Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: cognitive-behavioral therapy

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part I: pharmacological treatment

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

Body Dysmorphic Disorder and the influence of the media in demand for plastic surgery: the importance of proper evaluation / O Transtorno Dismórfico Corporal e a influência da mídia na procura por cirurgia plástica: a importância da avaliação adequada

Introduction: Since the beginning, plastic surgery has improved self-esteem and acceptance in a society that idealizes the cult of the body. The pressure of consumption and the ease of undergoing plastic surgery becomes an obsession in these patients' lives. Method: Female patients who underwent psychological evaluation and follow-up throughout the surgical and plastic surgery procedure, aged between 19 and 57, answered the Sociocultural Attitudes Questionnaire concerning appearance and the Body Dysmorphophobia Symptom Scale. Results: Of the 38 patients evaluated, 17 have the media as an influence concerning their body image and have symptoms of Body Dysmorphic Disorder (BDD), 13 patients have the media as an influence on their body image, but they do not have BDD symptoms, and in eight patients the media does not influence their body image, and they do not have BDD symptoms. Conclusion: The importance of a multidisciplinary team, with a psychologist, is highlighted to evaluate and monitor the patient throughout the surgical process, as the early diagnosis of BDD will avoid dissatisfaction with the result of the plastic surgery and, mainly, future court lawsuits.

Introdução: Desde os primórdios, a cirurgia plástica melhora a autoestima e a aceitação em uma sociedade que idealiza o culto ao corpo. A pressão do consumo e a facilidade de se submeter a um procedimento de cirurgia plástica acabam tornando-se obsessão na vida desses pacientes. Método: Pacientes do sexo feminino que passaram por avaliação e acompanhamento psicológico em todo o processo cirúrgico, e procedimento de cirurgia plástica, com a idade entre 19 e 57 anos, responderam ao questionário de Atitudes Socioculturais em relação a aparência e a Escala de Sintomas de Dismorfobia Corporal - Body Dysmorphic Scale. Resultados: Dos 38 pacientes avaliados, 17 têm a mídia como influência em relação a sua imagem corporal e apresentam sintomas do Transtorno Dismórfico Corporal (TDC), 13 pacientes têm a mídia como influência em relação a sua imagem corporal, mas não apresentam sintomas do TDC, e em oito pacientes a mídia não influencia em relação a sua imagem corporal e não apresentam sintomas do TDC. Conclusão: Destaca-se a importância de uma equipe multidisciplinar, com a presença de um psicólogo, para avaliar e acompanhar o paciente em todo processo cirúrgico, pois o diagnóstico precoce do TDC evitará uma insatisfação com o resultado da cirurgia plástica e, principalmente, futuros processos judiciais.

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach

Objectives: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. Methods: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. Results: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Conclusions: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

Dissecting Psychiatric Heterogeneity and Comorbidity with Core Region-Based Machine Learning / 神经科学通报·英文版

Machine learning approaches are increasingly being applied to neuroimaging data from patients with psychiatric disorders to extract brain-based features for diagnosis and prognosis. The goal of this review is to discuss recent practices for evaluating machine learning applications to obsessive-compulsive and related disorders and to advance a novel strategy of building machine learning models based on a set of core brain regions for better performance, interpretability, and generalizability. Specifically, we argue that a core set of co-altered brain regions (namely 'core regions') comprising areas central to the underlying psychopathology enables the efficient construction of a predictive model to identify distinct symptom dimensions/clusters in individual patients. Hypothesis-driven and data-driven approaches are further introduced showing how core regions are identified from the entire brain. We demonstrate a broadly applicable roadmap for leveraging this core set-based strategy to accelerate the pursuit of neuroimaging-based markers for diagnosis and prognosis in a variety of psychiatric disorders.

