Yale-Brown Obsessive Compulsive Scale Score Research Articles

Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents

In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment. To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder. A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020. Participants randomized to the stepped-care group (n = 74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n = 78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment. The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS. Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -∞ to 3.28]; P for noninferiority = .02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group). Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings. ClinicalTrials.gov Identifier: NCT03263546.

Brain Activation of Patients With Obsessive-Compulsive Disorder During a Mental Rotation Task: A Functional MRI Study.

Functional neuroimaging studies have implicated alterations in frontostriatal and frontoparietal circuits in obsessive-compulsive disorder (OCD) during various tasks. To date, however, brain activation for visuospatial function in conjunction with symptoms in OCD has not been comprehensively evaluated. To elucidate the relationship between neural activity, cognitive function, and obsessive-compulsive symptoms, we investigated regional brain activation during the performance of a visuospatial task in patients with OCD using functional magnetic resonance imaging (fMRI). Seventeen medication-free patients with OCD and 21 age-, sex-, and IQ-matched healthy controls participated in this study. Functional magnetic resonance imaging data were obtained while the subjects performed a mental rotation (MR) task. Brain activation during the task was compared between the two groups using a two-sample t-test. Voxel-wise whole-brain multiple regression analyses were also performed to examine the relationship between obsessive-compulsive symptom severity and neural activity during the task. The two groups did not differ in MR task performance. Both groups also showed similar task-related activation patterns in frontoparietal regions with no significant differences. Activation in the right dorsolateral prefrontal cortex in patients with OCD during the MR task was positively associated with their total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores. This study identified the specific brain areas associated with the interaction between symptom severity and visuospatial cognitive function during an MR task in medication-free patients with OCD. These findings may serve as potential neuromodulation targets for OCD treatment.

Topline Results of the CARE-PWS Phase 3 Study: Intranasal Carbetocin Improves Hyperphagia and Anxiety and Distress Symptoms in Prader-Willi Syndrome (PWS)

Prader-Willi syndrome (PWS) is a complex genetic disorder associated with multiple neuroendocrine abnormalities including significantly decreased hypothalamic oxytocin levels, resulting in symptoms of severe hyperphagia (an unrelenting false sense of starvation) and multiple severe neuropsychiatric and behavioral issues. CARE-PWS, a multi-center, randomized, double-blind, placebo-controlled phase 3 study, has evaluated the efficacy, safety, and tolerability of intranasal carbetocin, a selective oxytocin receptor agonist, in participants with PWS.Eligible participants aged 7 through 18 with genetically confirmed PWS were randomized in equal proportions to three treatment arms for the 8-week placebo-controlled period of the study: carbetocin 9.6 mg, carbetocin 3.2 mg, or a matching placebo, administered by nasal spray three times a day with meals. The primary endpoint assessed changes from baseline to week 8 in Hyperphagia Questionnaire for Clinical Trials (HQ-CT) or Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores for the carbetocin 9.6 mg arm vs placebo, and the first secondary endpoint assessed changes from baseline to week 8 in HQ-CT or CY-BOCS scores for the carbetocin 3.2 mg arm vs placebo. Additional secondary endpoints included changes from baseline to week 8 in PWS Anxiety and Distress Questionnaire (PADQ) scores, and Clinical Global Impression of Change (CGI-C) scores evaluating the overall change in severity of PWS symptoms at week 8.Due to COVID-19, enrollment was closed early with 119 evaluable participants for the primary analysis. In the carbetocin 9.6 mg arm, trends toward numerically greater improvements in HQ-CT and CGI-C scores relative to placebo were observed but did not reach statistical significance; however, the carbetocin 3.2 mg arm demonstrated a significant improvement in HQ-CT scores (LS mean improvement vs placebo -3.14 points, p=0.016). In the 3.2 mg arm, additional consistent evidence of improvements versus placebo was seen in multiple secondary endpoints, including CGI-C (p=0.027) and PADQ (p=0.027). Numeric trends toward improvement in CY-BOCS scores were observed in each dose arm, but did not reach statistical significance versus placebo. During the subsequent long-term follow-up period of the study, both carbetocin arms have experienced continued numeric improvements from baseline across multiple endpoints. Intranasal carbetocin was generally well-tolerated; the most frequently reported adverse event was flushing, which was generally mild and transient.In conclusion, results of the CARE-PWS study support that intranasal carbetocin appears to be safe and well tolerated, and reduces hyperphagia and anxiety and distress behaviors in PWS.

