Relationship between defense styles and neurochemical variables of the hippocampus in patients with obsessive-compulsive disorder.

OBJECTIVES: This study aims to assess the correlation between NAA (N-acetyl-l-aspartate), CHO (choline), and CRE (creatine) levels in the hippocampus regions of individuals suffering from obsessive-compulsive disorder (OCD) and defensive styles of the ego. METHODS: The study group was composed of twenty patients with OCD and twenty healthy controls. NAA, CHO, and CRE values in the hippocampal region using proton magnetic resonance spectroscopy (1H-MRS) were measured. Participants' defense styles were ascertained by administering the Defense Style Questionnaire-40. RESULTS: The patient group's NAA levels were considerably lower than the control group's on both sides of the hippocampus. The levels of CHO and CRE did not significantly differ between the two groups. The following statistically significant correlations were discovered: in the comparison group, there were negative correlations between the scores of mature defense styles and the right and left CHO levels, as well as between the immature defense mechanism scores and the right NAA levels in both the patient and control groups. In the patient group, there were also negative correlations between the left NAA values and the scores of mature defense styles. CONCLUSION: OCD patients have lower levels of NAA in the hippocampus. To validate and extend the current findings, more research involving a greater sample size is required.

Universal personality dimensions and dysfunctional obsessional beliefs in the DSM-5's OCD and related disorders (OCRDs).

This study aimed to determine the extent to which personality and cognitive factors contribute to the identification of shared associations between the DSM-5's OCD and Related Disorders (OCRDs). Participants (n = 239) were treatment-seeking outpatients with a principal diagnosis of obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (TTM), or excoriation disorder (EXC), as compared to healthy community controls (n = 100). Analyses examined the relationships between diagnostic group, personality dimensions, and obsessive beliefs. Results demonstrated that compared to non-clinical controls, all diagnostic groups scored significantly higher on neuroticism and lower on extraversion and conscientiousness. Few significant differences were found across diagnostic groups: extraversion was higher in the TTM group (vs. all OCRDs), conscientiousness was lower in the HD group (vs. OCD, TTM, EXC), and openness to experience was higher in the TTM and EXC groups (vs. OCD, HD). Obsessional beliefs were significantly elevated in all clinical conditions (vs. controls) except for beliefs surrounding responsibility and threat estimation, which were only significantly higher in OCD and BDD groups. These results highlight shared personality and cognitive vulnerability in the OCRDs as well as unique disorder-specific vulnerabilities related to OCD.

Brexpiprazole Augmentation in Treatment Resistant OCD: Safety and Efficacy in an Italian Sample.

Obsessive-compulsive disorder (OCD) is a common and debilitating psychiatric disorder with an approximate incidence of 2.5% in the general population. Serotonin reuptake inhibitors (SRIs) are considered the first line of pharmacological treatment but up to 50% of patients fail to achieve clinical remission or response. Atypical antipsychotics are one of the most common augmentation strategies in OCD treatment resistant patients. Brexpiprazole, a novel atypical antipsychotic with dopamine partial agonism action, has never been studied in addition to SRIs treatment in OCD resistant patients. This study retrospectively investigated the safety and efficacy of a 12 week brexpiprazole augmentation trial in 34 OCD resistant patients. SRI treatment resistance was defined as failing to improve the YBOCS total score by more than 25% from the beginning of the SRI trial. Brexpiprazole augmentation response was defined as at least a 25% improvement in the YBOCS total score. At the end of the study, 17 patients (50.0%) met the response criteria of ≥25% improvement in YBOCS total score vs. baseline. No safety issues were raised throughout the observation period. A total of 19 patients (55.9%) reported adverse experiences, generally mild and not requiring medical intervention. This is the first study to examine the safety and efficacy of brexpiprazole augmentation in resistant OCD patients. Our findings show that brexpiprazole may be a promising and well-tolerated augmentation strategy for SRI-resistant OCD patients. However, further research in larger populations is needed to confirm these results and investigate the long-term safety and tolerability of brexpiprazole in OCD patients.