Síndrome ortoréxico y perfeccionismo

Introducción: Existe una creciente evidencia investigativa sobre la relación entre el síndrome ortoréxico y el perfeccionismo. Objetivo: Se efectúa un análisis descriptivo interpretativo e integrador acerca de la relación entre el perfeccionismo con la ortorexia nerviosa, destacando los aspectos clínicos, etiopatogénicos y nosológicos. Método: Se realizó una búsqueda bibliográfica sobre la relación entre el síndrome ortoréxico y el perfeccionismo mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados: El término ortorexia se ha concebido como una fijación patológica hacia una alimentación equilibrada y saludable (Bratman, 1997), implicando restricciones dietéticas drásticas, con interferencia significativa en las relaciones sociales e insatisfacciones afectivas, que, además favorecen la conducta alimentaria desadaptativa. Etiopatogénicamente, existe controversia respecto a si es un mero estilo de vida, o puede incluirse definitivamente como un trastorno en los espectros alimentario u obsesivo-compulsivo. De hecho, posee similitudes, diferencias e incluso traslapes con ambas entidades psicopatológicas. Se destaca como rasgo relevante común, el perfeccionismo, orientado hacia sí mismo, hacía los demás, y socialmente prescrito, que favorece la tendencia a desarrollar conductas ortoréxicas elevadas. Conclusiones: El perfeccionismo surge como una característica sobresaliente, positivamente correlacionada con el síndrome ortoréxico, cuya presencia se superpone con los ámbitos, tanto alimentario (especialmente la anorexia nerviosa) como obsesivo-compulsivo.

Background: There is a growing research evidence on the relationship between orthorexic syndrome and perfectionism. Objective: An interpretive and integrative descriptive analysis on the relationship between perfectionism and orthorexia nervosa, highlighting the clinical, etiopathogenic and nosological aspects is carried through. Method: A bibliographic search on the relationship between orthorexic syndrome and perfectionism using the Medline/PubMed, SciELO and specialized text databases was carried out. Results: The term orthorexia has been conceived as a pathological fixation towards a balanced and healthy diet (Bratman, 1997), implying drastic dietary restrictions, with significant interference in social relationships and affective dissatisfactions, which also favor maladaptive eating behavior. From an etiopathogenic perspective, it is controversial if orthorexia nervosa is a mere lifestyle, or definitively must be included as a disorder in the eating or obsessive-compulsive spectrum. In fact, the orthorexic syndrome has similarities, differences and even overlaps with both psychopathological entities. Perfectionism stands out as a common relevant trait, oriented towards oneself, towards others, and socially prescribed, which favors a tendency to develop high orthorectic behaviors. Conclusions: Perfectionism emerges as an outstanding characteristic, positively correlated with the orthorexic syndrome, overlapping with both eating (especially anorexia nervosa) and obsessive-compulsive areas.

Psychopathological intersection between obsessive-compulsive disorder and post-traumatic stress disorder: scoping review of similarities and differences

Abstract Introduction Although post-traumatic stress disorder and obsessive-compulsive disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, which may lead to misdiagnosis and erroneous treatment decisions. This scoping review explores the psychopathological similarities and differences between these two disorders. Method The review complies with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles published in Portuguese, English, or Spanish in the last 50 years indexed in the PubMed database. Case-reports were excluded. Results Fifty-three studies with different designs were included (30 [56.5%] were cross-sectional studies; eight [15.1%] were case-control studies; one [1.9%] was a cohort study; three [5.7%] were clinical trials; nine [17%] were reviews/systematic reviews; and two [3.8%] were meta-analyses). The main psychopathological aspects described by the studies included were flashbacks x obsessions; avoidant behavior (AB); depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection between clinical features seems to occur in the extrinsic psychopathological dimension. Conclusion The disorders' core psychopathological symptoms (intrinsic characteristics) are distinctly different, since flashbacks and obsessions are consequences of different predominant defective mental functions: the former derives from defective memory, the latter from defective thought. Along the same lines, the ABs observed in the two disorders are products of different purposes and inner necessities.

Psychometric properties of the BALCI Turkish version

The present study aimed to adapt and validate the Beliefs About Losing Control Inventory (BALCI) in the non-clinical Turkish emerging adults sample. The study group consisted of 549 participants from three study phases and aged between 18 and 28 years and mainly women. According to the results of the confirmatory factor analysis (CFA), the BALCI Turkish Version (BALCI-TV) confirmed 21 items in three factors. The network analysis findings showed that the items including the factors were together. The results indicated that configural, metric, scalar, and strict invariance across the gender. Cronbach's α and McDonald's ω of the total BALCI-TV were .90. Test-retest correlation result was .89. All results indicated that the BALCI-TV had good psychometric properties. The BALCI-TV can be provided to measure control and beliefs related to control within obsessive-compulsive disorder for Turkish academics and mental health practitioners.