Comparing impulsivity in borderline personality, schizophrenia and obsessional-compulsive disorders: Who is ahead?

Impulsivity impacts life domains and in a psychiatric context is often associated with disorders severity and stigmatization. Borderline personality disorder's (BPD), Schizophrenic disorder's (SZD), and obsessional compulsive disorder's (OCD) impulsivity issues relate to worse prognosis. This study aims to compare these disorders assessing their proneness to impulsivity and urgency. We recruited 90 patients among them OCD (n = 25), SZD (n = 23), and BPD (n = 50), and 24 healthy control participants (HC). We assessed the diagnosis according and measured the impulsivity level. Our results showed that BPD was significantly more impulsive than HC, SZD, and OCD. HC, SZD, and OCD being equivalent on their global Urgency-Premeditation-Perseverance-Sensation seeking scores. For urgency, BPD was also superior to others, OCD was superior to HC, but SZD and HC were equivalent. The urgency was correlated to SZD's scale for SZD, no link appeared between borderline personality questionnaire and Yale-Brown Obsessive-Compulsive Scale's score. These results question the existent literature relating impulsivity and SZD.

Repetitive Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Meta-analysis of Randomized, Sham-Controlled Trials

BackgroundObsessive-compulsive disorder (OCD) is a chronic, disabling mental health condition with limited treatment options available to date. Numerous randomized controlled trials have explored the efficacy of repetitive transcranial magnetic stimulation (rTMS) in OCD. This meta-analysis synthesized data from selected randomized controlled trials and examined the impact of different treatment parameters to generate hypotheses that would direct future randomized controlled trials. MethodsA database search was performed to identify studies published in English up to October 2020. Randomized, sham-controlled studies that used rTMS to treat OCD were included. Effect sizes were calculated using Hedges’ g for pre- to post-treatment Yale-Brown Obsessive Compulsive Scale scores. Subgroup analyses were conducted to assess the effects of variations in rTMS treatment parameters. ResultsA total of 26 studies with 781 participants were included. Overall, rTMS demonstrated a modest effect on reduction of Yale-Brown Obsessive Compulsive Scale scores (Hedges’ g = 0.64, 95% confidence interval = 0.39–0.89; p < .0001). The largest significant effect size was obtained by targeting the bilateral dorsolateral prefrontal cortex. High- and low-frequency rTMS showed comparable effects. Studies with follow-up data suggested that the effects of active rTMS remain significantly superior to those of sham 4 weeks after treatment. ConclusionsThe therapeutic effects of rTMS are superior to those of sham in the treatment of OCD. Targeting the bilateral dorsolateral prefrontal cortex was the most favorable approach in administering rTMS. Further research is required to determine the optimal frequency, total pulses per session, and duration of treatment with rTMS for OCD.

Impact of the COVID-19 Pandemic on the Short-Term Course of Obsessive-Compulsive Disorder.

There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic ("pandemic" cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41-1.59; p = 0.535). Preexisting contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.

Deep brain stimulation versus ablative surgery for treatment-refractory obsessive-compulsive disorder: A meta-analysis.

