Symptom Provocation Research Articles

Glutamate dynamics and BOLD response during OCD symptom provocation in the lateral occipital cortex: A 7 Tesla fMRI-fMRS study

Obsessive-compulsive disorder (OCD) is linked with dysfunction in frontal-striatal, fronto-limbic, and visual brain regions. Research using proton magnetic resonance spectroscopy (1H-MRS) suggests that altered neurometabolite levels, like glutamate, may contribute to this dysfunction. However, static neurometabolite levels in OCD patients have shown inconsistent results, likely due to previous studies' limited focus on neurometabolite dynamics. We employ functional MRS (fMRS) and functional magnetic resonance imaging (fMRI) to explore these dynamics and brain activation during OCD symptom provocation.We utilized a combined 7-tesla fMRI-fMRS setup to examine task-related BOLD response and glutamate changes in the lateral occipital cortex (LOC) of 30 OCD participants and 34 matched controls during an OCD-specific symptom provocation task. The study examined main effects and between-group differences in brain activation and glutamate levels during the task.A whole sample task-effects analysis on data meeting predefined quality criteria showed significant glutamate increases (n = 41 (22 OCD, 19 controls), mean change: 3.2 %, z = 3.75, p < .001) and task activation (n = 54 (26 OCD, 28 controls), p < .001) in the LOC during OCD blocks compared to neutral blocks. However, no differences in task-induced glutamate dynamics or activation between groups were found, nor a correlation between glutamate levels and task activation.We were able to measure task-induced increases in glutamate and BOLD levels, emphasizing its feasibility for OCD research. The absence of group differences highlights the need for further exploration to discern to what extent neurometabolite dynamics differ between OCD patients and controls. Once established, future studies can use pre-post intervention fMRS-fMRI to probe the effects of therapies modulating glutamate pathways in OCD.

Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion.

Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation. To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery. Cross-sectional study; Level of evidence, 3. A total of 61 college-aged individuals (21 HC-using women, 21 non-HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores. Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020). HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.

Rehabilitation Oculomotor Screening Evaluation (ROSE)-A Proof-of-Principle Study for Acquired Brain Injuries.

Background/Objectives: Acquired brain injury (ABI) is a major cause of global disability. Many ABI patients exhibit oculomotor dysfunctions that impact their daily life and rehabilitation outcomes. Current clinical tools for oculomotor function (OMF) assessment are limited in their usability. In this proof-of-principle study, we aimed to develop an efficient tool for OMF screening and to assess the feasibility, acceptability, and relevance in a small sample of ABI and control participants. Methods: We created the Rehabilitation Oculomotor Screening Evaluation (ROSE) by reviewing existing OMF assessments. ROSE was pilot-tested on ABI patients (n = 10) and age-matched controls (n = 10). Data regarding the characteristics of the assessment, such as the duration, level of participant comprehension, and participant experience were also collected. Results: ROSE takes <20 min (x¯ = 12.5), is easy to complete (agreement x¯ = 4.6/5), and is well-accepted (x¯ = 4.8/5). Patients scored higher in all subtests and total score (x¯ = 34.8 for ABI vs. 8.9 for controls). Most subtests did not provoke any symptoms, especially for controls. There were no significant between-group differences in symptom provocation. This proof-of-principle study shows that ROSE is feasible, acceptable, and relevant for adult ABI patients. Conclusions: ROSE needs further evaluation for reliability testing and validation in larger samples and diverse neurological conditions. Establishing norms for various ages, sexes, and populations should be considered for the deployment of ROSE as an OMF clinical tool.

Cervical spine proprioception and vestibular/oculomotor function: An observational study comparing young adults with and without a concussion history

