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Zhao Z, Cai Q, Liu P, Li X, Zhang Y, Chen Y, Hu S. Evaluation of the measurement properties of premonitory urge patient-reported outcome measure: A systematic literature review. J Psychiatr Res 2025; 184:488-499. [PMID: 40138912 DOI: 10.1016/j.jpsychires.2025.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 03/12/2025] [Accepted: 03/20/2025] [Indexed: 03/29/2025]
Abstract
OBJECTIVE This study aims to systematically evaluate the measurement properties of premonitory urge patient-reported outcome measures (PROMs) in patients with tic disorder using Consensus-based standards for the selection of health measurement instruments (COSMIN) methodology and provide recommendations for clinical assessment. METHOD A systematic search was conducted in PubMed, EMBASE, Web of Science, and PsycINFO, from database inception to October 9, 2022, with an additional supplementary search conducted from October 9, 2022, to January 4, 2025. After literature screening and data extraction, two independent reviewers objectively assessed the measurement properties according to COSMIN. RESULTS A total of 18 studies were included, involving four PROMs: Premonitory Urge for Tics Scale (PUTS), University of São Paulo's Sensory Phenomena Scale (USP-SPS), Individualized Premonitory Urge for Tics Scale (I-PUTS), and the Rumination and Awareness Scale for tic-associated sensations (RASTS). Methodological quality and criteria were conducted for content validity, internal structure (structural validity, internal consistency), and remaining measurement properties (reliability, hypothesis testing for construct validity). CONCLUSION PUTS is recommended for assessing premonitory urge in tic disorder, which aligns with the "European Clinical Guidelines for Tourette Syndrome and other Tic disorder-version 2.0. Part I: assessment". To assess premonitory urge and sensory modulation disorder, the USP-SPS is deemed appropriate, while the RASTS is suitable for evaluating premonitory urge and tic-related cognitions. However, USP-SPS and RASTS need further validation due to limited evidence, and their use should be considered based on specific clinical or research objectives.
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Affiliation(s)
- Zehui Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China
| | - Qiuhan Cai
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China.
| | - Ping Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China
| | - Xuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China
| | - Yi Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China
| | - Yueyue Chen
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China
| | - Siyuan Hu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/ National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300181, China
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Muniz JA, McGuire JF, Ramsey KA. Evidence-Based Assessment of Tourette Syndrome. Psychiatr Clin North Am 2025; 48:61-75. [PMID: 39880516 DOI: 10.1016/j.psc.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
Tourette syndrome and persistent tic disorders (collectively, TS) are impairing childhood-onset neuropsychiatric conditions. Utilizing evidence-based assessments (EBA) is standard for effective and accurate screening, diagnosis, and monitoring of TS. EBAs consist of brief screening instruments, structured/semi-structured clinician-administered interviews, self-report, and parent-report and child-report. This article provides an overview of the quality, utility, and psychometric properties of available assessments to determine the presence of TS, evaluate symptom severity, and capture associated phenomenology (eg, premonitory urges, quality of life). The article concludes with considerations for best clinical practices and future directions for the EBA of TS.
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Affiliation(s)
- Jonathan A Muniz
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Developmental Behavioral Health, Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Joseph F McGuire
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Developmental Behavioral Health, Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA; Center for OCD, Anxiety, and Related Disorders for Children (COACH), Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kesley A Ramsey
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Developmental Behavioral Health, Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA; Center for OCD, Anxiety, and Related Disorders for Children (COACH), Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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3
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Stern ER, Collins KA, Bragdon LB, Eng GK, Recchia N, Coffey BJ, Leibu E, Murrough JW, Tobe RH, Iosifescu DV, Burdick KE, Goodman WK. Randomized Controlled Trial of the Effects of High-Dose Ondansetron on Clinical Symptoms and Brain Connectivity in Obsessive-Compulsive and Tic Disorders. Am J Psychiatry 2025; 182:285-296. [PMID: 39876680 DOI: 10.1176/appi.ajp.20240294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
OBJECTIVE Sensory phenomena (SP) are aversive sensations driving repetitive behaviors in obsessive-compulsive disorder (OCD) and Tourette's disorder that are not well addressed by standard treatments. SP are related to the functioning of an interoceptive-sensorimotor circuit that may be modulated by the 5-HT3 receptor antagonist ondansetron. The present study employed an experimental medicine approach to test the effects of 4 weeks of high-dose ondansetron compared to placebo on SP severity and brain connectivity in a cohort of individuals with OCD and/or Tourette's disorder. METHODS Of 51 participants who completed the study, 27 were assigned to receive 24 mg/day of ondansetron and 24 to receive placebo. Analyses examined changes in SP severity and, for participants with OCD, overall OCD severity from baseline to final visit. Functional MRI data were collected at both visits for analysis of intrinsic functional connectivity metrics characterizing global correlation (reflecting area "hubness") and local correlation (reflecting near-neighbor coherence). RESULTS There were no significant differences between ondansetron and placebo in the reduction of SP or overall OCD severity in the full sample. In a subsample of participants with OCD taking concomitant serotonin reuptake inhibitors (SRIs), ondansetron was associated with a significant decrease in overall OCD severity and global connectivity of the medial sensorimotor cortex compared with placebo. Longitudinal reductions in SP severity were related to decreases in right sensorimotor hubness in both groups, and to brainstem local coherence only in participants taking ondansetron. CONCLUSIONS There was no effect of high-dose ondansetron on SP. However, when used as an augmentation to SRIs, ondansetron reduced overall OCD severity, which may be related to changes in the "hubness" of the sensorimotor cortex. Ondansetron's ability to modulate brainstem connectivity may underlie its variable effectiveness in reducing SP.
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Affiliation(s)
- Emily R Stern
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Katherine A Collins
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Laura B Bragdon
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Goi Khia Eng
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Nicolette Recchia
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Barbara J Coffey
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Evan Leibu
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - James W Murrough
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Russell H Tobe
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Dan V Iosifescu
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Katherine E Burdick
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
| | - Wayne K Goodman
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY (Stern, Collins, Bragdon, Eng, Recchia, Tobe, Iosifescu); Department of Psychiatry (Stern, Bragdon, Eng, Recchia, Iosifescu) and Neuroscience Institute (Stern, Iosifescu), New York University Langone Medical Center, New York; Department of Psychiatry, University of Miami Medical School, Miami (Coffey); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Leibu, Murrough); Center for the Developing Brain, Child Mind Institute, New York (Tobe); Department of Psychiatry, Brigham and Women's Hospital, Boston (Burdick); Harvard Medical School, Boston (Burdick); Department of Psychiatry, Baylor College of Medicine, Houston (Goodman)
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Wilson LA, Scarfo J, Jones ME, Rehm IC. The relationship between sensory phenomena and interoception across the obsessive-compulsive spectrum: a systematic review. BMC Psychiatry 2025; 25:162. [PMID: 39994601 PMCID: PMC11849306 DOI: 10.1186/s12888-024-06441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/23/2024] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Uncomfortable sensations preceding repetitive behaviours, known as sensory phenomena, have been documented across the obsessive-compulsive spectrum. Indirect evidence suggests altered interoception may play a role in these shared experiences of sensory phenomena; however, research explicitly measuring this relationship is limited. The current systematic review aimed to establish the nature of sensory phenomena and interoception in obsessive-compulsive and related disorders (OCRDs) and tic disorders as potential maintaining factors of these disorders. METHODS PsycINFO, PubMed, and Scopus databases were searched from 2007 to April 2024, yielding 65 studies. RESULTS While the majority of studies presented low risk of bias, significant overlap and ambiguity characterised the measurement and conceptualisation of sensory phenomena and interoception. Overall, higher sensory phenomena was associated with greater symptom severity in several obsessive-compulsive spectrum disorders. Obsessive-compulsive disorder and tic disorder samples were characterised by lower interoceptive accuracy, with mixed findings on interoceptive sensibility. Some limited research emerged suggesting altered interoceptive abilities may be associated with greater sensory phenomena in obsessive-compulsive disorder and tic disorders. CONCLUSIONS Sensory phenomena are experienced across the obsessive-compulsive spectrum. Future research should explore interoceptive abilities across the OCRDs, and build upon evidence supporting a relationship between sensory phenomena and interoception in OCD and tic disorders. TRIAL REGISTRATION CRD42023422817.
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Affiliation(s)
- Lizzie A Wilson
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia
| | - Jessica Scarfo
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia
| | - Mikayla E Jones
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia
| | - Imogen C Rehm
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Road, Footscray, VIC, 3011, Australia.
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Vigil-Pérez A, Blázquez A, Garcia-Delgar B, Ortiz AE, Borràs R, Morer A, Escalona RC, Lázaro L. Phenomenology of repetitive and restrictive behaviors and sensory phenomena in neurodevelopmental disorders: an exploratory study. BMC Psychiatry 2025; 25:163. [PMID: 39994553 PMCID: PMC11849297 DOI: 10.1186/s12888-025-06569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 02/03/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Repetitive and restrictive behaviors (RRB) include simple motor stereotypes, tics and complex ritualized and rigid behaviors that are core symptoms in neurodevelopmental disorders such as obsessive-compulsive disorder (OCD), Tourette syndrome (TS) or autism spectrum disorder (ASD). Sensory phenomena (SP) are uncomfortable feelings, including bodily sensations, sense of inner tension, "just-right" perceptions, feelings of incompleteness, or "urge-only" phenomena, which have been described to precede, trigger, or accompany RRB. In such clinical contexts RRB and SP may be considered common variables that affect multiple aspects of daily functioning and are treatment targets. OBJECTIVE This study aims to further understand RRB and SP phenomenology in children and adolescents diagnosed with OCD, TS or ASD and identify whether specific RRB or SP can distinguish these groups. METHODS We assessed RRB and SP in participants aged between 6 and 17 with a main diagnosis of OCD (n = 23), TS (n = 19), or ASD (n = 21) with the Repetitive Behavior Scale-Revised (RBS-R) and The University of Sao Paulo-Sensory Phenomena Scale (USP-SPS). RESULTS The RBS-R mean was 17.3 ± 14.9 with no group differences for total RBS-R symptom severity, except for the routine subscale (OCD > ASD, p = 0.03). Ninety percent of participants showed at least one type of SP on the USP-SPS with a mean total severity of 5.3 ± 3.8, with no statistical differences between groups. The most frequent SP subtype was physical sensations (68.4%). CONCLUSION RRB and SP are transdiagnostic features in neurodevelopmental disorders and the RBS-R and the USP-SPS might be useful in their assessment and treatment plan.
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Affiliation(s)
- A Vigil-Pérez
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain.
