Research

11 pages, 273 KiB

Open AccessArticle

An Exploratory Study of a Novel Combined Therapeutic Modality for Obsessive-Compulsive Disorder

by Yueqi Huang, Hangyi Yang, Cheng Zhu, Xiaoying Jiang, Wenjing Zhu, Yan Liang, Lisha Ma, Yunzan Wang and Wenxin Tang

Brain Sci. 2022, 12(10), 1309; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12101309 - 28 Sep 2022

Cited by 2 | Viewed by 1471

Abstract

Objective: To explore whether a systematic combined therapeutic modality (CTM) could quickly and effectively improve the severity of obsessive–compulsive disorder (OCD) and the insight of OCD patients. Methods: Included in this study were 100 patients with OCD according to the 5th Edition of [...] Read more.

Objective: To explore whether a systematic combined therapeutic modality (CTM) could quickly and effectively improve the severity of obsessive–compulsive disorder (OCD) and the insight of OCD patients. Methods: Included in this study were 100 patients with OCD according to the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for a 2-week short-term treatment. They were assigned to a drug-alone group (n = 57), and a CTM group (n = 43) using drug treatment in combination with cognitive behavioral treatment (CBT) and repetitive transcranial magnetic stimulation (rTMS). The therapeutic outcome was assessed by the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Brown Assessment of Beliefs Scale (BABS), 24-item Hamilton Depression Scale (HAMD-24) and Hamilton Anxiety Scale (HAMA) before and after treatment. All data were treated with SPSS25.0 Software. Results: After the 2-week treatment, the success rate in the CTM group was significantly higher than that in the drug-alone group. Y-BOCS overall and factor scores were decreased as compared with those before treatment in both groups. HAMD, HAMA and BABS overall scores were all decreased after treatment in the CTM group. In addition, compared with the drug-alone group, the Y-BOCS overall score and factor score, HAMD overall score and HAMA overall score were all decreased significantly in CTM group, while the Y-BOCS score reduction rate was increased significantly. Insight was improved in eight cases (57.14%) in the CTM group containing 14 cases with poor insight. Multinomial logistic regression analysis showed that CTM was beneficial for the insight improvement of OCD patients (OR = 91.04–139.68); this improvement was more pronounced in patients with low baseline BABS overall scores (OR = 0.07). Conclusion: CTM may be an effective short-term strategy to improve the severity of OCD and insight of OCD patients and, therefore, is worthy of clinical promotion and application. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

20 pages, 2485 KiB

Open AccessArticle

Functional Connectivity within the Frontal–Striatal Network Differentiates Checkers from Washers of Obsessive-Compulsive Disorder

by Jianping Yu, Minyao Xie, Shasha Song, Ping Zhou, Fangzheng Yuan, Mengyuan Ouyang, Chun Wang, Na Liu and Ning Zhang

Brain Sci. 2022, 12(8), 998; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12080998 - 28 Jul 2022

Cited by 5 | Viewed by 1543

Abstract

Background: Obsessive-compulsive disorder (OCD) is a psychiatric disorder with high clinical heterogeneity manifested by the presence of obsessions and/or compulsions. The classification of the symptom dimensional subtypes is helpful for further exploration of the pathophysiological mechanisms underlying the clinical heterogeneity of OCD. Washing [...] Read more.