Internet-based, parent-led cognitive behavioral therapy for autistic youth with anxiety-related disorders: A randomized trial comparing email vs. telehealth support.

This study tested two versions of parent-led, Internet-delivered cognitive behavioral therapy for anxiety among autistic youth; one that provided weekly email support (iCBT-Email), and one that provided alternating bi-weekly emails and video calls (iCBT-Video) across 12 weeks. It was expected that those in the iCBT-Video condition would complete more treatment content, which in turn would lead to more anxiety improvement. Fifty-seven autistic youth (7-15 years-old) with anxiety disorders were randomized to iCBT-Email or iCBT-Video. There were no significant differences in improvement in clinician-rated, child-reported, or parent-reported anxiety severity or functional impairment. Posttreatment response rates were 55% in iCBT-Email and 67% in iCBT-Video. Module completion predicted improved treatment outcome, though there was no difference in module completion across groups. Therapists spent an average of 16.29 min/family/week (SD = 7.11) in the iCBT-Email condition and 24.13 min/family/week (SD = 6.84) in the iCBT-Video condition. Email and telehealth-supported, parent-led iCBT both appear to be effective treatments for autistic youth with anxiety disorders that require reduced therapist effort. Future research should seek novel methods to enhance engagement with iCBT content. CLINICALTRIALS.GOV IDENTIFIER: NCT05284435.

Psychometric attributes of the Dimensional Yale-Brown Obsessive-Compulsive Scale adapted in Bengali: A validation study in the Bengali-speaking population.

Introduction: Obsessive-compulsive disorder (OCD) is characterized by underlying obsessions and yielding/nonyielding compulsions, which often leads to significant levels of distress for the individual. Recently, obsessive-compulsive symptoms have been grouped into various symptom dimensions. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) gives a comprehensive picture regarding symptom severity in each individual dimension of OCD, while also providing a global severity score. Aims and Objectives: The psychometric properties of the Bengali adaptation of DY-BOCS have been assessed in this study. Material and Methods: A cross-sectional study was performed on 80 individuals suffering from OCD as per the ICD-10 DCR criteria. The Bengali version of the DY-BOCS and other scales for OCD, anxiety, and depression were administered to all of them. Inter-rater reliability was assessed for 34 individuals, and agreement between self and clinician-rated version of DY-BOCS was studied for 60 individuals. Internal consistency for items in a particular dimension of DY-BOCS, convergent validity, and divergent validity were also assessed. Results: Internal consistency was found to be excellent (Cronbach's α > 0.90 in all domains), and inter-rater reliability was found to be good to excellent for all the six dimensions of the DY-BOCS (intraclass correlation values >0.80 for aggressive and miscellaneous domains and >0.90 in all other domains). High correlation was found between self and clinician-rated versions of DY-BOCS for the age group 18-35 years, the highest correlations being found for the Contamination (r = 0.82) and Aggressive domains (r = 0.75), while it was found to decrease in the older age group. Convergent validity and divergent validity were found to be satisfactory. Conclusion: The psychometric attributes of the Bengali version of DY-BOCS appear to be satisfactory and thus can be reasonably administered to the population having Bengali as their mother tongue.

Harm avoidance and incompleteness core motivations in obsessive-compulsive disorder: validation of the Farsi version of the Obsessive-Compulsive Trait Core Dimensions Questionnaire (F-OC-TCDQ) in Iran.

