Obsessive-compulsive Disorder Symptom Severity Research Articles

Hoarding Symptoms in Children and Adolescents With Obsessive-Compulsive Disorder: Clinical Features and Response to Cognitive-Behavioral Therapy.

Although adult hoarding disorder is relatively common and often debilitating, few studies have examined the phenomenology of pediatric hoarding. We examined the clinical phenomenology and response to cognitive-behavioral therapy (CBT) treatment in youths with a diagnosis of obsessive-compulsive disorder (OCD) with and without hoarding symptoms. Age was tested as a moderator across analyses, given prior findings that the impact of hoarding symptoms may not become apparent until adolescence. Youths (N= 215; aged 7-17 years) with OCD pursuing evaluation and/or treatment at a university-based specialty clinic participated in the current study. Presence of hoarding symptoms was assessed as part of a larger battery. Data from a subset of youths (n= 134) who received CBT were included in treatment response analyses. Youths with hoarding symptoms did not differ from those without hoarding symptoms with respect to overall OCD symptom severity and impairment. Youths with hoarding met criteria for more concurrent diagnoses, including greater rates of internalizing and both internalizing/externalizing, but not externalizing-only, disorders. Youths with and without hoarding symptoms did not significantly differ in rate of response to CBT. Age did not moderate any of these relationships, suggesting that the presence of hoarding symptoms was not associated with greater impairments across the clinical presentation of OCD or its response to treatment by age. We found no evidence that hoarding is associated with greater OCD severity or poorer treatment response in affected youth. Theoretical and clinical implications of these findings, including future directions for research on testing developmental models of hoarding across the lifespan, are discussed.

Sudden gains in cognitive behavioral therapy among children and adolescents with obsessive compulsive disorder

Background and objectivesThis study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics. MethodsThe sample consisted of 136 youth (ages 7–17) with a primary diagnosis of OCD who were randomized in a double-blinded fashion to 10 sessions of CBT with augmentation of either d-cycloserine or placebo. Sudden gain status was determined based on clinician-rated obsessive-compulsive symptom severity, which was collected on 9 occasions across the study period. Results42.6% of youth experienced at least one sudden gain, which tended to occur either after starting exposure and response prevention or towards the end of treatment. After applying the Benjamini-Hochberg procedure for multiple comparisons, there were no significant pre-treatment predictors of sudden gains and only reduced insight predicted the reversal of gains. Individuals with at least one sudden gain had improved overall treatment outcomes, measured both by reduction in OCD symptom severity, and by global illness severity. LimitationsSeveral clinical constructs were not examined. Symptomatology was not assessed at every treatment session. Differences in those who achieved sudden gains and those who did not may be obscured. There is the possibility that a sudden gain reflected a scoring error generated by an optimistic or inaccurate report. Finally, a relatively homogenous sample may limit the generalizability of results. ConclusionsThe course of CBT for pediatric OCD is variable with many children experiencing sudden gains, but a sizable percentage experience a reversal of gains which was related to reduced insight. Sudden gains tended to occur after starting exposure and response prevention and towards the end of treatment. TrialsregistrationClinicaltrialsgovRegistry:NCT00864123. https://www.clinicaltrials.gov/ct2/show/NCT00864123.

Scrupulosity, Religious Affiliation and Symptom Presentation in Obsessive Compulsive Disorder.

Scrupulosity is a common yet understudied presentation of obsessive compulsive disorder (OCD) that is characterized by obsessions and compulsions focused on religion. Despite the clinical relevance of scrupulosity to some presentations of OCD, little is known about the association between scrupulosity and symptom severity across religious groups. The present study examined the relationship between (a) religious affiliation and OCD symptoms, (b) religious affiliation and scrupulosity, and (c) scrupulosity and OCD symptoms across religious affiliations. One-way ANOVAs, Pearson correlations and regression-based moderation analyses were conducted to evaluate these relationships in 180 treatment-seeking adults with OCD who completed measures of scrupulosity and OCD symptom severity. Scrupulosity, but not OCD symptoms in general, differed across religious affiliations. Individuals who identified as Catholic reported the highest level of scrupulosity relative to individuals who identified as Protestant, Jewish or having no religion. Scrupulosity was associated with OCD symptom severity globally and across symptom dimensions, and the magnitude of these relationships differed by religious affiliation. Findings are discussed in terms of the dimensionality of scrupulosity, need for further assessment instruments, implications for assessment and intervention, and the consideration of religious identity in treatment.

