Yale-Brown Research Articles

Severe Obsessive‒compulsive Disorder of Transformation in a 13-year-old Adolescent: A Case Report

Introduction: Obsessive-compulsive Disorder (OCD) with transformation obsession is a rare psychiatric disorder that can pose various diagnostic difficulties and treatment challenges. Scientific research focusing on this disorder in adolescents is scarce. In this work, we present the case of a teenage girl who was treated for severe OCD with transformation obsession. The psychiatric management of this adolescent was performed on an outpatient basis and took place in the juvenile department at Saint Ylie Hospital (France). We hope that our work will add to the existing data on the psychiatric management of this condition in adolescents. In this work, we used the Diagnostic and Statistical Manual of Mental Disorders 5th version for the evaluation of psychiatric disorders and the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) to assess the severity of symptoms. Case Presentation: The patient (13 years old) experienced persistent, intrusive, and distressing ideas about transforming into another person. Despite knowing how unreal these ideas were, she feared they would come true. She had rituals that she felt compelled to carry out to help her manage her worries temporarily. She also experienced involuntary non-rhythmic movements of the facial muscles simultaneously. The patient was diagnosed with OCD with good insight and comorbid tics. Initially, the total CY-BOCS score was 40/40. Psychosis was considered a differential diagnosis due to the atypicality of the clinical manifestation, but it was ruled out after a thorough clinical evaluation. Psychotherapeutic management was not possible before adequate pharmaceutical treatment was started because of invasive and distressing symptoms. The pharmacological management led to the administration of a combination of fluoxetine at a dose of 40mg with olanzapine at a dose of 5mg after a partial response to fluoxetine alone. Weekly individual Cognitive Behavioral Therapy (CBT) was started as soon as the adolescent's condition allowed and included psychoeducation, muscle relaxation techniques, cognitive restructuring, Exposure and Response Prevention (ERP), self-affirmation work, and relapse prevention. At the same time, parents also benefited from psychoeducational interventions. The evolution was marked by total clinical remission and clear psychometric improvement. The total CY-BOCS score ranged from 40/40 to 07/40 after 5 months of CBT. No adverse effects were reported throughout the treatment. Conclusion: This case shows the possibility of unusual and severe OCD in adolescents. It also highlights the importance of careful diagnosis so as not to be mistaken and consider it a psychosis. The management of this type of OCD requires the combination of two pharmacological treatments before starting individual CBT and psychoeducational intervention for parents. This combination allows a complete clinical remission after a few months. It is preferable that further clinical trials be conducted to protocolize the management of this type of OCD.

Remediating cognitive inflexibility in obsessive compulsive disorder and anorexia nervosa neither moderates nor mediates treatment effects: an exploratory study

ObjectiveObsessive compulsive disorder (OCD) and anorexia nervosa (AN) are conditions associated with poor cognitive flexibility, a factor considered to interfere with treatment, but research into the relationship between cognitive flexibility and treatment outcome is limited. This study explores whether baseline measures of cognitive flexibility predict outcomes in OCD and AN, evaluates whether changes in these measures contribute to treatment outcome, and evaluates the effectiveness of adjunctive cognitive remediation therapy (CRT) in improving cognitive flexibility.MethodsThis secondary analysis utilized linear mixed model analysis on data from a randomized controlled multicenter clinical trial involving adult participants with OCD (n=71) AND AN (n=61). Participants underwent 10 twice-weekly sessions of either CRT or a non-specific active control intervention (specialized attention therapy; SAT), followed by treatment as usual. Assessments using Yale-Brown Obsessive Compulsive Scale and the Eating Disorder Examination Questionnaire were conducted at baseline, post-CRT/SAT and at 6 and 12 months. Cognitive flexibility was evaluated through the Trail Making Test (TMT), the Color-Word Interference Test (CWIT) and the Detail and Flexibility Questionnaire (DFlex).ResultsLevels of cognitive flexibility at baseline did not predict or moderate treatment outcome, nor did change in cognitive flexibility (baseline post-CRT/SAT) mediate treatment outcome, with CRT providing no greater improvement in measures of cognitive flexibility than SAT.ConclusionsThis study failed to find any relationship between measures of cognitive flexibility and treatment outcome in OCD and AN, and thus questions hypothetical associations between measures of cognitive flexibility and mechanisms of change in patients with OCD and AN.