Background: Obsessive-compulsive disorder (OCD) is a psychiatric disorder with high clinical heterogeneity manifested by the presence of obsessions and/or compulsions. The classification of the symptom dimensional subtypes is helpful for further exploration of the pathophysiological mechanisms underlying the clinical heterogeneity of OCD. Washing and checking symptoms are the two major symptom subtypes in OCD, but the neural mechanisms of the different types of symptoms are not yet clearly understood. The purpose of this study was to compare regional and network functional alterations between washing and checking OCD based on resting-state functional magnetic resonance imaging (rs-fMRI). Methods: In total, 90 subjects were included, including 15 patients in the washing group, 30 patients in the checking group, and 45 healthy controls (HCs). Regional homogeneity (ReHo) was used to compare the differences in regional spontaneous neural activity among the three groups, and local indicators were analyzed by receiver operating characteristic (ROC) curves as imaging markers for the prediction of the clinical subtypes of OCD. Furthermore, differently activated local brain areas, as regions of interest (ROIs), were used to explore differences in altered brain functioning between washing and checking OCD symptoms based on a functional connectivity (FC) analysis. Results: Extensive abnormalities in spontaneous brain activity involving frontal, temporal, and occipital regions were observed in the patients compared to the HCs. The differences in local brain functioning between checking and washing OCD were mainly concentrated in the bilateral middle frontal gyrus, right supramarginal gyrus, right angular gyrus, and right inferior occipital gyrus. The ROC curve analysis revealed that the hyperactivation right middle frontal gyrus had a better discriminatory value for checking and washing OCD. Furthermore, the seed-based FC analysis revealed higher FC between the left medial superior frontal gyrus and right caudate nucleus compared to that in the healthy controls. Conclusions: These findings suggest that extensive local differences exist in intrinsic spontaneous activity among the checking group, washing group, and HCs. The neural basis of checking OCD may be related to dysfunction in the frontal–striatal network, which distinguishes OCD from washing OCD. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

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15 pages, 23504 KiB

Open AccessArticle

Comprehensive Cortical Structural Features Predict the Efficacy of Cognitive Behavioral Therapy in Obsessive-Compulsive Disorder

by Xiang-Yun Yang, Rui Liu, Jia Luo, Fang-Fang Huang, Peng-Chong Wang, Xiao-Jie Yang, Hang Wu, Yuan Zhou and Zhan-Jiang Li

Brain Sci. 2022, 12(7), 921; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12070921 - 14 Jul 2022

Cited by 1 | Viewed by 1961

Abstract

Although cognitive behavioral therapy (CBT) is effective for patients with obsessive-compulsive disorder (OCD), 40% of OCD patients show a poor response to CBT. This study aimed to identify the cortical structural factors that predict CBT outcomes in OCD patients. A total of 56 [...] Read more.

Although cognitive behavioral therapy (CBT) is effective for patients with obsessive-compulsive disorder (OCD), 40% of OCD patients show a poor response to CBT. This study aimed to identify the cortical structural factors that predict CBT outcomes in OCD patients. A total of 56 patients with OCD received baseline structural MRI (sMRI) scanning and 14 individual CBT sessions. The linear support vector regression (SVR) models were used to identify the predictive performance of sMRI indices, including gray matter volume, cortical thickness, sulcal depth, and gyrification value. The patients’ OC symptoms decreased significantly after CBT intervention (p < 0.001). We found the model with the comprehensive variables exhibited better performance than the models with single structural indices (MAE = 0.14, MSE = 0.03, R² = 0.36), showing a significant correlation between the true value and the predicted value (r = 0.63, p < 0.001). The results indicated that a model integrating four cortical structural features can accurately predict the effectiveness of CBT for OCD. Future models incorporating other brain indicators, including brain functional indicators, EEG indicators, neurotransmitters, etc., which might be more accurate for predicting the effectiveness of CBT for OCD, are needed. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

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10 pages, 10025 KiB

Open AccessArticle

Altered Regional Activity and Network Homogeneity within the Fronto-Limbic Network at Rest in Medicine-Free Obsessive–Compulsive Disorder

by Yunhui Chen, Yangpan Ou, Dan Lv, Zengyan Yu, Tinghuizi Shang, Jidong Ma, Chuang Zhan, Zhenning Ding, Xu Yang, Jian Xiao, Ru Yang, Zhenghai Sun, Guangfeng Zhang, Xiaoping Wang, Wenbin Guo and Ping Li

Brain Sci. 2022, 12(7), 857; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12070857 - 29 Jun 2022

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Abstract

Functional abnormalities in brain areas within the fronto-limbic network have been widely reported in obsessive–compulsive disorder (OCD). However, region- and network-level brain activities of the fronto-limbic network at rest have not been simultaneously investigated in OCD. In this study, 40 medicine-free and non-comorbidity [...] Read more.

