal clinical outcomes. Results: Functional organization in the STN and FC was reflected along a caudo-rostral gradient (Fig. 1). Beneficial DBS networks for DYT predominantly projected to the primary motor cortex, while in PD, electrode connectivity to pre- and supplementary motor areas, in TS to the dorsomedial preFC, and in OCD to ventromedial, dorsal anterior cingulate and dorsolateral preFC emerged. Conclusion: Our findings demonstrate the usefulness of DBS to investigate the organizational gradient of frontal network (dys)function. As such, they bear both interest for cognitive neurosciences as well as clinical-translational value for circuit-guided DBS.

Anxiety and Trauma-Related Distress

Key Points Anxiety symptoms (eg, fears about harm to self or loved ones; distress when child is asked to engage in feared activity; somatic complaints associated with fears) are common in children and adolescents; at some life stages and in some circumstances, a certain level of anxiety is developmentally appropriate.Anxiety symptoms may be features of 1 of 6 anxiety disorders or may cause functional impairment in the absence of a diagnosable disorder. Anxiety-like symptoms are a frequent response to trauma (physical or psychological) and can be features of posttraumatic stress disorder (PTSD), acute stress disorder, or adjustment disorder.Validated tools are available to screen for mental health symptoms generally, anxiety symptoms specifically, posttraumatic stress specifically, and impaired functioning, and to assess the effect of the child’s problem on caregivers; results lead to further discussions with the child and family.A child who feels anxious often has a parent who feels anxious or depressed; care of the parent is integral to helping the child.Pediatric clinicians can provide meaningful intervention, even in the absence of a diagnosis, through expressions of hope, empathy, and support to the child and family; encouragement of healthy habits and reducing overall stress; emphasis on coping with or gradual exposure to feared activities, rather than avoiding them; and brief interventions derived from cognitive behavioral therapy (CBT).Refer for full diagnostic evaluation and evidence-based care (CBT, plus medication for certain disorders) or comanage care with a mental health specialist ifThe child has severe functional impairments at school, at home, or with peers.Multiple symptoms of anxiety occur in many domains of life.The child or parent is very distressed by the symptom or symptoms.There are co-occurring behavioral problems (especially if combined with shyness).Anxiety was preceded by serious trauma or symptoms suggesting PTSD, acute stress disorder, or adjustment disorder.The child seems to have panic disorder or obsessive-compulsive disorder (OCD), both of which require specialized treatment.Anxiety occurs in a child with autism spectrum disorder (ASD).

Hypothesizing That Pediatric Autoimmune Neuropsychiatric Associated Streptococcal (PANDAS) Causes Rapid Onset of Reward Deficiency Syndrome (RDS) Behaviors and May Require Induction of “Dopamine Homeostasis”

Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a concept that is used to characterize a subset of children with neuropsychiatric symptoms, tic disorders, or obsessive-compulsive disorder (OCD), whose symptoms are exacerbated by group A streptococcal (GAS) infection. PANDAS has been known to cause a sudden onset of reward deficiency syndrome (RDS). RDS includes multiple disorders that are characterized by dopaminergic signaling dysfunction in the brain reward cascade (BRC), which may result in addiction, depression, avoidant behaviors, anxiety, tic disorders, and/or OCD. According to research by Blum et al., the dopamine receptor D2 (DRD2) gene polymorphisms are important prevalent genetic determinants of RDS. The literature demonstrates that infections like Borrelia and Lyme, as well as other infections like group A beta-hemolytic streptococcal (GABHS), can cause an autoimmune reaction and associated antibodies target dopaminergic loci in the mesolimbic region of the brain, which interferes with brain function and potentially causes RDS-like symptoms/behaviors. The treatment of PANDAS remains controversial, especially since there have been limited efficacy studies to date. We propose an innovative potential treatment for PANDAS based on previous clinical trials using a pro-dopamine regulator known as KB220 variants. Our ongoing research suggests that achieving "dopamine homeostasis" by precision-guided DNA testing and pro-dopamine modulation could result in improved therapeutic outcomes.

Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis.

