Relation between sensorimotor network dysfunction and clinical symptoms in patients with obsessive-compulsive disorder / 中华神经医学杂志

Objective:To investigate the changes of abnormal spontaneous brain activity and whole-brain effector connectivity in patients with obsessive-compulsive disorder (OCD) by combining low frequency amplitude (ALFF) and Granger causality analysis (GCA), and explore their relations with clinical symptoms.Methods:Forty-nine patients with OCD admitted to Department of Psychiatry, Second Affiliated Hospital of Xinxiang Medical College from January 2020 to September 2023 were selected as OCD group; 50 healthy volunteers matched with gender, age and years of education were enrolled as healthy control (HC) group. Obsessive-compulsive symptoms and severities in the OCD group were assessed by Yale Brown obsessive-compulsive scale (Y-BOCS). All subjects underwent whole-brain resting-state functional magnetic resonance imaging scanning (rs-fMRI). ALFF differences between the 2 groups were compared. Brain regions with ALFF differences were used as seed points, and effector connectivity changes in seed points were compared with those in whole-brain by GCA. Correlations of ALFF and effector connectivity in brain regions with ALFF differences with total scores, obsession scores and compulsion scores of Y-BOCS were analyzed by partial correlation analysis.Results:(1) Compared with that in the HC group, ALFF was significantly enhanced in the right supplementary motor area, right hippocampus, left caudate nucleus, and right fusiform gyrus, and statistically attenuated in the left suboccipital gyrus in the OCD group ( P<0.05). (2) Compared with that in the HC group, effector connectivity from the right dorsolateral superior frontal gyrus to right supplementary motor area was significantly attenuated, and effector connectivity from the left superior occipital gyrus to right supplementary motor area was significantly enhanced in the OCD group ( P<0.05); compared with that in the HC group, effector connectivity from the right fusiform gyrus to right precentral gyrus was significantly attenuated, and effector connectivity from the right hippocampus to left mesial temporal gyrus was significantly enhanced in the OCD group ( P<0.05). (3) In OCD patients, altered ALFF in the left caudate nucleus was positively correlated with obsession scores ( r=0.357, P=0.027), and altered effector connectivity from the right dorsolateral superior frontal gyrus to right supplementary motor area was negatively correlated with obsession scores ( r=-0.312, P=0.029). Conclusion:Abnormalities in sensorimotor network function are closely related to clinical symptoms in patients with OCD.

Efficacy of memantine-assisted deep brain stimulation in adolescents with refractory obsessive-compulsive disorder and its effect on serum neurofactors and inflammatory cytokines / 中国医科大学学报

Objective To explore the efficacy of memantine-assisted deep brain stimulation in adolescents with refractory obsessive-compulsive disorder and its effect on serum neurofactors and inflammatory cytokines.Methods A total of 115 adolescents with refractory obsessive-compulsive disorder were randomly divided into the control group(n = 57)and the study group(n = 58).The control group was treated with sertraline combined with deep brain stimulation for 3 months,while the study group was treated with memantine combined with deep brain stimulation for 3 months.The efficacy,adverse reactions,serum neurofactors(including 5-hydroxytryptamine[5-HT],brain-de-rived neurotrophic factor[BDNF],and glial neurotrophic factor[GDNF]),inflammatory cytokines(including tumor necrosis factor-α[TNF-α],interleukin[IL]-2,and IL-6),mental state,psychosocial functioning,and quality of life before and after treatment were compared between the two groups.Results The total effective rate in the study group was significantly higher than that in the control group(96.55%and 84.21%,P＜0.05).Compared with the control group,the serum 5-HT and BDNF levels at 1-and 3-month post-treatment were signifi-cantly higher in the study group,while the levels of serum GDNF,TNF-α,IL-2,and IL-6 were significantly lower(P＜0.05).The scores of Hamilton Anxiety Scale and Hamilton Depression Scale were significantly lower and the scores of Chinese Version of the Personal and Social Performance Scale,and TDL Quality of Life Assessment Scale were significantly higher in the study group than in the control group(P＜0.05).The incidence of adverse reactions between the two groups were similar(P＞0.05).Conclusion Our results support the efficacy of memantine-assisted deep brain stimulation for refractory obsessive-compulsive disorder in adolescents.In particular,the treatment can regulate neurofactor and inflammatory cytokine levels,relieve anxiety and depression,improved psychosocial function and quality of life,and is safe.