Ablative surgery (ABL) and deep brain stimulation (DBS) are last-resort treatment options for patients suffering from treatment-refractory obsessive-compulsive disorder (OCD). The aim of this study was to conduct an updated meta-analysis comparing the clinical outcomes of the ablative procedures capsulotomy and cingulotomy and deep brain stimulation. We conducted a PubMed search to identify all clinical trials on capsulotomy, cingulotomy, and DBS. Random effects meta-analyses were performed on 38 articles with a primary focus on efficacy in reducing OCD symptoms as measured by a reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score and the responder rate (≥35% reduction in Y-BOCS score). With responder rates of 48% and 53% after 12-16months and 56% and 57% at last follow-up for ABL and DBS, respectively, and large effect sizes in the reduction in Y-BOCS scores, both surgical modalities show effectiveness in treating refractory OCD. Meta-regression did not show a statistically significant difference between ABL and DBS regarding these outcomes. Regarding adverse events, a statistically significant higher rate of impulsivity is reported in studies on DBS. This meta-analysis shows equal efficacy of ABL and DBS in the treatment of refractory OCD. For now, the choice of intervention should, therefore, rely on factors such as risk of developing impulsivity, patient preferences, and experiences of psychiatrist and neurosurgeon. Future research should provide more insight regarding differences between ABL and DBS and response prediction following direct comparisons between the surgical modalities, to enable personalized and legitimate choices between ABL and DBS.

Network-based functional connectivity predicts response to exposure therapy in unmedicated adults with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is associated with alterations in cortico-striato-thalamo-cortical brain networks, but some resting-state functional magnetic resonance imaging studies report more diffuse alterations in brain connectivity. Few studies have assessed functional connectivity within or between networks across the whole brain in unmedicated OCD patients or how patterns of connectivity predict response to exposure and ritual prevention (EX/RP) therapy, a first-line treatment for OCD. Herein, multiband resting-state functional MRI scans were collected from unmedicated, adult patients with OCD (n = 41) and healthy participants (n = 36); OCD patients were then offered twice weekly EX/RP (17 sessions). A whole-brain-network-based statistic approach was used to identify group differences in resting-state connectivity. We detected altered pre-treatment functional connectivity between task-positive regions in the temporal gyri (middle and superior) and regions of the cingulo-opercular and default networks in individuals with OCD. Signal extraction was performed using a reconstruction independent components analysis and isolated two independent subcomponents (IC1 and IC2) within this altered connectivity. In the OCD group, linear mixed-effects models tested whether IC1 or IC2 values predicted the slope of change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores across EX/RP treatment. Lower (more different from controls) IC2 score significantly predicted greater symptom reduction with EX/RP (Bonferroni-corrected p = 0.002). Collectively, these findings suggest that an altered balance between task-positive and task-negative regions centered around temporal gyri may contribute to difficulty controlling intrusive thoughts or urges to perform ritualistic behaviors.

Refractory obsessive-compulsive disorder complicated by alcohol withdrawal seizures in a female.

Refractory obsessive-compulsive disorder complicated by alcohol withdrawal seizures in a female.

Technology-based CBT in Reducing Symptoms of OCD in Children: A Systematic Review

Background: Obsessive Compulsive Disorder (OCD) is an anxiety disorder affecting up to 3% of children and adolescent in the United States. Cognitive behavioral therapy (CBT) is the first-line treatment for mild to moderate OCD in children. Despite the benefits of CBT in treatment of OCD, only one-third of clinicians regularly use CBT compared to psychotropic medication due to lack of access. The COVID-19 pandemic has resulted in increased relapses in OCD severity and further limited access to traditional face-to-face CBT treatment due to health and safety precautions. Purpose: This systematic review aims to demonstrate the efficacy of technology-based CBT by evaluating results of clinical trials and its comparability to traditional CBT methods. Methods: An evidence-based search was conducted using terms such as “Obsessive-Compulsive disorder” AND “ internet” AND “cognitive behavior therapy” and “children”. A total of 716 articles were identified. Results: After screening titles, abstracts, and full articles for relevance, 7 studies with a total of 254 subjects and four different programs involving technology-based CBT were included in this systematic review. Information gathered in this review support the use of technology-based CBT as an effective treatment in reducing the severity of OCD symptoms as shown by statistically significant reductions in Children Yale-Brown Obsessive-Compulsive Scale scores. Additionally, the results from this review support previous clinical studies demonstrating that effects of technology-based CBT were non-inferior to traditional CBT methods. Conclusion: The results of this systematic review support the use of technology-based CBT for the treatment of OCD in children and adolescents, especially in times where access to in-person therapist sessions are not possible due to geographical or global concerns. Additional research is needed to understand the impact and acceptability of new CBT methods on daily-life as well as the effectiveness of technology-based methods on more severe cases of OCD.