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - A Blázquez
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - B Garcia-Delgar
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A E Ortiz
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament of Medicine, University of Barcelona, Barcelona, Spain
| | - R Borràs
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - A Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament of Medicine, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - RCalvo Escalona
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament of Medicine, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - L Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, Villarroel, 170, Staircase 11 - Floor 3, Barcelona, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Departament of Medicine, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d´Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Eng GK, De Nadai AS, Collins KA, Recchia N, Tobe RH, Bragdon LB, Stern ER. Identifying subgroups of urge suppression in Obsessive-Compulsive Disorder using machine learning. J Psychiatr Res 2024; 177:129-139. [PMID: 39004004 PMCID: PMC11409861 DOI: 10.1016/j.jpsychires.2024.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/21/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024]
Abstract
Obsessive-compulsive disorder (OCD) is phenomenologically heterogeneous. While predominant models suggest fear and harm prevention drive compulsions, many patients also experience uncomfortable sensory-based urges ("sensory phenomena") that may be associated with heightened interoceptive sensitivity. Using an urge-to-blink eyeblink suppression paradigm to model sensory-based urges, we previously found that OCD patients as a group had more eyeblink suppression failures and greater activation of sensorimotor-interoceptive regions than controls. However, conventional approaches assuming OCD homogeneity may obscure important within-group variability, impeding precision treatment development. This study investigated the heterogeneity of urge suppression failure in OCD and examined relationships with clinical characteristics and neural activation. Eighty-two patients with OCD and 38 controls underwent an fMRI task presenting 60-s blocks of eyeblink suppression alternating with free-blinking blocks. Latent profile analysis identified OCD subgroups based on number of erroneous blinks during suppression. Subgroups were compared on behavior, clinical characteristics, and brain activation during task. Three patient subgroups were identified. Despite similar overall OCD severity, the subgroup with the most erroneous eyeblinks had the highest sensory phenomena severity, interoceptive sensitivity, and subjective urge intensity. Compared to other subgroups, this subgroup exhibited more neural activity in somatosensory and interoceptive regions during the early phase (first 30 s) of blink suppression and reduced activity in the middle frontal gyrus during the late phase (second 30 s) as the suppression period elapsed. Heterogeneity of urge suppression in OCD was associated with clinical characteristics and brain function. Our results reveal potential treatment targets that could inform personalized medicine.
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Affiliation(s)
- Goi Khia Eng
- Department of Psychiatry, New York University Grossman School of Medicine, New York, 10016, USA; Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA.
| | - Alessandro S De Nadai
- Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Katherine A Collins
- Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA
| | - Nicolette Recchia
- Department of Psychiatry, New York University Grossman School of Medicine, New York, 10016, USA; Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA
| | - Russell H Tobe
- Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA; Center for the Developing Brain, Child Mind Institute, New York, 10022, USA
| | - Laura B Bragdon
- Department of Psychiatry, New York University Grossman School of Medicine, New York, 10016, USA; Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA
| | - Emily R Stern
- Department of Psychiatry, New York University Grossman School of Medicine, New York, 10016, USA; Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA; Neuroscience Institute, New York University Grossman School of Medicine, New York, 10016, USA
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Kowalewska E, Bzowska M, Engel J, Lew-Starowicz M. Comorbidity of binge eating disorder and other psychiatric disorders: a systematic review. BMC Psychiatry 2024; 24:556. [PMID: 39138440 PMCID: PMC11323383 DOI: 10.1186/s12888-024-05943-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/01/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE Binge eating disorder (BED), although relatively recently recognized as a distinct clinical syndrome, is the most common eating disorder. BED can occur as a separate phenomenon or in combination with other mental disorders, adding to the overall burden of the illness. Due to the relatively short history of recognizing BED as a distinct disorder, this review aimed to summarize the current knowledge on the co-occurrence of BED with other psychiatric disorders. METHOD This review adhered to the PRISMA guidelines. Multiple databases, such as MEDLINE, MEDLINE Complete, and Academic Search Ultimate, were used to identify relevant studies. Of the 3766 articles initially identified, 63 articles published within the last 13 years were included in this review. This systematic review has been registered through INPLASY (INPLASY202370075). RESULTS The most frequently observed comorbidities associated with BED were mood disorders, anxiety disorders and substance use disorders. They were also related to more severe BED presentations. Other psychiatric conditions frequently associated with BED include reaction to severe stress and adjustment disorders, impulse control disorder, ADHD, personality disorders, behavioral disorders, disorders of bodily distress or bodily experience, and psychotic disorders. Additionally, BED was linked to suicidality and sleep disorders. DISCUSSION The findings highlight the interconnected nature of BED with various psychiatric conditions and related factors, shedding light on the complexity and broader impact of BED on mental health and the need for appropriate screening and appropriately targeted clinical interventions.
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Affiliation(s)
- Ewelina Kowalewska
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Magdalena Bzowska
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jannis Engel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
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8
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Wang X, Li Y, Yu L, Xu H, Zhang A, Zhang W, Jiang Z, Cui Y, Li Y. Sensory Phenomenon Assessment Scale: a new tool for assessment of tic-associated sensations. Front Psychiatry 2024; 15:1387417. [PMID: 38979498 PMCID: PMC11228244 DOI: 10.3389/fpsyt.2024.1387417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/31/2024] [Indexed: 07/10/2024] Open
Abstract
Background Sensory symptoms linked to tic disorder (TD) are challenging to quantify via self- or parent-reported measures. The current study aimed to develop a novel observer-rated semi-structured interview, namely, the Sensory Phenomenon Assessment Scale (SPAS), to aid clinical evaluation on symptoms of TD among children. Methods To test its psychometric properties, tic, premonitory urge (PU), and obsessive-compulsive symptoms (OCS) were also assessed in 223 children via the Yale Global Tic Severity Scale (YGTSS), the Premonitory Urge for Tic Scale (PUTS), and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Factor analysis and internal consistency test were carried out using data from TD-diagnosed individuals. Results Good internal consistency and test-retest reliability were observed. Criterion validity was established by significant correlations between the PUTS, the YGTSS, the CY-BOCS, and scores of the SPAS. Factor analyses supported a single-factor model of the SPAS, in which the five items each showed a factor loading above 0.6. Conclusion This study demonstrated that the SPAS is reliable and valid and, thus, can serve as a good and concise measure of clinical symptoms among children and adolescents with TD.
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Affiliation(s)
- Xianbin Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Yanlin Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission (NHC) Key Laboratory of Mental Health (Peking University), Beijing, China
| | - Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Hui Xu
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Anyi Zhang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Wenyan Zhang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Zhongliang Jiang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Ying Li
- Department of Psychosomatic Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
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9
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Collins KA, Recchia N, Eng GK, Harvey JR, Tobe RH, Stern ER. Sensory over-responsivity and orbitofrontal cortex connectivity in obsessive-compulsive disorder. J Affect Disord 2024; 353:48-51. [PMID: 38382815 PMCID: PMC11066885 DOI: 10.1016/j.jad.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Sensory over-responsivity (SOR) in obsessive-compulsive disorder (OCD) is associated with illness severity and functional impairment. However, the neural substrates of SOR in OCD have not yet been directly probed. METHODS We examined resting-state global functional connectivity markers of SOR in 119 adults with OCD utilizing the CONN-fMRI Functional Connectivity Toolbox for SPM (v21a). We quantified SOR with the sensory sensitivity and sensory avoiding subscales of the Adult and Adolescent Sensory Profile (AASP). We also measured: OCD severity, with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Obsessive-Compulsive Inventory-Revised (OCI-R); sensory phenomena with the Sensory Phenomena Scale (SPS); general anxiety, with the Beck Anxiety Inventory (BAI); and depressive symptomatology, with Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR). RESULTS There was a significant positive relationship of SOR with global connectivity in anterior and medial OFC (Brodmanns area 11, k = 154, x = 14, y = 62, z = -18, whole-brain corrected at FWE p < 0.05). LIMITATIONS Future investigations should explore neural responses to sensory stimulation tasks in OCD and compare findings with those obtained in other conditions also characterized by high SOR, such as autism spectrum disorder. CONCLUSIONS This study implicates OFC functional connectivity as a neurobiological mechanism of SOR in OCD and suggests that the substrates of SOR in OCD may be dissociable from both that of other symptoms in OCD, and SOR in other disorders. With replication and extension, the finding may be leveraged to develop and refine treatments for OCD and investigate the pathophysiology of SOR in other conditions.
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Affiliation(s)
- Katherine A Collins
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America.
| | - Nicolette Recchia
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Goi Khia Eng
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Jeanmarie R Harvey
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Russell H Tobe
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America; Center for the Developing Brain, Child Mind Institute, New York, NY, United States of America
| | - Emily R Stern
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
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10
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Prato A, Saia F, Ferrigno M, Finocchiaro V, Barone R, Rizzo R. Sensory phenomena in children with Tourette syndrome or autism spectrum disorder. Front Psychiatry 2024; 15:1338234. [PMID: 38628261 PMCID: PMC11018939 DOI: 10.3389/fpsyt.2024.1338234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Background Tourette syndrome (TS) and autism spectrum disorder (ASD) are two neurodevelopmental disorders with an onset before the age of 18 years. TS patients frequently reported atypical sensory phenomena (SP). Sensory processing abnormalities are also particularly frequent in ASD individuals. Objectives Considering the higher rate of atypical sensory behaviours in both neurodevelopmental disorders, in the present study we analysed sensory experiences in patients with ASD and in patients with TS. Methods We enrolled patients with a primary diagnosis of TS or ASD. All participants were assessed for primary diagnosis and associated comorbidities. The presence of sensory behaviours was investigated using the University of Sao Paulo's Sensory Phenomena Scale (USP-SPS). Results SP were significantly more represented in the ASD-group versus TS-group, except for sound just-right perceptions and energy to released. ASD participants presented higher mean scores in all fields of USP-SPS severity scale respect on TS patients and healthy controls. The USP-SPS total score had significant positive correlations with the CYBOCS and MASC total scores in the TS cohort. In the ASD group, the USP-SPS total score was significantly negative correlated with the total IQ and marginally positive correlated with ADOS total score. Conclusion SP are a frequently reported characteristic both of ASD and TS. Future studies are needed to better evaluate the differences on their phenomenology in patients with TS and ASD.
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Affiliation(s)
- Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
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11
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Brandt V, Otte JH, Fremer C, Jakubovski E, Müller-Vahl K. Non-just-right experiences are more closely related to OCD than tics in Tourette patients. Sci Rep 2023; 13:19627. [PMID: 37949933 PMCID: PMC10638287 DOI: 10.1038/s41598-023-37658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/25/2023] [Indexed: 11/12/2023] Open
Abstract
Complex tics and obsessive or compulsive behaviour can be difficult to differentiate diagnostically. The majority of adult patients with Tourette syndrome report experiencing premonitory urges before tics. Some of these experiences have been linked to non-just-right experiences (NJRE), which are frequently reported by patients with obsessive-compulsive disorder or behaviours (OCD/OCB). We aimed to assess whether NJRE are more closely related to tics and tic-associated premonitory urges or whether they are more closely associated with OCD. A total of N = 111 patients (mean age = 34.77 + /-12.93; N = 37 female) with a confirmed diagnosis of Tourette syndrome completed the premonitory urges for tic disorders scale (PUTS), the revised non-just-right experiences scale (NJRE-QR), and questionnaires regarding their tic severity, and comorbid OCD/OCB. A multi-trait-multi-methods matrix was calculated to examine associations amongst scales measuring tic-related and OCB-related phenomena. The PUTS correlated overall higher with tic questionnaires than with OCD/OCB questionnaires. The NJRE correlated higher with OCD symptoms than with tic severity. The results indicate that non-just-right experiences are more closely associated with comorbid OCB than with tics in patients with Tourette syndrome.