Systematic Review and Meta-Analysis of Individual Participant Data: Randomized, Placebo-Controlled Trials of Selective Serotonin Reuptake Inhibitors for Pediatric Obsessive-Compulsive Disorder.

Selective serotonin reuptake inhibitors (SSRIs) are the first choice in pharmacotherapy for children and adolescents with obsessive-compulsive disorder (OCD). SSRI-trials for pediatric OCD have never been investigated using individual participant data (IPD), which is crucial for detecting patient-level effect modifiers. Here, we performed an IPD meta-analysis on the efficacy of SSRIs compared to placebo, and a meta-regression on baseline patient characteristics which might modify efficacy. We used crude participant data from short-term, randomized, placebo-controlled SSRI trials for pediatric OCD, available from the registry of the Dutch regulatory authority. We also performed a systematic literature search and approached the authors to provide IPD. We performed a one- and two-stage analysis, with change on the Children's Yale Brown Obsessive-Compulsive Scale (CY-BOCS) as the primary outcome. We used Odds Ratio (OR) with ≥ 35% CY-BOCS-reduction as the responder outcome measure. We examined modifying effect of age, sex, weight, duration of illness, family history and baseline symptom severity. We used the Cochrane Risk of Bias 2.0 tool to examine methodological rigor, and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in order to examine certainty of evidence. We obtained data from 4 studies with a total of 614 patients. Our sample represented 86% of all participants ever included in double blind placebo controlled SSRI trials for pediatric OCD. Meta-analysis showed a reduction of 3.0 CY-BOCS points compared to placebo (95% CI 2.5 - 3.5), corresponding to a small effect size (0.38 Hedges' g). Analysis of response showed an OR of 1.89 (95% CI 1.45 - 2.45). Of all possible modifiers, severity was correlated negatively with OR for response (beta -0.92, p 0.0074). Risk of bias was generally low. All studies were performed on the North American continent with an overrepresentation of White participants. Our findings were limited by the inability to include data on additional variables such as socio-economic status and comorbidities. Our IPD meta-analysis showed a small effect size of SSRIs in pediatric OCD, with baseline severity as a negative modifier of response. Generalizability of findings might be limited by selective inclusion of White, North American participants.

Psychometric evaluation of the Yale-Brown Obsessive-Compulsive Scale in pregnant women.

Although many women experience obsessive-compulsive symptoms during the perinatal period, the Yale-Brown Obsessive Compulsive Scale (YBOCS) has not yet been psychometrically evaluated in this population. This study examined the internal consistency, convergent and divergent validity, and factor structure of the YBOCS among pregnant women. 256 Women who were 20 to 24 weeks pregnant completed the clinician-administered YBOCS and Mini International Neuropsychiatric Interview (MINI) along with a series of self-report questionnaires including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Obsessive-Compulsive Inventory-Revised (OCI-R). Internal consistency of the YBOCS was excellent, and there were strong inter-scale correlations between the YBOCS Total Score, YBOCS Obsessions and Compulsions Severity Scales. The YBOCS demonstrated good known-groups validity differentiating women with and without OCD. Convergent validity with the OCI-R was demonstrated while relations with divergent validity were more mixed. The YBOCS possesses strong psychometric properties in pregnant women.

Psychometric properties of the Yale-Brown obsessive-compulsive scale, second edition, self-report (Y-BOCS-II-SR)

Psychometric properties of the Yale-Brown obsessive-compulsive scale, second edition, self-report (Y-BOCS-II-SR)

Effectiveness of the Rapid Eye Movement Sequential Therapy Program in Reducing Post-Traumatic Stress Disorders in Individuals with Obsessive-Compulsive Disorder: A Sample of Mothers of Children with Special Needs Referred from Psychological Clinics in Kha