Characteristic alteration of subcortical nuclei shape in medication-free patients with obsessive-compulsive disorder.

Subcortical nuclei are important components in the pathology model of obsessive-compulsive disorder (OCD), and subregions of these structures subserve different functions that may distinctively contribute to OCD symptoms. Exploration of the subregional-level profile of structural abnormalities of these nuclei is needed to develop a better understanding of the neural mechanism of OCD. A total of 83 medication-free, non-comorbid OCD patients and 93 age- and sex-matched healthy controls were recruited, and high-resolution T1-weighted MR images were obtained for all participants. The volume and shape of the subcortical nuclei (including the nucleus accumbens, amygdala, caudate, pallidum, putamen and thalamus) were quantified and compared with an automated parcellation approach and vertex-wise shape analysis using FSL-FIRST software. Sex differences in these measurements were also explored with an exploratory subgroup analysis. Volumetric analysis showed no significant differences between patients and healthy control subjects. Relative to healthy control subjects, the OCD patients showed an expansion of the lateral amygdala (right hemisphere) and right pallidum. These deformities were associated with illness duration and symptom severity of OCD. Exploratory subgroup analysis by sex revealed amygdala deformity in male patients and caudate deformity in female patients. The lateral amygdala and the dorsal pallidum were associated with OCD. Neuroanatomic evidence of sexual dimorphism was also found in OCD. Our study not only provides deeper insight into how these structures contribute to OCD symptoms by revealing these subregional-level deformities but also suggests that gender effects may be important in OCD studies.

Attention Deficit Hyperactivity Disorder, Impulsivity, Anxiety, and Depression Symptoms Mediating the Relationship Between Childhood Trauma and Symptoms Severity of Obsessive-Compulsive Disorder.

A growing body of research associates childhood trauma with obsessive-compulsive disorder (OCD). The aim of this study was to investigate the relationships between childhood trauma and OCD, including both its severity and OCD patients' comorbid impulsivity, ADHD, anxiety, and depressive symptoms. A convenient sample consisting of 106 patients with OCD was given the Childhood Trauma Questionnaire (CTQ), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Wender Utah Rating Scale (WURS), Hamilton Rating Scale for Depression (HAM-D), Beck Anxiety Inventory (BAI), and Barratt Impulsivity Scale-11 (BIS-11). The results showed that childhood trauma indirectly predicts the severity of OCD and directly predicts comorbidities in OCD patients, including anxiety, ADHD, WURS, and impulsivity. Patients with childhood trauma had higher WURS, BAI, and BIS-11 scores and fewer years of education. Ongoing adult ADHD was more common in individuals with childhood trauma. A history of childhood trauma in OCD patients has indirect effects on the severity of OCD and depressive symptoms and is associated with more severe anxiety, higher levels of impulsivity, higher prevalence of ADHD, and lower levels of education. More research is needed to clarify the effects of childhood trauma on OCD severity and comorbidity.

The predictors of occupational disability in obsessive-compulsive disorder in a large clinical sample

