Impulsivity, hostility and suicidality in patients diagnosed with obsessive compulsive disorder

Reversal Learning as a Neuropsychological Indicator for the Neuropathology of Obsessive Compulsive Disorder? A Behavioral Study

Suicidal ideation in patients with obsessive–compulsive disorder

Patients with obsessive-compulsive disorder (OCD) have historically been considered at low risk for suicide, but recent studies are controversial. To study the prevalence of suicidal thoughts and attempts in OCD patients and to compare those with and without suicidality according to demographic and clinical variables. Fifty outpatients with primary OCD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) from a Brazilian public university were evaluated. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess OCD severity, the Beck Depression Inventory to evaluate depressive symptoms and the Alcohol Use Disorders Identification Test to assess alcohol problems. All patients had obsessions and compulsions, 64% a chronic fluctuating course and 62% a minimum Y-BOCS score of 16. Half of the patients presented relevant depressive symptoms, but only three had a history of alcohol problems. Seventy percent reported having already thought that life was not worth living, 56% had wished to be dead, 46% had suicidal ideation, 20% had made suicidal plans, and 10% had already attempted suicide. Current suicidal ideation occurred in 14% of the sample and was significantly associated with a Y-BOCS score >16. Previous suicidal thoughts were associated with a Beck Depression Inventory score >19. Suicidality has been underestimated in OCD and should be investigated in every patient, so that appropriate preventive measures can be taken.

Introduction: Obsessive-compulsive disorder (OCD) is the fourth most common mental illness. It is associated with a wide range of functional impairments and therefore adversely affects the quality of life of patients. Objectives: To assess the risk factors, clinical features and management practices of OCD based on findings were stated in medical records. Methodology: The secondary data from the medical records of 9 OCD patients admitted in a tertiary care hospital over the past 10 years were recorded in a semi-structured proforma. Severity of OCD was assessed using Yale Brown Obsessive Compulsive Scale scores. Results: Mean age of onset among all patients (n=9) was 27.9±15.2 years. Family history of OCD was reported among 3(33.3%) patients. Six had predominant obsessions while the rest 3 had mixed type. The most common type of obsession was of sexual type reported among 3 patients. The most common compulsion reported was the checking type which was present among 2 patients. Reduced concentration, suicidal ideation and anhedonia were present each among 5(55.6%) patients. Depression was the most common co-morbidity reported among 5(55.6%) patients. Severity of OCD was mild among 5(55.6%). Fluvoxamine was the most common drug [5(55.6%)] used to treat OCD. Outcome of treatment was reported poor among 3(33.3%) patients. It was good/moderate among 1(25%) patient residing in urban area in comparison to 5(100%) from rural areas (p=0.048). Conclusion: Mean age of onset was found to be delayed among patients probably due to delay in identification of OCD. Hence awareness generation and early screening need to be initiated for early identification of OCD. The majority of OCD patients had positive history of suicide ideation and depression as co-morbidity, indicating the need of screening patients for these conditions.

BackgroundSuicidal ideations were reported in many studies among patient with obsessive-compulsive disorder (OCD); this study aimed to evaluate the prevalence and factors associated with current suicidal ideations among Egyptian patients with obsessive-compulsive disorder (OCD). A consecutive sample of 120 Egyptian OCD patients was included in the study. OCD was diagnosed using the structured clinical interview for DSM-V axis Ι disorders, clinical version (SCID-I-CV). Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was also applied to the patients. Presence of current suicidal ideations was assessed using Scale for Suicidal Ideation (SSI).ResultsTwenty eight (23.3%) of the OCD patients reported presence of current suicidal ideations, religious obsessions OR = 3.53, P = 0.009, and presence of comorbid major depressive disorder OR = 1.77, P = 0.04.ConclusionReligious obsessions and comorbid major depressive disorder were found to be significant predictors for the current suicidal ideations in patients with OCD; however, religious obsessions were the strongest predictor. Religious obsessions should be evaluated and treated to decrease the risk of suicidal thoughts in Egyptian OCD patients.