The study aimed to reveal the effectiveness of the Rapid Eye Movement Desensitization and Reprocessing (EMDR) program in reducing post-traumatic stress disorder among patients with obsessive-compulsive disorder (among a sample of mothers of children with special needs referred from psychiatric clinics in Khartoum). The study sample consisted of (14) mothers, who were intentionally selected from those attending psychiatric clinics in Khartoum, and suffering from obsessive-compulsive disorder as a result of post-traumatic stress disorder after being informed that their children have special needs. Their ages ranged between (35-40) years. Participation in the treatment program was approved based on the psychiatrists' orientations for them to attend the program to complete treatment after stopping medication. The Yale-Brown Obsessive Compulsive Scale was used and applied to the study sample before and after the program, as well as during follow-up. To achieve the study objectives, the EMDR program was applied to reduce post-traumatic stress disorder symptoms. It was prepared by the researcher and lasted for two months from January 1st (2023) until the end of February of the same year. The researcher applied the study tools before and after the program. The data was analyzed using the Statistical Package for Social Sciences (SPSS). The study reached the following results: The first hypothesis indicated statistically significant differences at the significance level (α=0.05) in obsessive thoughts among the study sample between the pre-test and post-test due to the EMDR program. The training program showed an effectiveness of (74.7%) in reducing their obsessive thoughts. The result of the second hypothesis also indicated statistically significant differences at the significance level (α=0.05) in compulsive acts among the sample between the pre-test and post-test, attributed to the EMDR program. The training program showed an effectiveness of (74.9%) in reducing the compulsive acts associated with post-traumatic stress disorder among the sample. The follow-up results indicated no statistically significant differences at the significance level (α=0.05) in obsessive thoughts among the sample between the post-test and follow-up test. There were also no statistically significant differences at the significance level (α=0.05) in compulsive acts among the sample between the post-test and follow-up test, indicating the effect and continued effectiveness of the training program during the follow-up stage. In light of these results, the study recommended conducting further studies on the effectiveness of the EMDR program in reducing post-traumatic stress disorder symptoms in patients with obsessive-compulsive disorder with a sample of males or other age groups to reduce their obsessive-compulsive acts.

Clinical Study of Limosilactobacillus reuteri for the Treatment of Children with Chronic Tic Disorders/Tourette Syndrome: A Mid-Term Efficacy Evaluation.

Gut microbiota plays an important role in tic disorders (TDs); however, clinical research on probiotics for chronic TDs treatment is lacking. We aimed to investigate the effectiveness of probiotics, hypothesizing that their clinical efficacy is comparable to that of clonidine in treating chronic TDs. Patients were randomly assigned to receive either Limosilactobacillus reuteri or clonidine transdermal patch treatment for 8weeks while maintaining their existing treatment. The Yale Global Tic Severity Scale (YGTSS); Swanson, Nolan, and Pelham-IV Scale (SNAP-IV); and Child Behavior Check List (CBCL) scores were assessed before and after treatment. We matched the patients in both groups for age, sex, age at onset, and tic type. A significant improvement in YGTSS scores was observed in both groups (p = 0.024). The improvement in attention deficits on the SNAP-IV scale was similar between the two groups, with no significant difference (p = 0.465). For hyperactivity disorder, after matching patients in both groups for age, sex, age at onset, tic type, and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores, a significant difference in improvement was observed between the groups (p = 0.010), with the probiotics group showing greater improvement (0.3 ± 0.58 vs. 0.1 ± 0.50). At 9weeks, social ability on the CBCL scale increased by 3.2 ± 6.26 from baseline in the probiotics group and by 0.6 ± 4.07 in the clonidine group, with a significant difference between the two (p = 0.049). Although there was no significant difference in behavioral problems between the two groups (p = 0.347), the trend of improvement was more pronounced in the probiotics group than in the clonidine group (12.7 ± 25.86 vs. 8.4 ± 13.15). The mid-term efficacy evaluation demonstrated that L.reuteri, when added to the treatment of children with chronic TDs, was more effective in improving tic symptoms than clonidine transdermal patch treatment. Additionally, it provided moderate improvement in hyperactivity symptoms. chictr.org.cn (registration numbers ChiCTR2200056708, ChiCTR2200056578).

Altered eotaxin-1 and interleukin-34 levels in obsessive-compulsive disorder: a case-control observational study in Bangladesh.