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Affiliation(s)
- Valerie Brandt
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany.
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK.
| | - Jan-Hendrik Otte
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Carolin Fremer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany.
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12
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Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
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Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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13
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Bragdon LB, Nota JA, Eng GK, Recchia N, Kravets P, Collins KA, Stern ER. Failures of Urge Suppression in Obsessive-Compulsive Disorder: Behavioral Modeling Using a Blink Suppression Task. J Obsessive Compuls Relat Disord 2023; 38:100824. [PMID: 37521712 PMCID: PMC10373599 DOI: 10.1016/j.jocrd.2023.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Many individuals with obsessive-compulsive disorder (OCD) report sensory-based urges (e.g. 'not-just-right experiences') in addition to, or instead of, concrete fear-based obsessions. These sensations may be comparable to normative "urges-for-action" (UFA), such as the urge to blink. While research has identified altered functioning of brain regions related to UFA in OCD, little is known about behavioral patterns of urge suppression in the disorder. Using an urge-to-blink task as a model for sensory-based urges, this study compared failures of urge suppression between OCD patients and controls by measuring eyeblinks during 60-second blocks of instructed blink suppression. Cox shared frailty models estimated the hazard of first blinks during each 60-second block and recurrent blinks following each initial erroneous blink. OCD patients demonstrated a higher hazard of first and recurrent blinks compared to controls, suggesting greater difficulty resisting repetitive sensory-based urges. Within OCD, relationships between task outcomes and symptom severity were inconsistent. Findings provide support for a deficit in delaying initial urge-induced actions and terminating subsequent actions in OCD, which is not clearly related to clinical heterogeneity. Elucidating the nature of behavioral resistance to urges is relevant for informing conceptualizations of obsessive-compulsive psychopathology and optimizing treatment outcomes.
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Affiliation(s)
- Laura B Bragdon
- Department of Psychiatry, New York University School of Medicine
- Nathan Kline Institute for Psychiatric Research
| | - Jacob A Nota
- Department of Psychiatry, McLean Hospital, Harvard Medical School
| | - Goi Khia Eng
- Department of Psychiatry, New York University School of Medicine
- Nathan Kline Institute for Psychiatric Research
| | - Nicolette Recchia
- Department of Psychiatry, New York University School of Medicine
- Nathan Kline Institute for Psychiatric Research
| | - Pearl Kravets
- Department of Psychiatry, New York University School of Medicine
- Nathan Kline Institute for Psychiatric Research
| | | | - Emily R Stern
- Department of Psychiatry, New York University School of Medicine
- Nathan Kline Institute for Psychiatric Research
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14
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Bettess Z, Albertella L, Destree L, Rosário MC, Ferrão YA, Miguel EC, Fontenelle LF. Clinical characteristics of transformation obsessions in obsessive-compulsive disorder: A psychopathological study. Aust N Z J Psychiatry 2023; 57:130-139. [PMID: 35303769 DOI: 10.1177/00048674221084241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The obsession of turning into another person (transformation obsessions [TO]), and its related compulsions have been initially conceptualised as a form of mental contamination. Nevertheless, it has remained understudied in the current obsessive-compulsive disorder (OCD) literature. In parallel, disturbances of the self have been identified as markers of prodromal psychosis in patients with schizophrenia. Based on the later association, this study aimed to investigate the sociodemographic and clinical correlates of TO. METHODS In all, 1001 OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used to compare 48 OCD patients with TO with 953 OCD patients without TO. A repression model investigated the relationships between the presence of current TO and statistically significant univariate test outcomes. RESULTS Participants with TO presented an overall younger age, a longer period of time between the onset of the OCD symptoms and an OCD diagnosis, greater severity of the sexual/religious dimension and increased suicidality symptoms. CONCLUSIONS These results indicate that TO may be better conceptualised as a form of forbidden/taboo thoughts rather than contamination. While no significant associations with psychotic features (e.g. decreased insight) were observed, TO patients displayed increased suicidality, overall younger age and a significantly larger disparity between seeking treatment and OCD diagnosis. This demonstrates that further clinical awareness and research into TO as an OCD symptom is most needed.
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Affiliation(s)
- Zoe Bettess
- Brain & Mental Health Research Hub (BrainPark), Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Lucy Albertella
- Brain & Mental Health Research Hub (BrainPark), Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Louise Destree
- Brain & Mental Health Research Hub (BrainPark), Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Maria C Rosário
- Child and Adolescent Psychiatry Unit, Department of Psychiatry at the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ygor Arzeno Ferrão
- Department of Clinical Medicine (Clinical Neurosciences), Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Euripedes C Miguel
- Obsessive-Compulsive Spectrum Disorders Program (PROTOC), Department and Institute of Psychiatry, University of São Paulo (USP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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15
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Schütteler C, Gerlach AL. Die Bedeutung des Vorgefühls bei Tic-Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Funktion des Vorgefühls in der Pathogenese und Aufrechterhaltung von Tic-Störungen (TS) wird in den letzten Jahren verstärkt erforscht. Die mögliche funktionelle Bedeutung der Vorgefühle wird aber noch nicht ausreichend verstanden. Methode: Im vorliegenden Review wird der Kenntnisstand zu Vorgefühlen entlang eines integrativen funktionalen Störungsmodells zusammengefasst. Ergebnisse: Im Vergleich zum Jugendalter nehmen Tic-Symptome bei Tic-Störungen im Erwachsenenalter ab, während immer mehr Betroffene ein Vorgefühl berichten. Hierbei kann zwischen einem allgemeinen Vorgefühl (trait) und dem Drang, Tics auszuführen (state) unterschieden werden. Das Vorgefühl als trait ist abhängig von der Interozeptionsfähigkeit. An den Drang, Tics auszuführen, kann habituiert werden, moderiert von Aufmerksamkeits- und Attributionsprozessen. Durch das Auflösen des Vorgefühl-Tic-Reizreaktionsmusters reduzieren sich die Tic-Symptome. Schlussfolgerung: Für weitere Erkenntnisse in Bezug auf die Bedeutung von Vorgefühl und den Drang, Tics auszuführen, sollten zukünftige Forschungsansätze Drang und allgemeine Vorgefühle in therapeutischen Interventionsstudien berücksichtigen, weitere Interozeptionsparadigmen einbeziehen und die Entwicklung von allgemeinem Vorgefühl und Drang über die Lebensspanne hinweg untersuchen.
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Affiliation(s)
- Christina Schütteler
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
| | - Alexander L. Gerlach
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
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16
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The price of love: an investigation into the relationship between romantic love and the expression of obsessive-compulsive disorder. CNS Spectr 2022; 27:691-698. [PMID: 34039460 DOI: 10.1017/s1092852921000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The present study explored the influence of romantic love on the expression of several obsessive-compulsive disorder (OCD) characteristics, including symptom severity, symptom dimensions, age at onset, sensory phenomena (SP), and developmental course, as well as other related comorbid disorders. It was hypothesized that love-precipitated OCD would be associated with a set of distinct characteristics and exhibit greater rates of comorbid disorders. METHODS The analyses were performed using a large sample (n = 981) of clinical patients with a primary diagnosis of OCD (Females = 67.3%, M age = 35.31). RESULTS Love-precipitated OCD was associated with greater severity of SP and later age at onset of obsessions. However, symptom severity, symptom dimension, developmental course, and psychiatric comorbidities were not associated with love-precipitated OCD. CONCLUSION It was concluded that romantic love does shape the expression of OCD, especially with regard to SP and onset age. These findings encourage further exploration to determine its clinical significance as a phenotype.
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17
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Eng GK, Collins KA, Brown C, Ludlow M, Tobe RH, Iosifescu DV, Stern ER. Relationships between interoceptive sensibility and resting-state functional connectivity of the insula in obsessive-compulsive disorder. Cereb Cortex 2022; 32:5285-5300. [PMID: 35257146 PMCID: PMC9712718 DOI: 10.1093/cercor/bhac014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/27/2022] Open
Abstract
Patients with obsessive-compulsive disorder (OCD) exhibit abnormality in their subjective perception of internal sensation, a process known as interoceptive sensibility (IS), as well as altered functioning of the insula, a key neural structure for interoception. We investigated the multivariate structure of IS in 77 OCD patients and 53 controls and examined associations of IS with resting-state functional connectivity (FC) of the insula within the OCD group. For each group, principal component analysis was performed on 8 subscales of the Multidimensional Assessment of Interoceptive Awareness assessing putatively "adaptive" and "maladaptive" aspects of IS. Associations between IS components and insula FC in the OCD group were evaluated using seed regions placed in each of 3 subdivisions of the insula (posterior, anterior dorsal, and anterior ventral). Behaviorally, controls showed a 2-component solution broadly categorized into "adaptive" and "maladaptive" IS, while OCD patients exhibited a 3-component solution. The general tendency to notice or be aware of sensation loaded onto an "adaptive" IS component in controls but loaded onto both "adaptive" and "maladaptive" IS components in OCD. Within OCD, insula FC was differentially associated with distinct aspects of IS, identifying network connections that could serve as future targets for the modulation of IS in OCD.
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Affiliation(s)
- Goi Khia Eng
- Department of Psychiatry, New York University School of Medicine, One Park Ave, 8th Floor, New York, NY 10016, United States.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Katherine A Collins
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Carina Brown
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, San Diego, CA 92120, United States
| | - Molly Ludlow
- Ferkauf Graduate School of Psychology, 1165 Morris Park Ave, Bronx, NY 10461, United States
| | - Russell H Tobe
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Dan V Iosifescu
- Department of Psychiatry, New York University School of Medicine, One Park Ave, 8th Floor, New York, NY 10016, United States.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
| | - Emily R Stern
- Department of Psychiatry, New York University School of Medicine, One Park Ave, 8th Floor, New York, NY 10016, United States.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, United States
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18
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Blair DS, Soriano-Mas C, Cabral J, Moreira P, Morgado P, Deco G. Complexity changes in functional state dynamics suggest focal connectivity reductions. Front Hum Neurosci 2022; 16:958706. [PMID: 36211126 PMCID: PMC9540393 DOI: 10.3389/fnhum.2022.958706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
The past two decades have seen an explosion in the methods and directions of neuroscience research. Along with many others, complexity research has rapidly gained traction as both an independent research field and a valuable subdiscipline in computational neuroscience. In the past decade alone, several studies have suggested that psychiatric disorders affect the spatiotemporal complexity of both global and region-specific brain activity (Liu et al., 2013; Adhikari et al., 2017; Li et al., 2018). However, many of these studies have not accounted for the distributed nature of cognition in either the global or regional complexity estimates, which may lead to erroneous interpretations of both global and region-specific entropy estimates. To alleviate this concern, we propose a novel method for estimating complexity. This method relies upon projecting dynamic functional connectivity into a low-dimensional space which captures the distributed nature of brain activity. Dimension-specific entropy may be estimated within this space, which in turn allows for a rapid estimate of global signal complexity. Testing this method on a recently acquired obsessive-compulsive disorder dataset reveals substantial increases in the complexity of both global and dimension-specific activity versus healthy controls, suggesting that obsessive-compulsive patients may experience increased disorder in cognition. To probe the potential causes of this alteration, we estimate subject-level effective connectivity via a Hopf oscillator-based model dynamic model, the results of which suggest that obsessive-compulsive patients may experience abnormally high connectivity across a broad network in the cortex. These findings are broadly in line with results from previous studies, suggesting that this method is both robust and sensitive to group-level complexity alterations.
