Obsessive-compulsive Disorder Symptom Severity Research Articles

Characteristics of Functional Connections and Topographical Properties Distinguished the Healthy State and Obsessive-Compulsive Disorder

Background: Obsessive-compulsive disorder (OCD) is characterized by alterations in brain connectivity, particularly within the default mode network (DMN) and the salience network (SN). Investigating these connectivity differences can provide a deeper understanding of the neural mechanisms underlying OCD. Methods: This cross-sectional study involved 58 patients diagnosed with OCD and 38 healthy control subjects, totaling 96 participants. Resting-state functional MRI (fMRI) data were acquired and analyzed using the CONN toolbox to examine functional connectivity within intrinsic resting-state networks. Graph theory metrics were applied to evaluate node connections and the overall network topology. Clinical symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and their correlations with connectivity patterns and graph-theory parameters were analyzed. Results: The OCD patients and healthy controls were matched in terms of age, gender, marital status, socioeconomic status, and handedness. However, OCD patients had significantly worse general health, quality of life, and higher levels of depression and anxiety. Network analyses revealed altered whole-brain connectivity in OCD patients, particularly within the DMN and the frontoparietal network. The most significant between-group connectivity differences were observed between the posterior parietal cortex (PPC) and the precuneus. Disruptions in the DMN, specifically altered connectivity between the medial prefrontal cortex and posterior cingulate cortex, and changes in the SN involving the anterior insula and anterior cingulate cortex, were significantly correlated with the severity of OCD symptoms. Conclusions: The findings suggest that OCD is associated with distinct alterations in DMN connectivity, which may play a critical role in the disorder's pathophysiology. These disruptions offer potential targets for therapeutic intervention. Further research is needed to explore these connectivity changes in larger cohorts and at various stages of OCD to better understand their clinical significance.

Inference-Based Cognitive Behavioral Therapy versus Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Multisite Randomized Controlled Non-Inferiority Trial

Introduction: Although cognitive behavioral therapy (CBT) effectively treats obsessive-compulsive disorder (OCD), many patients refuse CBT or drop out prematurely, partly because of anxiety regarding exposure and response prevention (ERP) exercises. Inference-based cognitive behavioral therapy (I-CBT) focuses on correcting distorted inferential thinking patterns, enhancing reality-based reasoning, and addressing obsessional doubt by targeting underlying dysfunctional reasoning, without incorporating an ERP component. We hypothesized that I-CBT would be non-inferior to CBT. Additionally, we hypothesized that I-CBT would be more tolerable than CBT. Methods: 197 participants were randomly assigned to 20 sessions CBT or I-CBT and assessed at baseline, posttreatment, and 6 and 12 months’ follow-up. The primary outcome was OCD symptom severity measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; non-inferiority margin: 2 points). The secondary outcome, treatment tolerability, was assessed using the Treatment Acceptability/Adherence Scale (TAAS). A linear mixed-effects model was used to assess the non-inferiority of the primary outcome and superiority of secondary outcomes. Results: Statistically significant within-group improvements in the primary and secondary outcomes were observed in both treatments. No statistically significant between-group differences in Y-BOCS were found at any assessment point, but the confidence intervals exceeded the non-inferiority threshold, making the results inconclusive. The estimated mean posttreatment TAAS score was significantly higher in the I-CBT group than in the CBT group. Conclusion: While both CBT and I-CBT are effective for OCD, whether I-CBT is non-inferior to CBT in terms of OCD symptom severity remains inconclusive. Nevertheless, I-CBT offers better tolerability and warrants consideration as an alternative treatment for OCD.