Obsessive-compulsive disorder (OCD) is a prevalent mental health condition that impacts daily life. It is thought to be associated with genetic, biological, and structural brain changes, serotonergic abnormalities, altered neuromodulation, and environmental factors. Limited observational studies have examined cytokines in Bangladeshi patients with OCD. This study aimed to assess the levels of eotaxin-1 and interleukin (IL)-34 in individuals with this disorder. This case-control observational study included 58 patients with OCD and 30 healthy controls (HCs) matched for age, sex, and body mass index. The severity of OCD was assessed using the Yale-Brown obsessive-compulsive scale (Y-BOCS). Psychiatrists evaluated participants according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Serum levels of eotaxin-1 and IL-34 were measured using enzyme-linked immunosorbent assay kits. Patients with OCD exhibited significantly higher serum eotaxin-1 levels (121.13±7.84 pg/mL) than HCs (85.52±9.42 pg/mL). Conversely, IL-34 levels were considerably lower in patients than in HCs (119.02±14.53 pg/mL vs. 179.96±27.88 pg/mL). The Cohen d values for eotaxin-1 and IL-34 were 0.55 and -0.48, respectively. Among patients with OCD, a significant positive correlation was found between serum eotaxin-1 level and Y-BOCS score, along with a negative correlation between serum eotaxin-1 and IL-34 levels. The findings suggest that altered eotaxin-1 and IL-34 levels may be associated with OCD. These chemokines and cytokines could serve as primary tools for assessing the risk of OCD, warranting further clinical investigation. This could potentially support more extensive research and the development of diagnostic and therapeutic strategies targeting these pathways.

Treatment of Obsessive-Compulsive Disorder in Children and Youth: A Meta-Analysis.

Treatments for obsessive-compulsive disorder (OCD) in children and adolescents. Evaluate the comparative efficacy of behavioral and pharmacologic treatments. Six databases and ClinicalTrials.gov registry; search last updated on 5/15/2024. Dual screening augmented by Abstrackr machine learning algorithm. Participant characteristics, intervention details and risk of bias. 71 randomized controlled trials (RCTs). In the random effects network meta-analysis of OCD symptom severity, assessed by the Children's Yale-Brown Obsessive Compulsive Scale Total (CY-BOCS), exposure and response prevention therapy (ERP) is more effective than waitlist (net mean difference [NMD] -10.5; 95% confidence interval [CI]: -12.6, -8.4) and probably more effective vs. behavioral control (NMD -5.3; 95% CI: -8.0, -2.7). Remote ERP is more effective than waitlist (NMD -9.4; 95% CI: -11.9, -7.0) and as effective as in-person ERP. Selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo (NMD -4.4; 95% CI: -6.1, -2.6). Clomipramine is probably more effective than placebo (NMD -4.5; 95% CI: -6.8, -2.1). ERP is probably more effective than SSRI (NMD -2.7; 95% CI -5.4, -0.0) and combined ERP and an SSRI are probably more effective than SSRI alone (NMD -3.0; 95% CI: -5.1, -1.0). Overall, treatments including ERP (ERP+SSRI, ERP and remote ERP) comprise the 3 highest ranked interventions. Non CY-BOCS outcomes were sparsely reported. ERP, delivered in-person or via telehealth, SSRIs and clomipramine are all effective treatments. ERP, alone or in combination with an SSRI, is probably more effective than SSRI alone.

Cognitive behavioral therapy for pediatric obsessive-compulsive disorder delivered via internet videoconferencing: a manualized sensor-assisted feasibility approach

BackgroundBetween 1 and 4% of children and adolescents suffer from obsessive-compulsive disorder (OCD) worldwide, but the majority of these young people do not have access to cognitive behavioral therapy (CBT) as a first-line treatment. CBT delivered via online videoconferencing (vCBT) offers a new way to provide young people with therapy, especially in the home environment where symptoms usually occur.MethodsIn this study, we investigated the feasibility of a newly revised vCBT manual, symptom change during treatment, and effects on family life and social functioning. 20 patients with OCD, aged 12–18 years, were treated during 14 weekly sessions while using a multimodal sensor system that assessed their physiological and behavioral responses during therapy. Treatment was delivered in real time via an online videoconferencing platform. Measurements of feasibility, acceptance, and implementation were evaluated descriptively, and clinical measures were assessed with t tests.ResultsThe primary results showed that patients and parents perceived the manual-based vCBT as feasible and easy to understand. According to the therapists’ ratings, all treatment modules and the content could be carried out in accordance with the manual. As a secondary outcome, OCD symptoms improved significantly during treatment (p <.001, d = 1.87), revealed by an average decrease of more than half in the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score. As the psychotherapy could be implemented directly in the patients’ home environment, low barriers to participation were reported, and the majority of participants reported improvements in family life after treatment.ConclusionsIn summary, the results of this feasibility study indicated a successful application of manual-based psychotherapy delivered via videoconferencing for pediatric OCD supported by a sensor system. This method should be further investigated in future randomized controlled trials with larger patient samples.Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT05291611], first submission: 2021-12-10.