Randomized trial of the efficacy of trial-based cognitive therapy for obsessive-compulsive disorder: preliminary findings

Abstract Introduction Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. Methods A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. Results Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. Conclusion TBCT may be a valid and promising treatment for this disorder.

Clinical characteristics and influencing factors of onset age in inpatients with early- and late-onset obsessive-compulsive disorder inpatients / 四川精神卫生

BackgroundThe obsessive-compulsive disorder （OCD） features complexity in etiological factors and high heterogeneity in clinical manifestations. OCD patients with different ages of onset vary in clinical symptoms and etiology. However， current studies on inpatients with early- and late-onset OCD are limited. ObjectiveTo explore the differences in clinical characteristics between early- and late-onset OCD inpatients as well as the factors affecting the onset age of OCD， so as to provide references for early screening and treatment of OCD patients. MethodsThis study was based on collected medical records of 540 patients with OCD who received inpatient treatments at the Affiliated Brain Hospital of Nanjing Medical University between March 2012 and March 2023. Patients with onset age above 18 were placed into early-onset group （n=310） and the others into late-onset group （n=230）. Then differences in demographic data and clinical symptoms between two groups of patients were compared. Binary logistic regression was used to analyze the factors that affect the onset age of OCD. ResultsObserving the demographic data， there were significant differences between the two groups in the results in gender， marital status， family history of mental illness， ratio of comorbidities with other mental illnesses， occupational composition， education level and types of obsessive-compulsive symptoms （χ2=22.302、170.556， 9.224， 13.624， 242.277， 59.791， 7.231， P<0.05 or 0.01）. Also， the results in ages of onset and hospitalization between two groups were significantly different （Z=-19.915， 16.831， P<0.01）. In terms of clinical symptoms， the early onset group had a higher proportion of symptoms including obsessive thinking （χ2=11.998， P<0.05）， ordering （χ2=7.731， P<0.05） and rituals （χ2=7.714， P<0.05）， while the proportion of obsessive checking （χ2=8.204， P<0.05） and washing （χ2=7.506， P<0.05） symptoms were relatively low. In terms of risk factors， there were several independent risk factors that influence the onset age of OCD inpatients， including comorbid neurodevelopmental disorder， comorbid affective disorder， family history of schizophrenia and family history of affective disorder （OR=19.587， 1.830， 3.065， 4.431， P<0.05）. Among them， comorbid neurodevelopmental disorder was the core influencing factor， and female gender was a protective factor for early-onset patients （OR=0.417， P<0.01）. ConclusionThere are differences in demographic data and clinical symptom characteristics between early- and late-onset OCD inpatients， and comorbid neurodevelopmental disorder plays as a core risk factor affecting the onset age of OCD inpatients. ［Funded by Jiangsu Province Key Research and Development Plan for Social Development Special Project（number， BE2021616） ； Jiangsu Province Social Development General Project （number， BE2022678）； Key Project of Nanjing Medical Science and Technology Development Fund （number， ZKX20029）］

Advances in social cognition of obsessive-compulsive disorder / 中华行为医学与脑科学杂志

The main clinical features of obsessive-compulsive disorder (OCD) are obsessions and/or compulsions. Due to its symptoms are heterogeneous and have a wide range of influences, OCD usually causes different degrees of damage to patients' social functions. Social cognition is the process of perceiving and judging the psychology and behavior of others or oneself. Its core is to understand the information processing process and the underlying mechanism of social psychological phenomena. Studies have shown that social cognitive deficits can affect an individual's social function. Therefore, many scholars believe that the social cognitive function of OCD patients are impaired. Through collecting and sorting out relevant literature, we find that OCD patients can’t perceive social cues accurately, and they have trouble recognizing their own emotions and those of others. In general, they are not prone to emotional response, that is, their ability of emotional experience is impaired, while because of their own emotional regulation dysfunction, they overreact to special events that can induce the obsession and/or compulsion.The patients have poor insight into the mental states of others.The researches on attributions of life events are dificient, so their characteristics of attribution styles are not yet clear.These findings provide a preliminary theoretical basis and reference for the specificity of social cognitive impairment in patients with OCD and for guiding clinical effective and precise intervention.