The relationship between emotional inhibition, emotional deprivation, failure, vulnerability to harm schema, and severity of symptoms among patients with obsessive-compulsive disorder

ObjectiveAssess the relationship between emotional inhibition, emotional deprivation, failure, vulnerability to harm schema, and severity of symptoms among obsessive-compulsive disorder.MethodsA descriptive correlational study was conducted on 30 patients with obsessive-compulsive disorder who were recruited to complete the Yale-Brown Obsessive-Compulsive Scale, Young Schema Questionnaire-Long Form.ResultsThe results of the study indicate that 66.6% of the 30 subjects exhibited high levels of OCD symptom severity, with a mean score of 33.20 ± 4.67. In terms of early maladaptive schemas, 60% of subjects displayed severe emotional deprivation, 66.7% showed severe emotional inhibition, and 83.3% had severe failure schemas. A strong positive correlation was found between failure schemas and OCD symptoms (r = 0.697, p < 0.001). However, what truly impressed the researchers was the predictive power of the failure schema. It was the only significant predictor of OCD symptoms (Beta = 0.992, p < 0.001), explaining 55.2% of the variance.ConclusionThe study underscores the crucial influence of early maladaptive schemas on the severity of obsessive-compulsive disorder symptoms in individuals with obsessive-compulsive disorder. It proposes that considering early maladaptive schemas, such as emotional self-awareness, failure, and vulnerability to harm, can aid in gauging the severity of obsessive-compulsive disorder symptoms. Moreover, the study’s findings are of significant importance to mental health professionals, researchers, and individuals involved in the treatment and management of obsessive-compulsive disorder, as they provide a deeper understanding of the condition and suggest practical approaches for its management.

Clinical features of obsessive-compulsive disorder among individuals who experience health-related obsessive-compulsive symptoms

BackgroundWhile some obsessive-compulsive disorder (OCD) phenotypes are well-established and better understood, it is unclear whether the presence of health-related obsessive-compulsive symptoms (OCS) is associated with specific clinical characteristics. We aimed to investigate whether OCS involving concerns with illness, diseases, body parts or aspects of appearance (i.e. health-related OCS) are associated with differences in demographics, experience of stressful life events, clinical severity, clinical course, endorsement of established OCD dimensions, and psychiatric comorbidities. MethodsIndividuals (N = 1001) with a clinical diagnosis of OCD (M = 34.85, SD = 12.99) completed a questionnaire battery assessing clinical course (age at symptom onset, age at diagnosis, duration of illness), total and dimensional symptom severity, and psychiatric comorbidities. We ran initial univariate, and follow-up multivariate analyses where appropriate, to compare individuals reporting health-related OCS with those not reporting health-related OCS in terms of demographics, symptom severity and clinical course, OCD symptom dimensions, and psychiatric comorbidities. ResultsThe presence of health-related OCS was associated with higher severity of contamination, hoarding and harm symptoms. Additionally, those with health-related OCS displayed significantly lower symptom insight, increased incidence of hypochondriasis, panic disorder and anxiety, and lower depression symptoms. Overall OCD symptom severity and clinical course did not differ between participants with and without health-related OCS. ImplicationsThese novel findings provide clinicians with an enhanced understanding of health-related OCS in order to guide assessment and allow for more targeted treatment planning. Future investigations may examine the effectiveness of specialised treatment methods which target underlying clinical features of health-related OCS.

The effectiveness of day clinic treatment in adolescents with obsessive compulsive disorder: Outcomes in Turkey

Background: Obsessive compulsive disorder (OCD) causes impairment in social and academic functionality. Intensive treatment methods such as day treatments are recommended in resistant cases. Aims: The aim of this study is to examine the changes in treatment responses according to gender in children and adolescents with OCD who are followed up in the day clinic and to evaluate the factors that predict treatment. Methods: Adolescents with OCD (n = 50) who were followed up in the day clinic between 2007 and 2021 were included in this study. Scales evaluating symptom severity and treatment responses were administered to the patients at admission and discharge. Results: The mean age of the adolescents included in the study was 14.24 (SD: 2.1). The mean length of stay in the day clinic was 8.3 (SD: 0.1) weeks. When the factors related to the treatment response were evaluated, a significant correlation was found between the length of stay in the day clinic and improvement. Conclusions: This study provides evidence for the importance of intensive treatment in adolescents experiencing severe OCD symptoms. Ensuring that intensive treatments such as day clinics become widespread and standardizing these treatments will provide important developments in the treatment of OCD.