BACKGROUND: Attention to the heterogeneous manifestations of obsessive-compulsive symptoms observed in clinical and nonclinical populations has motivated researchers to use tools to identify homogeneous subgroups of obsessive-compulsive disorder (OCD) patients. The Obsessive-Compulsive Trait Core Dimensions Questionnaire (OC-TCDQ) is used to evaluate two motivational dimensions of OCD (harm avoidance (HA) and incompleteness (INC)), which has been developed in recent years based on the core dimensions model, and to classify homogeneous subgroups. This study aimed to validate the Farsi version of the OC-TCDQ in Iran. METHODS: The psychometric properties of the OC-TCDQ were tested in two clinical samples (209 patients with OCD) and nonclinical samples (209 participants without OCD). Confirmatory factor analysis (CFA) was conducted to test the two-factor structure. The measurement invariance between the clinical and nonclinical groups was evaluated. Reliability was tested using Cronbach's alpha, split-half, and retesting (two-week intervals). Convergent and divergent validity were analysed with Pearson's correlation and the incremental validity of this scale in predicting Yale-Brown Obsession Scale (Y-BOCS) and Beck Anxiety Inventory (BAI) scores using hierarchical regression analysis. The discriminant validity of the two clinical and nonclinical groups was investigated with a t-test. RESULTS: Similar to the original version, the CFA showed a good fit for the two-factor structure. The invariance of measurement between samples, good internal consistency and retest reliability, and convergent and divergent validity of this scale were confirmed. The results of hierarchical regression analysis indicated the increasing validity of this scale in predicting the Y-BOCS and BAI compared to the OBQ-44 (p < 0.05), and comparing the scores of two groups with and without OCD indicated its discriminant validity (p < 0.01). CONCLUSION: These findings show that the Farsi-OC-TCDQ is a valid tool for evaluating the motivational dimensions of harm avoidance and incompleteness in Iranian individuals with and without OCD, and it allows us to compare the scores across groups.

Cognitive Rehabilitation for Adult Patients With Obsessive-compulsive Disorder: A Systematic Review of Randomized Controlled Trials.

Introduction: Obsessive-compulsive disorder (OCD) is a disabling mental condition. Many studies have shown that OCD patients have cognitive deficits in various aspects of their cognition, which is a worsening factor of symptom severity, a potential endophenotype, insight predictor, and prognostic indicator of OCD. We designed this systematic review to evaluate the clinical efficacy of cognitive rehabilitation in cognitive deficits and symptom severity of patients with OCD following the PRISMA guidelines. Methods: We searched PubMed, Scopus, ScienceDirect, Google Scholar, and Cochrane Library using the MeSH terms and keywords of 'cognitive rehabilitation' and 'obsessive-compulsive disorder'. The database search identified 200 records of interest, and then 105 duplicates were removed from them. From 95 remaining studies, six articles were eligible for the study and met the inclusion criteria. The six articles described individual RCT studies representing a wide variety of study designs. Results: The six included studies investigated the effect of "organizational training", "cognitive remediation", "attention splitting" and "goal management training" on cognitive impairments and symptom severity of OCD patients.There are a small number of studies with different designs and some biases that have examined the effectiveness of cognitive rehabilitation in OCD patients, with conflicting results regarding the effect of cognitive rehabilitation on OCD symptom severity or cognitive deficit. Conclusion: According to the results, we cannot conclude about the efficacy of cognitive rehabilitation in adults with OCD. Considering the importance of cognitive deficits in OCD patients, it is necessary to design and conduct standard trials to investigate the role of cognitive rehabilitation in these disorders.

Neuropsychological Functioning Among Patients with OCD in Asian Countries: A Systematic Review.