Orthorexia nervosa (ON) is defined as an unhealthy obsession with healthy eating, focusing on concerns regarding food quality and composition. Currently, there is still a lack of consensus about a clear definition of the construct. Specifically, it has yet to be clarified whether ON pertains to eating disorders (EDs) or obsessive-compulsive disorder (OCD) spectrum. Hence, we conducted a systematic review and meta-analysis addressing the magnitude of the association between these groups of symptoms. PubMed, Medline, SCOPUS, PsychINFO, CINAHL, and Web of Science were searched from inception up to February 2021. Data from individual studies were pooled using a random-effects model. Pearson's r was used as the effect size metric. Subgroup analyses were conducted exploring the role of ON-related instruments, body mass index, study quality, and cultural context. Thirty-six studies met the eligibility criteria and were included in the meta-analysis. Random-effects model yielded a moderate association between ON and EDs symptoms with an overall effect size of r=.36 (p < .001; 95% confidence interval [CI]=0.30-0.43). On the other hand, the results showed a small association between ON and OCD symptoms with a mean effect size of r =.21 (p < .001; 95% CI=0.15-0.27). Meta-analytic findings showed that ON symptoms are more associated to EDs compared to OCD. Despite the similarities, the nonhigh magnitude of the pooled correlations suggests that ON might be different from pre-existing EDs and OCD. Hence, ON might be treated as a stand-alone ED and included as an emerging syndrome in the DSM classification.

Meta-Analysis: Pediatric Placebo Response in Depression Trials Does Not Replicate in Anxiety and Obsessive-Compulsive Disorder Trials.

Background: Placebo response has been identified as an important factor influencing the success of adult antidepressant trials, yet little research of placebo response has been conducted in pediatric populations. Understanding disorder-specific and transdiagnostic predictors of pediatric placebo response is important in designing successful child psychopharmacological trials. Methods: A PubMed search was conducted for all pediatric antidepressant randomized controlled trials treating depression, anxiety, or obsessive-compulsive disorder (OCD). A random-effects model was utilized to examine the magnitude of placebo symptom improvement using standardized mean difference (SMD) and placebo response rates. Stratified subgroup analysis was performed by diagnostic indication. Meta-regression was utilized to search possible correlates of placebo symptom improvement and placebo response rate. Results: Thirty antidepressant trials involving 2911 participants receiving placebo were included in this meta-analysis. Magnitude of placebo improvement and placebo response rates varied significantly across disorders; being greater in depression (SMD = 1.44, 95% confidence interval [CI]: 1.18 to 1.71) than anxiety disorders (SMD = 1.09, 95% CI: 0.77 to 1.41) and the lowest in OCD (SMD = 0.71, 95% CI: 0.32 to 1.12). Different predictors were associated with placebo response in different indications. Conclusions: Both the magnitude and predictors of placebo response in pediatric depression trials do not replicate across anxiety and OCD. Based on our results, across disorders, minimizing the number of sites might significantly reduce placebo improvement. In addition to these, we could potentially decrease the placebo response in depression trials by increasing the number of subjects enrolled per study site, minimizing the number of study visits and conducting the studies in the United States. Further research is needed into the predictors of placebo response in pediatric anxiety and OCD.

Elevated C-reactive protein levels across diagnoses: The first comparison among inpatients with major depressive disorder, bipolar disorder, or obsessive–compulsive disorder

ObjectiveWe addressed elevated C-reactive protein level (eCRP) specificity comparing, for the first time, eCRP (i.e., serum CRP > 3 and ≤10 mg/L) in patients with major depressive disorder (MDD), bipolar disorder (BD), or obsessive–compulsive disorder (OCD). We also assessed to what extent multiple variables that can potentially increase inflammation may have influenced eCRP in our sample. MethodsWe performed a retrospective, observational, cross-sectional study using information documented in the electronic medical records (EMRs) of patients hospitalized for a 4-week psychiatric rehabilitation program. We collected all information according to the standardized procedures of the hospital's clinical practice and applied a logistic regression model (α = 0.05). ResultsWe included 388 inpatients, that is, 156 (40.2%) with MDD, 135 (34.8%) with BD, and 97 (25.0%) with OCD, and found considerable eCRP rates among them (36.5%, 47.4%, and 29.9% in MDD, BD, and OCD, respectively) but without significant differences across groups. In the whole sample, eCRP variations were only partially attributable (approximately for one-third) to potential confounders. All groups presented considerable rates of cardiovascular risk factors, and we classified most patients as having medium or high CRP-based cardiovascular risk. ConclusionThis first study comparing eCRP in MDD, BD, and OCD suggests that eCRP may be a transdiagnostic feature of different psychiatric disorders, and other mechanisms beyond the effects of multiple confounders may explain the presence of eCRP in a substantial portion of psychiatric patients. Therefore, we encourage the routine measurement of CRP in psychiatric clinical practice.