Functional abnormalities in brain areas within the fronto-limbic network have been widely reported in obsessive–compulsive disorder (OCD). However, region- and network-level brain activities of the fronto-limbic network at rest have not been simultaneously investigated in OCD. In this study, 40 medicine-free and non-comorbidity patients with OCD and 38 age-, education-, and gender-matched healthy controls (HCs) underwent a resting-state functional magnetic-resonance-imaging scan. Fractional amplitude of low-frequency fluctuations (fALFF), network homogeneity (NH), and support vector machine were used to analyze the data. Patients with OCD showed increased fALFF in the right orbital frontal cortex (OFC), increased NH in the left OFC, and decreased NH in the right putamen. Decreased NH of the right putamen was negatively correlated with the Y-BOCS total and compulsive behavior scores. Furthermore, a combination of NH in the left OFC and right putamen could be applied to differentiate OCD from HCs with optimum specificity and sensitivity. The current findings emphasize the crucial role of the fronto-limbic network in the etiology of OCD. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

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Review

Jump to: Research, Other

20 pages, 382 KiB

Open AccessReview

Early Identification and Intervention in Pediatric Obsessive-Compulsive Disorder

by Xingyu Liu and Qing Fan

Brain Sci. 2023, 13(3), 399; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci13030399 - 25 Feb 2023

Cited by 2 | Viewed by 2521

Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and [...] Read more.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and course from adult OCD. Delayed and inadequate treatment is associated with a worse prognosis, making the need for early identification and intervention in pediatric OCD very urgent. In this paper, we reflected on the current constraints that make early interventions for pediatric OCD unpromoted and reviewed the approaches with potential application for early identification and early intervention in pediatric OCD, categorized by three-level prevention stages corresponding to a clinical staging model. Since the etiology of pediatric OCD is still unclear, primary prevention is most lacking, and early interventions for pediatric OCD are currently focused on the secondary prevention stage, which aims to prevent the conversion of obsessive-compulsive symptoms into full-blown OCD; tertiary prevention mostly focuses on the alleviation of mild to moderate OCD, while interventions for co-morbidities are still in their infancy. We closed by considering the important research questions on this topic. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

15 pages, 968 KiB

Open AccessReview

The Applicability of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

by Tamini Soondrum, Xiang Wang, Feng Gao, Qian Liu, Jie Fan and Xiongzhao Zhu

Brain Sci. 2022, 12(5), 656; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12050656 - 17 May 2022

Cited by 9 | Viewed by 4514

Abstract

Background: Acceptance and commitment therapy (ACT), a third-generation cognitive behavioral therapy (CBT), has proved its efficacy amidst various mental disorders. A growing body of studies has shown that ACT can improve obsessive-compulsive disorder (OCD) severity in recent years. To assess the effect of [...] Read more.

Background: Acceptance and commitment therapy (ACT), a third-generation cognitive behavioral therapy (CBT), has proved its efficacy amidst various mental disorders. A growing body of studies has shown that ACT can improve obsessive-compulsive disorder (OCD) severity in recent years. To assess the effect of ACT on OCD, we carried out a systematic review and meta-analysis to provide a basis for therapists to use different psychological dimensions of ACT for OCD. Methods: PubMed, the Cochrane Library, EMBASE, EBSCO Host, and literature references were searched until May 2021. Randomized controlled trials (RCTs) and other study designs assessing the effect of ACT among adults suffering from OCD were examined. Results: Fourteen studies, including 413 participants, published between 2010 and 2021 were identified. ACT made statistically significant progress in the Yale–Brown Obsessive–Compulsive Scale (YBOCS) compared with control conditions. Conclusion: After reviewing all the ACT studies, we acknowledge the plausibility of ACT in treating OCD and improving its symptoms for the clinical population. ACT can also be an adjunct therapy for other well-established treatments. It also favors targeting psychological inflexibility. Further well-controlled and high-quality RCTs are required for a better conclusion in further studies. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