A Study of Adverse Drug Effects in Patients with Obsessive Compulsive Disorder

Aims: To identify and record adverse effects/adverse drug reactions in patients receiving pharmacotherapy for obsessive compulsive disorder (OCD) visiting Psychiatry Out patient department of King George’s Medical University, Lucknow and to assess the causality of adverse drug reactions reported by these patients. Study Design: A prospective observational study. Place and Duration of Study: This study was conducted in the Department of Pharmacology, in collaboration with Department of Psychiatry, King George’s Medical University, Lucknow between February 2023 to January 2024. Methods: Patients receiving pharmacotherapy for Obsessive Compulsive disorder were recruited into the study after satisfying inclusion and exclusion criteria and observed for Adverse drug reaction. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to rate the severity and type of symptoms of OCD. The UKU Side Effect Rating Scale was used for assessing the side effects of medications prescribed to OCD patients and the causality of the observed adverse effects. Quantitative data summarized as Mean and Chi-Square test used for analysis of Qualitative data. Results: A total of 72 patients were included in the study out of which 37(51.3%) developed adverse drug reactions during the study period. Most of the adverse drug reactions occurred in 18-30 years group (62.1%) with majority in male group(54%). Psychic type adverse drug reactions were commonly observed (54%) with majority reported with fluoxetine (72.9%) and dyspepsia (24.3%) was the most commonly observed adverse drug reaction. On causality assessment, most of the adverse drug reactions belonged to possible type (75.7%). 75.7% adverse drug reactions required symptomatic treatment and remaining 24.3% resolved spontaneously. Conclusion: This study provides a representative profile of the adverse drug reactions which can be expected in obsessive compulsive disorder patients receiving pharmacotherapy. Nearly half of the study participants experienced adverse effects. Regular monitoring of ADRs in psychiatry OPD and educating the patients about ADR can reduce the risk and it may improve the quality of care, reduction in cost of treatment, adherence to drugs and improved outcome.

Chronic Tic Disorders in Youth: Clinical Phenotypes and Response to Pharmacological Treatment with Aripiprazole.

Tic disorders are neurodevelopmental conditions often associated with comorbidities like attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Our aims were: (a) in a sample of youth with tic disorders to explore the clinical and psychopathological characteristics of different phenotypes based on the presence of comorbid ADHD and/or ASD and gender; (b) in a subgroup of patients treated with Aripiprazole, to evaluate symptoms variation over time and to identify potential predictors of response. A total of 95 subjects with tic disorders (age range 6 to 17.9 years, mean 11.1 ± 2.11 years, 80 males) were naturalistically recruited. Questionnaires and semi-structured interviews were administered to assess the symptomatology and investigate the presence of psychiatric comorbidities (Clinic Global Impression-Severity (CGI-S), Children's Global Assessment Scale (C-GAS), Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), Child Yale-Brown Obsessive Compulsive Scale for Children (CYBOCS), Child Behavior Checklist 6-18 (CBCL 6-18), Conners' Parent Rating Scale-Revised-short form (CRSR-S), Reactivity Intensity Polarity Stability Questionnaire-youth version (RIPoSt-Y), and Social Communication Questionnaire-lifetime version (SCQ); Autism Diagnostic Observation Scale-second version (ADOS-2) and Autism Diagnostic Interview-revised version (ADI-R) were administered where ASD was suspected). A total of 22 subjects treated with Aripiprazole were reassessed through the use of some of the clinical measures used at baseline. The presence of ADHD was associated with higher externalizing problem scores on the CBCL 6-18, while ASD was linked to higher internalizing problem scores. A positive correlation was found between the ADHD-ASD interaction and increased internalizing symptoms on CBCL 6-18 and higher ADOS-2 scores. Patients treated with Aripiprazole showed significant improvement across all scales during follow-up. ADHD was identified as a negative predictor of reduced tic severity on the YGTSS. Comorbid neurodevelopmental disorders, such as ADHD or ASD, result in worse emotional and behavioral functioning in patients with tic disorders. ADHD-ASD interaction may be linked to more internalizing symptoms and autistic behaviors. Aripiprazole improves overall clinical outcomes, although comorbid ADHD may hinder the reduction of tic symptoms.