Aim: Obsessive-compulsive disorder (OCD) is a common mental disorder leading to severe loss of functioning. We aimed to investigate socio-demographic and clinical factors affecting occupational disability in OCD. Material and Methods: It is a cross sectional study with individuals recruited from an outpatient psychiatry clinic. A total of 393 patients were given the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale-17 Item (HAM-D), Beck Anxiety Inventory, Barratt Impulseness Scale-11 and Wender Utah Rating Scale. Occupational disability was defined as the inability to work over the past month due to pychopathology associated with OCD. Housewives, students and retired people were excluded. Results: The rates of occupational disability were 52.9% in the whole sample, 44.3% in men and 60% in women. Higher Y-BOCS scores, higher HAM-D scores, being single, female gender, younger age at first treatment, less school years and previous suicide attempt were associated with a higher risk of occupational disability. The BAI scores, previous hospitalization, age at onset, smoking, childhood ADHD and past or present tic disorder did not statistically affect occupational status. Conclusions: OCD is associated with serious occupational disability causing inability to work in more than half of patients. The severity of OCD and depressive symptoms, marital status, gender, education level, age at first treatment and history of suicide attempt predict occupational disability. Keywords: Occupational disability; disability; functioning; obsessive-compulsive disorder; impulsivity; Attention Deficit and Hyperactivity Disorder (ADHD).

The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescent obsessive-compulsive disorder: Does comorbid anxiety disorder affect inflammatory response?

Recent adult etiologic studies indicated evidence linking increased inflammatory parameters with psychiatric disorders. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are easily obtainable clinical markers of inflammation and have been found to be increased in various medical and mental disorders. In this study, we aimed to investigate the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with obsessive-compulsive disorder (OCD). Secondarily, the effect of comorbid anxiety disorder with OCD on the inflammatory response was investigated. Sixty drug-naïve adolescents with OCD aged 12 to 18 years were enrolled in the patient group. Twenty-three of the OCD group had comorbid anxiety disorder (AD) and 37 had no comorbidities. One hundred twenty-eight adolescents in the same age range with no psychiatric disorders were recruited as the healthy control group. The severity of OCD symptoms was evaluated using the Children's Yale-Brown Obsessive Compulsive Scale. There were statistically significant differences in the neutrophil-lymphocyte ratio, white blood cell, neutrophil, and platelet counts among the three groups, even after adjusting for age and sex. The adolescents with OCD and AD had the highest neutrophil-lymphocyte ratio and white blood cell counts. A comorbid anxiety disorder diagnosis in addition to obsessive-compulsive disorder may increase the inflammatory response.

Sudden gains in internet-based cognitive behavior therapy for obsessive-compulsive disorder

BackgroundWe investigated the occurrence and effects of sudden gains in internet-based cognitive behavioral therapy (ICBT) for obsessive-compulsive disorder (OCD). As secondary analysis, we studied whether sudden gains are moderated by D-Cycloserine (DCS). MethodsUsing data from a recent trial (N = 128), we assessed sudden gains based on weekly symptom change on the self-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Treatment outcome was assessed using the clinician-administered Y-BOCS. We compared treatment outcomes for sudden gainers vs. non-sudden gainers and gradual gainers at post-treatment and 3, 12 and 24-month follow-up. ResultsThirty-eight percent of the patients experienced a sudden gain. Sudden gainers showed significantly larger improvements on the clinician-administered Y-BOCS than non-sudden gainers at post-treatment (d = 1.11), as well as at 3-month (d = 1.06), 12-month (d = 0.88) and 24-month follow-up (d = 0.77). Sudden gainers also showed significantly less severe OCD symptoms than gradual gainers at post-treatment (d = 0.50), as well as 3-month (d = 0.55) and 12-month follow-up (d = 0.57). In addition, patients receiving DCS showed a significantly higher rate of sudden gains. ConclusionsSudden gains are common in ICBT for OCD and are associated with favorable short and long-term treatment outcomes.

Contrasting contributions of anhedonia to obsessive-compulsive, hoarding, and post-traumatic stress disorders