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.

Changes in harm avoidance and incompleteness across group CBT for OCD and their relationship with symptom change.

Obsessive-compulsive disorder (OCD) symptoms are hypothesized to be driven by two core motivations: harm avoidance and incompleteness. While cognitive-behavioural therapy (CBT) is an effective treatment for OCD, many posit that OCD presentations characterized by high incompleteness may be harder to treat. The relationship between the core motivations and treatment outcomes remains to be further explored. To investigate if harm avoidance and incompleteness decrease across group CBT and to examine the relationship between treatment outcomes and both baseline and changes in harm avoidance and incompleteness throughout treatment. A naturalistic sample of 65 adult out-patients with OCD completed self-report questionnaires measuring OCD symptom severity and the core motivations before, during, and after 12 weeks of group CBT for OCD. Harm avoidance and incompleteness scores significantly decreased from pre- to post-treatment. Pre-treatment harm avoidance and incompleteness levels did not predict post-treatment symptom severity, but changes in the core motivations throughout treatment were significant predictors of treatment outcome. Specifically, reductions in harm avoidance across treatment and reductions in incompleteness early in treatment, were associated with better treatment outcomes. Participants who completed group CBT for OCD experienced modest reductions in the core motivations thought to maintain OCD symptoms and these changes predicted better outcomes. However, pre-treatment levels of harm avoidance and incompleteness do not appear to moderate treatment outcome.

ASSYST-Individual Adapted for the Treatment of Obsessive-Compulsive Disorder

Clients with obsessive-compulsive disorder (OCD) symptoms pose a challenge for psychotherapists. Current evidence-based treatments have limitations in efficacy and client retention. This article reports on 17 cases treated with the Acute Stress Syndrome Stabilization Individual (ASSYST-I) Adapted for OCD in an outpatient mental health clinic in Uruguay. The average number of sessions was 16. Clients completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to assess OCD symptom severity before and after treatment. Wilcoxon signed-rank tests found significant differences between pre- and posttreatment on the Y-BOCS total scores (z= −3.624,p&lt; .001), obsessions subtotal scores (z= −3.627,p&lt; .001), and compulsions subtotal scores (z= −3.624,p&lt; .001). This study describes the ASSYST-I Adapted for OCD and discusses its preliminary safety, feasibility, and acceptability.

Continuous theta burst stimulation to relieve symptoms in patients with moderate obsessive-compulsive disorder: a preliminary study with an external validation

Obsessive-compulsive disorder (OCD) is a clinically challenging and refractory psychiatric disorder characterized by pathologically hyperactivated brain activity. Continuous theta burst stimulation (cTBS) is considered a potentially non-invasive treatment for inducing inhibitory effects on the underlying cortex. Numerous studies showed an unsatisfactory efficacy of cTBS for OCD. Accordingly, it seems that cTBS is ineffective for OCD. However, the neglect of varying OCD severities, modest sample size, absence of a multicenter design incorporating inpatients and outpatients, and lack of personalized imaging-guided targeting may constrain the conclusive findings of cTBS efficacy for OCD. In the preliminary experiment, 50 inpatients with OCD were enrolled to receive cTBS (10 sessions/day for five continuous days) or sham over the personalized right pre-supplementary motor area determined by the highest functional connectivity with the subthalamic nucleus according to our prior study. In the extension experiment, 32 outpatients with OCD received cTBS to generalize the treatment effects. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) was assessed before and after treatment. In the preliminary experiment, the response rates in the cTBS group were 56.52%, respectively, significantly higher than those in the sham group. Further analysis revealed significant YBOCS improvement in patients with moderate OCD symptoms than those with severe OCD symptoms. In the extension experiment, the response rates were 50.00%. Additionally, a significant decrease in YBOCS scores was only found in patients with moderate OCD symptoms. This is the first study with an external validation design across two centers to identify OCD symptoms as playing an important role in cTBS treatment effects, especially in patients with moderate OCD symptoms.