Influência da microbiota intestinal no transtorno obsessivo- compulsivo e nos transtornos relacionados: protocolo de revisão de escopo / Influence of the gut microbiome on obsessive-compulsive disorder and related disorders: scoping review protocol

RESUMO Objetivo Identificar e mapear as evidências disponíveis sobre a composição da Microbiota Intestinal em indivíduos com Transtorno Obsessivo-Compulsivo e seus transtornos relacionados. Métodos https://osf.io/bd2ns Resultados Espera-se encontrar uma relação entre a composição da Microbiota Intestinal, em quantidade e tipo de espécies, e os sintomas do TOC e dos seus Transtornos relacionados. Conclusão Esta será a primeira scoping review que procura investigar a relação entre a microbiota intestinal e o Transtorno Obsessivo-Compulsivo e Transtornos relacionados. A publicação prévia deste protocolo de revisão irá colaborar para um melhor planejamento do estudo e divulgação da investigação junto da comunidade científica.

ABSTRACT Objective To identify and map the available evidence regarding Gut Microbiota composition in individuals with obsessive-compulsive disorder and its related Disorders. Methods https://osf.io/bd2ns Results It's hoped to find a relationship between the composition of the gut microbiota, in terms of quantity and type of species, and the symptoms of OCD and its related disorders. Conclusion This will be the first scoping review that seeks to investigate the relationship between Gut Microbiota and Obsessive-Compulsive Disorder and its related disorders. The previous publication of this review protocol will collaborate for a better planning of the study and dissemination of the research to the scientific community.

Thermocoagulation in Multiple Targets to Treat Obsessive-Compulsive Disorder Associated with Drug Addiction: Case Report / Termocoagulação de múltiplos alvos para tratar transtorno obsessivo-compulsivo associado à drogadição: Relato de caso

Substance-related disorders are chronic psychiatric conditions defined by substance abuse, and they compromise patients both clinically and functionally. Currently, pharmacotherapy, behavioral therapy, or an association of both are the treatments of choice for obsessive-compulsive disorder associated with drug addiction. However, the refractoriness to treatment, as a result of the high failure rates of these approaches, has led to the need to develop surgical techniques to treat severe cases of substance-related disorders. In the present article, we report the case of a patient who underwent neurosurgery through the stereotactic technique after refractoriness to the conventional treatment for drug addiction. The patient showed sustained improvement in his addiction to drugs. Despite the numerous reports on the effectiveness and applicability of neurosurgery in psychiatric disorders, some concerns regarding stereotactic surgery as a treatment for drug addiction still remain, especially in relation to its efficacy, safety, and ethical implications.

Transtornos relacionados ao uso de substâncias são condições psiquiátricas crônicas definidas pelo abuso de substâncias, que deixam o paciente comprometido clínica e funcionalmente. Atualmente, a farmacoterapia, a terapia comportamental ou a associação de ambas são os tratamentos de escolha para o transtorno obsessivo-compulsivo associado ao vício em drogas. Contudo, a refratariedade ao tratamento, resultante das altas taxas de fracasso dessas abordagens, tornou necessário o desenvolvimento de técnicas cirúrgicas para tratar casos graves de transtornos relacionados ao uso de substâncias. Neste artigo, relatamos o caso de um paciente submetido a neurocirurgia pela técnica estereotáxica após fracasso do tratamento convencional para drogadição. O paciente apresentou melhora sustentada do vício em drogas. Apesar dos inúmeros relatos sobre a eficácia e a aplicabilidade da neurocirurgia em transtornos psiquiátricas, ainda existem certa preocupação a respeito da cirurgia estereotáxica como tratamento para a drogadição, principalmente em relação à sua eficácia, segurança e implicações éticas.