Positive impact of COVID-19 outbreak on the treatment of contamination fear in obsessive-compulsive patients in Armenia

Objective: To observe the effects that the COVID-19 pandemic has had on patients with contamination fear at obsessive-compulsive disorder (OCD), and how this can be used to improve psychotherapeutic treatment. Materials and methods: 33 patients were involved, divided into 2 groups, in one of which we used additional experimental features of psychotherapy. OCD total condition and separate symptoms were assessed using Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Results: Patients, included in Group A, showed significantly better improvement in both total Y-BOCS score, as well as in particular symptoms connected with so-called mental contamination. Conclusions: Adding reality-based and emotionally significant features of contamination control and prevention to standard cognitive-behavioral therapy protocol may seriously improve outcomes in the treatment of mental contamination obsessions. The period of pandemics, as well as post-pandemic, can be used for intense further research in this area in a larger selection of patients. Long-term follow-up is recommended to clarify the stability of positive changes.

Gamma oscillations predict paroxetine response of patients with Obsessive Compulsive Disorder

BackgroundObsessive compulsive disorder is a distressing psychiatric illness with considerable treatment resistance rates. Prediction of treatment response leads to an increase in patient compliance and a decrease in morbidity. To decrease the treatment resistance rates, valid and useful instruments have been searched. Quantitative electroencephalography (QEEG) based markers have been objective predictors of the treatment response in psychiatric disorders. AimThis retrospective pilot study aims to explore QEEG as a biomarker to predict early response to paroxetine in OCD patients. MethodResting state QEEG and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were administered to 30 drug-free OCD patients without comorbidity. After maximum 12-week of treatment with paroxetine, patients with and without an early improvement were classified based on at least a 35% reduction in Y-BOCS scores. Pre-treatment QEEG data were compared between the two groups. ResultsPre-treatment gamma, gamma 1 and gamma 2 oscillations were significantly higher in OCD patients who did not show an early improvement. ConclusionThese preliminary results indicate that gamma oscillations could be acknowledged as the electrophysiological predictors of early clinical outcomes of OCD patients during paroxetine treatment.

Prevalence and Characteristics of Obsessive-Compulsive Disorder Among Urban Residents in Wuhan During the Stage of Regular Control of Coronavirus Disease-19 Epidemic.

Background: Coronavirus disease-19 (Covid-19) is one of the most devastating epidemics in the 21st century, which has caused considerable damage to the physical and mental health of human beings. Despite a few regions like China having controlled the epidemic trends, most countries are still under siege of COVID-19. As the emphasis on cleaning and hygiene has been increasing, the problems related to obsessive-compulsive disorder (OCD) may appear.Objective: This study was designed to investigate the prevalence of OCD in the urban population in Wuhan during the stage of regular epidemic control and prevention. Meanwhile, characteristics and risk factors for OCD were also explored.Method: Five-hundred and seventy residents in urban areas of Wuhan were recruited using the snowball sampling method to complete questionnaires and an online interview from July 9 to July 19, 2020. Collected information encompassed socio-demographics, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, Social Support Rating Scale (SSRS) scores and Pittsburgh Sleep Quality Index(PSQI) values.Results: Three months after lifting the quarantine in Wuhan, the prevalence of OCD was 17.93%. About 89% of OCD patients had both obsessions and compulsions, while 8% had only obsessions and 3% had only compulsions. Top 3 common dimensions of obsessions were miscellaneous (84.0%), aggressive (76.6%), and contamination (48.9%), and of compulsions were miscellaneous (64%), checking (51.7%), and cleaning/washing/repeating (31.5%). The unmarried were more vulnerable to OCD than the married (p < 0.05, odds ration = 1.836). Students had 2.103 times the risk of developing OCD than health care workers (p < 0.05). Those with positive family history of OCD and other mental disorders (p < 0.05, odds ration = 2.497) and presence of psychiatric comorbidity (p < 0.05, odds ration = 4.213) were also at higher risk. Each level increase in sleep latency increased the risk of OCD to 1.646 times (p < 0.05).Conclusion: In the background of regular epidemic control, the prevalence of OCD was high, and the symptoms were widely distributed. Obsessions often accompanied compulsions. Being single and a student, positive family history of OCD and other mental disorders, presence of psychiatric comorbidity, and longer sleep latency were predictors of OCD. Early recognition and detection of these issues may help to intervene in OCD.