ObjectiveTo investigate dizziness, vestibular/oculomotor symptoms, and cervical spine proprioception among adults with/without a concussion history. MethodsAdults ages 18–40 years with/without a concussion history completed: dizziness handicap inventory (DHI), visio-vestibular exam (VVE), and head repositioning accuracy (HRA, assesses cervical spine proprioception). Linear regression models were used to assess relationships between (1) concussion/no concussion history group and VVE, HRA, and DHI, and (2) DHI with HRA and VVE for the concussion history group. ResultsWe enrolled 42 participants with concussion history (age = 26.5 ± 4.5 years, 79% female, mean = 1.4± 0.8 years post-concussion) and 46 without (age = 27.0± 3.8 years, 74% female). Concussion history was associated with worse HRA (β = 1.23, 95% confidence interval [CI]: 0.77, 1.68; p < 0.001), more positive VVE subtests (β = 3.01, 95%CI: 2.32, 3.70; p < 0.001), and higher DHI scores (β = 9.79, 95%CI: 6.27, 13.32; p < 0.001) after covariate adjustment. For the concussion history group, number of positive VVE subtests was significantly associated with DHI score (β = 3.78, 95%CI: 2.30, 5.26; p < 0.001) after covariate adjustment, while HRA error was not (β = 1.10, 95%CI: −2.32, 4.51; p = 0.52). ConclusionsVestibular/oculomotor symptom provocation and cervical spine proprioception impairments may persist chronically (i.e., 3 years) after concussion. Assessing dizziness, vestibular/oculomotor and cervical spine function after concussion may inform patient-specific treatments to address ongoing dysfunction.

A - 26 A Survey of Sports Concussion Specialists’Clinical Criteria to Determine Concussion Recovery

Abstract Purpose To identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in use of decision-making criteria among neuropsychologists, physicians, and certified athletic trainers (ATCs). Method 143 sports concussion specialists (neuropsychologists = 45, physicians = 41, and certified athletic trainers (ATCs) = 57) completed a survey rating the importance of specific criteria for determining concussion recovery in youth and adult athletes. Differences between specialist groups were examined with Kruskal-Wallis tests. Results There were significant differences in criteria ratings across specialist groups regarding youth and adults for “use of neurocognitive test scores,”“balance testing,”“physical examination,”“no symptom provocation with neurocognitive testing,”“athlete report of anxiety about return to sport,“and “family member’s report of recovery,“all p’s &amp;lt; 0.001. For youth and adults, physicians ranked “use of neurocognitive test scores”and “no symptom provocation with neurocognitive testing”as less important than other providers, while “physician examination”was ranked as more important. Neuropsychologists ranked “balance testing”and “athlete report of anxiety about return to sport”as less important than other providers; and ATCs ranked “family member’s report of recovery”as less important than other providers. Conclusions Our results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers.

A - 42 Differences in Exercise Tolerance and Autonomic Function Based on Concussion Clinical Profile

Abstract Purpose This study examined differences in clinical profiles (e.g., post-traumatic migraine, vestibular, anxiety/mood, oculomotor, and cognitive) between exercise tolerance groups determined by the Buffalo Concussion Bike Test (BCBT). We hypothesized the exercise-intolerant group would be more likely to have anxiety and/or vestibular profiles. Method Patients (18–49 years; 8 days to 6 months from concussion) completed demographic and medical history, the Clinical Profile Screen, Brief Symptom Inventory-18, and BCBT. Participants were adjudicated into one or more clinical profiles and classified as exercise tolerant or intolerant. Independent-sample t-tests and chi-square tests were used to compare demographics, clinical profiles, reasons for stopping the BCBT, and ANS metrics. Results One hundred six participants (mean age = 27.9¬ ± 8.1, 62.3% female) were included in the study (71 exercise-intolerant; 35 exercise-tolerant). No demographic or medical history differences were noted between groups. The exercise-intolerant group had significantly lower odds of having an adjudicated headache profile (OR = 0.39, 95%CI = 0.16–0.93, p = 0.03) and significantly greater odds of having an adjudicated autonomic profile (OR = 2.28, 95%CI = 1.01–5.21, p = 0.04). A greater proportion of those with the vestibular profile stopped the BCBT due to symptom exacerbation than those without (90.5% vs. 9.5%, p = 0.04). Conclusions Adjudicated clinical profiles and ANS metrics were similar between exercise-tolerant and intolerant groups. Vestibular sensitivities have a considerable contribution to symptom provocation during the BCBT, as a significant proportion of participants with the vestibular profile discontinued the BCBT due to symptom exacerbation. These findings corroborate previous research and suggest that exercise intolerance is pervasive across all concussion clinical profiles and should be considered in all evaluations.

