Standardized low-resolution electromagnetic tomography in obsessive-compulsive disorder--a replication study.

Previous EEG source localization studies in obsessive-compulsive disorder (OCD) reported ambiguous results. The reason probably lies in different OCD samples included in the studies - obsessive-compulsive subjects selected based on a psychopathology questionnaire (the Symptom Checklist - Revised), drug-naïve OCD cases or patients with a long-term disorder. This study was conceived as a replication of our previous research on OCD population coming to treatment in Prague Psychiatric Centre [9]. We included 50 OCD patients (8 drug-free and 42 medicated with SSRIs) and 50 healthy controls. All subjects were different from those enrolled in the previous study. Resting state EEG was analyzed in 8 frequency bands as well as with 1 Hz frequency resolution using the standardized low-resolution electromagnetic tomography (sLORETA). In OCD, sLORETA indicated low-frequency power excess at 2 and 3 Hz in the cingulate gyrus with maximal t-values in Brodmann area 24. The low-frequency activity was unrelated to the severity of clinical symptoms and illness duration but delta power in the right orbitofrontal cortex positively correlated with age of OCD onset. Our results confirm previous finding of the low-frequency excess in the cingulate gyrus in OCD and document the essential role of delta frequencies. Delta activity in the cingulate gyrus is negatively associated with reward-signalling dopamine release in the ventral striatum and increases in states connected with a need for reinforcement. Thus, delta activity could reflect a repetitive need to perform compulsive behaviour in OCD patients.

Prediction of treatment response and the effect of independent component neurofeedback in obsessive-compulsive disorder: a randomized, sham-controlled, double-blind study.

AIMS: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of clinical symptoms. METHODS: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback (SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response. RESULTS: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield significant results; however, in the NFB group, the nominal values at the downtrained frequency were lower after treatment. The NFB group showed significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. CONCLUSION: Independent component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a network related to treatment resistance.

EEG source analysis in obsessive-compulsive disorder.

OBJECTIVE: The goal of this study was to assess the activity of intracortical EEG sources in patients with OCD. METHODS: We compared resting state EEG from 50 OCD patients and 50 matched controls using standardized low-resolution electromagnetic tomography (sLORETA) and normative independent component analysis (NICA). Data were analyzed with 1 Hz frequency resolution. Group ICA was used to separate seven independent components from the control group data. The resulting weights and norms served to derive the same components from the OCD group and to compare their power with controls. RESULTS: In OCD, sLORETA indicated low-frequency power excess (2-6 Hz) in the medial frontal cortex, whereas group ICA showed increased low-frequency power in a component reflecting the activity of subgenual anterior cingulate, adjacent limbic structures and to a lesser extent also of lateral frontal cortex. CONCLUSIONS: Both methods provided evidence for medial frontal hyperactivation in OCD. SIGNIFICANCE: Our study is the first to use normative ICA in a clinical sample and indicates its potential utility as a diagnostic tool. The findings provide consistent results based on EEG source localization in OCD and are of practical interest for therapeutic interventions.

Obsessive compulsive disorder and dissociation - comparison with healthy controls.

The aim of our study is to examine if the dissociation can influence the intensity of psychopathology in patients suffering from obsessive compulsive disorder and to compare the levels of dissociation in the groups of the patients and healthy subjects. Method. Fifty five patients suffering from obsessive compulsive disorder and 123 healthy controls were included into the study. The patients were psychiatrically assessed. The diagnosis was made using ICD-10 research criteria confirmed with structured interview MINI. The subjective intensity of anxiety and depressive symptoms was evaluated using Beck Anxiety Inventory and Beck Depression Inventory. The intensity of obsessions and compulsions was evaluated using Yale Brown Obsessive Compulsive Scale. All participants were assessed with the Dissociative Experiences Scale (DES). Results. Level of the psychological dissociation assessed with the DES was correlated with the severity of subjective anxiety (p<0.0001), depression (p<0.0001), and with the severity of obsessive-compulsive symptoms (p<0.005). Patients have significantly lower mean score on the DES than healthy controls (p<0.0001). Conclusion. Our results suggest that the level of psychological dissociation in OCD patients is lower than in healthy controls, and is associated with the severity of anxiety, depression and obsessive compulsive symptoms.

Augmentation of antidepressants with bright light therapy in patients with comorbid depression and borderline personality disorder.

BACKGROUND: Borderline personality disorder (BPD) is typically characterized by instability and impaired behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Both sleep and diurnal rhythms are disturbed and the symptoms fluctuate. Bright light may be an effective in treatment of seasonal affective disorder, circadian sleep disorder and jet lag. It also improves sleep-wake patterns and behavioural disorders in hospitalized patients with Alzheimer's disease. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far. METHOD: The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories. RESULTS: According to all the assessment instruments, the application of bright white light leads to a significant improvement. However, the results must be interpreted with caution due to the open nature of the study.