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Affiliation(s)
| | - Carles Soriano-Mas
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge, Barcelona, Spain
- Network Center for Biomedical Research on Mental Health, Carlos III Health Institute, Madrid, Spain
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Joana Cabral
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Pedro Moreira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga, Portugal
- Psychological Neuroscience Lab, CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga, Portugal
- Clinical Academic Center—Braga, Braga, Portugal
| | - Gustavo Deco
- Facultad de Comunicación, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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19
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Moreno-Amador B, Cervin M, Martínez-González AE, Piqueras JA. Sensory over-responsivity and symptoms across the obsessive-compulsive spectrum: a web-based study (Preprint). J Med Internet Res 2022; 25:e37847. [PMID: 37052983 PMCID: PMC10141273 DOI: 10.2196/37847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/19/2022] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Sensory overresponsivity (SOR) has emerged as a potential endophenotype in obsessive-compulsive disorder (OCD), but few studies have examined SOR in relation to the major symptom dimensions of OCD and to symptoms across the full obsessive-compulsive (OC) symptom spectrum. OBJECTIVE This study had 2 main objectives. First, we examined the psychometric properties of the SOR Scales in a community-based sample of Spanish adolescents and adults. Second, we identified how SOR difficulties are related to symptoms across the full OC spectrum (eg, OC, body dysmorphic, hoarding, skin-picking, and hair-pulling symptoms), including the heterogeneity of OC symptoms. METHODS We translated the SOR Scales into Spanish-a measure that assesses SOR across the 5 sensory modalities-and created a web-based version of the measure. A sample of 1454 adolescents and adults (mean age 23.84, SD 8.46 years) participated in the study, and 388 (26.69%) participants completed the survey twice (approximately 8 months apart). The survey also contained a web-based measure that assesses symptoms across the full OC spectrum: harm and checking, taboo obsessions, contamination or cleaning, symmetry and ordering, body dysmorphic, hoarding, hair-pulling, and skin-picking symptoms. RESULTS The psychometric properties of the SOR Scales were excellent, and the test-retest reliability was adequate. All types of SOR were related to all major symptom dimensions of OCD and to all OC spectrum symptoms. CONCLUSIONS SOR across the sensory modalities can be validly assessed using a web-based measure. SOR emerged as a pure transdiagnostic phenomenon in relation to symptoms across the OC spectrum, with no specific sensory modality being more strongly related to OC symptoms. SOR can shed much needed light on basic mechanisms that are important for the onset and maintenance of OC spectrum symptoms, and this study shows that large-scale web-based studies can aid in this endeavor. Future studies should examine whether SOR precedes or emerges alongside OC symptoms.
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Affiliation(s)
- Beatriz Moreno-Amador
- Area of Personality, Assessment and Psychological Treatment, Department of Health Psychology, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Jose A Piqueras
- Area of Personality, Assessment and Psychological Treatment, Department of Health Psychology, Universidad Miguel Hernández de Elche, Elche, Spain
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20
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Stern ER, Eng GK, De Nadai AS, Iosifescu DV, Tobe RH, Collins KA. Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder. Transl Psychiatry 2022; 12:19. [PMID: 35022398 PMCID: PMC8755709 DOI: 10.1038/s41398-022-01780-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the "unacceptable thoughts" symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles-areas that are part of, or closely linked to, the default mode network (DMN)-and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the "unacceptable thoughts" and "symmetry/not-just-right-experiences" symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.
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Affiliation(s)
- Emily R. Stern
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Goi Khia Eng
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Alessandro S. De Nadai
- grid.264772.20000 0001 0682 245XDepartment of Psychology, Texas State University, San Marcos, TX USA
| | - Dan V. Iosifescu
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Russell H. Tobe
- grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Katherine A. Collins
- grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
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21
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Shephard E, Stern ER, van den Heuvel OA, Costa DL, Batistuzzo MC, Godoy PB, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy JY, Lochner C, Stein DJ, Simpson HB, Miguel EC. Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 2021; 26:4583-4604. [PMID: 33414496 PMCID: PMC8260628 DOI: 10.1038/s41380-020-01007-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. .,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Emily R. Stern
- Department of Psychiatry, The New York University School of Medicine, New York, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Odile A. van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Daniel L.C. Costa
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo C. Batistuzzo
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla B.G. Godoy
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Antonio C. Lopes
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre R. Brunoni
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Q. Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roseli G. Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Janardhan Y.C Reddy
- Department of Psychiatry OCD Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - H. Blair Simpson
- Center for OCD and Related Disorders, New York State Psychiatric Institute and the Department of Psychiatry, Columbia University Irving Medical Center, New York New York
| | - Euripedes C. Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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22
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Bragdon LB, Eng GK, Belanger A, Collins KA, Stern ER. Interoception and Obsessive-Compulsive Disorder: A Review of Current Evidence and Future Directions. Front Psychiatry 2021; 12:686482. [PMID: 34512412 PMCID: PMC8424053 DOI: 10.3389/fpsyt.2021.686482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoceptive processes are present in a range of psychiatric conditions, and there is a small but growing body of research on the role of interoception in obsessive-compulsive disorder (OCD). In this review, we outline dimensions of interoception and review current literature on the processing of internal bodily sensations within OCD. Investigations in OCD utilizing objective measures of interoception are limited and results mixed, however, the subjective experience of internal bodily sensations appears to be atypical and relate to specific patterns of symptom dimensions. Further, neuroimaging investigations suggest that interoception is related to core features of OCD, particularly sensory phenomena and disgust. Interoception is discussed in the context of treatment by presenting an overview of existing interventions and suggesting how modifications aimed at better targeting interoceptive processes could serve to optimize outcomes. Interoception represents a promising direction for multi-method research in OCD, which we expect, will prove useful for improving current interventions and identifying new treatment targets.
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Affiliation(s)
- Laura B. Bragdon
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Goi Khia Eng
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Amanda Belanger
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Katherine A. Collins
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emily R. Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, United States
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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23
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Vellozo AP, Fontenelle LF, Torresan RC, Shavitt RG, Ferrão YA, Rosário MC, Miguel EC, Torres AR. Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates. J Clin Med 2021; 10:jcm10020274. [PMID: 33451078 PMCID: PMC7828517 DOI: 10.3390/jcm10020274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
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Affiliation(s)
- Aline P. Vellozo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
- D’Or Institute for Research and Education & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Correspondence: ; Tel.: +61-3-990-29755
| | - Ricardo C. Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Roseli G. Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Ygor A. Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90570-080, Brazil;
| | - Maria C. Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil;
| | - Euripedes C. Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
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24
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Stamatis CA, Batistuzzo MC, Tanamatis T, Miguel EC, Hoexter MQ, Timpano KR. Using supervised machine learning on neuropsychological data to distinguish OCD patients with and without sensory phenomena from healthy controls. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:77-98. [PMID: 33300635 DOI: 10.1111/bjc.12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES While theoretical models link obsessive-compulsive disorder (OCD) with executive function deficits, empirical findings from the neuropsychological literature remain mixed. These inconsistencies are likely exacerbated by the challenge of high-dimensional data (i.e., many variables per subject), which is common across neuropsychological paradigms and necessitates analytical advances. More unique to OCD is the heterogeneity of symptom presentations, each of which may relate to distinct neuropsychological features. While researchers have traditionally attempted to account for this heterogeneity using a symptom-based approach, an alternative involves focusing on underlying symptom motivations. Although the most studied symptom motivation involves fear of harmful events, 60-70% of patients also experience sensory phenomena, consisting of uncomfortable sensations or perceptions that drive compulsions. Sensory phenomena have received limited attention in the neuropsychological literature, despite evidence that symptoms motivated by these experiences may relate to distinct cognitive processes. METHODS Here, we used a supervised machine learning approach to characterize neuropsychological processes in OCD, accounting for sensory phenomena. RESULTS Compared to logistic regression and other algorithms, random forest best differentiated healthy controls (n = 59; balanced accuracy = .70), patients with sensory phenomena (n = 29; balanced accuracy = .59), and patients without sensory phenomena (n = 46; balanced accuracy = .62). Decision-making best distinguished between groups based on sensory phenomena, and among the patient subsample, those without sensory phenomena uniquely displayed greater risk sensitivity compared to healthy controls (d = .07, p = .008). CONCLUSIONS Results suggest that different cognitive profiles may characterize patients motivated by distinct drives. The superior performance and generalizability of the newer algorithms highlights the utility of considering multiple analytic approaches when faced with complex data. PRACTITIONER POINTS Practitioners should be aware that sensory phenomena are common experiences among patients with OCD. OCD patients with sensory phenomena may be distinguished from those without based on neuropsychological processes.
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Affiliation(s)
- Caitlin A Stamatis
- Department of Psychology, University of Miami, Florida, USA.,Weill Cornell Medicine/NewYork-Presbyterian Hospital, USA
| | | | - Tais Tanamatis
- Department of Psychiatry, University of São Paulo, Brazil
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25
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Bhikram T, Crawley A, Arnold P, Abi-Jaoude E, Sandor P. Neuroimaging the emotional modulation of urge inhibition in Tourette Syndrome. Cortex 2020; 135:341-351. [PMID: 33317808 DOI: 10.1016/j.cortex.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/24/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
Tourette Syndrome (TS) is a neuropsychiatric condition characterized by tics that are typically preceded by uncomfortable urges that build until the tic is performed. Both tics and their associated urges are commonly exacerbated during states of heightened emotion. However, the neural substrates that are responsible for the development of urges have not been fully elucidated, particularly with regards to the influence of emotion. In this study, we investigate the brain areas associated with the development of urges and their modulation by emotion in patients with TS. Moreover, we explore the influence of obsessive-compulsive symptoms (OCS) which are commonly comorbid in TS. Forty patients with TS and 20 healthy controls completed an emotional blink suppression paradigm while undergoing functional magnetic resonance imaging. For the paradigm, participants completed alternating blocks of blink inhibition and free blinking while viewing pictures of angry and neutral facial expressions. Compared to controls, patients exhibited greater activity in the superior temporal gyrus and midcingulate during the inhibition of urges. Within the patient group, tic severity was associated with activity in the superior frontal gyrus during the angry inhibition contrast as compared to neutral; greater premonitory urge severity was associated with greater activity in the hippocampus, middle temporal gyrus and in the subcortex; blink inhibition ability was negatively associated with activity in the thalamus and insula. There were no significant associations with OCS severity for the emotion-related contrasts. The observed activated regions may represent a network that produces urges in patients, or alternatively, could represent compensatory cortical activity needed to keep urges and tics under control during emotional situations. Additionally, our findings suggest that OCS in the context of TS is similar to traditional obsessive-compulsive disorder and is neurobiologically dissociable from tics.
