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The American Journal of Psychiatry Jan 2021Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response... (Review)
Review
Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response prevention, and serotonin reuptake inhibitor medications (SRIs). However, a subset of patients fails to respond to either modality, and few experience complete remission. Beyond SRI monotherapy, antipsychotic augmentation is the only medication approach for OCD with substantial empirical support. Our incomplete understanding of the neurobiology of OCD has hampered efforts to develop new treatments or enhance extant interventions. This review focuses on several promising areas of research that may help elucidate the pathophysiology of OCD and advance treatment. Multiple studies support a significant genetic contribution to OCD, but pinpointing the specific genetic determinants requires additional investigation. The preferential efficacy of SRIs in OCD has neither led to discovery of serotonergic abnormalities in OCD nor to development of new serotonergic medications for OCD. Several lines of preclinical and clinical evidence suggest dysfunction of the glutamatergic system in OCD, prompting testing of several promising glutamate modulating agents. Functional imaging studies in OCD show consistent evidence for increased activity in brain regions that form a cortico-striato-thalamo-cortical (CSTC) loop. Neuromodulation treatments with either noninvasive devices (e.g., transcranial magnetic stimulation) or invasive procedures (e.g., deep brain stimulation) provide further support for the CSTC model of OCD. A common substrate for various interventions (whether drug, behavioral, or device) may be modulation (at different nodes or connections) of the CSTC circuit that mediates the symptoms of OCD.
Topics: Brain; Cognitive Behavioral Therapy; Humans; Neural Pathways; Obsessive-Compulsive Disorder; Treatment Outcome
PubMed: 33384007
DOI: 10.1176/appi.ajp.2020.20111601 -
Nature Reviews. Disease Primers Aug 2019Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the... (Review)
Review
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
Topics: Cognitive Behavioral Therapy; Humans; Obsessive-Compulsive Disorder; Prevalence; Psychometrics
PubMed: 31371720
DOI: 10.1038/s41572-019-0102-3 -
Neuron Apr 2019Obsessive-compulsive disorder is a severe and disabling psychiatric disorder that presents several challenges for neuroscience. Recent advances in its genetic and... (Review)
Review
Obsessive-compulsive disorder is a severe and disabling psychiatric disorder that presents several challenges for neuroscience. Recent advances in its genetic and developmental causation, as well as its neuropsychological basis, are reviewed. Hypotheses concerning an imbalance between goal-directed and habitual behavior together with neural correlates in cortico-striatal circuitry are evaluated and contrasted with metacognitive theories. Treatments for obsessive-compulsive disorder (OCD) tend to be of mixed efficacy but include psychological, pharmacological, and surgical approaches, the underlying mechanisms of which are still under debate. Overall, the prospects for new animal models and an integrated understanding of the pathophysiology of OCD are considered in the context of dimensional psychiatry.
Topics: Animals; Anxiety; Anxiety Disorders; Brain; Cognitive Behavioral Therapy; Compulsive Behavior; Disease Models, Animal; Dopamine Antagonists; Food Addiction; Functional Neuroimaging; Gambling; Genetic Predisposition to Disease; Gyrus Cinguli; Humans; Implosive Therapy; Magnetic Resonance Imaging; Neurosurgical Procedures; Obsessive-Compulsive Disorder; Phenotype; Positron-Emission Tomography; Selective Serotonin Reuptake Inhibitors; Substance-Related Disorders
PubMed: 30946823
DOI: 10.1016/j.neuron.2019.01.046 -
Archives of Disease in Childhood May 2015Obsessive-compulsive disorder (OCD) in childhood and adolescence is an impairing condition, associated with a specific set of distressing symptoms incorporating... (Review)
Review
Obsessive-compulsive disorder (OCD) in childhood and adolescence is an impairing condition, associated with a specific set of distressing symptoms incorporating repetitive, intrusive thoughts (obsessions) and distressing, time-consuming rituals (compulsions). This review considers current knowledge of causes and mechanisms underlying OCD, as well as assessment and treatment. Issues relating to differential diagnosis are summarised, including the challenges of distinguishing OCD from autism spectrum disorders and tic disorders in youth. The recommended treatments, namely cognitive behaviour therapy and serotonin reuptake inhibiting/selective serotonin reuptake inhibitor medications, are outlined along with the existing evidence-based and factors associated with treatment resistance. Finally, novel clinical developments that are emerging in the field and future directions for research are discussed.