Abnormal dynamics of functional connectivity in first-episode and treatment-naive patients with obsessive-compulsive disorder.

The aim of this study was to assess the whole-brain dynamic functional connectivity of first-episode and treatment-naive patients with obsessive-compulsive disorder (OCD) and to investigate the clinical correlations of abnormal changes in dynamic functional connectivity. Twenty-nine patients in our hospital diagnosed with first-episode OCD and 29 healthy controls matched for age, sex, and education were included in our study. Resting-state functional magnetic resonance imaging scans were performed on a 3.0-Tesla magnetic resonance scanner in our hospital. Three temporal metrics of connectivity state expression were calculated: (i) fraction of time; (ii) mean dwell time; and (iii) number of transitions. The Yale-Brown Obsessive-Compulsive Scale was used to assess the severity of OCD symptoms. In the comparison of dynamic functional connectivity indicators, we found that there were significant differences in the number of transitions among the four functional connectivity states but no significant differences in the fraction of time or the mean dwell time. The total Yale-Brown Obsessive-Compulsive Scale score was positively correlated with the number of transitions. In the validation analysis, when the size of the sliding window changed, there was still a significant difference in the number of transitions between OCD patients and healthy controls. The functional networks of OCD patients have lost the correct dynamic rhythm, which may be considered as a potential marker for OCD and for new directions for its intervention.

Serotonin transporter gene promoter hypomethylation in obsessive-compulsive disorder – Predictor of impaired response to exposure treatment?

Treatment resistance is common in obsessive-compulsive disorder (OCD) and associated with a significant burden for the individual patient. Accordingly, the identification of biomarkers as early predictors of the clinical response has become a central goal in the search for more efficacious and personalized treatments. Epigenetic mechanisms such as DNA methylation of the serotonin transporter gene (SLC6A4) have been suggested to predict therapy outcome in mental disorders closely related to OCD, but have not yet been investigated as such in OCD. The present therapy-epigenetic study therefore sought to address the potential role of SLC6A4 promoter methylation in the prediction of treatment response for the first time in OCD.Overall, 112 patients with primary OCD were investigated over the course of 8–10-week OCD-specific, cognitive behavioral therapy (CBT) comprising exposure and response prevention/management (phase I) and in vivo exposure exercises (‘flooding’, phase II). OCD symptoms were measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline as well as before and after the in vivo exposure phase. SLC6A4 promoter methylation at baseline was analyzed via pyrosequencing of sodium bisulfite-treated DNA extracted from blood cells.Lower baseline SLC6A4 promoter methylation predicted impaired treatment response (defined as reduction in Y-BOCS scores) in phase II (but not phase I) of CBT (β = −0.359, p = .002).SLC6A4 methylation may thus constitute a potential early biomarker predicting biologically mediated clinical changes elicited specifically by exposure treatment. These results carry promise for clinical application and in the future could aid in early treatment modification and personalized treatment efforts.

Obsesif kompulsif bozukluk hastalarında mizaç, karakter özellikleri ve aleksitimi