Objective: This systematic review aimed to identify the effect of obsessive compulsive disorder (OCD) on cognitive processes, such as memory, executive functioning, and cognitive flexibility, among the adult populations of Asian countries. Methods: The systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It is comprised of articles sourced from Asian countries published from 2018 to 2022, and literature about deficits in memory, executive functioning, and cognitive flexibility in the OCD population was gathered from five electronic databases, including Google Scholar, PubMed, Research Gate, Science Direct, and Wiley Online Library. Full-text impact factor articles in the English language were considered in this study. Results: This study screened 44 articles; five were included based on the eligibility criteria for the present systematic review. Four articles found cognitive deficits in the domains of executive functioning, memory, and cognitive flexibility among patients with OCD, whereas results of one article showed normal cognitive performance of the patients. Demographic variables showed no significant differences between patients with OCD and healthy controls. Conclusion: This systematic review indicated deficits specifically in the cognitive functioning and flexibility of patients with OCD. Despite a noticeable prevalence of OCD in Asian countries, the literature on correlates and neurological functioning is scarce. Further studies are required to examine the effects on the larger population and provide knowledge in those countries and areas where people are suffering because of minimal knowledge regarding OCD.

Metaanalysis of Repetitive Transcranial Magnetic Stimulation (rTMS) Efficacy for OCD Treatment: The Impact of Stimulation Parameters, Symptom Subtype and rTMS-Induced Electrical Field.

Background: Repetitive transcranial magnetic stimulation (rTMS) has recently demonstrated significant potential in treating obsessive-compulsive disorder (OCD). However, its effectiveness depends on various parameters, including stimulation parameters, OCD subtypes and electrical fields (EFs) induced by rTMS in targeted brain regions that are less studied. Methods: Using the PRISMA approach, we examined 27 randomized control trials (RCTs) conducted from 1985 to 2024 using rTMS for the treatment of OCD and conducted several meta-analyses to investigate the role of rTMS parameters, including the EFs induced by each rTMS protocol, and OCD subtypes on treatment efficacy. Results: A significant, medium effect size was found, favoring active rTMS (gPPC = 0.59, p < 0.0001), which was larger for the obsession subscale. Both supplementary motor area (SMA) rTMS (gPPC = 0.82, p = 0.048) and bilateral dorsolateral prefrontal cortex (DLPFC) rTMS (gPPC = 1.14, p = 0.04) demonstrated large effect sizes, while the right DLPFC showed a significant moderate effect size for reducing OCD severity (gPPC = 0.63, p = 0.012). These protocols induced the largest EFs in dorsal cognitive, ventral cognitive and sensorimotor circuits. rTMS protocols targeting DLPFC produced the strongest electrical fields in cognitive circuits, while pre-supplementary motor area (pre-SMA) and orbitofrontal cortex (OFC) rTMS protocols induced larger fields in regions linked to emotional and affective processing in addition to cognitive circuits. The pre-SMA rTMS modulated more circuits involved in OCD pathophysiology-sensorimotor, cognitive, affective, and frontolimbic-with larger electrical fields than the other protocols. Conclusions: While rTMS shows moderate overall clinical efficacy, protocols targeting ventral and dorsal cognitive and sensorimotor circuits demonstrate the highest potential. The pre-SMA rTMS appears to induce electrical fields in more circuits relevant to OCD pathophysiology.

Deep Brain Stimulation for Childhood Treatment-Resistant Obsessive-Compulsive Disorder: Mental Health Clinician Views on Candidacy Factors.

INTRODUCTION: Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS. OBJECTIVES: To explore mental health clinicians' views on what clinical and psychosocial factors they would consider when determining which children with OCD would be good DBS candidates. MATERIALS AND METHODS: In depth, semi-structured interviews were conducted with n = 25 mental health clinicians who treat pediatric patients with OCD. The interviews were transcribed, coded, and analyzed using thematic content analysis. Three questions focused on key, clinical, and psychosocial factors for assessing candidacy were analyzed to explore respondent views on candidacy factors. Our analysis details nine overarching themes expressed by clinicians, namely the patient's previous OCD treatment, OCD severity, motivation to commit to treatment, presence of comorbid conditions, family environment, education on DBS, quality of life, accessibility to treatment, and patient age and maturity. CONCLUSIONS: Clinicians generally saw considering DBS treatment in youth as a last resort and only for very specific cases. DBS referral was predominantly viewed as acceptable for children with severe TR-OCD who have undertaken intensive, appropriate treatment without success, whose OCD has significantly reduced their quality of life, and who exhibit strong motivation to continue treatment given the right environment. Appropriate safeguards, eligibility criteria, and procedures should be discussed and identified before DBS for childhood TR-OCD becomes practice.