Transcranial direct current stimulation as an augmentation therapy in patients with obsessive-compulsive disorder: A case series

Obsessive-compulsive disorder (OCD) is characterized by intrusive, distressing thoughts and/or repetitive behaviors. Transcranial direct current stimulation (tDCS) is a promising neuromodulation technique for augmenting pharmacotherapy in OCD. This case series identified patients diagnosed with OCD, who showed residual symptoms even after two adequate trials of pharmacotherapy corroborated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (score of eight and above taken as cutoff). tDCS was given in the form of two milliamperes current with anode at SMA and cathode at the right orbitofrontal area, for twenty minutes, for six sessions (one session per day) in addition to pharmacotherapy. Clinical assessment was performed using the Y BOCS at baseline and post treatment. The results revealed a reduction in OCD symptom severity in all the patients (as per both subjective report and Y-BOCS scores). The patients did not have any severe adverse effects. tDCS appears to be a potential augmentation therapy for individuals with OCD. However, further research is warranted to optimize stimulation parameters and elucidate the long-term effects of tDCS as part of a comprehensive treatment approach for OCD.

From Zero to Overwhelm: PANS and PANDAS as Culprits Behind Sudden OCD in Pediatrics

Pediatric autoimmune neuropsychiatric disorders (PANDAS) and patient neuropsychiatric syndrome (PANS) are psychiatric illnesses characterized by a rapid onset of symptoms, including obsessive-compulsive disorder (OCD), behavioral symptoms and poor motor functions in children. The rapid onset and severity of OCD symptoms prompted investigations to provide an evidence-based intervention. This case series investigates the causes, diagnosis and treatment of the disease among children presenting with neuropsychiatric symptoms and acute-onset OCD. The diagnostic procedures provided grounds for the indication of medication. Methods: Bacterial infections, autoimmune cases and viral infections among 12 children with PANDAS and PANS were retrospectively studied. Pre- and post-treatment symptomatology were examined to monitor the effectiveness of interventions, following laboratory diagnostic approaches, including the Cunningham panel, serology, stool sample analysis, polymerase chain reaction (PCR), and bacterial cultures to determine the cause of the disorder. Diagnostic results informed treatments like non-steroidal anti-inflammatory drugs (NSAIDs), intravenous immunoglobulin (IVIG), fluid therapy, antibiotics, antivirals, steroids, and selective serotonin reuptake inhibitors (SSRIs) in each child. Post-treatment diagnostic results revealed remarkably improved symptoms of PANDAS and PANS, like inflammation and viral or bacterial infection. A combined therapy of antibiotics and NSAIDs or steroids was used to clear bacterial infections and manage inflammation. SSRIs and antiviral or fluid therapy were indicated for OCD and viral infections, respectively. Conclusions: OCD is a common comorbid disorder among children with PANS and PANDAS. Despite the severity and prevalence, OCD in children raises health concerns. The case series demonstrated the effectiveness of antibiotic therapy, RRIs, cognitive behavioral therapy, IVIG, steroids and NSAIDs in managing OCD in PANDAS and PANS, with a unique rationale of indication to every child. Keywords: PANS, PANDAS, Sudden Onset OCD, Pediatric OCD, Autoimmune Neuropsychiatric Disorders

Transcranial Magnetic Stimulation–Induced Plasticity Improving Cognitive Control in Obsessive-Compulsive Disorder, Part I: Clinical and Neuroimaging Outcomes From a Randomized Trial