Introduction: Alexithymia levels have generally been found high in patients with obsessive compulsive disorder (OCD). It is thought that there is a correlation between alexithymia and the severity of OCD symptoms. One of the factors influencing alexithymia is temperament-character traits. In this study, it was aimed to investigate the temperament-character traits in OCD patients and the correlation of these traits with alexithymia. Methods: This study included 43 OCD patients who applied to Atatürk University Psychiatry Outpatient Clinic and 33 healthy individuals as the control group. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV), Sociodemographic and clinical data form, and Temperament and Character Inventory (TCI), Toronto Alexithymia Scale (TAS-20) were applied to participants whereas Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was additionally applied to the patient group.Results: No difference was detected between both groups in terms of age and gender. In the OCD group, harm avoidance (HA) and self-transcendence (ST) scores were found high, and self-directedness (SD), cooperativeness (C) and novelty seeking (NS) were found low when compared to the control group. In the OCD group, difficulty in expressing feelings (TAS-B), extroverted thinking (TAS-C) and TAS-20 scores were found to be higher than the control group. In the alexithymic OCD group, the mean disorderliness and persistence(P) scores were found to be lower compared to the non-alexithymic group. A positive correlation was discovered between Y-BOCS scores and TAS-C scores in OCD patients.Conclusion: Alexithymia is observed at a high rate in OCD. The extroverted thinking sub-dimension of alexithymia is correlated with the severity of OCD symptoms. Some temperament-personality traits differ in alexithymic-OCD patients compared to those who are not alexithymic. The evaluation of alexithymia and the factors influencing alexithymia has the potential to offer a new approach to understand the etiology and treatment of OCD.

Effects of the COVID-19 Pandemic on Obsessive-Compulsive Symptoms Among University Students: Prospective Cohort Survey Study

BackgroundThe COVID-19 pandemic is associated with common mental health problems. However, evidence for the association between fear of COVID-19 and obsessive-compulsive disorder (OCD) is limited.ObjectiveThis study aimed to examine if fear of negative events affects Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores in the context of a COVID-19–fear-invoking environment.MethodsAll participants were medical university students and voluntarily completed three surveys via smartphone or computer. Survey 1 was conducted on February 8, 2020, following a 2-week-long quarantine period without classes; survey 2 was conducted on March 25, 2020, when participants had been taking online courses for 2 weeks; and survey 3 was conducted on April 28, 2020, when no new cases had been reported for 2 weeks. The surveys comprised the Y-BOCS and the Zung Self-Rating Anxiety Scale (SAS); additional items included questions on demographics (age, gender, only child vs siblings, enrollment year, major), knowledge of COVID-19, and level of fear pertaining to COVID-19.ResultsIn survey 1, 11.3% of participants (1519/13,478) scored ≥16 on the Y-BOCS (defined as possible OCD). In surveys 2 and 3, 3.6% (305/8162) and 3.5% (305/8511) of participants had scores indicative of possible OCD, respectively. The Y-BOCS score, anxiety level, quarantine level, and intensity of fear were significantly lower at surveys 2 and 3 than at survey 1 (P<.001 for all). Compared to those with a lower Y-BOCS score (<16), participants with possible OCD expressed greater intensity of fear and had higher SAS standard scores (P<.001). The regression linear analysis indicated that intensity of fear was positively correlated to the rate of possible OCD and the average total scores for the Y-BOCS in each survey (P<.001 for all). Multiple regressions showed that those with a higher intensity of fear, a higher anxiety level, of male gender, with sibling(s), and majoring in a nonmedicine discipline had a greater chance of having a higher Y-BOCS score in all surveys. These results were redemonstrated in the 5827 participants who completed both surveys 1 and 2 and in the 4006 participants who completed all three surveys. Furthermore, in matched participants, the Y-BOCS score was negatively correlated to changes in intensity of fear (r=0.74 for survey 2, P<.001; r=0.63 for survey 3, P=.006).ConclusionsOur findings indicate that fear of COVID-19 was associated with a greater Y-BOCS score, suggesting that an environment (COVID-19 pandemic) × psychology (fear and/or anxiety) interaction might be involved in OCD and that a fear of negative events might play a role in the etiology of OCD.

A pilot study of magnetic seizure therapy for treatment-resistant obsessive-compulsive disorder.