Contamination fear during the COVID-19 pandemic in patients with lifetime obsessive compulsive disorder and healthy controls: A longitudinal cohort study

BackgroundThe COVID-19 pandemic could be considered a 'symptom provocation test,' which may trigger specific OCD and other psychiatric symptoms. Therefore, we aimed to compare the long-term impact of the pandemic on fear of COVID-19, and contamination, depressive and anxiety symptoms in three groups: individuals with OCD with and without pre-pandemic contamination symptoms and healthy controls. MethodsFrom April 2020 to February 2022, we administered 16 online questionnaires on 138 persons with a lifetime diagnosis of OCD and 373 healthy controls. We evaluated outcomes related to fear of COVID-19, cleaning obsessions and compulsions, anxiety, and depressive symptoms. Using mixed models, we compared the trajectories among persons with OCD who had pre-pandemic contamination symptoms, those without such symptoms, and healthy controls. ResultsPre-pandemic contamination symptoms were significantly associated with higher fear of COVID-19, contamination symptoms, anxiety, and depressive symptoms. Persons with OCD without pre-pandemic contamination symptoms scored, on average, quite similarly to healthy controls. ConclusionsOnly in persons with pre-pandemic contamination symptoms did the pandemic provoke more fear of COVID-19 and contamination symptoms than in controls. It seems that stress caused by external factors, does not tri trigger OCD symptoms unless there is a connection to the subtype of OCD.

A threat from within: Learning to fear by observing aversive bodily symptoms in others

Although observational fear learning has been implicated in the development of phobic-related fears, studies investigating observational learning of fear of bodily symptoms remain scarce. Therefore, the aim of the present study was to investigate whether fear in response to bodily symptoms can be acquired simply by observing a fearful reaction to provocation of aversive bodily symptoms in others. Forty healthy participants underwent an observational fear conditioning paradigm consisting of two phases. In the first phase, participants observed a demonstrator reacting to an aversive bodily symptom provocation (unconditioned stimulus or US, i.e., labored breathing) paired with one conditioned stimulus (CS+) but not with the other one (CS-, both CSs were geometric symbols presented on a screen the demonstrator was watching). In the second phase, participants were directly presented with the same conditioned stimuli, but in the absence of the US. Our results revealed enhanced conditioned fear responses in the beginning of the second phase to the CS + as compared to CS-, as indexed by greater skin conductance and subjective fear responses, as well as greater potentiation of startle eyeblink responses to the CS + as compared to the ITI. Taken together, these findings implicate that fear of bodily symptoms can be learned through observation of others, that is, without first-hand experience of bodily threat.

Acute Eye-Tracking Changes Correlated With Vestibular Symptom Provocation Following Mild Traumatic Brain Injury.

To quantify norms and changes in eye-tracking proficiency, and determine vestibular symptom correlations in varsity college athletes following acute mild traumatic brain injury (mTBI). We hypothesized that mTBI impacts central coordination between the vestibular and oculomotor systems with resultant changes in eye-tracking proficiency that are correlated with vestibular symptom provocation. Retrospective cohort study. Sports medicine care at a single institution. One hundred and nineteen college athletes diagnosed with mTBI by a physician between 2013 and 2019. N/A. Standard deviation of tangential error, standard deviation of radian error, mean phase error, and horizontal gain from virtual reality-based, circular eye-tracking goggles used at baseline and within 72 hours post-mTBI. Headache, dizziness, nausea, and fogginess provocation after the Vestibular Ocular Motor Screening (VOMS) smooth pursuits subtest compared with pretest baseline, assessed within 72 hours post-mTBI. One hundred and nineteen college athletes (N = 56 women and 63 men) aged 18 to 24 years sustained a total of 177 mTBI. Forty-four percent of athletes displayed abnormal eye-tracking on at least 1 eye-tracking measure following acute mTBI compared with their baseline. From the VOMS, horizontal gain showed medium-sized to large-sized positive correlations with headache ( r = 0.34) and dizziness ( r = 0.54), respectively. Mean phase error showed a medium-sized negative correlation with nausea ( r = -0.32) on the VOMS. Eye-tracking proficiency was impaired and correlated with vestibular symptom provocation following acute mTBI in college athletes. Future research should examine eye-tracking proficiency testing in other acute care settings to support mTBI diagnosis.