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Affiliation(s)
- Tracy Bhikram
- Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Adrian Crawley
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Program in Genetics and Genomic Biology, University of Calgary, Calgary, Alberta, Canada
| | - Elia Abi-Jaoude
- Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Sandor
- Tourette Syndrome Neurodevelopmental Clinic, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Child Psychiatry, Department of Psychiatry, Youthdale Treatment Centers, Toronto, Ontario, Canada.
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26
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Kracker Imthon A, Antônio Caldart C, do Rosário MC, Fontenelle LF, Constantino Miguel E, Arzeno Ferrão Y. Stressful Life Events and the Clinical Expression of Obsessive-Compulsive Disorder (OCD): An Exploratory Study. J Clin Med 2020; 9:E3371. [PMID: 33096706 PMCID: PMC7590000 DOI: 10.3390/jcm9103371] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In obsessive-compulsive disorder (OCD), symptom content and severity appear to fluctuate over the course of the life cycle in accordance with stressful life events. The objective of this paper was to compare OCD patients with and without reported stressful life events (SLEs) in terms of the sociodemographics of patients and the clinical characteristics of OCD. METHODS This was a cross-sectional study involving 1001 patients with OCD. Data concerning SLEs were collected via the Yale OCD Natural History Questionnaire, while for OCD symptoms, the Dimensional Yale-Brown Obsessive-Compulsive Scale was used. RESULTS Of the 1001 OCD patients, 605 (60.5%) reported experiencing at least one SLE in their lifetime. Self-declared nonwhite skin color (odds ratio (OR) = 1.51), the presence of a sensory phenomenon (OR = 1.47), and comorbidity with post-traumatic stress disorder (PTSD) (OR = 2.38) were some of the logistic regression variables related to the reported SLEs with relevant statistical significance and risk (i.e., OR) values. CONCLUSIONS Our results indicate that SLEs may make Brazilian OCD patients vulnerable to the onset or exacerbation of obsessive-compulsive symptoms. The positive association of the occurrence of SLEs and sensory phenomena in this population could corroborate that environmental influences impact the neurobiology associated with OCD, and likely with other psychiatric disorders as well.
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Affiliation(s)
- André Kracker Imthon
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| | - César Antônio Caldart
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| | - Maria Conceição do Rosário
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Child and Adolescent Psychiatry Unit (UPIA) at the Department of Psychiatry, Federal University of São Paulo, São Paulo 04017-030, Brazil
| | - Leonardo F. Fontenelle
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Turner Institute for Brain and Mental Health, Monash University, Clayton VIC 3800, Australia
- D’Or Institute for Research and Education (IDOR) and Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Euripedes Constantino Miguel
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Department of Psychiatry, São Paulo University Medical School, São Paulo 05403-903, Brazil
| | - Ygor Arzeno Ferrão
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
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27
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Eng GK, Collins KA, Brown C, Ludlow M, Tobe RH, Iosifescu DV, Stern ER. Dimensions of interoception in obsessive-compulsive disorder. J Obsessive Compuls Relat Disord 2020; 27:100584. [PMID: 33194538 PMCID: PMC7665060 DOI: 10.1016/j.jocrd.2020.100584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Interoceptive sensibility (IS) refers to the subjective experience of perceiving and being aware of one's internal body sensations, and is typically evaluated using self-report questionnaires or confidence ratings. Here we evaluated IS in 81 patients with OCD and 76 controls using the Multidimensional Scale of Interoceptive Awareness (MAIA), which contains 8 subscales assessing adaptive and maladaptive responses to sensation. Compared to controls, OCD patients showed hyperawareness of body sensations. Patients also demonstrated a more maladaptive profile of IS characterized by greater distraction from and worry about unpleasant sensations, and reduced tendency to experience the body as safe and trustworthy. These findings were independent of medication status and comorbidities in the patient group. Correlational analyses showed that subscales of the MAIA were differentially associated with OCD symptom dimensions. These findings indicate that patients with OCD show abnormality of IS that is independent of confounding factors related to medication and comorbidities and associated with different OCD symptom dimensions. Future work would benefit from examining neural correlates of these effects and evaluating whether dimensions of IS are impacted by treatments for the disorder.
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Affiliation(s)
- Goi Khia Eng
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Katherine A. Collins
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
- Department of Psychiatry, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Carina Brown
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Molly Ludlow
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Russell H. Tobe
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Dan V. Iosifescu
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Emily R. Stern
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
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28
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Summers BJ, Wilver NL, Garratt GH, Cougle JR. A Multimethod Analysis of Incompleteness and Visual "Not Just Right" Experiences in Body Dysmorphic Disorder. Behav Ther 2020; 51:764-773. [PMID: 32800304 DOI: 10.1016/j.beth.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/26/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) often report engaging in repetitive behaviors aimed at reducing feelings of imperfection anchored to their appearance. "Not just right" experiences (NJREs) and incompleteness (INC) are constructs related to perfectionism that have traditionally been studied in obsessive-compulsive disorder, though recent research has also linked these phenomena to BDD. We sought to replicate and extend this research via two studies. Study 1 examined BDD symptoms, INC, as well as harm avoidance (HA) in an unselected sample (N = 179); moderate associations were observed between symptoms and both INC and HA. Participants also completed a novel visual NJRE task in which they were shown appearance-related and non-appearance-related images meant to evoke an NJRE response (i.e., discomfort and urge to "fix" stimuli). BDD symptoms predicted reactivity to appearance-related NJRE stimuli above negative affect. Study 2 compared INC, HA, and task reactivity in a BDD sample (N = 50) to nonpsychiatric controls (N = 44). The BDD group evidenced greater INC, HA, and reactivity to both appearance and nonappearance NJRE stimuli, relative to controls; however, group differences did not remain after controlling for age and negative affect. These studies broadly corroborate previous research highlighting NJREs and INC as potential vulnerability factors relevant to BDD, though these phenomena may not be specific to BDD symptoms.
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Affiliation(s)
- Berta J Summers
- Massachusetts General Hospital/Harvard Medical School; Florida State University.
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29
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Edwards KR, Raines JM, Winnick JB, Sherman MF, Higginson CI, Navin K, Conteh F, Ricketts EJ, Specht MW. Sex and psychiatric comorbidity correlates of the premonitory urge for tic scale in youth with persistent tic disorders. J Neural Transm (Vienna) 2020; 127:977-985. [PMID: 32212016 DOI: 10.1007/s00702-020-02151-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/24/2020] [Indexed: 12/01/2022]
Abstract
The premonitory urge for tics scale (PUTS) is a common self-report measure of premonitory sensations preceding tics. The present study aimed to examine the internal consistency and concurrent validity of the PUTS by sex and psychiatric comorbidity status; and explored interactions between sex and psychiatric comorbidity in predicting premonitory urge and tic symptom severity. Seventy-four youth and young adults with persistent tic disorders completed the PUTS, while their parents completed the parent tic questionnaire (PTQ) and a demographic measure. Independent samples t-tests revealed no significant sex differences in PUTS items or total score. The PUTS total score also did not significantly differ between participants with and without attention-deficit hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD) comorbidity. Internal consistency did not significantly differ between females (α = 0.85) and males (α = 0.75), and those with comorbid ADHD and/or OCD (α = 0.83) relative to those without (α = 0.69). With respect to concurrent validity, the PUTS total was significantly correlated with PTQ tic frequency, intensity, number, and severity for males but not for females. Among those with ADHD and/or OCD, the PUTS total score was correlated significantly and strongly with tic number and moderately with tic intensity. Interactions between sex and psychiatric comorbidity performed using 2 × 2 analysis of variance did not significantly predict the PUTS total or PTQ subscale scores. Findings suggest sex and comorbidity status may influence premonitory urge expression. Results have implications for understanding and measurement of the premonitory urge.
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Affiliation(s)
- K R Edwards
- Department of Psychiatry and Behavioural Neurosciences, McMaster Children's Hospital and McMaster University, 1200 Main Street West, Hamilton, ON, L8P 1H1, Canada.
| | - J M Raines
- University of North Dakota, Grand Forks, USA
| | | | | | | | - K Navin
- Loyola University Maryland, Baltimore, USA
| | - F Conteh
- East Virginia Medical School, Norfolk, USA
| | - E J Ricketts
- University of California, Los Angeles Department of Psychiatry and Biobehavioral Sciences, Los Angeles, USA
| | - M W Specht
- Weill Cornell Medical College and NewYork-Presbyterian Hospital-Westchester, White Plains, USA
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30
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Examining the functional activity of different obsessive-compulsive symptom dimensions in Tourette syndrome. NEUROIMAGE-CLINICAL 2020; 26:102198. [PMID: 32062563 PMCID: PMC7025096 DOI: 10.1016/j.nicl.2020.102198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
Patients with Tourette Syndrome completed an obsessive–compulsive provocation task. Patients reported higher anxiety for the provocation conditions than did controls. Group differences found in the insula, sensorimotor cortex and supramarginal gyri. Obsessive–compulsive severity associated with frontal and parietal lobe activity. Tic severity associated with anterior cingulate activity for the symmetry condition. Objectives Tourette syndrome (TS) is commonly comorbid with obsessive–compulsive disorder (OCD) and many phenomenological similarities exist between tics and obsessive–compulsive symptoms (OCS). Therefore, due to the clinical importance of comorbid OCD, the goal of this study was to investigate the neural substrates of OCS in TS using functional magnetic resonance imaging. Methods Forty patients with TS and 20 healthy controls underwent functional magnetic resonance imaging while viewing blocks of OCS-provoking pictures relating to washing, checking and symmetry symptoms, as well as generally disgusting and neutral scenes. Statistical comparisons were made between patients with moderate/severe OCS, absent/mild OCS and healthy controls. As well, within the entire TS patient group, significant associations with clinical measures were assessed for each of the provocation conditions. Results Group differences in the insula, sensorimotor cortex, supramarginal gyrus and visual processing regions were common among the checking, washing and disgust conditions. In the patient group, negative associations between OCS severity and activity in the supramarginal gyrus, inferior frontal gyrus, sensorimotor cortex, precuneus and visual processing regions were common among the provocation conditions. Tic severity was only associated with activity in the anterior cingulate cortex for the symmetry condition. Conclusion Our findings implicate areas previously reported to be involved in OCD, as well as areas not typically implicated in OCD, suggesting that the neurobiological profile of TS+OCD is intermediate to pure TS and pure OCD.