There is growing interest in the potential of neuromodulation options in treatment-resistant obsessive-compulsive disorder (OCD). Magnetic seizure therapy (MST), is a new treatment intervention in which generalized seizures are induced with transcranial magnetic stimulation. We conducted a pilot study to assess the efficacy and cognitive effects of MST in patients with treatment-resistant OCD. In an open-label pilot study, participants with treatment-resistant OCD and a baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores of ≥16 were treated with up to 24 acute treatments. The primary clinical outcomes were clinical response (Y-BOCS score reduction ≥30%) and remission (final Y-BOCS score ≤8). A neurocognitive battery, the Quick Inventory for Depressive Symptoms-Self Report (QIDS-SR), the Beck Scale for Suicidal Ideation (SSI), and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) were also completed as secondary measures. Ten participants with OCD who had not responded to medications or psychotherapy enrolled in the study and seven completed an adequate trial (defined as ≥8 treatments). MST was associated with minimal cognitive effects except for some decrease in autobiographical memory and no serious adverse effects. Only one participant met the predefined criteria for response, and none for remission. The baseline and endpoint Y-BOCS scores were not statistically different. Overall, MST was not beneficial in a small group of patients with treatment-resistant OCD. At this time, other studies of MST for OCD are not warranted until different coil placements targeting other brain circuits can be proposed.

Study the therapeutic role of transcranial magnetic stimulation in a sample of Egyptian patients with resistant obsessive-compulsive disorder

Background: Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects approximately 2-3% of the world population. The first-line treatments are selective serotonin reuptake inhibitors and cognitive behavioral therapy. Despite that, approximately 40- 60% of patients remain treatment refractive. Aim of work: Evaluating the efficacy of different frequencies of repetitive transcranial magnetic stimulation (rTMS) applied over the right dorsolateral prefrontal cortex (DLPFC) as an adjunctive treatment for resistant OCD. Patient and Methods: Thirty patients with treatment resistant OCD were randomly assigned to 2 weeks either active LF (1 Hz, n=10), HF (10 Hz, n=10) with parameters (25-minute trains, 1,500 pulses/day at 100% of the resting motor threshold RMT, 5 sessions/week) or sham (n=10) (same HF parameters with coil tilting). OCD, anxiety and depressive symptoms were assessed using: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAM-A), Beck Depression Inventory (BDI) and Clinical Global Impression-Severity scale (CGI-S) before and immediately after sessions and 3 months later. Results: A repeated-measures analysis of variance (ANOVA) revealed a non-significant reduction in Y-BOCS scores in the active groups compared with the sham group after 2 weeks and 3 months later. Similarly, there was non-significant effect of time and time×group interaction on scores of (HAM-A) (CGI-S). While there was a significant effect of time and time×group interaction on scores of (BDI) after 2 weeks with active stimulation especially LF-rTMS not after 3 months. There were no reports of serious adverse effects following the active or sham rTMS treatments. Conclusion: Neither LF nor HF rTMS over the right DLPFC appeared to be superior to sham rTMS for relieving OCD and anxiety symptoms in patients with treatment-resistant OCD. However, rTMS has a role in improving depressive symptoms, especially with LF-rTMS. Further trials with larger sample sizes should be conducted to confirm the present findings.

Bidirectional comorbidity between bipolarand obsessive-compulsive disorders: symptoms frequency, treatment challenges and underexplored areas

The high comorbidity of bipolar- (BD) and obsessive-compulsive disorder (OCD) is a challenge in the psychiatric field. This topic has been scarcely investigated in Latin America, and we could not find published studies conducted in Venezuela. Given the common difficulty to establish a categorical diagnosis in comorbid conditions, we assessed the frequency of current OC symptoms (OCS) in subjects with primary BD, and of BD symptoms (BDS) insubjects with primary OCD. We administered the Yale-Brown Obsessive-CompulsiveScale (Y-BOCS) to 40 patients with BD, and the Young Mania RatingScale (YMRS) and the Mood Disorder Questionnaire (MDQ) to 42 patients withOCD. We observed clinically significant OCS (Y-BOCS score ≥ 16) in 20% of BDsubjects, and current hypomania or mania in 16.7% and 19% of OCD patientsrespectively. A significant positive correlation between age and YMRS was detectedin OCD females, p = 0.04. We here confirmed the high comorbidity inthe bipolar and obsessive-compulsive dimensions. Numerous studies identifythe clinical burden, diagnostic difficulties and treatment intricacy of this comorbidity,which warrants for further research to assist this sensible population.We illustrate the challenges of pharmacological and psychological treatment,and the issue of family history of psychopathology, with two conspicuousclinical vignettes extracted from the studied sample.