P02 - 369 - Neuroimaging of the various symptom dimensions in obsessive - compulsive disorder - a systematic review

IntroductionSeveral neuroimaging studies in obsessive-compulsive disorders (OCD) have shown a dysfunction in the orbito-fronto-striato-thalamamic neural circuitry as the fundamental neuropathological correlate, consistent across all symptom subtypes.Therefore, the neurobiological differentiation of the various obsessive-compulsive symptoms is attracting increasing interest in neuroimaging as this clinical picture becomes increasingly subclassified.MethodA systematic literature survey was used to search for original papers that studied the neurobiological correlates of the various symptom dimensions of OCD (symmetry, forbidden thoughts, washing, hoarding).ResultsIt was possible to include a total of 15 original papers in the assessment. The “forbidden thoughts” factor, which also includes compulsion to control, is associated mainly with activations in brain structures of the cognitive control system, i.e. the basal ganglia and parts of the anterior cingulate cortex (ACC). Therefore, the neural representation pattern of “forbidden thoughts” differs clearly from that of “washing”, in which cerebral regions of emotional control seem to be particularly involved, i.e. the orbito-frontal cortex (OFC), ACC, the amygdala and insula. On the other hand, the “hoarding and collecting” dimension is primarily associated with brain areas involved in decision-making, i.e. the ventro-medial OFC, the dorsal ACC and the dorso-lateral prefrontal cortex (DLPC).DiscussionThe results confirm the hypothesis that all dimensions of OCD are based on different neuronal networks, which underlines the neurobiological heterogeneity of the clinical picture of OCD, thus pointing the way for future research strategies.

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Patterns of Neural Response to Emotive Stimuli Distinguish the Different Symptom Dimensions of Obsessive-Compulsive Disorder

CNS Spectrums ◽

10.1017/s1092852900009214 ◽

2004 ◽

Vol 9 (4) ◽

pp. 275-283 ◽

Cited By ~ 17

Author(s):

Mary L. Phillips ◽

David Mataix-Cols

Keyword(s):

Treatment Response ◽

Obsessive Compulsive Disorder ◽

Emotion Perception ◽

Anterior Cingulate ◽

Neural Systems ◽

Obsessive Compulsive ◽

Specific Symptom ◽

Symptom Dimensions ◽

Related Material ◽

Compulsive Disorder

ABSTRACTDespite its heterogeneous symptomatology, obsessive-compulsive disorder (OCD) is currently conceptualized as a unitary diagnostic entity. Recent factor-analytic studies have identified several OCD symptom dimensions that are associated with different demographic variables, comorbidity, patterns of genetic transmission, and treatment response. Functional abnormalities in neural systems important for emotion perception, including the orbitofrontal cortex, lateral prefrontal cortex, anterior cingulate gyrus, and limbic regions, have been reported in OCD. In this review, we discuss the extent to which neurobiological markers may distinguish these different symptom dimensions and whether specific symptom dimensions, such as contamination/washing, are associated with abnormalities in emotion and, in particular, disgust, perception in OCD. Also discussed are findings that indicate that anxiety can be induced in healthy volunteers in response to OCD symptom-related material, and that associated increases in activity within neural systems important for emotion perception occur to washing- and hoarding-related material in particular in these subjects. Further examination of neural responses during provocation of different symptom dimensions in OCD patients will help determine the extent to which specific abnormalities in neural systems underlying emotion perception are associated with different symptom dimensions and predict treatment response in OCD.

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Neuroanatomy of Obsessive Compulsive and Related Disorders

10.1093/oxfordhb/9780195376210.013.0027 ◽

2012 ◽

Cited By ~ 1

Author(s):

David Mataix-Cols ◽

Odile A. van den Heuvel

Keyword(s):

Neural Systems ◽

Future Research ◽

Affective Neuroscience ◽

Obsessive Compulsive ◽

Statistical Manual ◽

Symptom Dimensions ◽

Compulsive Disorder ◽

Diagnostic And Statistical Manual ◽

Psychiatric Conditions ◽

Spectrum Disorders

Obsessive-compulsive disorder (OCD) shares features and often co-occurs with other anxiety disorders, as well as with other psychiatric conditions classified elsewhere in the Diagnostic and Statistical Manual (DSM-IV), the so-called “OCD spectrum disorders.” Neurobiologically, it is unclear how all these disorders relate to one another. The picture is further complicated by the clinical heterogeneity of OCD. This chapter will review the literature on the common and distinct neural correlates of OCD vis-à-vis other anxiety and “OCD spectrum” disorders. Furthermore, the question of whether partially distinct neural systems subserve the different symptom dimensions of OCD will be examined. Particular attention will be paid to hoarding, which is emerging as a distinct entity from OCD. Finally, new insights from cognitive and affective neuroscience will be reviewed before concluding with a summary and recommendations for future research.