Ketamine for treatment-resistant obsessive-compulsive disorder: Double-blind active-controlled crossover study.

Obsessive-Compulsive Disorder (OCD) may respond to ketamine treatment. To examine the responsiveness and tolerability of treatment-refractory OCD to intramuscular (IM) ketamine compared to IM fentanyl. This was a randomised double-blind psychoactive-controlled study with single doses of racemic ketamine 0.5 mg/kg, 1.0 mg/kg or fentanyl 50 µg (psychoactive control). Pre-dosing with 4 mg oral ondansetron provided nausea prophylaxis. Eligible participants were aged between 18 and 50 years with severe treatment-resistant OCD. The primary efficacy measure was the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Tolerability was measured with the Clinician-Administered Dissociative States Scale (CADSS). Repeated measures analysis of variance with orthogonal polynomial trends was used to assess the effect of drug treatment on Y-BOCS and CADSS scores. Twelve participants were randomised and 10 completed the study (7 females, 3 males, mean age 33 years). Two participants dropped out due to not tolerating dissociative effects associated with the study medication. The reductions in Y-BOCS scores were greater and statistically dose-related for both ketamine doses than fentanyl (dose [linear], F(1, 9) = 6.5, p = 0.031). Score changes for all treatments were maximal at 1-2 h with a steady separation of scores out to 168 h. Ketamine was associated with short-term dissociative and cardiovascular effects. We provide further preliminary evidence for the efficacy and tolerability of IM ketamine in an outpatient cohort of OCD. Additional work is required to establish the optimal dosing regimen and longer-term role of ketamine for OCD. These findings are encouraging given the well-known limitations that exist for treatments in this area.

Comparisons between obsessive-compulsive disorder and trichotillomania in terms of autistic traits and repetitive behaviors in adolescents

Background Our study aims to reveal the relationship between autistic traits and repetitive behaviors in adolescents diagnosed with obsessive-compulsive disorder and trichotillomania and to compare them to healthy controls. Method A total of 100 adolescents, 33 of whom were diagnosed with obsessive-compulsive disorder, 32 of whom were diagnosed with trichotillomania and 35 healthy controls, aged 11-18 years, who applied to a Child and Adolescent Psychiatry Outpatient Clinic between February 2023 and July 2023, were included in the study. Participants were evaluated with the Autism Spectrum Quotient (AQ)-Adolescent, Repetitive Behavior Scale-Revised (RBS-R), Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression Scale-Severity (CGI-S). SPSS 25.0 program was used in the analysis. p < 0.05 was accepted as the significance level. Results It was found that adolescents diagnosed with obsessive-compulsive disorder and trichotillomania had higher autistic trait levels compared to healthy controls, while there was no significant difference between the obsessive-compulsive disorder and trichotillomania groups. While stereotypic, routine, sameness, and restricted repetitive behaviors were more common in the obsessive-compulsive disorder and trichotillomania groups as opposed to healthy controls, it was found that compulsive behavior was more common in the obsessive-compulsive disorder group, and self-injurious behavior was more common in the trichotillomania group compared to healthy controls. Conclusion The findings of our study indicate that adolescents diagnosed with trichotillomania, similar to those with obsessive-compulsive disorder, have a higher level of autistic traits and repetitive behaviors. The authors believe it is crucial to focus on the social skill difficulties these adolescents may be experiencing.

Multimodal Neuroimaging in the Prediction of Deep TMS Response in OCD.