Objective: Suicide is one of the preventable causes of death. Obsessive-compulsive disorder (OCD) has been shown to increase the risk of suicide as in most mental illnesses. However, there are limited number of studies to determine predictors of suicide in OCD patients. Due to the lack of literature, this study aims to reveal the relationship between impulsivity and suicidal behavior in OCD patients. Methods: The sample of this cross-sectional study consisted of 122 OCD patients who were diagnosed according to DSM-5 diagnostic criteria and included in the study. The participants were evaluated with Sociodemographic Data Form, Yale-Brown Obsessive Compulsion Scale (Y-BOCS) and Hamilton Depression Scale (HAM-D), Barratt Impulsivity Scale-11 (BIS-11) and Beck Anxiety Inventory (BAI). The patients were divided into two groups with and without suicide attempt and were subjected to appropriate statistical treatment. Results: There was no statistically significant difference between BIS-11 total and subscale scores and BAI scores of two groups with and without suicide attempt, but there was a statistically significant difference between HAM-D, Y-BOCS total, obsession, compulsion scores and suicide attempts. In OCD patients, gender, Y-BOCS and HAM-D scores were predictive of suicide, whereas age and BIS-11 scores were not predictive. Conclusion: This study suggests that suicidal behavior in OCD patients results from symptom severity rather than impulsivity. Long-term follow-up studies are needed to investigate the relationship between impulsivity and suicide in OCD patients.

The aim of this study is to determine whether the levels of zonulin and occludin, tight junctions (TJ) proteins in the intestinal epithelium, will differ between obsessive compulsive disorder (OCD) patients and healthy controls. We also intended to investigate whether these would vary in OCD patients with and without major depressive disorder (MDD) comorbidity and in comparison with healthy controls. Sixty patients diagnosed with OCD and 30 healthy controls were included in the study. The cases were administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HDRS). The patients were divided into two subgroups based on their HDRS scores and presence of MDD comorbidity. Zonulin and occludin levels were measured using the ELISA method. The research was carried out between April 2021 and October 2021. Zonulin and occludin levels were significantly higher in the OCD patient group than in the control group (p<0.001). The levels of both were also significantly higher in the OCD patients with MDD comorbidity (OCD+MDD) compared to those without MDD (OCD-MDD) (p<0.001). Zonulin and occludin levels also rose significantly as disease severity increased in the OCD patient group (respectively; p<0.001, p=0.001). The levels of both increased in line with the severity of depression based on HDRS scores in the OCD+MDD group (p<0.001). A positive correlation was determined between the duration of OCD and zonulin and occludin levels. Evaluation of the entire OCD group revealed a moderate positive correlation between Y-BOCS and HDRS scores and zonulin and occludin. Zonulin and occludin levels in this research were significantly higher in the patients with OCD than in the healthy controls. That elevation was positively correlated with disease duration and severity, and the increase was significantly more pronounced in OCD with MDD comorbidity. These findings point to a possible disorder in the intestinal barrier and blood-brain barrier in OCD patients.

Chronic tics and Tourette syndrome in patients with obsessive–compulsive disorder

Background Although the effect of obsessive-compulsive disorder (OCD) on sleep is not well-known, recent studies suggest an association between OCD and sleep quality. Aims We aimed to assess sleep quality in children and adolescents with OCD and to seek its association with OCD symptoms and OCD severity. Methods All of the subjects were assessed using DSM 5 and affective disorders and schizophrenia for school-age children – present and lifetime version, which is based on DSM-IV. The Yale-Brown obsessive-compulsive scale and children’s Yale-Brown obsessive-compulsive scale were applied to the subjects with OCD. Pittsburgh sleep quality index (PSQI) was used to assess sleep quality, and the Wechsler intelligence scale for children-revised (WISC-R) was used to measure their intelligence levels. Results PSQI total score was significantly higher in patients with OCD (p < 0.001), suggesting that patients with OCD have a significantly worse sleep quality. The presence of somatic disorders was also associated with worse sleep quality (p = 0.040). Sleep quality was not significantly associated with OCD severity (p = 0.152). Among patients with extreme OCD, the ‘sleep duration’ component of the PSQI was higher than those with moderate or severe OCD (p = 0.019). The patients with ‘contamination/cleaning’ symptom group had a lower total PSQI score compared with ‘symmetry/hoarding’ symptom group (p = 0.014). Conclusions The findings of the present study indicate that the sleep quality of children and adolescents with OCD is influenced, and there may be an association between sleep quality and OCD symptoms and severity in these patients.