Caudate nucleus and thalamus in untreated patients with obsessive-compulsive disorder: a magnetic resonance spectroscopy study / 中华行为医学与脑科学杂志

Objective:To investigate the neurobiochemical metabolites of caudate nucleus and thalamus in patients with obsessive-compulsive disorder and their relationship with obsessive-compulsive symptoms.Methods:From April 2019 to January 2022 in Beijing Anding Hospital, totally 25 untreated patients with obsessive-compulsive disorder were recruited, and 20 healthy controls matched with gender, age and educational background were recruited for the study.The maps of neurobiochemical metabolites of patients and normal controls were collected by hydrogen proton magnetic resonance spectroscopy.With bilateral caudate nucleus and thalamus as brain regions of interest.The relative concentrations of N-acetylaspartic acid (NAA), glutamic acid (Glu) and γ-aminobutyric acid (GABA) were fitted by LCModel software.At the same time, the clinical symptoms of patients were evaluated with Yale-Brown obsessive-compulsive scale (Y-BOCS) and Hamilton anxiety scale (HAMA). SPSS 20.0 software was used for statistical analysis.Independent double sample t-test was used to compare the differences of different nerve biochemical metabolite concentrations between patients with obsessive-compulsive disorders and healthy controls.Pearson correlation analysis was used to explore the correlation between biochemical metabolite concentrations and clinical symptoms. Results:The Glu concentration in the left thalamus of patients with obsessive-compulsive disorder (3.97±0.41) was higher than that of the control group (3.66±0.55)( t=-2.11, P<0.05), while the NAA concentration was (4.87±0.47)lower than that of the control group (5.15±0.44)( t=2.05, P<0.05). The GABA concentrations in the right caudate nucleus (0.50±0.18) and thalamus (0.80±0.19) were lower than those in the control group ((0.63±0.23), (0.96±0.24))( t=2.08, 2.36, both P<0.05). Pearson correlation analysis showed that the Glu concentration in the left caudate nucleus of patients with obsessive-compulsive disorder was positively correlated with the total score of Y-BOCS( r=0.46, P<0.05). Spearman correlation analysis showed that Glu concentration in the right caudate nucleus was positively correlated with the total score of HAMA in patients with obsessive-compulsive disorder ( r=0.46, P<0.05). Conclusion:NAA, Glu and GABA metabolism in caudate nucleus and thalamus are abnormal in patients with obsessive-compulsive disorder, and Glu concentration is positively correlated with the severity of obsessive-compulsive and anxiety symptoms.

Meta-analysis of randomized controlled trials of exposure and response prevention for obsessive compulsive disorder / 中华行为医学与脑科学杂志

Objective:To systematically evaluate the intervention effect of exposure and response prevention (ERP) on obsessive compulsive disorder (OCD).Methods:PubMed, Web of Science Core Collection, EBSCO, Cochrane Library, Embase, Science Direct, Wanfang Data, China National Knowledge Infrastructure and VIP-CSTJ were used to collect randomized controlled studies related to ERP for OCD.Randomized controlled studies that met the criteria were included, with the score of Yale-Brown obsessive-compulsive scale as the primary outcome indicator and the scores of anxiety and depression scale as secondary outcome indicators, while the included literatures were evaluated for literature quality and data extraction.Review Manager 5.3 and Stata 16.0 softwares were used to conduct Meta-analysis on the extracted data.Results:Twenty-seven studies with a total of 1 239 patients were included, and 599 cases in the ERP group and 640 cases in the control group.Meta-analysis results showed that the efficacy of ERP group was significantly better than that of blank control group(MD=-6.55, 95% CI: -8.75--4.35, P<0.001) and significantly better than chlorpromazine control group treatment (MD=-5.88, 95% CI: -8.20--3.56, P<0.001) for improving patients' obsessive-compulsive symptoms, but not significantly different from CBT intervention (MD=0.21, 95% CI: -1.62-2.04, P=0.82), and the efficacy of ERP and CBT had no significant during the post-intervention follow-up period (MD=0.41, 95% CI: -2.45-3.27, P=0.78). For improving patients' depressed mood, ERP was effective in improving patients' depressed mood (SMD=-0.45, 95% CI: -0.74--0.17, P=0.002), but not significantly different from CBT (SMD=-0.05, 95% CI: -0.27-0.16, P=0.62). For improving anxiety, the efficacy of ERP group was not different from that of control group (SMD=-0.17, 95% CI: -0.56-0.23, P=0.41). Conclusion:ERP has good feasibility in improving obsessive-compulsive symptoms and depression in patients with OCD.However, long-term efficacy was not verified for improving anxiety and maintaining long-term efficacy during the follow-up period.