Glutamate dynamics and BOLD response during OCD symptom provocation in the lateral occipital cortex: A 7 Tesla fMRI-fMRS study.

Obsessive-compulsive disorder (OCD) is linked with dysfunction in frontal-striatal, fronto-limbic, and visual brain regions. Research using proton magnetic resonance spectroscopy (1H-MRS) suggests that altered neurometabolite levels, like glutamate, may contribute to this dysfunction. However, static neurometabolite levels in OCD patients have shown inconsistent results, likely due to previous studies' limited focus on neurometabolite dynamics. We employ functional MRS (fMRS) and functional magnetic resonance imaging (fMRI) to explore these dynamics and brain activation during OCD symptom provocation. We utilized a combined 7-tesla fMRI-fMRS setup to examine task-related BOLD response and glutamate changes in the lateral occipital cortex (LOC) of 30 OCD participants and 34 matched controls during an OCD-specific symptom provocation task. The study examined main effects and between-group differences in brain activation and glutamate levels during the task. A whole sample task-effects analysis on data meeting predefined quality criteria showed significant glutamate increases (n = 41 (22 OCD, 19 controls), mean change: 3.2 %, z = 3.75, p < .001) and task activation (n = 54 (26 OCD, 28 controls), p < .001) in the LOC during OCD blocks compared to neutral blocks. However, no differences in task-induced glutamate dynamics or activation between groups were found, nor a correlation between glutamate levels and task activation. We were able to measure task-induced increases in glutamate and BOLD levels, emphasizing its feasibility for OCD research. The absence of group differences highlights the need for further exploration to discern to what extent neurometabolite dynamics differ between OCD patients and controls. Once established, future studies can use pre-post intervention fMRS-fMRI to probe the effects of therapies modulating glutamate pathways in OCD.

Distinct cognitive and functional connectivity features from healthy cohorts can identify clinical obsessive-compulsive disorder.

Improving diagnostic accuracy of obsessive-compulsive disorder (OCD) using models of brain imaging data is a key goal of the field, but this objective is challenging due to the limited size and phenotypic depth of clinical datasets. Leveraging the phenotypic diversity in large non-clinical datasets such as the UK Biobank (UKBB), offers a potential solution to this problem. Nevertheless, it remains unclear whether classification models trained on non-clinical populations will generalise to individuals with clinical OCD. This question is also relevant for the conceptualisation of OCD; specifically, whether the symptomology of OCD exists on a continuum from normal to pathological. Here, we examined a recently published "meta-matching" model trained on functional connectivity data from five large normative datasets (N=45,507) to predict cognitive, health and demographic variables. Specifically, we tested whether this model could classify OCD status in three independent clinical datasets (N=345). We found that the model could identify out-of-sample OCD individuals. Notably, the most predictive functional connectivity features mapped onto known cortico-striatal abnormalities in OCD and correlated with genetic brain expression maps previously implicated in the disorder. Further, the meta-matching model relied upon estimates of cognitive functions, such as cognitive flexibility and inhibition, to successfully predict OCD. These findings suggest that variability in non-clinical brain and behavioural features can discriminate clinical OCD status. These results support a dimensional and transdiagnostic conceptualisation of the brain and behavioural basis of OCD, with implications for research approaches and treatment targets.

TMS-induced plasticity improving cognitive control in OCD II: Task-based neural predictors of treatment response.