ORIGINAL ARTICLE&#x0D; PREVALENCE OF SUICIDAL IDEATION AMONG THE PATIENTS SUFFERING FROM OBSESSIVE COMPULSIVE DISORDER ATTENDING PSYCHIATRY DEPARTMENTS OF A TERTIARY CARE HOSPITALS OF LAHORE, PAKISTAN&#x0D; Ahmed Waheed, M. Ismail Tariq, Sumira Qambar Bokhari, Shahid Hameed Warris, Aysha Rashid, Surya Fazal Hashmi.&#x0D; &#x0D; &#x0D; ABSTRACT&#x0D; Background: &#x0D; Obsessive compulsive disorder (OCD) is a debilitating disease which runs a chronic course and affects patient’s functioning badly. Frequency of Suicidal thoughts and attempts is much more common in OCD patients than it was thought previously.&#x0D; &#x0D; Objective: &#x0D; To determine the frequency of suicidal ideation among patients with obsessive compulsive disorder presenting in a tertiary care hospital.&#x0D; &#x0D; Material &amp; Methods&#x0D; This Cross-sectional study was done in a tertiary care hospital on 159 patients of OCD. Demographic data was taken. All patients were assessed for history of suicidal attempt. History of suicidal ideation was obtained from patients on a Performa comprising of BECK suicidal intent scale. Data was analyzed on SPSS version 20.&#x0D; &#x0D; Results:&#x0D; Suicidal ideation was found in 40(25.2%) patients. Frequency of suicidal ideation was higher among female (57.5%) patients as compared to male (42.5%) patients. Socio-demographic factors like age, gender, duration of OCD, marital status, educational status and financial condition did not show any statistically significant association with suicidal ideation.&#x0D; &#x0D; Conclusion:&#x0D; Current study showed that suicidal ideation was present in 25% of the patients of OCD which signifies the importance of assessment of suicidal ideation in all OCD patients routinely.&#x0D; &#x0D; Key words:&#x0D; Suicidal ideation, Obsessive compulsive disorder, Psychiatry department.&#x0D;

Objective To investigate the regulatory effect of cognitive behavioral therapy (CBT) on the functional connectivity of cognitive control network in untreated obsessive-compulsive disorder (OCD) patients, so as to provide evidence for understanding the neurobiological mechanism of CBT. Methods A total of 45 OCD patients and 45 matched normal controls were recruited at the outpatient clinic in Beijing Anding Hospital. Four therapists provided 14 times of CBT treatment for OCD patients. All subjects underwent clinical symptom assessment and magnetic resonance imaging at baseline and at the end of 12 weeks. The clinical symptoms were assessed by the psychiatrists using Y-BOCS, HAMD17 and HAMA. The clinical symptoms of OCD patients before and after CBT treatment were compared. The GRETNA software package was used to preprocess the resting-state fMRI data. The whole brain function network was constructed with the template of Power 264 functional brain area as the network node. The function connection intensity outside the cognitive control network was calculated, and the function connection of 2 groups of brain networks at two timepoints were compared by repeated measurement of variance analysis. Results A total of 41 patients completed CBT. The scores of obsessive-compulsive symptoms, anxiety symptoms and depressive symptoms decreased at the end of 12th week, of which 32 patients were improved (Y-BOCS reduction ≥35%). Single factor repeated analysis of variance and post hoc tests were performed between patients with improvement and normal controls. At baseline, the functional connection between the cingulo-opercular network and the salience network of OCD patients was lower than that of the normal control (0.172±0.060 vs. 0.215±0.076, t=1.731, P=0.040), it increased after treatment (0.186±0.171 vs. 0.172±0.060, t=2.480, P=0.010). At baseline, the functional connection of cingulo-opercular network and subcortical network in OCD patients was lower than that of normal control (0.119±0.081 vs. 0.129±0.070, t=1.640, P=0.040), and it increased after treatment (0.130±0.161 vs. 0.119±0.081, t=2.421, P=0.020). At baseline, the functional connection between the frontal-parietal network and subcortical network was lower than that of normal controls (-0.004±0.039 vs. 0.021±0.054, t=2.280, P=0.020), and it increased after treatment (0.020±0.042 vs.-0.004±0.039, t=-2.300 P=0.020). Conclusions CBT could effectively improve obsessive-compulsive symptoms accompanying with improvement of the external functional connectivity of cognitive control network in OCD patients. Key words: Obsessive-compulsive disorder; Cognitive therapy; Cognitive control network; Functional connectivity