Backgrounds: .Brain morphological biomarkers could contribute to understanding the treatment response in patients with obsessive-compulsive disorder (OCD). Multimodal neuroimaging addresses this issue by providing more comprehensive information regarding neural processes and structures. Objectives. The present study aims to investigate whether patients responsive to deep Transcranial Magnetic Stimulation (TMS) differ from non-responsive individuals in terms of electrophysiology and brain morphology. Secondly, to test whether multimodal neuroimaging is superior to unimodal neuroimaging in predicting response to deep TMS. Methods. Thirty-two OCD patients who underwent thirty sessions of deep TMS treatment were included in the study. Based on a minimum 50% reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores after treatment, patients were grouped as responders (n = 25) and non-responders (n = 7). The baseline resting state qEEG and magnetic resonance imaging (MRI) records of patients were recorded. Independent sample t-test is used to compare the groups. Then, three logistic regression model were calculated for only QEEG markers, only MRI markers, and both QEEG/MRI markers. The predictive values of the three models were compared. Results. OCD patients who responded to deep TMS treatment had increased Alpha-2 power in the left temporal area and increased volume in the left temporal pole, entorhinal area, and parahippocampal gyrus compared to non-responders. The logistic regression model showed better prediction performance when both QEEG and MRI markers were included. Conclusions. This study addresses the gap in the literature regarding new functional and structural neuroimaging markers and highlights the superiority of multimodal neuroimaging to unimodal neuroimaging techniques in predicting treatment response.

Ketamine for the Treatment of Psychiatric Disorders: A Systematic Review and Meta-Analysis.

Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders. We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference. The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment. Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.

Comparative Efficacy of Antipsychotic Medication for Stereotypic Behavior in Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Background: Stereotypic movements in autism form core symptoms under the rubric of repetitive and restricted patterns of behavior. Aim: The systematic review was aimed to find which antipsychotic has better efficacy in treating stereotypic behavior in autism spectrum disorder. Methods: We searched for journal publications in the English from PubMed and Cochrane databases (CENTRAL), January 1992–June 2024, for randomized controlled trials that compared antipsychotics with a placebo of at least 6 weeks’ trial, with the outcome measure being a change in stereotypy score. Quality assessment of the included studies in the meta-analysis was done using Cochrane risk of bias tool version 2. We followed PRISMA guidelines for systematic review. The mean difference in change of stereotypy symptoms score was calculated between antipsychotic and placebo participants along with 95% confidence interval (CI) using the random-effects model. Results: 146 studies were screened, and 25 studies were deemed eligible to retrieve full-length articles for review. A total of nine studies were included in the systematic review that had used aripiprazole, risperidone, or lurasidone as an antipsychotic. Six studies (n = 726) that had all data on mean difference in stereotypy scores on the Aberrant Behavior Checklist (ABC)-Stereotypy subscale and four studies (n = 554) that reported stereotypy scores using Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)-Compulsions subscale were included in the meta-analysis. Antipsychotics showed a significant reduction in ABC-Stereotypy scores (−1.84 [−2.84, −0.85; 95% CI], Z = 3.83, P &lt; 0.001) with moderate heterogeneity between the studies (I 2 = 53%). Whereas, antipsychotics did not show significant improvement in compulsions as measured on CY-BOCS (−0.87 [−1.89, 0.16; 95% CI], Z = 1.65, P = 0.10). Conclusion: Stereotypy in autism is difficult to measure, and no uniform measure exists. Trials are limited to short duration and limited to few antipsychotics. Among antipsychotics, risperidone has robust efficacy in reducing stereotypic behaviors.