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for obsessive-compulsive disorder (OCD). The neurobiological mechanisms of rTMS in OCD have been incompletely characterized. We compared clinical outcomes and changes in task-based brain activation following 3 different rTMS protocols, all combined with exposure and response prevention. MethodsIn this 3-arm proof-of-concept randomized trial, 61 treatment-refractory adult patients with OCD received 16 sessions of rTMS immediately before exposure and response prevention over 8 weeks, with task-based functional magnetic resonance imaging scans and clinical assessments before and after treatment. Patients received high-frequency rTMS to the left dorsolateral prefrontal cortex (n = 19 [13 women/6 men]), high-frequency rTMS to the left pre-supplementary motor area (preSMA) (n = 23 [13 women/10 men]), or control rTMS to the vertex (n = 19 [13 women/6 men]). Changes in task-based functional magnetic resonance imaging activation before/after treatment were compared using both a Bayesian region of interest and a general linear model whole-brain approach. ResultsMean OCD symptom severity decreased significantly in all treatment groups (Δ = −10.836, p < .001, 95% CI −12.504 to −9.168), with no differences between groups. Response rate in the entire sample was 57.4%. The dorsolateral prefrontal cortex rTMS group showed decreased planning-related activation after treatment that was associated with greater symptom improvement. No group-level activation changes were observed for the preSMA and vertex rTMS groups. Participants in the preSMA group with greater symptom improvement showed decreased error-related activation, and symptom improvement in the vertex group was associated with increased inhibition-related activation. ConclusionsrTMS to preSMA and dorsolateral prefrontal cortex combined with exposure and response prevention led to activation decreases in targeted task networks in individuals showing greater symptom improvement, although we observed no differences in symptom reduction between groups.

Symptom Profiles and Intensive Treatment Outcomes in Sexual Minority and Heterosexual Patients With OCD

Sexual minority (SM) individuals appear to be at greater risk for obsessive-compulsive disorder (OCD). Despite this, little is known about OCD presentation and treatment outcomes among SM individuals. Although some research has suggested that SM individuals may be more likely to endorse intrusive thoughts related to violence/sex/religion compared to heterosexual individuals, extant literature has neglected to examine potential differences across different SM groups, a notable limitation given the apparent differences in the types of minority stress that each group experiences and the unique health disparities affecting each group. The current study sought to address these gaps by examining potential differences in OCD symptom severity, presentation, and treatment outcomes using analysis of variance and profile analysis in a clinical sample of 1,502 cisgender patients diagnosed with OCD enrolled in intensive OCD treatment (87.5% heterosexual, 6.6% bisexual, 4.7% lesbian or gay, and 1.1% questioning). Replicating previous research, neither OCD severity nor treatment outcomes differed by sexual orientation, and findings extended previous research that no differences across SM groups were observed, either. However, contrary to previous research, there was also no evidence for unique profiles of OCD symptoms across sexual orientation groups, and questioning individuals reported significantly less severe symmetry symptoms compared to heterosexual and bisexual individuals. Findings are encouraging in that they suggest that cisgender bisexual, lesbian or gay, and questioning individuals with OCD can still benefit significantly and to the same degree as their cisgender heterosexual peers in intensive OCD treatment. Potential explanations for conflicting findings regarding symptom profiles are discussed.

Psychometric Evaluation of the Chinese Version of the Family Accommodation Scale for Obsessive–Compulsive Disorder Patient Version

This study aimed to examine the psychometric properties of the Chinese version of the family accommodation scale for obsessive–compulsive disorder (OCD) patient version (FAS-PV). A total of 171 adult OCD patients and 145 family members were enrolled in the present study. The majority of the adult OCD patients (89.5%) reported engaging in at least one accommodating behavior in the past week. The FAS-PV comprised three components that included (a) direct participation and facilitation, (b) provision of reassurance and assumption, and (c) modification of routines and avoidance. The FAS-PV demonstrated excellent internal consistency. The correlation between the total FAS-PV score and the criteria measure demonstrated excellent convergent validity when assessing the OCD symptom severity, global functioning, family functioning, and functioning impairment. The findings supported that the FAS-PV could be used widely in evaluating and identifying the accommodating behavior both in clinical and in research settings, especially in adult OCD patients who usually present to the clinic alone.