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) has the potential to increase the clinical effect of exposure with response prevention (ERP) psychotherapy for obsessive-compulsive disorder (OCD). We investigated the use of task-based functional MRI (tb-fMRI) for predicting clinical outcomes to different rTMS protocols combined with ERP in OCD. METHOD: 61 adults with OCD underwent rTMS and ERP and were randomized to different high frequency rTMS conditions: left dorsolateral prefrontal cortex (DLPFC; n=19), left pre-supplementary motor area (preSMA; n=23), and control stimulation at the vertex at low intensity (n=19). The Tower of London task and Stop-Signal Task were used to assess pretreatment activation during planning and inhibitory control, respectively. We adopted a Bayesian region-based approach to test whether clinical improvement can be predicted by tb-fMRI-derived measures of task-related brain activation or functional connectivity between task-relevant regions and the bilateral amygdala. RESULTS: For the vertex group, but not the DLPFC/preSMA rTMS conditions, higher activation in several task-relevant regions during planning and response inhibition, and lower error-related activation, corresponded with better short-term clinical improvement. Lower precuneus activation with increased planning taskload correlated with symptom reduction in the DLPFC group. In the preSMA group, higher error-related activation and lower inhibition-related insular-amygdalar connectivity was associated with symptom reduction. CONCLUSIONS: Pretreatment tb-fMRI-derived measures of activation and connectivity during planning and inhibition-related processes are associated with clinical response for specific rTMS conditions in OCD. Future placebo-controlled trials with larger sample sizes should combine clinical information and neural correlates to improve prediction of clinical outcome.

The Effect of Brainwave Synchronization Using Binaural Beats on Improving Working Memory and Reducing the Severity of Symptoms in Women With Obsessive-compulsive Disorder.

Introduction: Binaural beats are one of the new methods of brainwave synchronization. However, there is little knowledge about its clinical applications. The positive effect of this method on executive functions, such as attention and working memory, in the γ band has been mainly confirmed in healthy individuals. Still, its effectiveness on disorders such as obsessive-compulsive disorder (OCD), with a prominent cognitive profile, has not been established. Therefore, the present study was conducted to examine the effect of binaural beats on working memory and the severity of OCD symptoms in the γ band in the affected women. Methods: Twenty-nine OCD women aged 25-40 years referring to psychological clinics in Tehran City, Iran, were selected by convenience sampling. After completing the symptom checklist 90 (SCL90) and the Yale-Brown severity scale (SS), the participants were given the Wechsler memory scale (WMS) digit repetition subtests. Then, they were randomly assigned to the experimental (n=15) and control (n=14) groups. The audio file of the binaural beats in the γ band was provided to the experimental group. The participants in the control group listened to the normal (no-wave) audio file. Both groups listened to the audio files for two weeks, three times a week, for 30 minutes each time. The Yale-Brown SS and digit repetition in post-test and one-month follow-up periods were obtained from both groups. Results: According to the results, the severity of OCD symptoms was significantly reduced in the post-test and follow-up stages by the γ binaural beats (P<0.05). Also, the working memory function was improved, although it was not statistically significant (P>0.05). Conclusion: The results of this study show that binaural beats can be used as a complementary treatment to reduce the severity of OCD symptoms. Also, it seems that the patients' working memory is strengthened with this method.

A concentrated approach for treating OCD: a pilot study examining the feasibility and potential effectiveness of the Bergen Four Day Treatment in the U.S.

The Bergen Four Day Treatment (B4DT) is a concentrated treatment for OCD that has demonstrated promising effectiveness in Nordic country samples. The B4DT is delivered over four days and provides individual treatment in a group context. The effectiveness of the B4DT for OCD has not been tested outside Nordic countries. The current pilot study evaluated the feasibility and the potential effectiveness of B4DT in a different culture and health-care system in the United States. Findings from 48 adults with OCD who completed the B4DT indicated that OCD, anxiety, and depression symptom severity significantly decreased from pre- to post-treatment, and gains were maintained at six month follow-up. The Yale-Brown Obsessive Compulsive Scale scores were reduced from moderate to subclinical; specifically, the average scores of 27.0 (pre-treatment) fell to 11.7 (post-treatment), 12.7 (3-month follow-up), and 13.7 (6-month follow-up). The B4DT was rated as highly acceptable by the US patients. Over 95% of the patients stated that they would recommend the treatment to a friend. These findings provide the first preliminary evidence for the generalizability of the B4DT to patients outside Nordic countries. Cultural and context-dependent issues that affected this dissemination pilot study are discussed in addition to future clinical and research directions.