How neuropsychiatric comorbidity, modulatory indication, demographics, and other factors impact deep brain stimulation inpatient outcomes in the United States: A population-based study of 27,956 patients

ObjectiveTo determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes. MethodsThis is a retrospective study of 45 months’ worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance. ResultsOf 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p < 0.05). Patients with ET had favorable outcomes. Neuropsychiatric comorbidity, Black race, and Charlson Comorbidity Index > 0 were significantly associated with unfavorable outcomes (p < 0.05). ConclusionThe risk of adverse inpatient outcomes for DBS in the United States is independently correlated with non-PD/ET disorders, neuropsychiatric comorbidity, and non-White race, reflecting the heterogeneity and infancy of widespread DBS for these patients.

Impact of sertraline daily treatment regimen on adherence, persistence and healthcare resource utilisation in patients with major depressive disorder or obsessive-compulsive disorder: A real-world evidence analysis from the United States.

ObjectiveTo generate real‐world evidence (RWE) from the United States to assess the impact of pill burden and the importance of achieving a stable daily dose of sertraline (time taken, number of dose adjustments needed) on adherence/persistence and healthcare resource utilisation (HCRU).MethodsRetrospective analysis of the PharMetrics® Plus database (1 October 2012 to 31 March 2020) in the United States. Eligible patients had major depressive disorder (MDD) or obsessive‐compulsive disorder (OCD) and ≥1 claim for sertraline during index period (1 April 2013 to 31 March 2019, allowing 6‐months prior, 1‐year post‐index follow‐up). Patients who achieved stable daily dose of sertraline (>90 days on same dose) were categorised into five cohorts, depending on pill burden/daily dose: Cohort (1): 1 × 50 mg/d; Cohort (2): 1 × 100 mg/d; Cohort (3): 2 × 50 mg/d; Cohort (4): 1.5 × 100 mg/d; Cohort (5): 3 × 50 mg/d. Impact of pill burden on adherence/persistence and HCRU was assessed among cohorts using logistic regression analysis, and between patients who did vs did not stabilise on therapy. P < .05 was considered significant for all analyses.ResultsOf 224 412 eligible patients, 108 729 stabilised on sertraline (50, 100 or 150 mg/d) and formed Cohorts 1‐5. Stabilised patients on lower pill burden had statistically higher adherence and were more likely to remain persistent throughout 1‐year post‐index period vs patients on higher pill burden but same overall dose (100 mg/d [Cohort 2 vs 3] and 150 mg/d [Cohort 4 vs 5], respectively). Patients who did not stabilise had significantly lower adherence/persistence vs patients who achieved stable daily dose (Cohorts 1‐5 combined). Persistence improved when stable daily dose was achieved quickly (within 1‐4 months) and efficiently (within 1‐3 dose adjustments). Probability of HCRU increased for patients who did not stabilise on their initial prescription.ConclusionSimplifying treatment regimen and decreasing pill burden improved adherence and/or persistence with sertraline therapy (100 or 150 mg/d). Patients achieving stable daily dose of sertraline in an efficient and timely manner were more likely to remain persistent throughout 1‐year follow‐up.

Altering the development of the dopaminergic system through social play in rats: Implications for anxiety, depression, hyperactivity, and compulsivity

Dopamine is essential to many functions like reward, motivation, and attention; when its neural pathways do not function properly, various disorders (e.g., anxiety, depression, hyperactivity, compulsions) can arise. Truncated-DAT rats display persistent stereotypies and aggressiveness; hence they are a new valuable animal model to study the pathogenesis of these disorders. The focus of research is often on the individual epigenetic determinants and much less on the impact of social experiences. Here, we investigate the developmental impact of the social environment on adolescent wild type (WT) rats. We divided subjects at weaning into three groups: living with another adolescent (WT Peer), with a WT adult, or with a truncated-DAT one, and we observed homecage social behavior of these pairs (play, jump, victory, and “bullying”) during whole adolescence. When adult, we observed the same subjects in plus maze, forced swim, and social preference tests to measure levels of anxiety, depression, and quality of social interactions. Compared to the other groups, WT rats that had spent their adolescence with a truncated-DAT adult as companion show more anxious, depressive, hyperactive, impulsive, and compulsive behaviours. Results confirm that social interactions and healthy play (i.e., when play has behavioural, social, and psychomotor rewards that support the cognitive, emotional and physical development of the individual) are essential to neurobehavioral maturation. Conversely, anomalous interactions like poor play and “bullying” in developing rats may impact onto their dopaminergic system. Consequently, an impoverished social play could be one of the factors contributing to the appearance of putative indexes of attention deficit hyperactivity disorder (ADHD) and\\or obsessive–compulsive disorder (OCD).