Topics: Adolescent; Child; Cognitive Behavioral Therapy; Diagnosis, Differential; Humans; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors
PubMed: 25398447
DOI: 10.1136/archdischild-2014-306934 -
Current Psychiatry Reports Apr 2022We review recent evidence concerning the epidemiology, etiology, and treatment of obsessive-compulsive disorder (OCD) in the perinatal period. We examine studies... (Review)
Review
PURPOSE OF REVIEW
We review recent evidence concerning the epidemiology, etiology, and treatment of obsessive-compulsive disorder (OCD) in the perinatal period. We examine studies reporting on rates of both new-onset OCD and exacerbation in both pregnancy and postpartum; explore both biological and psychosocial risk factors for the disorder; and review the latest evidence concerning treatment.
RECENT FINDINGS
Evidence is limited in all areas, with rates of both OCD and subthreshold obsessive-compulsive symptoms varying widely across studies. Prevalence is likely higher in the perinatal period than in the general population. Clinical features in the perinatal period are more likely than at other times to concern harm to the child, with contamination and aggressive obsessions and cleaning and checking compulsions especially common. Research into the biological etiology is too limited at this time to be definitive. Both observational and randomized controlled trials support cognitive behavioral therapy with exposure and response prevention (CBT with ERP) as a first-line treatment, with limited evidence also supporting the use of selective serotonin reuptake inhibitors (SSRIs). Treatment considerations in the perinatal period must weigh the risks of treatment vs. the risks of untreated illness. Perinatal OCD is common and can be impairing. Clinical features differ somewhat compared to non-perinatal periods. Treatment does not differ from that used in the general population, though evidence pertaining specifically to the perinatal period is sparse.
Topics: Child; Compulsive Behavior; Female; Humans; Obsessive-Compulsive Disorder; Parturition; Postpartum Period; Pregnancy; Selective Serotonin Reuptake Inhibitors
PubMed: 35384553
DOI: 10.1007/s11920-022-01333-4 -
Current Psychiatry Reports Oct 2017This review aims to synthesize the most recent research on anxiety disorders and obsessive-compulsive disorder (OCD) in individuals with autism spectrum disorder (ASD)... (Review)
Review
PURPOSE OF REVIEW
This review aims to synthesize the most recent research on anxiety disorders and obsessive-compulsive disorder (OCD) in individuals with autism spectrum disorder (ASD) and discuss the relationship between these conditions and challenges for assessment. Furthermore, implications for treatment and future directions are discussed.
RECENT FINDINGS
Research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. However, the significant overlap of ASD features with anxiety and OCD symptomology makes differential diagnosis of these disorders particularly challenging. Though several treatments for anxiety have been adapted for youth with ASD (e.g., cognitive behavior therapy), pharmacological treatments and treatments for adults are still marked undeveloped. Despite the high prevalence of anxiety disorders and OCD in ASD and some recent advances in assessment and treatment, research is needed to clarify the multifaceted relationship of these conditions and develop tailored assessment and treatment approaches appropriate for a full range of individuals with ASD.
Topics: Adult; Anxiety Disorders; Autism Spectrum Disorder; Behavioral Symptoms; Diagnosis, Differential; Disease Management; Humans; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales
PubMed: 29082426
DOI: 10.1007/s11920-017-0846-y -
The Psychiatric Clinics of North America Sep 2014Obsessive-compulsive disorder (OCD) affects up to 2.5% of the population of the course of a lifetime and produces substantial morbidity. Approximately 70% of patients... (Review)
Review
Obsessive-compulsive disorder (OCD) affects up to 2.5% of the population of the course of a lifetime and produces substantial morbidity. Approximately 70% of patients can experience significant symptomatic relief with appropriate pharmacotherapy. Selective serotonin reuptake inhibitors are the mainstay of pharmacological treatment. These drugs are typically used at higher doses and for longer periods than in depression. Proven second-line treatments include the tricyclic clomipramine and the addition of low-dose neuroleptic medications. OCD refractory to available treatments remains a profound clinical challenge.