Metacognition in Children and Adolescents With Obsessive-Compulsive Disorder Treated With Cognitive Behavioral Therapy

According to the metacognitive theory, maladaptive metacognition is associated with the development and maintenance of emotional disorders. This study is the first to explore maladaptive metacognition in a sample of children and adolescents (7–17 years) with obsessive-compulsive disorder (OCD) in the context of cognitive behavioral therapy (CBT). A total of 114 children and adolescents were included in the study. Of these 56 were OCD patients who were assessed on metacognition (Metacognitions Questionnaire–Child Version) and OCD symptom severity (Children’s Yale-Brown Obsessive Compulsive Scale) before and after 14 sessions of individual CBT. Fifty-eight children and adolescents without any psychiatric diagnoses constituted a control group and were assessed on metacognition temporally corresponding to the OCD group. Results showed that the OCD group had significantly elevated maladaptive metacognition relative to the control group, with the exception of positive beliefs about worry. The maladaptive metacognition in the OCD group was significantly reduced from pre- to posttreatment. Additionally, the reduction in the total level of maladaptive metacognition was significantly larger than that reported by the control group. However, it remained significantly elevated relative to controls at posttreatment. Furthermore, lower posttreatment OCD severity was associated with larger reductions in negative beliefs about worry, beliefs about the need to control thoughts, and cognitive self-consciousness, as well as with a higher pretreatment level of positive beliefs about worry. Overall, age group (children vs adolescents) did not moderate these results. Collectively, the results suggest that amending maladaptive metacognition in children and adolescents with OCD might be important considering the associations between reductions in maladaptive metacognition and favorable treatment outcome.

Towards the correlates of stressful life events as precipitants of obsessive-compulsive disorder: a systematic review and metanalysis.

Obsessive-compulsive disorder (OCD) is a prevalent condition with multifactorial etiology involving genetic and environmental factors. The present study aims to summarize the correlates of stressful life events (SLEs) in OCD by reviewing studies comparing OCD associated or not with SLEs before its onset. To do so, a systematic review was performed by searching PubMed, Web of Science, Scopus, and PsycINFO databases for studies published between the database's inception and November 27, 2023. Studies including individuals whose OCD was precipitated or not by SLEs (SLEs OCD and NSLEs OCD, respectively) were assessed. Effect sizes or odds ratios were then calculated to identify the strength of association between SLEs and clinical characteristics, such as gender, age of onset, family history of OCD, severity of OCD symptoms, depressive symptoms, and mood comorbidities among patients with OCD. Out of the 4083 records initially identified, 5 studies met the inclusion criteria and 3 were comparable through a meta-analysis. Notably, the analyses were limited by the small number of studies available in the literature. The meta-analysis demonstrated SLEs OCD to be associated with female gender, later OCD onset, and increased comorbidity rates with mood disorders. Despite the cross-sectional nature of the reviewed studies, women may be more vulnerable to develop a later onset of OCD following SLEs, which may also lead to mood disorders. Caution is needed to avoid prematurely classifying this presentation as a distinct subtype of OCD.