325. Increased Amygdala Activation During Symptom Provocation Predicts Response to Combined rTMS and Exposure Therapy in Obsessive-Compulsive Disorder

325. Increased Amygdala Activation During Symptom Provocation Predicts Response to Combined rTMS and Exposure Therapy in Obsessive-Compulsive Disorder

Symptom provocation in obsessive-compulsive disorder: Validation of the Braga Obsessive Compulsive image set (BOCIS)

Symptom provocation paradigms are paramount to understand a heterogeneous disorder as obsessive-compulsive disorder (OCD). The main aim of our work was to develop and validate an open-access set of OCD-related images comprising three main subtypes: washing, checking, and symmetry.Twenty-six OCD patients and 25 controls provided valence and arousal ratings for a set of OCD-related, aversive, and neutral images.Linear mixed model analyses were used to estimate the main effects of group, image category, and group-image category interaction in image ratings. All main effects were found to be significant for both arousal and valence ratings, except for the group in arousal ratings.Path analysis confirmed our hypothesis that the OCI-R subscales influenced the subjective ratings of the corresponding image categories, particularly among patients. Independent samples t-tests were performed for each OCD picture to compose the set. Arousal demonstrated a greater capacity to distinguish controls and patients, thus sustaining our choice of using these ratings for the final Braga Obsessive-Compulsive Image Set (BOCIS).Our study demonstrated that the stimuli of the BOCIS reliably portray OCD-like triggers for washing, checking and symmetry subtypes. Its open-access availability will facilitate significant progress in both clinical and research settings.

A Multimodal Exertional Test for concussion: a pilot study in healthy athletes.

Exertional tests have become a promising tool to assist clinicians in the management of concussions, however require expensive equipment, extensive spaces, and specialized clinician expertise. As such, we developed a test with minimal resource requirements encompassing key elements of sport and physical activity. The purpose of this study was to pilot test the Multimodal Exertional Test (MET) protocol in a sample of healthy interuniversity athletes. The MET comprises four stages, each featuring three distinct tasks. The test begins with engaging in squats, alternating reverse lunges, and hip hinges (Stage 1). The next stage progressively evolves into executing these tasks within specified time limits (Stage 2). Following this, the test advances to a stage that incorporates cognitive tasks (Stage 3), and the final stage demands greater levels of physical exertion, cognition, and multi-directional movements (Stage 4). Heart rate (HR) was obtained during each stage of the MET and participants' symptom severity scores were recorded following each task. Fourteen healthy interuniversity athletes (n = 8 female, n = 6 male) participated in the study. HR was obtained for 10 of the 14 athletes (females: n = 6, males: n = 4). Increases in average and maximum HR were identified between pre-MET and Stage 1, and between Stages 3 and 4. Consistent with the tasks in each stage, there were no increases in average and maximum HR observed between MET Stages 1 to 3. Female athletes exhibited higher average and maximum HRs compared to male athletes during all four stages. All 14 athletes reported minimal changes in symptom severity following each task. Among healthy athletes, the MET elicits an increase in average and maximum HR throughout the protocol without symptom provocation. Female athletes exhibit higher HRs during all four stages in comparison to male athletes.

State-dependent effects of repetitive transcranial magnetic stimulation on symptom dimensions of obsessive-compulsive disorder: A case report

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation procedure that is FDA-cleared for treating obsessive-compulsive disorder (OCD). Evidence suggests that controlling brain state during rTMS treatment can influence treatment outcomes. We present the case of a patient with refractory OCD who received symptom provocation immediately preceding rTMS treatment sessions. The patient experienced more subjective and objective improvement in OCD symptoms targeted by provocations than in other symptom domains. These results suggest the importance of brain state during rTMS and could be used to guide and optimize neuromodulation treatment for OCD.

Collegiate Adapted Athlete Baseline Performance on the Vestibular/Ocular Motor Screening.

Concussion assessment in adapted and para-sport athletes has continued to evolve with growing considerations in para-sports, but little is known about vestibular/ocular performance assessment in this sample. To examine baseline performance on the Vestibular/Ocular Motor Screening (VOMS) in collegiate adapted athletes. A secondary objective was to investigate the role of sex, history of concussion, and functional classification on baseline measures. Cross-sectional study. University adapted athletics facility. 54 collegiate adapted athletes (age=21.19±2.6 years) from multiple institution's adapted athletics programs across the United States. Adapted athletes completed a baseline VOMS assessment while at the host university for in-season competition and tournaments. Independent variables were sex, history of concussion and functional classification (1.0-4.5 at 0.5 intervals). VOMS performance consisted of pre-test symptoms (headache, dizziness, nausea, and fogginess) and post-item (e.g., smooth pursuits, saccades) symptom provocation/change from pre-test scores. 50.9% reported 0 symptom provocation on the VOMS, with 72% having no pre-test symptoms. No sex differences were noted on the VOMS (p>0.05); However, adapted athletes with a history of concussion reported greater VOMS provocation on horizontal saccades (p=0.008) than those with no history. Higher functional classifications (2.0-4.5) reported greater provocation on horizontal saccades (p=0.010), horizontal and vertical saccades (p=0.043 and 0.048) vestibular ocular reflex (VOR), and VOR cancellation (p=0.036) than 1.0-1.5 athletes. Our findings provide context for baseline VOMS performance in collegiate adapted athletes and identifying modifiers at baseline. Special consideration is warranted on vestibular and oculomotor assessment in adapted and para-sport athletes with a history of concussion and higher functional classifications.

Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder.

Cognitive behaviour therapy with exposure and response prevention is efficient in treating patients with obsessive-compulsive disorder (OCD). Nevertheless, it would be helpful for many patients to complement the therapeutic treatment with acceptance strategies to further increase the therapeutic benefit. The aim of the present study was to examine neurobiological responses to acceptance and intensification strategies during symptom provocation alongside the psychotherapeutic process. A total of 23 patients diagnosed with OCD (subtype: washing/contamination fear) was instructed to utilise either an acceptance strategy (ACS) or an intensification strategy (INS) to cope with their emotional and cognitive reactions to personalised symptom-triggering and neutral pictures. Fourteen patients participated twice: at the beginning [T1] and at the end [T2] of an inpatient multimodal treatment including cognitive behaviour therapy with response prevention to assess functional variations. For the contrast of T1 and T2, ACS showed increased brain activity in the left inferior frontal gyrus (IFG), left caudate body, and posterior cingulate gyrus (PCC). They also showed decreased activity in the left anterior insula. INS showed decreased activation in right lingual gyrus and right caudate body. At T2, ACS showed increased activation compared to INS in the left cerebrum: IFG, caudate nucleus, middle and superior temporal gyrus, and PCC/cuneus. For the comparison of T1 and T2, the ACS revealed increased brain activity in the left IFG, left caudate body, and right inferior parietal lobe. It showed decreased activity in the left anterior insula. The INS revealed decreased activity in right lingual gyrus and right caudate body.The psychometric questionnaires suggested that patients were able to reduce obsession, compulsion, and depression symptoms. Furthermore, patients rated the ACS as more useful for themselves compared with the INS. The increased left IFG activity using ACS (T1 vs. T2) could be interpreted as a better inhibitory top-down process, while the increased PCC response might be due to a better reappraisal strategy after therapy. ACS seems to mobilise neuronal activations under therapy, especially in the left hemisphere. Both strategies showed reductions in emotional networks as a neuronal correlate of therapy success. Overall, ACS may be more efficient than INS, as rated by the patients and as in accordance with neurobiological findings.

Brain Activation During Virtual Reality Symptom Provocation in Obsessive-Compulsive Disorder: Proof-of-Concept Study

Background Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by obsessions and compulsions. We previously showed that a virtual reality (VR) game can be used to provoke and measure anxiety and compulsions in patients with OCD. Here, we investigated whether this VR game activates brain regions associated with symptom provocation. Objective In this study, we aim to investigate the neural regions that are activated in patients with OCD when they are interactively confronted with a symptom-provoking event and when they are performing compulsive actions in VR. Methods In a proof-of-concept study, we investigated brain activation in response to the VR game in 9 patients with OCD and 9 healthy controls. Participants played the VR game while regional changes in blood oxygenation were measured using functional magnetic resonance imaging. We investigated brain activation in relation to OCD-related events and virtual compulsions in the VR game. Due to low statistical power because of the sample size, we also reported results at trend significance level with a threshold of P&lt;.10. Additionally, we investigated correlations between OCD severity and brain activation. Results We observed a trend for increased activation in the left amygdala (P=.07) upon confrontation with OCD-related events and for increased activation in the bilateral amygdala (P=.06 and P=.09) and right insula (P=.09) when performing virtual compulsive actions in patients with OCD compared to healthy controls, but this did not attain statistical significance. The amygdala and insula activation did not correlate with OCD severity. Conclusions The findings of this proof-of-concept study indicate that VR elicits brain activation in line with previous provocation studies. Our findings need to be replicated in a study with a larger sample size. VR may be used as an innovative and unique method of interactive symptom provocation in future neuroimaging studies. Trial Registration Netherlands Trial Register NTR6420; https://onderzoekmetmensen.nl/nl/trial/25755