Psychological dissociation in obsessive-compulsive disorder is associated with anxiety level but not with severity of obsessive-compulsive symptoms.

OBJECTIVE: According to recent findings, clinical symptoms in patients with obsessive-compulsive disorder (OCD) seem be related with dissociation. The aim of the present study was to evaluate the relationship of psychological dissociation and clinical characteristics in OCD. METHODS: The study sample comprised of 49 patients with OCD (55.1% females) and 45 healthy controls (66.7% females). All participants were assessed with the Yale-Brown Obsessive-Compulsive Scale, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Dissociation was quantified by the Dissociative Experiences Scale (DES). RESULTS: Psychological dissociation assessed with the DES was associated with the severity of anxiety symptoms (beta=0.49, t=3.89, df=47, p<0.001), but not with the level of OCD symptoms. Patients had higher level of dissociation than healthy controls. CONCLUSION: Our results suggest that the level of psychological dissociation is associated with the severity of anxiety symptoms rather than with OCD symptoms. Further investigation of association between dissociative and anxiety states is needed.

Predicting the therapeutic response to cognitive behavioural therapy in patients with pharmacoresistant obsessive-compulsive disorder.

OBJECTIVE: The aim of our study was to establish the efficacy of CBT on the sample of non-selected medication-resistant patients with OCD and to search for predictors of therapeutic response in such a group. METHODS: The treatment was carried out under usual conditions at the department for anxiety disorders. Systematic CBT steps were tailored to the needs of each patient. Pharmacology treatment remained grossly unchanged during the trial period. We used the following outcome measures in the study: Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS), the Clinical Global Impression - Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatoform Dissociation Questionnaire (SDQ-20) and Dissociative Experience Scale (DES). The primary outcome measure was a decrease by 35% in Y-BOCS rating. Remission was defined as a 12 point score or lower in Y-BOCS and 1 or 2 points in CGI-S. RESULTS: 47 patients completed the study (19 male and 28 female). One female patient refused to participate. All patients completed at least 5 weeks of intensive CBT programme and showed significant improvement on Y-BOCS, CGI-S, and BDI scales. At the end of the treatment 40.4% of the patients achieved clinical remission according to the CGI-S scale. The main characteristics present at the beginning of the trial increasing probability of achieving improvement or remission during the treatment were a Y-BOCS score lower than 22, good insight, higher resistance to symptoms, low level of dissociation, and aggressive obsessions. CONCLUSION: As negative predictors we identified higher scores in Y-BOCS, poorer insight, low resistance to symptoms, high level of dissociation, obsessions focused on control/symmetry and obsessive slowness/ambivalence as associated with poor improvement.

Medial frontal and dorsal cortical morphometric abnormalities are related to obsessive-compulsive disorder.

Whole-brain voxel-based morphometry (VBM) studies provide support for orbitofrontal, medial frontal as well as for dorsal cortical volumetric alteration in obsessive-compulsive disorder (OCD). However, there is still a need to replicate a priori unpredicted findings and to elucidate white matter volumetric abnormalities and relationships between grey (GM) and white (WM) matter volume and clinical characteristics of OCD. We compared GM and WM volume in a group of 14 patients with OCD and 15 healthy controls using a 3T MRI scanner and an optimized VBM protocol. Regression analysis was used to examine relationships between GM and WM volume and clinical variables. In OCD we have found total WM volume reduction and marked mediofrontal, right temporo-parieto-occipital, right precentral, left middle temporal, left cerebellar and bilateral pons and mesencephalon GM volume reduction in the voxel-based analysis (p

Depressed patients perception of the efficacy of electroconvulsive therapy and venlafaxine therapy.

BACKGROUND: The aim of our study was to evaluate the efficacy of electroconvulsive (ECT) and venlafaxine therapy from the patient's point of view. METHODS: We used a retrospective chart review from 22 inpatients who underwent ECT and 22 patients treated with venlafaxine due to resistant unipolar or bipolar depression. We used bilateral ECT in a median of 8 (IQR 7-9.7) sessions and venlafaxine therapy with a median daily dosage of 225 mg (IQR 150-225 mg) for a median of 4 (IQR 4-5) weeks. The main outcome was change in a self-evaluation scale - Short Form of the Beck Depression Inventory (BDI-SF). The response was defined as the decreasing of the BDI-SF score by >or=50%, remission as decreasing of BDI-SF score