Proof of Principle: Is a Pre-treatment Behavior Approach Test a Potential Predictor for Response to Intensive Residential Treatment in Patients With Treatment Refractory Obsessive Compulsive Disorder?

Patients with severe and treatment refractory obsessive compulsive disorder (OCD) are usually referred to a specialized center for intensive residential treatment (IRT), consisting of exposure and response prevention (EX/RP), pharmacotherapy and additional therapies. About 50% of the patients does not respond to IRT. Currently we are not able to predict treatment response. If we were to have predictive tools, we could personify treatment at an earlier stage. Recent studies show that early adherence and willingness to EX/RP and low avoidance during EX/RP measured during treatment were associated with treatment response. In this observational study willingness and ability of patients with severe and treatment refractory OCD (N = 58) is conceptualized by a behavioral measurement, measured before the start of 12 weeks of IRT, using a Behavior Approach Test (BAT), as opposed to relying on self-report measurements. A medium or strong association between pre-treatment performance on the BAT and treatment response would justify next steps to test the BAT as a predictive tool for IRT. Results of regression analyses showed that there is a significant association between the performance on the BAT and change in OCD symptom severity after IRT. However, the effect-size is too small to use the BAT in its current form as predictor in clinical practice. The principle of the association between pre-treatment behaviorally measured willingness and ability to fully engage in EX/RP, and treatment response has now been proven. To ultimately design a predictive tool, future research is needed to refine a behavioral measurement of pre-treatment willingness and ability.

Microbial Induced Autoimmune Inflammation as a Cause of Mental Illness in Adolescents: A Case Series

The incidence of mental health disorders in adolescents continues to rise. The cause of the increase in mental illness is multifactorial, including both environmental and biological causes. To investigate the latter, ten adolescents at a psychiatric residential treatment center in Colorado with the DSM-5 diagnosis of major depressive disorder (MDD), of whom seven were additionally diagnosed with generalized anxiety disorder (GAD), were chosen at random for further serologic study. Testing revealed exposureto group A Streptococcus(GAS) in 2 of 10 (20%); Borrelia Burgdorferi sensulato (Bbsl)in 2 of 10 (20%); and Bartonella speciesin 3 of 10 (30%). In addition, 9 of 10 (90%) subjects had abnormal Cunningham Panels, which measures levels of antineuronal antibodies that have been associated with psychiatric disturbances. Given the degree of psychological dysfunction in these adolescents requiring intensive residential treatment, this case series lends support to the hypothesis that exposure to infectious agents may play a role, perhaps by autoimmune mechanisms, in the significant and ongoing rise in the rate of neuropsychiatric illness in adolescents. This preliminary report adds to this premise and requires further investigation.

The effects of depression on the treatment of OCD in a residential sample

Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment. OCD patients receiving residential treatment based primarily on exposure and response prevention (ERP) provided data regarding symptoms of depression and OCD at admission and discharge. Patients reported large and significant reductions in OCD symptoms over the course of treatment. Change in OCD symptoms was not significantly affected by depressive symptoms, including patients with severe depressive symptoms. Change in depressive symptoms over the course of treatment was, however, robustly related to change in OCD symptoms, especially among patients who began treatment with severe symptoms of depression. These findings suggest that cognitive-behavior therapy delivered in a residential treatment setting drastically reduces OCD symptoms regardless of depressive symptoms.