Pharmacological and Psychological Treatment Have Common and Specific Effects on Brain Activity in Obsessive-Compulsive Disorder

Initial treatment for obsessive-compulsive disorder (OCD) consists of pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) and/or psychological treatment with cognitive behavioral therapy (CBT). The assumption is that both treatments have different neural working mechanisms, but empirical evidence is lacking. We investigated whether these treatments induce similar or different functional neural changes in OCD. We conducted a longitudinal nonrandomized controlled trial in which thirty-four OCD patients were treated with sixteen weeks of CBT or SSRIs. Functional magnetic resonance imaging was performed before and after treatment during emotional processing (emotional face matching and symptom provocation tasks) and response inhibition (stop signal task). Twenty matched healthy controls were scanned twice with a similar time interval. Both CBT and SSRIs were successful in reducing OCD symptoms. Compared to healthy controls, treatment led to a reduction of insula activity in OCD patients during symptom provocation. The comparison between treatment groups revealed widespread divergent brain changes in the cerebellum, posterior insula, caudate nucleus, hippocampus, and occipital and prefrontal cortex during all tasks, explained by relative increases of activity following CBT compared to relative decreases of activity following SSRIs. Pharmacological and psychological treatment primarily lead to opposite changes in brain function, with a common reduction of insula activity during symptom provocation. These findings provide insight into common and specific neural mechanisms underlying treatment response, suggesting that CBT and SSRIs support recovery from OCD along partly distinct pathways. This trial is registered with NTR6575.

Single-cell transcriptomics of the immune system in ME/CFS at baseline and following symptom provocation

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious and poorly understood disease. To understand immune dysregulation in ME/CFS, we use single-cell RNA sequencing (scRNA-seq) to examine immune cells in patient and control cohorts. Postexertional malaise (PEM), an exacerbation of symptoms following strenuous exercise, is a characteristic symptom of ME/CFS. To detect changes coincident with PEM, we applied scRNA-seq on the same cohorts following exercise. At baseline, ME/CFS patients display classical monocyte dysregulation suggestive of inappropriate differentiation and migration to tissue. We identify both diseased and more normal monocytes within patients, and the fraction of diseased cells correlates with disease severity. Comparing the transcriptome at baseline and postexercise challenge, we discover patterns indicative of improper platelet activation in patients, with minimal changes elsewhere in the immune system. Taken together, these data identify immunological defects present at baseline in patients and an additional layer of dysregulation in platelets.

A - 136 Association of Pre-Injury Anxiety and Oculomotor Symptoms Following Concussion among Adolescents.

To investigate the utility of demographic risk factors and post-concussion oculomotor symptoms to identify adolescents with anxiety panic disorder symptoms. Participants included 124 patients (63 male) aged 10 to 18 (M = 14.4, SD = 2.3) within 2-30days of injury (M = 9.3, SD = 6.3) who presented to a concussion specialty clinic between 2017-2018. All participants completed the Screening for Child Anxiety Related Disorders (SCARED-C) to evaluate pre-injury anxiety as well as the Vestibular/Ocular Motor Screening (VOMS) as part of standard clinical care. A backward logistic regression (LR) was employed to determine the utility of symptom provocation on oculomotor components of the VOMS (i.e., smooth pursuits, horizontal saccades, vertical saccades, and near point of convergence) and demographic risk factors (i.e., history of anxiety or depression and gender) to identify adolescents with panic disorder symptoms on the SCARED-C. The LR model was statistically significant (χ2 (6) = 26.8, p < 0.001) and explained 32.0% of the variance. The model correctly classified 84.7% of cases with high specificity = 0.97 but low sensitivity = 0.27. Variables retained in the model included provocation of dizziness during vertical saccades (OR = 1.85, p = 0.016), self-reported history of depression (OR = 7.34, p = 0.032), and sex (i.e., female; OR = 5.45, p = 0.009). The results indicate that symptom provocation on oculomotor components of the VOMS (i.e., dizziness during vertical saccades), sex, and self-reported history of depression diagnosis are modest predictors of panic disorder symptoms in adolescents. Clinicians should consider these symptoms when interpreting symptoms post-injury.

Brain Neurochemistry After Concussion Among Adolescents With And Without Vestibular/oculomotor Symptom Provocation

Brain Neurochemistry After Concussion Among Adolescents With And Without Vestibular/oculomotor Symptom Provocation