Anhedonia is a transdiagnostic construct that can occur independent of other symptoms of depression; its role in neuropsychiatric disorders that are not primarily affective, such as obsessive compulsive disorder (OCD), hoarding disorder (HD), and post-traumatic stress disorder (PTSD) has received limited attention. This paper addresses this gap. First, the data revealed a positive contribution of anhedonia, beyond the effects of general depression, to symptom severity in OCD but not in HD or PTSD. Second, anhedonia was operationalized as a reduced sensitivity to rewards, which allowed employing the value based decision making framework to investigate effects of anhedonia on reward-related behavioral outcomes, such as increased risk aversion and increased difficulty of making value-based choices. Both self-report and behavior-based measures were used to characterize individual risk aversion: risk perception and risk-taking propensities (measured using the Domain Specific Risk Taking scale) and risk attitudes evaluated using a gambling task. Data revealed the positive theoretically predicted correlation between anhedonia and risk perception in OCD; effects on self-reported risk taking and behavior-based risk aversion were non-significant. The same relations were weaker in HD and absent in PTSD. Response time during a gambling task, an index of difficulty of making value-based choices, significantly correlated with anhedonia in individuals with OCD and individuals with HD, even after controlling for general depression, but not in individuals with PTSD. The results suggest a unique contribution of one aspect of anhedonia in obsessive-compulsive disorder and confirm the importance of investigating the role of anhedonia transdiagnostically beyond affective and psychotic disorders.

Individual white matter bundle trajectories are associated with deep brain stimulation response in obsessive-compulsive disorder

BackgroundThe ventral anterior limb of the internal capsule (vALIC) is a target for deep brain stimulation (DBS) in obsessive-compulsive disorder (OCD). Conventional surgical planning is based on anatomical landmarks.Objective/hypothesis: We hypothesized that treatment response depends on the location of the active DBS contacts with respect to individual white matter bundle trajectories. This study thus aimed to elucidate whether vALIC DBS can benefit from bundle-specific targeting. MethodsWe performed tractography analysis of two fiber bundles, the anterior thalamic radiation (ATR) and the supero-lateral branch of the medial forebrain bundle (MFB), using diffusion-weighted magnetic resonance imaging (DWI) data. Twelve patients (10 females) who had received bilateral vALIC DBS for at least 12 months were included. We related the change in OCD symptom severity on the Yale-Brown obsessive-compulsive scale (Y-BOCS) between baseline and one-year follow-up with the distances from the active contacts to the ATR and MFB. We further analyzed the relation between treatment response and stimulation sites in standard anatomical space. ResultsWe found that active stimulation of the vALIC closer to the MFB than the ATR was associated with better treatment outcome (p = 0.04; r2 = 0.34). In standard space, stimulation sites were largely overlapping between treatment (non)responders, suggesting response is independent of the anatomically defined electrode position. ConclusionThese findings suggest that vALIC DBS for OCD may benefit from MFB-specific implantation and highlight the importance of corticolimbic connections in OCD response to DBS. Prospective investigation is necessary to validate the clinical use of MFB targeting.

Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample✰

BackgroundObsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study. MethodsParticipants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported. ResultsThe best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts. LimitationsThe study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study. DiscussionOCD symptom severity predicted next year suicidal ideation severity. In contrast, suicidal ideation severity in a given year did not predict next-year OCD symptom severity in this OCD sample. Thus, rather than waiting for suicidal ideation to resolve, clinicians should consider providing empirically supported treatments for OCD.

Intrinsic brain abnormalities in drug-naive patients with obsessive-compulsive disorder: A resting-state functional MRI study

BackgroundUsing the resting-state functional magnetic resonance imaging (rs-fMRI) in a relatively large sample of drug-naive patients with obsessive-compulsive disorder (OCD), the current study aims to explore alterations in regional and network-level neural function and to determine the association between these alterations in intrinsic neural activity and symptom severity in OCD. MethodsA total of 68 drug-naive OCD patients and 68 healthy control subjects (HCS) were examined using rs-fMRI. Regional cerebral function was evaluated by measuring the fraction of amplitude of low-frequency fluctuation (fALFF). Regions with fALFF alterations were used as seeds in whole-brain functional connectivity (FC) analysis. Statistical analyses of fALFF and FC differences between OCD patients with HCS were performed voxel-by-voxel using a two-sample t-test in Statistical Parametric Mapping version 8 (SPM8). Whole brain correlation analyses were performed to identify the association between functional neural correlates and OCD symptom severity evaluated using Yale-Brown Obsessive Compulsive scale (Y-BOCS) and subscale scores. ResultsRelative to HCS, OCD patients showed higher fALFF in the right putamen and right superior frontal gyrus (P < 0.05, corrected for AlphaSim); higher FC in the limbic-striatal circuit and lower FC in the fronto-temporal and fronto-striato-thalamic networks (P < 0.05, corrected for AlphaSim). FC in striato-thalamic junction was negatively correlated with the Y-BOCS total score (r = -0.493, P < 0.001). ConclusionThese findings of focal spontaneous hyperfunction confirmed the prevailing frontal-striatal model of OCD, and altered brain connectivity in large-scale resting-state networks indicated a connectivity-based pathophysiological process in OCD.