Differences of resting-state brain functional connectivity in patients with early-onset and late-onset obsessive compulsive disorder and their correlation with cognitive flexibility / 中华行为医学与脑科学杂志

Objective:To explore the differences of the resting-state functional connectivity(FC) between goal-directed network and habituation networks in patients with early- and late-onset obsessive compulsive disorder (OCD) and the correlation between the strength of FC in the differential brain regions and cognitive flexibility.Methods:From October 2019 to April 2021, 40 patients with OCD were included in this study, including 22 patients with early-onset OCD and 18 patients with late-onset OCD.The cognitive flexibility of all subjects was assessed using the Wisconsin card sorting test (WCST), the Stroop task and the trail making test (TMT). The brain regions which were associated with goal-directed network(caudate, orbitofrontal cortex, ventromedial prefrontal cortex, and anterior cingulate cortex) and the brain regions which were associated with habituation network(putamen, supplementary motor area and insula) were selected as FC regions of interest (ROI). The DPABI and SPM12 plug-ins in the matlab2011a platform were used for whole brain FC analysis to compare the difference of FC between patients with early-onset OCD and patients with late-onset OCD on the two networks.The data were analyzed by SPSS 25.0 with χ2 test, independent samples t-test, and Pearson correlation analysis. Results:Compared with patients with early-onset OCD, patients with late-onset OCD had significantly enhanced FC of the left supplementary motor area with the left putamen and left insula.The total number of persistent errors of WCST in patients with late-onset OCD was greater than that in patients with early-onset OCD ((20.61±11.30), (14.95±8.94), P<0.05). The FC of the left putamen-left supplementary motor area was significantly and positively correlated with the total number of sustained responses ( r=0.678, P=0.003) and the total number of incorrect responses ( r=0.590, P=0.013) in patients with late-onset OCD.The FC of the left supplementary motor area-left insula was significantly positively correlated with the number of responses required to complete the first classification in patients with late-onset OCD ( r=0.485, P=0.049). Conclusion:Patients with late-onset OCD have stronger habituation network FC than patients with early-onset OCD, and the enhanced FC correlates with patients' cognitive flexibility performance, while late-onset OCD has more impaired cognitive flexibility than early-onset OCD.

Phenomenology of Obsessive-Compulsive Disorder in Sudan and its association with Socio-demographic Factors

Background: Symptoms of Obsessive-Compulsive Disorder OCD tend to be shaped by socio-cultural context. There are very few studies related to OCD in Sudan. Aim: This study aimed to explore the phenomenology of obsessive-compulsive disorder in a sample of Sudanese patients in relation to socio-demographic factors. Methods: We reviewed the case notes of Sudanese patients with Obsessive-Compulsive Disorder who presented to a psychiatry clinic in Khartoum, Sudan during a period of two years. Data was collected using a checklist of obsessive and compulsive features, subtypes of Obsessive-Compulsive Disorder, comorbidities, as well as socio-demographic data. Results: Eighty-nine Sudanese patients were included in this study. The mean age of the first onset of the disorder was 21.72 years (SD ±7.51). The most common obsession among participants was doubting followed by Religious thoughts while the most common compulsion was washing, then checking. Obsession of contamination was significantly higher in females while religious obsessions were more common in males. Obsession of contamination and compulsive washing was significantly associated with younger age of onset. Conclusion: Common features of obsessive-compulsive disorder in Sudanese patients are doubts, religious thoughts, contamination obsession, and washing compulsion which is likely to be related to the strong emphasis on traditional values and religiosity in Sudanese culture.