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The Co-Occurrence of Mania with Medical and other Psychiatric Disorders

The International Journal of Psychiatry in Medicine ◽

10.2190/cm8e-46r5-9ajl-03fn ◽

1994 ◽

Vol 24 (4) ◽

pp. 305-328 ◽

Cited By ~ 40

Author(s):

Stephen M. Strakowski ◽

Susan L. McElroy ◽

Paul W. Keck ◽

Scott A. West

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Brain Structures ◽

Future Research ◽

Medical Illness ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Medical Disorders ◽

Current State ◽

Secondary Mania

Objective: The co-occurrence of mania with other medical and psychiatric disorders has been little studied. The authors reviewed the literature in order to clarify the current state of knowledge of this subject and to identify possible areas of future research. Methods: Published articles which specifically addressed associations of mania with medical disorders and other psychiatric syndromes were identified using the Paperchase® medical literature search system and by cross-referencing from other published work. The articles were then organized into three categories: 1) medical disorders associated with secondary mania; 2) medical comorbidity in bipolar disorder; and 3) psychiatric comorbidity in bipolar disorder. Results: The review of medical illness and secondary mania supports the hypothesis that injuries involving right-side and mid-line brain structures are associated with so-called secondary mania. Additionally, an association between bipolar disorder and migraine is identified. Several psychiatric disorders appear to occur with mania at rates higher than expected including obsessive-compulsive disorder, bulimia nervosa, panic disorder, impulse control disorders, and substance abuse. Conclusions: The authors discuss the potential implications of these findings and suggest research approaches to further examine the relationships between mania and other medical and psychiatric syndromes.

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Towards a definitive symptom structure of obsessive−compulsive disorder: a factor and network analysis of 87 distinct symptoms in 1366 individuals

Psychological Medicine ◽

10.1017/s0033291720005437 ◽

2021 ◽

pp. 1-13

Author(s):

Matti Cervin ◽

Euripedes C. Miguel ◽

Ayşegül Selcen Güler ◽

Ygor A. Ferrão ◽

Ayşe Burcu Erdoğdu ◽

...

Keyword(s):

Network Analysis ◽

Obsessive Compulsive Disorder ◽

Structural Equation ◽

Factor Model ◽

Equation Modeling ◽

Future Research ◽

Obsessive Compulsive ◽

Symptom Dimensions ◽

Compulsive Disorder ◽

Clinical Variables

Abstract Background The symptoms of obsessive−compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques. Methods A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive−Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM). Results Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables. Conclusions Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD.

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Psychological Trauma Exposure and Obsessive-Compulsive Symptoms

10.1093/med/9780190228163.003.0055 ◽

2017 ◽

Author(s):

Dean McKay ◽

Rachel Ojserkis ◽

Jon D. Elhai

Keyword(s):

Stress Disorder ◽

Trauma Exposure ◽

Psychological Trauma ◽

Future Research ◽

Obsessive Compulsive ◽

Symptom Dimensions ◽

Compulsive Disorder ◽

Considerable Research ◽

Prognostic Implications ◽

Trauma Disorders

This chapter has three broad aims: it outlines research on the shared and unique features of OCD and PTSD; it reviews the extant literature on how trauma exposure impacts treatment outcome for OCD; and it offers recommendations for treatment and future research on the intersection of trauma and OCD. Obsessive-compulsive disorder is a complex and heterogeneous condition. Considerable research has been conducted related to subtypes and symptom dimensions, but comparably little attention has been paid to commonly cooccurring psychiatric disorders. One diagnosis that has distinct etiological and prognostic implications is cooccurring posttraumatic stress disorder, and other trauma disorders. The chapter focuses on trauma generally and its impact on OCD. However, the literature also refers specifically to PTSD. Accordingly, the research related to PTSD is highlighted, to distinguish it from literature discussing trauma exposure more generally.

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Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder

Translational Psychiatry ◽

10.1038/s41398-022-01780-w ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Emily R. Stern ◽

Goi Khia Eng ◽

Alessandro S. De Nadai ◽

Dan V. Iosifescu ◽

Russell H. Tobe ◽

...

Keyword(s):

Obsessive Compulsive Disorder ◽

Anterior Cingulate ◽

Local Connectivity ◽

Resting State Functional Connectivity ◽

Obsessive Compulsive ◽

Symptom Dimensions ◽

Default Mode ◽

Compulsive Disorder ◽

Global Connectivity ◽

Perseverative Thinking

AbstractObsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the “unacceptable thoughts” symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles—areas that are part of, or closely linked to, the default mode network (DMN)—and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the “unacceptable thoughts” and “symmetry/not-just-right-experiences” symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.

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Additive and Alternative Approaches to Treating Obsessive Compulsive Disorder

10.1093/oxfordhb/9780195376210.013.0086 ◽

2012 ◽

Author(s):

Jordana Muroff ◽

Abigail Ross ◽

Joseph Rothfarb

Keyword(s):

Obsessive Compulsive Disorder ◽

Behavioral Therapy ◽

Alternative Methods ◽

Herbal Remedies ◽

Future Research ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Specific Alternative ◽

Alternative Approaches ◽

Complementary And Alternative

While cognitive-behavioral therapy (CBT) and pharmacotherapy are “gold standard” treatments for obsessive-compulsive disorder (OCD), complementary and alternative treatments are frequently sought for anxiety disorders. The purpose of this chapter is to review and discuss the available research on the application, efficacy and effectiveness of complementary and alternative methods for treating OCD. The first section identifies and reviews studies focusing on specific alternative and complementary treatments that are independent from, or work in conjunction with CBT, such as yoga, herbal remedies, motivational strategies, and bibliotherapy. The second section discusses alternative and complementary methods of more mainstream CBT and related techniques, with a particular focus on technology-supported approaches. The chapter concludes with a discussion of the methodological issues in the existing research on complementary and alternative methods in the treatment of OCD, questions for future research, and implications for providers.

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