Adequacy of treatment in outpatients with obsessive-compulsive disorder

ObjectiveTo examine whether patients with obsessive-compulsive disorder (OCD) are adequately treated with pharmacotherapy before referral to a specialized center for OCD. MethodsWe performed a retrospective chart review of patients with OCD who were seen for intake at an academic outpatient center in The Netherlands between 2016 and 2023. We collected data on age, gender, illness severity using the Yale-Brown Obsessive-Compulsive Scale, duration of illness, comorbidity and past pharmacotherapy and psychotherapy. Following the international treatment guidelines, we calculated percentages of patients treated with one SSRI, two or more SSRIs, clomipramine and/or antipsychotic augmentation treatments. Using multiple regression, we analyzed if patient and illness characteristics influenced the adequacy of treatment. ResultsWe included 673 patients with an average YBOCS score of 27. 76 % had taken at least one SSRI, and 35 % at least two SSRIs before admission. Only 29 % received a high SSRI-dose and 4 % had taken at least two SSRIs in high dose. Clomipramine and antipsychotics augmentation had been taken by less than one-third of patients. Only 3 % of referred patients followed all guideline-recommended treatment steps. Although the vast majority of patients had received some form of psychotherapy, a minority had received exposure and response prevention treatment. Multiple regression showed that illness duration and having received psychotherapy were independent moderators of the adequacy of pharmacological treatment. ConclusionPatients with OCD are not being treated adequately according to the pharmacological guidelines. Poor pharmacological treatment may lead to increased duration of illness, suboptimal recovery and unnecessary societal costs. Further research could clarify barriers for patients and caregivers, and facilitate improvement of pharmacological treatment for OCS.

Acceptance and Commitment Therapy with Exposure and Response Prevention and Schema Therapy with Exposure and Response Prevention on Obsession: An Effectiveness Comparison

Aim: Obsessive-compulsive disorder is one of the common disorders and there are many interventions for this disorder, but some patients do not get the desired results from the interventions. The aim of this research was to compare the effectiveness of acceptance and commitment therapy along with exposure and response prevention (ACT+ERP) with schema therapy along with exposure and response prevention (ST+ERP) of the intensity of obsessions and obsessive beliefs of patients with obsessive-compulsive disorder. Methods: The research method was quasi-experimental having pre-test and post-test with a control group. The statistical population included all patients with obsessive-compulsive disorder in the year 2023 in Isfahan city. Sixty people were selected through convenience sampling and were randomly assigned to 2 experimental groups and one control group (20 people in each group). The experimental groups received eight 60- minute sessions of ACT+ERP and ST+ERP. In this research, Obsessional Beliefs Questionnaire -44 (Group of Experts Working on Obsessive-Obsessive Cognitions, 1997) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (Goodman et al., 1989) were used. Multivariate analysis of covariance statistical tests was used to analyze the hypotheses. Results: compared to the control group, ACT+ERP and ST+ERP had significant effect on the intensity of obsessions and obsessive beliefs of patients (p&lt;0.001). Conclusion: Based on the research findings, ACT+ERP and ST+ERP are effective in reducing the severity of obsessions and obsessive beliefs of patients with obsessive-compulsive disorder. Also, ACT+ERP compared to ST+ERP had a greater effect on reducing the severity of obsessions and compulsions in patients with obsessive-compulsive disorder

Assessing orthorexic behaviors in a clinical sample: validity and reliability study of the Turkish version of the Düsseldorf orthorexia scale

BackgroundOrthorexia nervosa (ON) is defined as a pathological fixation on eating healthy and pure food. In this study, it was aimed to evaluate the psychometric properties of the Turkish version of the Düsseldorf orthorexia scale (DOS) in a clinical sample.MethodsA total of 385 individuals, 117 with generalized anxiety disorder (GAD), 108 with major depressive disorder (MDD), 56 with obsessive–compulsive disorder (OCD) and 104 healthy controls, participated in the study. Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Eating Attitude Test (EAT-40), Orthorexia Nervosa Inventory (ONI) and Düsseldorf Orthorexia Scale (DOS) were applied to all participants.ResultsThe DOS demonstrated high internal consistency (Cronbach’s alpha = 0.87) and good construct validity. Confirmatory factor analysis supported a one-factor structure, explaining a significant portion of variance among responses. In the analyses performed to test the convergent validity of DOS, a positive correlation was found with ONI and EAT scores (p < 0.001 for each). There was no significant correlation between DOS and HAM-D and HAM-A scores (p > 0.05 for each). The severity of orthorexic symptoms measured by DOS was similar between each patient group and healthy control group. DOS was applied to 70 more participants two weeks apart and the test–retest reliability was determined as 0.99.ConclusionsThis study shows that the Turkish version of DOS is valid and reliable in clinical samples and healthy individuals, is largely consistent with ONI, and that this scale can be used in studies investigating ON.