TREATING OBSESSIVE COMPULSIVE DISORDER WITH ACCEPTANCE AND COMMITMENT THERAPY AND EXPOSURE AND RESPONSE PREVENTION– A CLINICAL CASE ILLUSTRATION

Obsessive Compulsive Disorder (OCD) is ranked the top 10 of the most handicapping illnesses by lost income and decreased quality of life. Hence the need to overcome OCD is imminent. With the present case of OCD, Acceptance and Commitment Therapy (ACT) and Exposure Prevention Response (ERP) were used for treating OCD. Assessment was done using Yale Brown Obsessive Compulsive Scale and Weiss Functional Impairment Rating Scale – Self report. Results show that OCD reduced signi?cantly after the treatment.

Prevalence of Obsessive–Compulsive Symptoms and the Level of Fear Due to COVID-19 Pandemic among the Undergraduate Medical Students in a Tertiary Care Unit in Southern India

Background: The emergence of COVID?19 and its consequences is causing widespread fears, anxiety, and worries. To overcome the transmission of COVID?19, people resorted to compulsive behaviors. Objectives: The objectives of this study were to assess the prevalence of obsessive–compulsive symptoms (OCSs) due to COVID?19 pandemic, the prevalence of level of fear due to COVID?19 pandemic, and to assess the factors associated with OCSs due to COVID?19 pandemic among the undergraduate medical students of in tertiary unit in Southern India. Methods: The cross?sectional study was conducted in 250 undergraduate medical students (both MBBS and BDS, from 1st to 4th year) in the institute. Students who had consented in the study were included as study participants. The Yale–Brown Obsessive–Compulsive Scale and Fear of COVID?19 Scale (FCV?19 S) were used in assessing OCSs and the level of fear due to COVID?19. Chi?square test and multiple logistic regression were used to compute the factors associated with OCS. Results: The mean age of the respondents was 21 ± 1.313 years. The prevalence of OCS in undergraduate medical students was 36 (14.4%), and the level of FCV?19 was 107 (42.8%). Male students (17.8%, 44.2%) had higher OCSs and levels of fear as compared to female students (13.6%, 42.4%). Students with FCV?19 were three (adjusted odds ratio?3.418, 95% confidence interval?1.596, 7.319) times more likely to manifest OCSs while factors such as age, gender, and course were not significantly associated with OCS. Conclusion: Psychological counseling for undergraduate students should be pivotal, especially during pandemics and outbreaks.

Clinical perspectives on the management of common psychiatric disorders in India

Psychiatric disorders are common health problems in patients of all age groups, under-diagnosis and under-treatment of these disorders can result in disability and serious complications. With an objective of creating a comprehensive evidence-based consensus on common mental health disorders and their management in the Indian setting, 10 expert groups meetings involving 98 psychiatrists across India were conducted in the month of May 2020. Clinical insights related to burden, signs and symptoms, diagnosis and management were summarized based on the discussions during these meetings. Experts agreed that depressive disorders and anxiety disorders represent two important psychiatric disorders in India. Selective serotonin reuptake inhibitors (SSRIs) are commonlyused for the treatment of depression. Benzodiazepines are effective for the treatment of comorbid anxiety in patients with depression, but their long-term use causes adverse events such as dependence and withdrawal reaction. Obsessive compulsive disorder (OCD), bipolar disorder, substance use especially alcohol withdrawal syndrome, and sleep disorders are other common psychiatric disorders found among Indian patients. Lithium and valproate represent the commonly used and effective pharmacological treatments for bipolar disorder. SSRIs are preferred drugs in the treatment of OCD,whereas benzodiazepines such as chlordiazepoxide and diazepam represent important pharmacological treatment optionsfor alcohol withdrawal. Early identification and timely and effective treatment of psychiatric disorders is important for prevention of complications. Treatment should be individualized based on efficacy, tolerability profile of the medicine, risk of drug interactions, and cost. This consensus may be useful to psychiatrists and general practitioners treating common psychiatric conditions in Indian patients.