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31
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Simpson HB, van den Heuvel OA, Miguel EC, Reddy YCJ, Stein DJ, Lewis-Fernández R, Shavitt RG, Lochner C, Pouwels PJW, Narayanawamy JC, Venkatasubramanian G, Hezel DM, Vriend C, Batistuzzo MC, Hoexter MQ, de Joode NT, Costa DL, de Mathis MA, Sheshachala K, Narayan M, van Balkom AJLM, Batelaan NM, Venkataram S, Cherian A, Marincowitz C, Pannekoek N, Stovezky YR, Mare K, Liu F, Otaduy MCG, Pastorello B, Rao R, Katechis M, Van Meter P, Wall M. Toward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative. BMC Psychiatry 2020; 20:68. [PMID: 32059696 PMCID: PMC7023814 DOI: 10.1186/s12888-020-2439-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/10/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. METHODS We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. DISCUSSION Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
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Affiliation(s)
- Helen Blair Simpson
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Odile A. van den Heuvel
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Euripedes C. Miguel
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Y. C. Janardhan Reddy
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Dan J. Stein
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Roberto Lewis-Fernández
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Roseli Gedanke Shavitt
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Christine Lochner
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Petra J. W. Pouwels
- grid.12380.380000 0004 1754 9227Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Janardhanan C. Narayanawamy
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Dianne M. Hezel
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Chris Vriend
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Marcelo C. Batistuzzo
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Marcelo Q. Hoexter
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Niels T. de Joode
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands ,grid.12380.380000 0004 1754 9227Department of Anatomy and Neuroscience, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Daniel Lucas Costa
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Maria Alice de Mathis
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Karthik Sheshachala
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Madhuri Narayan
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Neeltje M. Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest, Specialised Mental Health Care, Amsterdam, The Netherlands
| | - Shivakumar Venkataram
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anish Cherian
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Clara Marincowitz
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Nienke Pannekoek
- grid.11956.3a0000 0001 2214 904XSAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Yael R. Stovezky
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Karen Mare
- grid.7836.a0000 0004 1937 1151SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Feng Liu
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Maria Concepcion Garcia Otaduy
- grid.11899.380000 0004 1937 0722Obsessive-Compulsive Spectrum Disorders Program, Institute & Department of Psychiatry, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil ,grid.500696.cNational Institute of Developmental Psychiatry, Sao Paulo, Brazil
| | - Bruno Pastorello
- grid.11899.380000 0004 1937 0722Institute of Radiology, Hospital das Clinicas-HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rashmi Rao
- grid.416861.c0000 0001 1516 2246National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Martha Katechis
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Page Van Meter
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
| | - Melanie Wall
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, Columbia University, New York, NY 10032 USA ,grid.413734.60000 0000 8499 1112The New York State Psychiatric Institute, New York, NY 10032 USA
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Stern ER, Brown C, Ludlow M, Shahab R, Collins K, Lieval A, Tobe RH, Iosifescu DV, Burdick KE, Fleysher L. The buildup of an urge in obsessive-compulsive disorder: Behavioral and neuroimaging correlates. Hum Brain Mapp 2020; 41:1611-1625. [PMID: 31916668 PMCID: PMC7082184 DOI: 10.1002/hbm.24898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/22/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is highly heterogeneous. While obsessions often involve fear of harm, many patients report uncomfortable sensations and/or urges that drive repetitive behaviors in the absence of a specific fear. Prior work suggests that urges in OCD may be similar to everyday "urges-for-action" (UFA) such as the urge to blink, swallow, or scratch, but very little work has investigated the pathophysiology underlying urges in OCD. In the current study, we used an urge-to-blink approach to model sensory-based urges that could be experimentally elicited and compared across patients and controls using the same task stimuli. OCD patients and controls suppressed eye blinking over a period of 60 s, alternating with free blinking blocks, while brain activity was measured using functional magnetic resonance imaging. OCD patients showed significantly increased activation in several regions during the early phase of eyeblink suppression (first 30 s), including mid-cingulate, insula, striatum, parietal cortex, and occipital cortex, with lingering group differences in parietal and occipital regions during late eyeblink suppression (last 30 s). There were no differences in brain activation during free blinking blocks, and no conditions where OCD patients showed reduced activation compared to controls. In an exploratory analysis of blink counts performed in a subset of subjects, OCD patients were less successful than controls in suppressing blinks. These data indicate that OCD patients exhibit altered brain function and behavior when experiencing and suppressing the urge to blink, raising the possibility that the disorder is associated with a general abnormality in the UFA system that could ultimately be targeted by future treatments.
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Affiliation(s)
- Emily R Stern
- Department of Psychiatry, New York University School of Medicine, New York, New York.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Carina Brown
- Department of Psychiatry, New York University School of Medicine, New York, New York.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Molly Ludlow
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Rebbia Shahab
- Department of Psychiatry, New York University School of Medicine, New York, New York.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Katherine Collins
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexis Lieval
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Russell H Tobe
- Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Dan V Iosifescu
- Department of Psychiatry, New York University School of Medicine, New York, New York.,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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33
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Matsuda N, Nonaka M, Kono T, Fujio M, Nobuyoshi M, Kano Y. Premonitory Awareness Facilitates Tic Suppression: Subscales of the Premonitory Urge for Tics Scale and a New Self-Report Questionnaire for Tic-Associated Sensations. Front Psychiatry 2020; 11:592. [PMID: 32719621 PMCID: PMC7350852 DOI: 10.3389/fpsyt.2020.00592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Awareness of premonitory urge in Tourette syndrome (TS) may facilitate tic suppression; however, previous studies have not supported this observation. We aimed to clarify the relationship between tic-associated sensation and tic suppression by identifying the subtypes of tic-associated sensations, including the Premonitory Urge for Tics Scale (PUTS). We developed a new questionnaire called "Rumination and Awareness Scale for tic-associated sensations" (RASTS) to assess the two additional aspects of tic-associated sensations: the intensity of somatosensory hyperawareness and the ability to identify signals of emerging tics. Sixty-two individuals with TS participated in the study (mean age = 19.2 ± 10.3 years). All participants completed the RASTS, PUTS, and Tic Suppression Scale. Of all participants, 41 were evaluated by the Yale Global Tic Severity Scale (YGTSS), while another group of 41 completed both the Leyton Obsessional Inventory-Child Version (LOI-CV) and the Tics Symptom Self-Report (TSSR). Factor analyses including nine items of the PUTS and the RASTS were conducted, and their relationships with patients' tic suppression ability were examined. The results support using RASTS for the two supposed dimensions (rumination about sensation and premonitory awareness) for assessing the two different tic-associated sensations, and PUTS for three dimensions for assessing the two types of quality of premonitory urges and intensity of premonitory urges. Premonitory awareness correlated with tic suppression ability. Conversely, rumination about sensation, PUTS total score, and the three subscales of PUTS correlated with obsessive-compulsive symptoms. In summary, being aware of signals for emerging tics facilitated self-initiated tic suppression, while ruminative tic-associated sensations did not. This study provides new insights into behavioral therapy for tics by identifying two distinct aspects of tic-associated sensations that include premonitory urges.
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Affiliation(s)
- Natsumi Matsuda
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Maiko Nonaka
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Course of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Kono
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miyuki Fujio
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Psychology, Faculty of Liberal Arts, Teikyo University, Tokyo, Japan
| | - Marina Nobuyoshi
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Course of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
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Reddy YCJ, Sudhir PM, Manjula M, Arumugham SS, Narayanaswamy JC. Clinical Practice Guidelines for Cognitive-Behavioral Therapies in Anxiety Disorders and Obsessive-Compulsive and Related Disorders. Indian J Psychiatry 2020; 62:S230-S250. [PMID: 32055066 PMCID: PMC7001348 DOI: 10.4103/psychiatry.indianjpsychiatry_773_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - M Manjula
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Kano Y, Fujio M, Kaji N, Matsuda N, Nonaka M, Kono T. Changes in Sensory Phenomena, Tics, Obsessive-Compulsive Symptoms, and Global Functioning of Tourette Syndrome: A Follow-Up After Four Years. Front Psychiatry 2020; 11:619. [PMID: 32695033 PMCID: PMC7338586 DOI: 10.3389/fpsyt.2020.00619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Sensory phenomena and related features of Tourette syndrome are related to poorer quality of life. Therefore, sensory phenomena might also have a negative impact on global functioning. However, the influence of sensory phenomena, tics, and obsessive-compulsive symptoms (OCS) on global functioning after several years of usual treatment has not been investigated. Twenty out of 45 Japanese patients with Tourette syndrome who had previously undergone an evaluation of these clinical features were assessed again after an average of four years. We conducted a panel of assessments for premonitory urges, broader sensory phenomena, tic severity, OCS, and global functioning. Based on Pearson's correlation coefficient, current global functioning was significantly negatively correlated with previous tics and marginally negatively correlated with previous broader sensory phenomena. Current global functioning was marginally correlated with change in tics. Change in global functioning was significantly correlated with change in OCS and marginally correlated with change in premonitory urges. Due to the small sample size, it was not possible to use a multiple regression analysis to conclude that sensory phenomena, tics, and OCS predict global functioning in adolescents and adults with TS. However, it was suggested that further investigation of this relationship would be meaningful.
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Affiliation(s)
- Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Miyuki Fujio
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Course of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan.,Department of Psychology, Faculty of Liberal Arts, Teikyo University, Tokyo, Japan
| | - Namiko Kaji
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Office for Mental Health Support, Division for Counseling and Support, The University of Tokyo, Tokyo, Japan
| | - Natsumi Matsuda
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan
| | - Maiko Nonaka
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Course of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Kono
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Inhibition-related differences between tic-free and tic-related obsessive–compulsive disorder: evidence from the N2 and P3. Exp Brain Res 2019; 237:3449-3459. [DOI: 10.1007/s00221-019-05688-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
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Quality and temporal properties of premonitory urges in patients with skin picking disorder. Cortex 2019; 121:125-134. [PMID: 31605885 DOI: 10.1016/j.cortex.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 12/30/2022]
Abstract
Skin picking is a newly recognized obsessive-compulsive spectrum disorder in DSM-5. Similar to some repetitive behaviors in Gilles de la Tourette syndrome (GTS) and obsessive-compulsive disorder (OCD), premonitory urges are assumed to play a critical role in maintaining skin picking behavior, by creating a vicious cycle. The present study is the first to investigate the quality of premonitory urges, as well as the temporal relationship between urges and skin picking behavior in individuals with skin picking disorder. Quality and intensity of premonitory urges was assessed in 15 individuals with skin picking. Urge quality was assessed with the translated University of São Paulo Sensory Phenomena Scale (USP-SPS). Urge intensity was assessed continuously over 20 min using a computer-based tool. Participants were instructed either a) to pick freely or b) to suppress their skin picking behavior. Skin picking events during the free and suppression condition were recorded on video and coded manually. Regarding the types of urges, individuals with skin picking reported mainly physical urge sensations (80%), visual "just-right" feelings (80%), and urge-only sensations (80%) similar to urges reported by GTS and OCD patients. Moreover, the data showed a strong temporal relationship between the intensity of premonitory urges and the emergence of skin picking behavior (R2 = .23) that was weakened when skin picking was suppressed (R2 = .06). The results suggest that skin picking behavior is maintained by premonitory urges and that this vicious cycle of negative reinforcement can be, at least partially, broken by suppressing skin picking behavior.