Empirically-derived response trajectories of intensive residential treatment in obsessive-compulsive disorder: A growth mixture modeling approach

BackgroundThis study investigated distinct trajectories of treatment response in a naturalistic intensive/residential treatment (IRT) program for adults with severe obsessive-compulsive disorder (OCD). We hypothesized that: (1) distinct trajectories would emerge and (2) demographic variables, psychiatric comorbidity, OCD symptom subtype, level of insight, previous exposure and response prevention (ERP) treatment, and quality of life, would differentially predict assignment to these trajectories. MethodsParticipants included 305 individuals with primary OCD admitted for IRT. ResultsTwo trajectories emerged over the course of the first eight weeks of treatment, with the vast majority of participants demonstrating treatment response. The first trajectory (96%, n = 292) showed a negative, linear treatment response (a.k.a. “linear responders”) and more severe OCD symptoms at admission. The second trajectory (4%, n = 13) had less severe OCD symptoms at admission and did not exhibit a significant overall change in symptoms over the course of treatment. More specifically, this second trajectory or “u-shaped responders” show a non-significant linear response through week four of treatment, followed by slightly increased symptoms in week five. Assignment to these classes was not differentially predicted by hypothesized predictor variables. LimitationsOur final model had inconsistent fit indices and small class prevalance of the u-shaped responder group; therefore, model selection was based on both fit indices and substantive meaning. ConclusionsThis study emprically derived two distinct trajectories of OCD symptom severity over the course of IRT. These findings have the potential to refine IRT for patients with severe OCD, and to potentially guide future investigation into the optimal delivery of ERP treatment for OCD generally.

Reduced prefrontal-temporal cortical activation during verbal fluency task in obsessive-compulsive disorder: A multi-channel near-infrared spectroscopy study

Functional neuroimaging studies by near-infrared spectroscopy (NIRS) have focused on the role of the prefrontal cortex (PFC) in the pathophysiology of obsessive-compulsive disorder (OCD). However, the reported areas in the PFC were inconsistent in OCD, and correlations between hemodynamic response and clinical symptoms have not been investigated. This study aimed to evaluate the hemodynamic response related to the verbal fluency task (VFT) and assess the relationship between activation and clinical status in OCD patients using a 52-channel NIRS with a wide coverage over the prefrontal and temporal cortices. Seventy patients with OCD and 70 age-, gender- and education level-matched healthy control subjects were examined by NIRS. The relative concentration changes of oxygenated hemoglobin ([oxy-Hb]) were measured. The Yale-Brown obsessive-compulsive scale (Y-BOCS) was used to evaluate the severity of OCD symptoms. Compared to healthy controls group, OCD patients showed smaller [oxy-Hb] changes in most areas of the prefrontal and temporal cortex, including the bilateral orbitofrontal cortex (OFC), right dorsolateral prefrontal cortex (DLPFC), bilateral inferior prefrontal cortex (IPFC), bilateral frontopolar cortex (FPC), left superior temporal gyrus (STG), and bilateral middle temporal gyrus (MTG). Furthermore, the [oxy-Hb] changes in the right FPC were negatively correlated with the Y-BOCS obsessions score and Y-BOCS total score, and the [oxy-Hb] changes in the left OFC were negatively correlated with the Y-BOCS compulsions score. These results suggest that patients with OCD have reduced prefrontal-temporal cortex hemodynamic responses, and that the abnormalities of brain activation were associated with the severity of OCD symptoms.