Análisis de la correlación del trastorno obsesivo-compulsivo con la ansiedad de estudiantes universitarios de medicina / Analysis of the correlation between obsessive-compulsive disorder and anxiety in university medical students

INTRODUCCION: en América Latina y el Caribe, tanto los trastornos de ansiedad como el Trastorno ObsesivoCompulsivo (TOC) se ocupan como algunos de los trastornos mentales más comunes. En Paraguay se ha estudiado a ambos trastornos de manera individual, más no así en correlación. OBJETIVO: determinar la correlación de las dimensiones del trastorno obsesivo-compulsivo con los factores de ansiedad de estudiantes universitarios de medicina de la Universidad Nacional de Asunción en el año 2019. MATERIAL Y MÉTODO: estudio cuantitativo, diseño correlacional - descriptivo, muestreo no probabilístico por conveniencia en cadena, desde abril hasta mayo del 2019, en la Facultad de Ciencias Médicas (sede Sajonia). Universo conformado por N=450 estudiantes y muestra necesaria de n=201. Se aplicó el Inventario Obsesivo Compulsivo -Revisado (OCI-R) y el Inventario De Ansiedad Estado -Rasgo (STAIC). RESULTADOS: se analizaron 208 encuestas,. donde se pudo determinar una Edad media de 20,875±1,76 años; la mayoría de los encuestados corresponden al sexo femenino. Se encontró una correlación (r=0,431) significativa (p<0,05) entre el TOC y ansiedad de estudiantes de medicina. CONCLUSIÓN: en la presente investigación se determinó una correlación positiva para las dimensiones del trastorno obsesivo-compulsivo y los factores de la ansiedad; se indica que el aumento cuantitativo en el puntaje de dichas dimensiones se acompaña con un aumento en los factores de la ansiedad.

BACKGROUND: in Latin America and the Caribbean, both anxiety disorders and Obsessive-Compulsive Disorder (OCD) are among the most common mental disorders. In Paraguay, both disorders have been studied, but not in correlation. OBJECTIVE: to determine the correlation of the dimensions of obsessive-compulsive disorder with anxiety factors in undergraduate medical students of the National University of Asuncion in 2019. METHODS: quantitative study, correlational-descriptive design, non-probabilistic chain convenience sampling, from April to May 2019, at the Faculty of Medical Sciences (Saxony campus). Universe made up of N=450 students and necessary sample of n=201. The Obsessive Compulsive Inventory-Revised (OCI-R) and the StateTrait Anxiety Inventory (STAIC) were applied. RESULTS: 208 surveys were analyzed. Mean age was 20.875±1.76 years. The majority of respondents were female. A significant correlation (r=0.431) (p<0.05) was found between OCD and Anxiety in medical students. CONCLUSION: in the present investigation a positive correlation was determined for the dimensions of obsessive-compulsive disorder and anxiety factors; it is indicated that the quantitative increase in the score of these dimensions is accompanied by an increase in anxiety factors.

Efficacy of group cognitive-behavioral therapy in adolescents with obsessive compulsive disorder: a systematic review and meta-analysis

Objective: To evaluate the effectiveness of group cognitive-behavioral therapy (GCBT) for the treatment of adolescents with obsessive compulsive disorder (OCD). Methods: This review was registered in PROSPERO under number CRD42020158475. Five databases (PubMed, Virtual Health Library, Web of Science, Scopus, and PsycINFO) were searched. After applying the inclusion and exclusion criteria, 13 studies were analyzed in the qualitative synthesis (i.e., systematic review) and eight in the quantitative synthesis (i.e., meta-analysis). For the latter, fixed-effect modeling was used to assess the primary outcome (i.e., OCD symptoms). Results: The main findings suggest that GCBT is effective in reducing the symptoms of OCD in adolescents (d = -1.32). However, these results must be interpreted with caution, since all of the included studies showed some bias in their design. Conclusions: GCBT is effective in reducing OCD symptoms in adolescents.