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Domingues-Castro MS, Torresan RC, Shavitt RG, Fontenelle LF, Ferrão YA, Rosário MC, Torres AR. Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: Prevalence and predictors. J Affect Disord 2019; 256:324-330. [PMID: 31201983 DOI: 10.1016/j.jad.2019.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) often present with comorbidities, mainly anxiety and affective disorders, which may influence OCD course, help-seeking and treatment response. Some authors have studied bipolar disorder (BD) comorbidity in patients with OCD, but usually in small samples. The objective was to estimate the lifetime prevalence of BD in a large clinical sample of OCD patients, and to compare demographic and clinical features of patients with and without BD comorbidity. METHOD This cross-sectional study with 955 adult OCD patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC) used several assessment instruments, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Descriptive and bivariate analyses were followed by logistic regression. RESULTS The lifetime prevalence of BD was 7.75% (N = 74). The variables that were independently associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders, and suicide attempts. LIMITATIONS The cross-sectional design does not permit causal inferences; the external validity may be limited, as the participants were from tertiary services. Despite the large sample size, some analyses may have been underpowered due to the relatively low prevalence of the outcome and of some explanatory variables. CONCLUSIONS Patients with OCD comorbid with BD have some clinical features indicative of greater severity, including higher suicide risk, and require a careful therapeutic approach for the appropriate treatment of both disorders.
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Affiliation(s)
- Mariana S Domingues-Castro
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil
| | - Ricardo C Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, University of São Paulo (USP), Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, D'Or Institute for Research and Education, Brazil; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Maria C Rosário
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Brazil
| | - Albina R Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil.
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Gao J, Zhou Y, Yang X, Luo J, Meng F, Zheng D, Li Z. Abnormalities within and beyond the cortico-striato-thalamo-cortical circuitry in medication-free patients with OCD revealed by the fractional amplitude of low-frequency fluctuations and resting-state functional connectivity. Neurosci Lett 2019; 712:134449. [PMID: 31470044 DOI: 10.1016/j.neulet.2019.134449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/24/2019] [Accepted: 08/21/2019] [Indexed: 12/30/2022]
Abstract
Neuroimaging studies of obsessive-compulsive disorder (OCD) often focus on the cortico-striato-thalamo-cortical (CSTC) circuitry, but recent studies have found abnormal spontaneous brain activity in regions outside the CSTC circuitry in patients with OCD using resting-state functional magnetic resonance imaging. Researchers have not clearly determined whether changes in spontaneous brain activity within and beyond the CSTC circuitry coexist in medication-free patients with OCD. To address this question, we recruited 64 medication-free patients with OCD and 60 matched healthy controls (HCs) to investigate their spontaneous brain activity by measuring the fractional amplitude of low-frequency fluctuation (fALFF) and resting-state functional connectivity. Patients with OCD showed increased fALFF values in the left dorsolateral prefrontal cortex (DLPFC) and decreased fALFF values in the right rolandic operculum compared with HCs. Furthermore, patients with OCD exhibited significantly increased functional connectivity between the left DLPFC and the left cerebellum and reduced negative functional connectivity between the right rolandic operculum and the left precuneus. These findings provided new insights into the pathophysiological model of OCD, which may include CSTC circuitry and regions outside this circuitry.
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Affiliation(s)
- Jian Gao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, PR China
| | - Yuan Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China; CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China
| | - Xiangyun Yang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, PR China
| | - Jia Luo
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, PR China
| | - Fanqiang Meng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, PR China
| | - Dang Zheng
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, PR China.
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40
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Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5:52. [PMID: 31371720 PMCID: PMC7370844 DOI: 10.1038/s41572-019-0102-3] [Citation(s) in RCA: 371] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Daniel L C Costa
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christine Lochner
- Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa
| | - Euripedes C Miguel
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Roseli G Shavitt
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - H Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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41
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da Silva RDMF, Batistuzzo MC, Shavitt RG, Miguel EC, Stern E, Mezger E, Padberg F, D'Urso G, Brunoni AR. Transcranial direct current stimulation in obsessive-compulsive disorder: an update in electric field modeling and investigations for optimal electrode montage. Expert Rev Neurother 2019; 19:1025-1035. [PMID: 31244347 DOI: 10.1080/14737175.2019.1637257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation intervention that has been investigated for several psychiatric disorders, including Obsessive-Compulsive Disorder (OCD). As there are several candidate brain regions for targeting OCD relevant networks, clinical studies using tDCS have considerably varied in terms of the electrode montages used. Computer modeling of electric field currents induced by tDCS can help guiding the research of relevant targets for OCD. In this review, the authors used this tool to investigate targeted brain areas from previous studies of tDCS in OCD. Areas covered: A literature search for articles with the keywords 'tDCS', 'Transcranial Direct Current Stimulation' and 'Obsessive Compulsive Disorder' was conducted to identify relevant publications. For comparing different electrode montages, electric field (EF) models were performed using high-resolution brain scan templates. Authors found 13 studies mostly showing an improvement in OCD symptoms. The electrode montages varied considerably between studies. Nonetheless, two main patterns of EFs could be identified: 'focal montages', with EFs concentrated in the prefrontal cortex, and 'diffuse montages', with widespread EFs over cortical areas. Expert opinion: Electric field simulation can guide future clinical trials in psychiatry, using personalized tDCS montages with distinct electrode positioning according to clusters of symptoms.
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Affiliation(s)
- Renata de Melo Felipe da Silva
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Service of Interdisciplinary Neuromodulation (SIN), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Marcelo Camargo Batistuzzo
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Roseli Gedanke Shavitt
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Eurípedes Constantino Miguel
- Department and Institute of Psychiatry, Obsessive-Compulsive Spectrum Disorders Program, Laboratory of Psychopathology and Psychiatric treatment (LIM-23), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
| | - Emily Stern
- Department of Psychiatry, New York University School of Medicine , New York , NY , USA.,Nathan Kline Institute for Psychiatric Research , Orangeburg , NY , USA
| | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich , Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich , Munich , Germany
| | - Giordano D'Urso
- Unit of Psychiatry, Department of Clinical Neuroscience, University of Naples Federico II , Naples , Italy
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil
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Li Y, Zhang JS, Wen F, Lu XY, Yan CM, Wang F, Cui YH. Premonitory urges located in the tongue for tic disorder: Two case reports and review of literature. World J Clin Cases 2019; 7:1508-1514. [PMID: 31363480 PMCID: PMC6656667 DOI: 10.12998/wjcc.v7.i12.1508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Premonitory urges (PUs) was defined as the uncomfortable physical sensations of inner tension that can be relieved by producing movement responses. Nearly 70%-90% patients with Tourette syndrome reported experiences of PUs.
CASE SUMMARY In this paper, we present two cases of young patients with PUs located in their tongue, which is very rare and easily misdiagnosed in clinical work. Both two young patients complained of an itchy tongue and cannot help biting their tongue. These two cases were worth reporting because it was rare that PUs was the initial symptom and located in the tongue. The results indicated that PUs seem to play an important role in the generation of tics.
CONCLUSION Thus, PUs may be the first process, and an essential part, of the formation of tics.
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Affiliation(s)
- Ying Li
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Ji-Shui Zhang
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Fang Wen
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Xiao-Yan Lu
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Chun-Mei Yan
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Fang Wang
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Yong-Hua Cui
- National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
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43
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Blanco-Vieira T, Santos M, Ferrão YA, Torres AR, Miguel EC, Bloch MH, Leckman JF, do Rosario MC. The impact of attention deficit hyperactivity disorder in obsessive-compulsive disorder subjects. Depress Anxiety 2019; 36:533-542. [PMID: 30990937 DOI: 10.1002/da.22898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients. METHODS A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinical characteristics in adult OCD patients with and without comorbid ADHD were compared using Fisher's exact test, t-tests or Mann-Whitney tests. Bivariate analyses were followed by logistic regression analysis to identify clinical characteristics independently associated with ADHD comorbidity. RESULTS The lifetime prevalence of ADHD in adult OCD patients was 13.7%. The current results indicate that OCD + ADHD patients were more severe, had an earlier onset of the obsessive-compulsive symptoms, a higher history of rheumatic fever, with higher frequencies of sensory phenomena and comorbidity with Tourette syndrome. They also had an increased risk for academic impairment and suicide attempts. CONCLUSION Adult OCD patients with ADHD present some specific clinical features and may represent a special subgroup of adult OCD. Future studies should focus on the development of interventions more tailored to the phenotype of this subgroup of patients.
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Affiliation(s)
- Thiago Blanco-Vieira
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Matheus Santos
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ygor A Ferrão
- Department od Psychiatry, Porto Alegre Health Science Federal University, Porto Alegre, Brazil
- Brazilian OCD Research Consortium (CTOC), Brazil
| | - Albina R Torres
- Brazilian OCD Research Consortium (CTOC), Brazil
- Department of Psychiatry, Faculty of Medicine of Botucatu, State University of São Paulo, São Paulo, Brazil
| | - Eurípedes C Miguel
- Brazilian OCD Research Consortium (CTOC), Brazil
- Psychiatry Institute, Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Maria C do Rosario
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
- Brazilian OCD Research Consortium (CTOC), Brazil
- Child Study Center, Yale University, New Haven, Connecticut
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44
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Brown C, Shahab R, Collins K, Fleysher L, Goodman WK, Burdick KE, Stern ER. Functional neural mechanisms of sensory phenomena in obsessive-compulsive disorder. J Psychiatr Res 2019; 109:68-75. [PMID: 30508745 PMCID: PMC6347462 DOI: 10.1016/j.jpsychires.2018.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022]
Abstract
Sensory phenomena (SP) are aversive or uncomfortable sensations that accompany and/or drive repetitive behaviors in obsessive-compulsive disorder (OCD). Although SP are associated with significant distress and may respond less well to standard treatments than harm-related obsessions, little is known about their underlying neurobiology. The present study used functional magnetic resonance imaging (fMRI) to measure brain functioning related to severity of SP during a "body-focused" videos task designed to elicit activation in sensorimotor brain regions. Regression analysis examined the relationship between severity of SP and activation during task using permutation analysis, cluster-level corrected for multiple comparisons (family-wise error rate p < 0.05). The distribution of SP severity was not significantly different from normal, with both high- and low-severity scores represented in the OCD sample. Severity of SP was not correlated with other clinical symptoms in OCD including general anxiety, depression, or harm avoidance. When viewing body-focused videos, patients with greater severity of SP showed increased activity in the mid-posterior insula, a relationship that remained significant when controlling for other clinical symptoms, medication status, and comorbidities. At uncorrected thresholds, SP severity was also positively related to somatosensory, mid orbitofrontal, and lateral prefrontal cortical activity. These data suggest that SP in OCD are dissociable from other symptoms in the disorder and related to hyperactivation of the insula. Future work examining neural mechanisms of SP across different disorders (tics, trichotillomania) as well as with other imaging modalities will be needed to further understand the neurobiology of these impairing symptoms.