Development of Computed Tomography Image Processing Procedure for the Diagnosis of Human Respiratory Infectious Diseases: COVID-19

Computed Tomography (CT) is a non-invasive method to give CT images of every part of the human body without superimposition of end-to-end structures. Some issues in measurements with CT are limiting too few parameters like quantum noise, beam hardening, X-ray scattering by the patient, and nonlinear partial volume effects. Image processing with Adobe Photoshop, ImageJ, and Origin software have been used to achieve good quality images for numerical analysis. Statistical functions permit to investigate the general characteristics of a human respiratory infections disease. Using Automatic Diagnosis system, differentiation in diseases can be filtered out with the help of CT images. Data can be analyzed from the CT images to distinguish between a human respiratory infections disease, a common disorder like Major Depression (MD) or Obsessive-Compulsive Disorder (OCD) and a normal lung.

Improving Delivery Behaviors During Exposure Therapy: A Cluster Randomized Controlled Training Trial with Community Therapists

ABSTRACT This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors that have been associated with youth outcomes in prior clinical trials of exposure therapy. Sixteen therapists in practice settings treated 46 youths with an anxiety disorder or obsessive-compulsive disorder (OCD). Therapists were randomly assigned to receive “gold-standard” exposure therapy training with weekly consultation (GS) or “gold-standard” training with weekly consultation plus the EG (EG). The primary outcome was therapist behavior during in-session exposures, observed using a validated coding system. Secondary outcomes included training feasibility/acceptability and observer-rated patient fear habituation; we also explored independent evaluator-rated clinical outcome. As hypothesized, therapists used similarly high rates of exposure with patients in both groups, but those in the EG condition used more fear-increasing behaviors and fewer fear-decreasing behaviors compared with those in the GS condition. Attendance data and therapist feedback support EG feasibility and acceptability. Patients treated by EG-trained therapists showed increased rates of in-session habituation. Descriptive clinical outcome data showed a slightly higher treatment response rate in the EG group (66.7% EG, 58.8% GS) that was more pronounced among patients completing a posttreatment assessment (83.3% EG, 60.0% GS). Results confirm the effectiveness of EG training for improving therapist delivery behaviors. Future studies will be needed to determine whether EG training can improve rates of patient treatment response via improved delivery behaviors. Public Health Significance: This study shows that the Exposure Guide, a therapist training tool, improves therapist delivery of exposure.

A Rathole: Foucault, Freud, and the Problem of Isolation

The article discusses the problem of isolation and draws a parallel between two different approaches to it - Michel Foucault’s archeology of power and Sigmund Freud’s psychoanalysis. Foucault’s perspective is exemplified by his critique of the strategies of power as they were applied to the epidemics of leprosy and bubonic plague. For leprosy there was an undifferentiated exclusionary space, while the the plague brought about a segmented space for confinement. The passage from the one strategy to the other marks the development of the disciplinary model of power: leper colonies are transformed into prisons and psychiatric wards. Freud’s approach is examined in his treatment of the Rat Man, the patient whose analysis prompted Freud to formulate his theory of obsessional neurosis, or obsessive-compulsive disorder (OCD). The article emphasizes the relevance of the problem of OCD to the COVID-19 pandemic of 2020. The traditional strategy of power applied to leprosy was isolation by means of exile from towns, while for the plague isolation meant shutting towns down with their inhabitants each in their own place as if imprisoned. COVID-19 brought about a new strategy of self-isolation which entails creating physical and psychological barriers together with social distancing. Obsessional neurosis is evolving from an individual pathology into a kind of collective one: epidemiology influences mentality. In conclusion, the article takes up two literary examples - Roman Mikhailov’s text “The Wrong Side of a Rat,” and Varlam Shalamov’s story “Lepers,” from the Kolyma Stories collection - in which breaking out of isolation, disease and infection are presented as alternative affective experiences.