Obsessive Compulsive Disorder (OCD) During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic, present in Indonesia for 17 months, has significantly impacted mental health, especially in individuals with obsessive-compulsive disorder (OCD). Studies in Europe reported a 17.9% to 60.3% increase in OCD symptom severity. Notably, no research in Indonesia has explored the pandemic’s effects on OCD patients. Lockdown measures in Indonesia may exacerbate symptoms, but some OCD patients benefit, finding relief from societal stigmatization and the opportunity to advise others on infection prevention. This review aims to examine the impact of the COVID-19 pandemic on OCD patients in Indonesia and discuss potential management strategies. Methods: We conducted a comprehensive literature search, identifying studies, articles, and reports relevant to the effects of the COVID-19 pandemic on OCD patients in Indonesia. These sources were critically evaluated to provide a comprehensive overview. Results: This review reveals that the pandemic poses unique challenges to OCD patients in Indonesia. Lockdown measures may worsen symptoms, although some patients find relief from societal stigmatization. OCD patients can play a valuable role in advising others on infection prevention. Telemedicine, especially CBT, and medication adherence tools are crucial for effective management. Conclusion: The COVID-19 pandemic affects OCD patients in Indonesia in various ways. It is essential to recognize how lockdown measures impact symptom severity and the opportunities for patients to contribute positively to society. Telemedicine and medication adherence tools are valuable for managing OCD during the pandemic. Addressing the needs of OCD patients and implementing effective strategies for their care during COVID-19 is essential in Indonesia.

Neurological soft signs as trait markers of a subset of patients with obsessive-compulsive disorder with low insight and altered cognitive abilities

Neurological soft signs (NSS) are subtle motor control impairments that include involuntary movements and abnormalities of motor coordination, sensory integration and lateralization. They engage different brain networks, including the prefrontal networks that support the higher cognitive functions that are dysfunctional in obsessive-compulsive disorder (OCD). This study investigated the relationships between the presence of NSS and patients' severity of OCD symptoms, insight, and treatment resistance in a sample of 63 patients. Treatment-resistance was assessed considering all the treatments the patients received during the course of their disease. The four dimensions of OCD defined in the dimensional obsessive-compulsive scale were considered. Links between the patients’ cognitive abilities and NSS were assessed using tests targeting specifically the core components of executive functions.As expected, OCD patients displayed more NSS than individually matched control participants. In OCD patients, high NSS scores were associated with poor insight and lower cognitive abilities. Multiple regression analysis identified worse visuospatial working memory, attentional control, and verbal fluency as predictive factors of high NSS scores among cognitive functions. Unexpectedly, the patients displaying symptoms in the contamination/washing dimension displayed less NSS than the other patients. In contrast, neither the severity of OCD symptoms nor long-range treatment resistance was significantly related to patients’ NSS scores. Altogether, our findings suggest that high NSS scores may be a trait marker of a subset of OCD patients with low insight and particularly altered cognitive abilities who would not express the contamination/washing dimension of the pathology.

Lose yourself: feared self, emotion regulation, and obsessive-compulsive and eating disorder symptomatology

ABSTRACT Objectives Feared self refers to an individual’s “possible” self that has undesired qualities or characteristics and has been linked to obsessive compulsive symptoms. However, feared self may also relate to eating disorder pathology, given the importance of views of self in the disorder. Method This questionnaire-based study in a non-clinical sample (N = 238) examined whether a feared self would independently predict the symptom severity of obsessive-compulsive disorder (OCD) and eating disorders (ED), while controlling for potential comorbidity of the respective symptoms. A secondary aim was to examine whether emotion regulation moderated the relationship between a feared self and OCD symptoms and a feared self and ED symptoms. Results Feared self was a significant unique predictor of symptoms of both disorders. Emotion regulation was not found to significantly moderate the relationship between feared self and either OCD or ED symptoms, although emotion regulation was a significant independent predictor of the respective symptoms. Conclusions The study is one of the first to show that a feared self uniquely predicts ED symptoms, over-and-above coexisting OCD symptoms. As such, the results provide support for feared self as a potential transdiagnostic factor. Implications and limitations are discussed.

Impact of Benzodiazepines and Illness Duration on Obsessive-Compulsive Disorder during COVID-19 in Italy: Exploring Symptoms' Evolutionary Benefits.

Obsessive-compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insights of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas the severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need for additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and an extraordinary supply of essential resources.