Psychometric validation of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV)

Aim: The aim of the study was to examine the psychometric properties of a Danish version of the Obsessive Beliefs Questionnaire – Child Version (OBQ-CV). The OBQ-CV assesses dysfunctional beliefs concerning responsibility/threat estimation, perfectionism/uncertainty, and importance/control of thoughts, which according to cognitive theories are important in the development and maintenance of obsessive-compulsive disorder (OCD).Methods: The study included a pediatric sample (age 7-17 years) consisting of 57 children and adolescents with OCD, 49 children and adolescents with an anxiety disorder (AD), and 58 typically developing (TD) children and adolescents without a psychiatric diagnosis. All participants completed the OBQ-CV and the Child Behavior Checklist – the School Age Scales (CBCL/6-18). The Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to assess OCD symptom severity in the OCD group.Results: Confirmatory factor analyses supported the three-factor structure and thereby the construct validity of the OBQ-CV. Gender was not associated with subscale scores, whereas age influenced the subscale scores differently in the three groups. Reliability analyses showed acceptable to excellent internal consistency and acceptable test-retest reliability of the instrument. There were significant differences between the OCD group and the TD group, supporting the criterion validity. Results on convergent validity were mixed.Conclusions: Overall, results supported the reliability and validity of the Danish OBQ-CV and thus the use of the questionnaire for future clinical and research purposes.

Development and Psychometric Evaluation of the Children’s Yale-Brown Obsessive-Compulsive Scale Second Edition

To develop and examine the psychometric properties of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) in children and adolescents with obsessive-compulsive disorder (OCD). Youth with OCD (N= 102; age range 7-17 years), who were seeking treatment from 1 of 2 specialty OCD treatment centers,participated in the study. The CY-BOCS-II was administered at an initial assessment, and measures of OCD symptom severity,anxiety and depressive symptoms, behavioral and emotional problems, and global functioning were administered. Inter-rater and test-retest reliabilities were assessed on a subsample of participants (n= 50 and n= 31, respectively) approximately 1 week after intial assessment. The CY-BOCS-II demonstrated moderate-to-strong internal consistency (α= 0.75-0.88) and excellent inter-rater (intraclass correlation coefficient= 0.86-0.92) and test-retest (intraclass correlation coefficient= 0.95-0.98) reliabilities across all scales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of anxiety symptoms. Exploratory factor analysis showed a 2-factor structure, which was generally inconsistent with its adult counterpart, the Yale-Brown Obsessive-Compulsive Scale Second Edition. Initial findings support the CY-BOCS-II as a reliable and valid measure of obsessive-compulsive symptoms in youth.

Exploring Retrospective Biases in Obsessive-Compulsive Disorder: an Experience-Sampling Study

Standard methods of symptom assessment for obsessive-compulsive disorder (OCD) entail retrospective report of symptoms over a specified period (e.g., a week, a month). However, such methods may be subject to recall bias, leading to symptom assessments potentially discrepant from actual patient experience. The current study explored potential recall biases in two domains of symptom severity, distress, and interference, using experience-sampling methods (ESMs). Twenty-one adults with a primary diagnosis of OCD rated distress and interference of their two most upsetting obsessions and compulsions four times daily for 6 to 10 days using a modified version of the Yale-Brown Obsessive Compulsive Scale. After the ESM period, participants provided retrospective estimates of the same symptoms. Overall, participant’s retrospective ratings were significantly greater than their average ESM ratings. Results suggest the presence of recall biases of OCD symptom severity, potentially obscuring detection of symptom change and interfering with progress monitoring. Future directions and implications are discussed.