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Other

Jump to: Research, Review

14 pages, 646 KiB

Open AccessSystematic Review

A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder

by Hanyang Ruan, Yang Wang, Zheqin Li, Geya Tong and Zhen Wang

Brain Sci. 2022, 12(7), 936; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12070936 - 17 Jul 2022

Cited by 2 | Viewed by 2114

Abstract

Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental disorder. Deep brain stimulation (DBS) is a promising approach for refractory OCD patients. Research aiming at treatment outcome prediction is vital to provide optimized treatments for different patients. The primary purpose of this systematic [...] Read more.

Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental disorder. Deep brain stimulation (DBS) is a promising approach for refractory OCD patients. Research aiming at treatment outcome prediction is vital to provide optimized treatments for different patients. The primary purpose of this systematic review was to collect and synthesize studies on outcome prediction of OCD patients with DBS implantations in recent years. This systematic review (PROSPERO registration number: CRD42022335585) followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. The search was conducted using three different databases with the following search terms related to OCD and DBS. We identified a total of 3814 articles, and 17 studies were included in our review. A specific tract confirmed by magnetic resonance imaging (MRI) was predictable for DBS outcome regardless of implant targets, but inconsistencies still exist. Current studies showed various ways of successful treatment prediction. However, considering the heterogeneous results, we hope that future studies will use larger cohorts and more precise approaches for predictors and establish more personalized ways of DBS surgeries. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

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10 pages, 592 KiB

Open AccessStudy Protocol

The Efficacy and Safety of Deep Brain Stimulation of Combined Anterior Limb of Internal Capsule and Nucleus Accumbens (ALIC/NAcc-DBS) for Treatment-Refractory Obsessive-Compulsive Disorder: Protocol of a Multicenter, Randomized, and Double-Blinded Study

by Tingting Xu, Yuan Gao, Bin Li, Jiaxin Jiang, Huirong Guo, Xianzhi Liu, Hongxing Huang, Yuqi Cheng, Hualin Yu, Jie Hu, Xi Wu, Wei Wang and Zhen Wang

Brain Sci. 2022, 12(7), 933; https://0-doi-org.brum.beds.ac.uk/10.3390/brainsci12070933 - 16 Jul 2022

Cited by 1 | Viewed by 1905

Abstract

Backgrounds: Deep brain stimulation (DBS) is an emerging and promising therapeutic approach for treatment-refractory obsessive-compulsive disorder (OCD). The most common DBS targets include the anterior limb of internal capsule (ALIC) and nucleus accumbens (NAcc). This protocol aims to explore the efficacy and safety [...] Read more.

Backgrounds: Deep brain stimulation (DBS) is an emerging and promising therapeutic approach for treatment-refractory obsessive-compulsive disorder (OCD). The most common DBS targets include the anterior limb of internal capsule (ALIC) and nucleus accumbens (NAcc). This protocol aims to explore the efficacy and safety of the combined ALIC- and NAcc-DBS for treatment-refractory OCD. Methods: We will recruit 64 patients with refractory OCD from six centers, randomly allocate them to active and sham-stimulation groups through a three-month double-blind phase, then enter a three-month open-label phase. In the open-label stage, both groups experience real stimulation. Outcome measures: The primary outcome will be the efficacy and safety of combined ALIC- and NAcc-DBS, determined by treatment response rate between the active and sham-stimulation groups at the double-blind stage and spontaneously reported adverse events. The secondary outcomes are comparisons of change in Y–BOCS, CGI, HAMD, and HAMA scores at the third and sixth months compared to baseline between the active and sham-control groups, as well as the scores of the third month minus the sixth month between the two groups. Full article

(This article belongs to the Special Issue Therapeutic Approaches for Obsessive Compulsive Disorder and the Study of Related Pathogenesis)

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