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Affiliation(s)
- Carina Brown
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Rebbia Shahab
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Katherine Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wayne K Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Emily R Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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45
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Kennedy GA, McDermott KA, Mathes BM, Summers BJ, Cougle JR. "Not just right" experiences account for unique variance in eating pathology. Eat Disord 2018; 26:464-476. [PMID: 29863434 DOI: 10.1080/10640266.2018.1481305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
"Not just right" experiences (NJREs) are uncomfortable sensations of incompleteness linked to obsessive-compulsive disorder; however, NJREs may be transdiagnostic and play a role in eating pathology. The current study examined relations between NJREs and eating pathology in undergraduate students. Participants (n = 248) completed self-report and behavioral assessments. Controlling for obsessive-compulsive symptoms, negative affect, and perfectionism, NJRE frequency was associated with greater drive for thinness, body dissatisfaction, and bulimic symptoms. Discomfort in response to a visual in vivo NJRE task was positively associated with drive for thinness and body dissatisfaction. The present study provides initial evidence for NJREs in eating pathology. Theoretical implications are discussed.
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Affiliation(s)
- Grace A Kennedy
- a Department of Psychology , Florida State University , Tallahassee , Florida , USA
| | | | - Brittany M Mathes
- a Department of Psychology , Florida State University , Tallahassee , Florida , USA
| | - Berta J Summers
- a Department of Psychology , Florida State University , Tallahassee , Florida , USA.,b Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - Jesse R Cougle
- a Department of Psychology , Florida State University , Tallahassee , Florida , USA
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Sigurdsson HP, Pépés SE, Jackson GM, Draper A, Morgan PS, Jackson SR. Alterations in the microstructure of white matter in children and adolescents with Tourette syndrome measured using tract-based spatial statistics and probabilistic tractography. Cortex 2018; 104:75-89. [PMID: 29758375 PMCID: PMC6020130 DOI: 10.1016/j.cortex.2018.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 02/24/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterised by repetitive and intermittent motor and vocal tics. TS is thought to reflect fronto-striatal dysfunction and the aetiology of the disorder has been linked to widespread alterations in the functional and structural integrity of the brain. The aim of this study was to assess white matter (WM) abnormalities in a large sample of young patients with TS in comparison to a sample of matched typically developing control individuals (CS) using diffusion MRI. The study included 35 patients with TS (3 females; mean age: 14.0 ± 3.3) and 35 CS (3 females; mean age: 13.9 ± 3.3). Diffusion MRI data was analysed using tract-based spatial statistics (TBSS) and probabilistic tractography. Patients with TS demonstrated both marked and widespread decreases in axial diffusivity (AD) together with altered WM connectivity. Moreover, we showed that tic severity and the frequency of premonitory urges (PU) were associated with increased connectivity between primary motor cortex (M1) and the caudate nuclei, and increased information transfer between M1 and the insula, respectively. This is to our knowledge the first study to employ both TBSS and probabilistic tractography in a sample of young patients with TS. Our results contribute to the limited existing literature demonstrating altered connectivity in TS and confirm previous results suggesting in particular, that altered insular function contributes to increased frequency of PU.
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Affiliation(s)
| | | | - Georgina M Jackson
- Institute of Mental Health, School of Medicine, University of Nottingham, UK
| | - Amelia Draper
- Nuffield Department of Clinical Neuroscience, University of Oxford, UK
| | - Paul S Morgan
- Department of Academic Radiology, University of Nottingham, UK
| | - Stephen R Jackson
- School of Psychology, University of Nottingham, UK; Institute of Mental Health, School of Medicine, University of Nottingham, UK.
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Buse J, Beste C, Roessner V. Neural correlates of prediction violations in boys with Tourette syndrome: Evidence from harmonic expectancy. World J Biol Psychiatry 2018; 19:130-141. [PMID: 28010171 DOI: 10.1080/15622975.2016.1274052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES It has been suggested that Tourette syndrome (TS) might be associated with alterations of the attention system, but the nature of these alterations and the underlying neuroanatomical network remains elusive. We aimed at investigating the functional neuroanatomical modulators of attention allocation towards predictable versus unpredictable stimuli in boys with TS. METHODS Using functional magnetic resonance imaging, we ran a harmonic expectancy violation paradigm in 17 boys with TS and 23 matched healthy controls (HCs). We presented chord sequence in which the first four chords induced a strong expectancy for a harmonic chord at the next position. In 70% this expectancy was fulfilled (harmonic), in 30% the expectancy was violated (disharmonic). RESULTS HCs responded faster to the disharmonic compared to harmonic chords, indicating a stronger attention allocation towards unpredictable stimuli, while this effect was not found in boys with TS. HCs showed stronger anterior cingulate cortex (ACC) activation during disharmonic compared to harmonic chords. Boys with TS showed stronger ACC activation during harmonic chords, which was associated with greater tic severity. CONCLUSIONS Our findings indicate that boys with TS showed altered reactions towards predictable versus unpredictable stimuli in brain regions playing an important role in attention control. This might indicate altered allocation of attention towards those stimuli.
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Affiliation(s)
- Judith Buse
- a Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden , Dresden , Germany
| | - Christian Beste
- a Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden , Dresden , Germany.,b Experimental Neurobiology , National Institute of Mental Health , Klecany , Czech Republic
| | - Veit Roessner
- a Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden , Dresden , Germany
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Boisseau CL, Sibrava NJ, Garnaat SL, Mancebo MC, Eisen JL, Rasmussen SA. The Brown Incompleteness Scale (BINCS): Measure development and initial evaluation. J Obsessive Compuls Relat Disord 2018; 16:66-71. [PMID: 29750139 PMCID: PMC5937536 DOI: 10.1016/j.jocrd.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, incompleteness has received increased clinical attention as a core motivation underlying obsessive-compulsive spectrum disorders. Yet, assessment of incompleteness has relied almost exclusively on self-report and has assumed a unitary conceptualization of this phenomenon. Therefore, we sought to develop and validate a new multi-faceted clinician-administered measure of incompleteness. The Brown Incompleteness Scale (BINCS) consists of 21 items; each rated on a 5-point scale, with higher scores indicating a greater degree of incompleteness. The current study describes the measure's development and preliminary validation. METHODS The scale was administered to 100 consecutive participants who were part of a longitudinal follow-up study of OCD. The reliability, validity, and factor analytic structure of the scale were evaluated. RESULTS Exploratory factor analysis supported a two-factor solution, which can best be described as representing both behavioral and sensory manifestations of incompleteness. CONCLUSIONS The BINCS demonstrated strong internal consistency as well as convergent and divergent validity. This clinician-administered scale will provide a more comprehensive clinical assessment of patients with incompleteness.
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Affiliation(s)
- Christina L. Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Nicholas J. Sibrava
- Department of Psychology, Baruch College – The City University of New York, NY, United States
| | - Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Maria C. Mancebo
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
| | - Jane L. Eisen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
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Fornés-Romero G, Belloch A. Induced not just right and incompleteness experiences in OCD patients and non-clinical individuals: An in vivo study. J Behav Ther Exp Psychiatry 2017; 57:103-112. [PMID: 28500953 DOI: 10.1016/j.jbtep.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 04/06/2017] [Accepted: 05/02/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Research on incompleteness and not-just right experiences, (INC/NJREs) indicate that some OCD symptom dimensions are motivated by these experiences rather than by anxiety. Most published data are correlational, using non-clinical individuals. This study sought to examine INC/NJREs in vivo in non-clinical and OCD individuals. METHODS Study 1: Ninety-three undergraduates were randomly assigned to a INC/NJREs induction (n=44) or non-induction task (n=47). Scores on self-reports assessing INC, NJREs, OCD, Anxiety, and Depression were also recorded. Study 2: Twenty adults with OCD performed the induction task and completed the same questionnaire-packet as the non-clinical participants. RESULTS Study 1: The induction-group scored higher on several DVs of the experimental task, as INC/NJREs and uncomfortable physical sensations predicted impulses/urges to do something. All the DVs correlated with INC, NJREs, and OCD symptoms. Anxiety was only related to suppressing difficulties of the most intense sensation. Study 2: Results were comparable to those found in non-clinical people. Induced INC/NJREs correlated with compulsions severity and were associated with ordering, washing, and hoarding symptoms. OCDs did not differ from non-clinical subjects in the number of induced INC/NJREs, but they were more disturbing, difficult to suppress, and instigated more urges to do in OCDs. LIMITATIONS The small group of OCDs and the lack of a non-OCD clinical group kept us from drawing conclusions about the specificity of INC/NJREs to some OCD symptoms. CONCLUSIONS Findings support the role of INC/NJREs as stimuli triggering urges and/impulses to do and their impact on OCD severity.
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Affiliation(s)
- Gertrudis Fornés-Romero
- Department of Personality Psychology, Faculty of Psychology, Research and Treatment Unit for Obsessive-Compulsive and Related Disorders, I'TOC. University of Valencia, Spain.
| | - Amparo Belloch
- Department of Personality Psychology, Faculty of Psychology, Research and Treatment Unit for Obsessive-Compulsive and Related Disorders, I'TOC. University of Valencia, Spain.
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Moritz S, Purdon C, Jelinek L, Chiang B, Hauschildt M. If it is absurd, then why do you do it? The richer the obsessional experience, the more compelling the compulsion. Clin Psychol Psychother 2017; 25:210-216. [PMID: 29154502 DOI: 10.1002/cpp.2155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/02/2017] [Accepted: 10/06/2017] [Indexed: 12/26/2022]
Abstract
Mounting evidence suggests that obsessive intrusions are often accompanied and amplified by perceptual experiences of different modalities (e.g., feeling dirt on one's skin while experiencing intrusive thoughts about contamination). Pilot studies conducted online with individuals endorsing mild obsessive-compulsive symptoms have linked the co-occurrence of perceptual experiences and obsessions to the severity of subsequent compulsive behaviour as well as low insight. However, it is presently unclear whether sensory experiences accompany all types of obsessional thoughts or are restricted to certain preoccupations (e.g., contamination and aggression). The present study examined a clinical inpatient and outpatient sample with a formally diagnosed obsessive-compulsive disorder (N = 34). Perceptual properties of intrusive thoughts were assessed with the Sensory Properties of Obsessions Questionnaire. The prevalence of perception-laden obsessive thoughts was comparable with prior studies (73.5%), but the intensity was significantly greater. No association was observed between perceptual experiences and expert-rated insight. However, the severity of perception-laden obsessions predicted the frequency of and impairment associated with compulsive behaviour. This was particularly strong for obsessions about contamination. The present study confirms the high prevalence and clinical relevance of perceptual experiences that accompany obsessions and further challenges the traditional trichotomy splitting mental phenomena into thoughts, intrusions, and hallucinations.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brenda Chiang
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Marit Hauschildt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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