Polygenic Risk Scores Derived From a Tourette Syndrome Genome-wide Association Study Predict Presence of Tics in the Avon Longitudinal Study of Parents and Children Cohort

BackgroundTourette syndrome (TS) has a well-established genetic background, but its genetic architecture remains largely unknown. The authors investigated the role of polygenic risk scores (PRSs) derived from a TS genome-wide association study in relation to the occurrence of tics and associated traits in a general population cohort. MethodsUsing the most recent TS genome-wide association study (n = 4819 cases; n = 9488 controls) as the discovery sample, PRSs were calculated in Avon Longitudinal Study of Parents and Children participants (n = 8941). Regression analyses were used to assess whether PRS predicted the presence and chronicity of tics, and symptom severity of obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, and autism spectrum disorder in Avon Longitudinal Study of Parents and Children participants. ResultsFollowing correction for multiple testing, the PRS significantly predicted the presence (R2 = .48%, p empirical = .01, Q = .04) but not the chronicity (R2 = .16%, p empirical = .07, Q = .14) of tics in the Avon Longitudinal Study of Parents and Children cohort; it did not predict the severity of obsessive-compulsive disorder (R2 = .11%, p empirical = .11, Q = .15), attention-deficit/hyperactivity disorder (R2 = .09%, p empirical = .19, Q = .21), or autism spectrum disorder (R2 = .12%, p empirical = .09, Q = .14). ConclusionsThe authors found a significant polygenic component of tics occurring in a general population cohort based on PRS derived from a genome-wide association study of individuals with a TS diagnosis. This finding supports the notion that tics along a spectrum from nonclinical to clinical symptom levels share a similar genetic background.

Long-term outcome of CBT in adults with OCD and comorbid ASD: A naturalistic follow-up study

Obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD) are highly comorbid. In adults with OCD, cognitive-behavioral therapy (CBT) has been extensively demonstrated to be an effective treatment. However, to date, no follow-up studies exist regarding the long-term outcome of CBT in adults with OCD with comorbid ASD in a regular and naturalistic clinical setting. In the current study, we aimed to study the long-term outcome of CBT among OCD patients with and without ASD. In total, 30 patients diagnosed with OCD who received CBT at a naturalistic psychiatric clinic in Japan were included in the follow-up study. The patients were divided into two groups: OCD with ASD and OCD without ASD. The results revealed no group differences regarding age, gender and OCD symptom severity at baseline. The Yale-Brown Obsessive-Compulsive Scale total score (primary outcome) at follow-up showed decreased severity of symptoms in both groups, thus indicating both groups responded to CBT. However, no significant differences were evident between the groups. Overall, the results suggest that even adults with OCD with comorbid ASD benefit from CBT. A survey on patients’ impressions of treatment effect at follow-up showed high rates of satisfaction with CBT and most participants attributed their improvement to CBT as opposed to pharmacological treatment. This study showed the outcome differences of OCD symptom dimensions in OCD with ASD patients compared with the OCD without ASD patients. These differences suggest the need for developing adapted CBT for adults with OCD with ASD and for optimizing the treatment and their lives.

Use of an Individual-Level Approach to Identify Cortical Connectivity Biomarkers in Obsessive-Compulsive Disorder

BackgroundExisting functional connectivity studies of obsessive-compulsive disorder (OCD) support a model of circuit dysfunction. However, these group-level observations have failed to yield neuroimaging biomarkers sufficient to serve as a test for the OCD diagnosis, predict current or future symptoms, or predict treatment response, perhaps because these studies failed to account for the substantial intersubject variability in structural and functional brain organization. MethodsWe used functional regions, localized in each of 41 individual OCD patients, to identify cortical connectivity biomarkers of both global and dimension-specific symptom severity and to detect functional connections that track changes in symptom severity following intensive residential treatment. ResultsGlobal OCD symptom severity was directly linked to dysconnectivity between large-scale intrinsic brain networks—particularly among the dorsal attention, default, and frontoparietal networks. Changes within a subset of connections among these networks were associated with symptom resolution. Additionally, distinct and nonoverlapping cortical connectivity biomarkers were identified that were significantly associated with the severity of contamination/washing and responsibility for harm/checking symptoms, highlighting the contribution of dissociable neural networks to specific OCD symptom dimensions. By contrast, when we defined functional regions conventionally, using a population-level brain atlas, we could no longer identify connectivity biomarkers of severity or improvement for any of the symptom dimensions. ConclusionsOur findings would seem to encourage the use of individual-level approaches to connectivity analyses to better delineate the cortical and subcortical networks underlying symptom severity and improvement at the dimensional level in OCD patients.