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by repetitive thoughts and behaviors. The kynurenine pathway has been increasingly implicated in psychiatric disorders. This study aimed to investigate the predictive value of kynurenine pathway metabolites, including serotonin and tryptophan, in patients with varying degrees of OCD. One hundred fifty OCD patients and 30 healthy controls were included in this study. Patients were divided into mild-moderate, severe, and extremely severe OCD groups based on their Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores. Serum levels of serotonin, tryptophan, kynurenine, kynurenic acid, indolamine 2,3-dioxygenase (IDO), tryptophan 2,3-dioxygenase (TDO), 3-hydroxykynurenine, quinolinic acid and picolinic acid were measured using enzyme-linked immunosorbent assay. Logistic regression and receiver operating characteristic (ROC) analysis were performed to evaluate the predictive value of these analytes for OCD severity. Serotonin and tryptophan levels were significantly decreased in OCD patients compared to healthy controls, while kynurenine pathway metabolites were significantly increased in patients with OCD. Serum levels of kynurenine pathway metabolites increased with severity in OCD patients. As a result of ROC analysis, serotonin, tryptophan and kynurenine pathway metabolites had higher AUC values in distinguishing OCD patients from healthy volunteers, while kynurenine and tryptophan had higher AUC values in distinguishing disease severity. This study clarifies the role of the kynurenine pathway in the pathophysiology of OCD and suggests that kynurenine pathway metabolites, especially kynurenine, may serve as useful biomarkers to diagnose and differentiate OCD severity. Further research is needed to confirm these findings and explore therapeutic implications.

Objective To explore the association of peripheral catechol-O-methyl-transferase (COMT)gene expression and obsessive-compulsive disorder(OCD)in Han Chinese.Methods Peripheral blood samples were collected from individuals with OCD(n=35)and age-and sex-matched healthy subjects (n=31).Relative COMT gene expression levels were examined with real-time quantitative reverse transcription PCR in peripheral blood of all the subjects.Structured clinical interview for the 4th Edition of Diagnostic and Statistical Manual of Mental Disorder axisⅡ(SCID-Ⅱ)was used to assess the co-morbidity of OCD and obsessive-compulsive personality disorders(OCPD).The Yale-Brown Obsessive-Compulsive Scale(Y-BOCS)was used to evaluate the severity of obsessive compulsive symptoms.Results The COMT gene expression levels were significantly decreased in the OCD group compared with healthy control group (t=2.56,P＜0.05).The OCD patients showed a 32%down-regulation of COMT gene expression.A significant lower COMT gene expression was observed in non-OCPD patients(n=15)in comparison with healthy controls(t=2.41.P＜0.05),while there was,no significant difference between OCPD patients (n=20)and healthy controls(t=1.50,P＞0.05).The rates of COMT gene expression down-regulation in OCD patients with OCPD and ones without OCPD were 14%and 56%respectively.There was no significant correlation between COMT expression level and the Y-BOCS score(r=0.09,P=0.62).Conclusions These results suggest that COMT gene expression down-regulation is associated with OCD,and the OCD patients with and without OCPD may have different genetic background. Key words: Obsessive-compulsive disorder; Compulsive personality disorder; Catechol Omethyl transferase; Gene expression

Clinical correlates of social adjustment in patients with obsessive-compulsive disorder

Background Obsessive-compulsive disorder (OCD) is a biologically heterogeneous neuropsychiatric disorder. It is associated with impulsive as well as compulsive neurocognitive mechanisms. Cigarette smoking is common among most psychiatric patients; however, OCD patients are thought to show reduced rates. OCD smokers may thus represent a relatively uncommon OCD subtype, characterised by increased impulsivity. In this study, we aim to establish the prevalence of smoking in a large, well-defined OCD cohort. We investigate whether smokers with OCD differ from non-smokers with OCD on clinical measures of behavioural impulsivity and domains of personality and temperament, including reward-dependence and novelty-seeking. Method 183 of 200 outpatients with DSM-IV OCD were interviewed to determine smoking status. A sub-sample of 10 smokers was compared with 10 non-smokers, pair wise matched for age and gender. Patients were assessed for DSM co-morbidity, symptom profile, OCD severity, behavioural impulsivity and personality dimensions. Results Only 10 individuals (5.46%; five males) were smokers. Compared to OCD non-smokers, OCD smokers scored significantly higher on the Barratt Impulsiveness Scale (p < 0.001). They also scored significantly higher on TCI measures of novelty seeking (p < 0.001) and reward dependence (p < 0.001) and significantly lower on measures of harm avoidance (p < 0.001). Conclusions Tobacco smoking is rare in OCD. Significantly higher levels of behavioural impulsivity and temperamental factors associated with reward driven impulsivity are seen in OCD smokers compared to non-smokers. Tobacco smoking may indicate a possible source of neurocognitive heterogeneity in OCD.