Topics: Combined Modality Therapy; Drug Therapy, Combination; Humans; Nonprescription Drugs; Obsessive-Compulsive Disorder; Precision Medicine; Psychotherapy; Psychotropic Drugs
PubMed: 25150568
DOI: 10.1016/j.psc.2014.05.006 -
Psychiatry and Clinical Neurosciences Aug 2014Obsessive-compulsive disorder (OCD) was previously considered refractory to most types of therapeutic intervention. There is now, however, ample evidence that selective... (Review)
Review
Obsessive-compulsive disorder (OCD) was previously considered refractory to most types of therapeutic intervention. There is now, however, ample evidence that selective serotonin reuptake inhibitors and behavior therapy are highly effective methods for treatment of OCD. Furthermore, recent neurobiological studies of OCD have found a close correlation between clinical symptoms, cognitive function, and brain function. A large number of previous neuroimaging studies using positron emission tomography, single-photon emission computed tomography or functional magnetic resonance imaging (fMRI) have identified abnormally high activities throughout the frontal cortex and subcortical structures in patients with OCD. Most studies reported excessive activation of these areas during symptom provocation. Furthermore, these hyperactivities were decreased after successful treatment using either selective serotonin reuptake inhibitors or behavioral therapy. Based on these findings, an orbitofronto-striatal model has been postulated as an abnormal neural circuit that mediates symptomatic expression of OCD. On the other hand, previous neuropsychological studies of OCD have reported cognitive dysfunction in executive function, attention, nonverbal memory, and visuospatial skills. Moreover, recent fMRI studies have revealed a correlation between neuropsychological dysfunction and clinical symptoms in OCD by using neuropsychological tasks during fMRI. The evidence from fMRI studies suggests that broader regions, including dorsolateral prefrontal and posterior regions, might be involved in the pathophysiology of OCD. Further, we should consider that OCD is heterogeneous and might have several different neural systems related to clinical factors, such as symptom dimensions. This review outlines recent neuropsychological and neuroimaging studies of OCD. We will also describe several neurobiological models that have been developed recently. Advanced findings in these fields will update the conventional biological model of OCD.
Topics: Behavior Therapy; Brain; Cognition; Humans; Models, Neurological; Neuroimaging; Neuropsychological Tests; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors
PubMed: 24762196
DOI: 10.1111/pcn.12195 -
Comprehensive Psychiatry Oct 2022Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life... (Review)
Review
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
Topics: Comorbidity; Humans; Obsessive-Compulsive Disorder; Psychometrics; Quality of Life; Social Adjustment
PubMed: 36007341
DOI: 10.1016/j.comppsych.2022.152342 -
Treatment of obsessive-compulsive disorders (OCD) and obsessive-compulsive-related disorders (OCRD).Psychiatria Polska Aug 2019The purpose of this article is to present an overview of current knowledge on the treatment of obsessive-compulsive and obsessive-compulsive-related disorders (OCRD -... (Review)
Review
The purpose of this article is to present an overview of current knowledge on the treatment of obsessive-compulsive and obsessive-compulsive-related disorders (OCRD - according to DSM-5). The article presents commonly used pharmacological treatments and psychotherapy, as well as surgical and other forms of treatment. According to the analyses that have been made, the variety of responses to the pharmacological treatment of obsessive-compulsive disorders (OCD) depending on the kinds of symptoms is not relevant enough to justify these other forms of treatment. Instead, the choice of medication should be made based on other factors, such as the severity of symptoms and the level of insight into the illness or the symptoms of other disorders co-occurring with the obsessions. These factors are also significant in psychotherapy, but in this case, the dependency between the types of obsessions and compulsions and the therapeutic approach has greater importance. Generally speaking, in OCRD treatment, atendency to use other forms of treatment can be observed for disorders based mainly on the mechanism of compulsivity or impulsivity. Hopes for a more effective treatment are related to the types of pharmacological treatment and modifications of psychotherapeutic methods based on the development happening in the cognitive behavioural approach.
Topics: Adult; Compulsive Behavior; Compulsive Personality Disorder; Female; Humans; Obsessive-Compulsive Disorder; Severity of Illness Index; Treatment Outcome
PubMed: 31760412
DOI: 10.12740/PP/105130