Recomendaciones clínicas para la solicitud de evaluación de neurocirugía en el trastorno obsesivo compulsivo / Clinical recommendations for requesting neurosurgical evaluation in obsessive-compulsive disorder

Estas recomendaciones clínicas delinean los criterios utilizados por el Equipo de Cirugía de los Trastornos Psiquiátricos del Hospital de Clínicas para la selección de candidatos a neurocirugía en pacientes con trastorno obsesivo compulsivo grave y refractario al tratamiento convencional. Los criterios de inclusión se enfocan en la cronicidad, la gravedad y la resistencia, considerando procedimientos ablativos o de neuromodulación. La gravedad se evalúa mediante la Escala Yale-Brown Obsessive Compulsive, junto con una evaluación integral del desempeño y la discapacidad. La refractariedad se define como la falta de respuesta, según criterios consensuados, a diversos tratamientos farmacológicos y no farmacológicos respaldados por evidencia científica significativa para el trastorno obsesivo compulsivo. Es esencial realizar una evaluación dimensional del desempeño global y estimar el pronóstico sin intervención quirúrgica. Los criterios de exclusión abarcan comorbilidades graves, trastornos de personalidad específicos y discapacidad intelectual. Además, se especifican pruebas paraclínicas necesarias, incluyendo evaluaciones sanguíneas, serológicas, cardíacas y neurológicas. Se detallan las tablas utilizadas para el registro de información necesaria para la evaluación. Todas las evaluaciones de neurocirugía culminan en un ateneo clínico conjunto entre el Equipo de Cirugía de los Trastornos Psiquiátricos del Hospital de Clínicas y la Unidad Académica de Psiquiatría de la Facultad de Medicina en donde se determinan las estrategias terapéuticas posibles.

These clinical recommendations outline the criteria used by the Psychiatric Disorders Surgery Team for selecting neurosurgery candidates among patients with severe Obsessive Compulsive Disorder refractory to conventional treatment. Inclusion criteria focus on chronicity, severity, and resistance. Ablative procedures or neuromodulation are taken into consideration. Severity is assessed by means of Yale-Brown Obsessive Compulsive Scale, and a comprehensive evaluation of performance and disability. Refractoriness is defined as lack of response, according to consensus criteria, to various pharmacological and non-pharmacological treatments for Obsessive Compulsive Disorder supported by significant scientific evidence. It is essential to conduct a dimensional assessment of overall performance and estimate prognosis without surgical intervention. Exclusion criteria encompass serious comorbidities, specific personality disorders, and intellectual disability. Furthermore, necessary paraclinical tests are specified, including blood, serological, cardiac, and neurological evaluations. Tables used for recording essential information for assessment are detailed. All neurosurgical assessments culminate in a joint clinical discussion of possible therapeutic strategies between the Psychiatric Disorders Surgery Team and the Psychiatry Academic Department (Facultad de Medicina) at the Hospital de Clínicas.

Revisión narrativa de escalas para cribado de trastorno obsesivo compulsivo y adaptación cultural uruguaya / Revisione narrativa delle scale di screening dei disturbi disturbo ossessivo compulsivo e adattamento culturale uruguaiano

El trastorno obsesivo compulsivo es diagnosticado tardíamente, factor que empeora su pronóstico. Contar con una escala de cribado facilitaría el diagnóstico oportuno. Los objetivos de este trabajo fueron seleccionar la escala más adecuada para cribado de trastorno obsesivo compulsivo en adultos y someterla a un proceso de adaptación cultural uruguaya. Se efectuó una revisión narrativa de escalas diseñadas para cribado de este trastorno en Internet, entre febrero y mayo de 2021. Las escalas fueron analizadas según una lista de criterios preestablecidos, que permitió descartar progresivamente aquellas que no reunían las condiciones: extensión menor a 30 ítems, método autoaplicado, adecuadas propiedades psicométricas, punto de corte establecido para la detección, incluir las temáticas y presentaciones características de la patología. Seleccionado el inventario, se efectuó su traducción directa y reversa, y revisión conceptual por comité de expertas. Fue seleccionada la escala Florida Obsessive Compulsive Inventory (FOCI), que presenta buena apariencia lógica, lenguaje accesible y una sensibilidad del 92 % para detección de trastorno obsesivo compulsivo. De su adaptación cultural se obtuvo una versión preliminar en lenguaje regional. La versión preliminar de FOCI deberá ser testeada cualitativamente en estudio piloto, donde será completada por usuarios con trastorno obsesivo compulsivo, para obtener una versión regional equivalente a la original.

Obsessive-compulsive disorder is diagnosed late, a factor that worsens its prognosis. Having a screening scale would facilitate timely diagnosis. The objectives are to select the most appropriate scale for obsessive-compulsive disorder screening in adults and submit it to a process of Uruguaiyan cultural adaptation. Between February and May 2021, a narrative review of scales designed for that disorder screening on the Internet was carried out. The scales were analyzed according to a list of pre-established criteria, which made it possible to progressively discard those that did not meet the conditions: an extension less than 30 items, self-applied method, adequate psychometric properties, cut-off point established for the detection, including the topics and characteristic presentations of the pathology. Once the inventory was selected, its direct and reverse translation was carried out, as well as a conceptual review by a committee of experts. The Florida Obsessive Compulsive Inventory (FOCI) scale was selected, which presents good logical appearance, accessible language and a sensitivity of 92 % for obsessive-compulsive disorder screening. From its cultural adaptation, a preliminary version in regional language was obtained. The preliminary version of FOCI must be qualitatively tested in a pilot study, where it will be completed by users with obsessive-compulsive disorder, in order to obtain a regional version equivalent to the original.

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.

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.

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.

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.

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.

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）］

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.

Association of cognitive function,plasma C-reactive protein level in patients with treatment-resistant obsessive-compulsive disorder / 中国心理卫生杂志

Objective:To evaluate the association of cognitive function,clinical symptoms,and plasma C-reac-tive protein(CRP)level in patients with treatment-resistant obsessive-compulsive disorder(trOCD).Methods:Fif-ty-five patients with trOCD,45 patients with non-trOCD,and 65 normal controls were enrolled.The Yale-Brown Obsessive-Compulsive Scale(YBOCS),Hamilton depression scale,Hamilton anxiety scale,MATRICS Consensus Cognitive Battery(MCCB)were used to evaluate the OCD,depressive or anxious clinical symptoms,as well as cognitive function,in above-mentioned subjects.The plasma CRP level were examined by using the latex-enhanced immunoturbidimetry methods in three groups.Results:Compared with the other two groups,the MCCB cognition scores,especially information processing speed,working memory,inferential knowledge and problem-solving skills were higher in the trOCD group,respectively(Ps＜0.05).The plasma CRP level and percentage of cases with high CRP level(≥3 mg/L)in the trCOD group were higher than those in other two groups(P＜0.05).However,difference of MCCB and its factorial scores revealed no statistical significances in non-trOCD group(Ps＞0.05).Logistic regression analysis showed that potential risk factors of treatment-resistant OCD including,more obsessive-compulsive symptoms(OR=2.01),higher severity of OCD(OR=2.29),lower MCCB total scores(OR=4.01),higher plasma CRP level(OR=4.24),and longer disease course of OCD(OR=3.23)(P＜0.05).Conclusion:Impaired cognitive function,high plasma C-reactive protein level,may be associated with more obsessive-compul-sive symptoms,higher severity of OCD,as well as long disease course of OCD.

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.

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.