Advances in Pediatric Obsessive-Compulsive Disorder (OCD) Treatment: A Comprehensive Narrative Review.

Obsessive-compulsive disorder (OCD), characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions), can significantly impact a child's daily functioning, academic performance, and overall quality of life. As the prevalence of pediatric OCD continues to rise, there is a critical demand for evidence-based treatments that not only alleviate symptoms but also enhance the quality of life for affected children and adolescents. By identifying gaps in knowledge and suggesting directions for future research, this narrative review contributes to the ongoing discourse on pediatric OCD treatments. Ultimately, the synthesis of evidence aims to enhance our understanding and inform best practices in the compassionate and effective management of OCD in children and adolescents. The aim of this study is to provide a comprehensive overview of current trends and emerging strategies in the treatment of pediatric obsessive-compulsive disorder (OCD) and highlights the significance of tailoring treatment approaches to individual patient needs, considering factors such as symptom severity and treatment response. Concentrating on interventions supported by empirical evidence, the review delves into cognitive-behavioral therapy (CBT), pharmacotherapy, the synergistic effects of these modalities, and inventive therapeutic approaches, all while considering the distinctive developmental aspects pertinent to pediatric populations. We conducted this review by searching for titles in the PubMed database from 2013 to present. Our comprehensive literature review focused on advancements in treating pediatric OCD, using keywords like "Obsessive-compulsive disorder," "Pediatric," "treatment," "CBT," "SSRI," "Pharmacotherapy," and "combination therapy." While both pharmacotherapy and CBT show individual efficacy, the combination of these approaches appears to be more effective, especially for medication non-responders with no prior exposure to CBT, despite some mixed findings. These findings contribute significantly to the ongoing discussion on optimizing combined therapy strategies tailored to the complexities of pediatric OCD.

Deep brain stimulation for obsessive compulsive disorder: the functional neurosurgeon armamentarium.

Deep brain stimulation (DBS) is a neurosurgical procedure that utilizes implanted electrodes and electrical stimulation for the treatment of neurological disorders. In cases where patients present with severe functional impairment while being refractory to less invasive treatment options, DBS is considered "gold standard." Still, DBS-related work is still widely under investigation, with ethical issues arising that may impact a patient's physical and psycho-social status. These include patient selection, informed consent, patient autonomy, pre-operation counseling and professional psycho-social preparation and follow-up support. Bioethicists and philosophers have increasingly worked together with in clinicians and researchers to identify, address and present ethical consideration in both clinical practice and research to balance the risk-benefit ratio in DBS treatment for obsessive-compulsive disorder.

A prospective longitudinal investigation of the trajectory of obsessive-compulsive symptoms during adolescence.

Obsessive-compulsive symptoms (OCS) increase with age during childhood and adolescence, and subthreshold OCS in childhood associate with a higher probability of obsessive-compulsive disorder (OCD) diagnosis in adulthood. Additionally, average age of onset for OCD is in adolescence, with the majority of OCD cases emerging by early adulthood. Despite these trends, the specific course of OCS development in adolescence is relatively unknown. To this end, the present prospective longitudinal study used latent growth mixture modeling and a diverse community sample of 3,335 high schoolers to identify and characterize growth trajectories of OCS across middle to late adolescence. Results identified three trajectories: High-but-Remitting, Moderate-but-Escalating, and Low-and-Stable. Results also indicated age, gender, anxiety sensitivity, and distress tolerance as significant predictors of trajectory group membership, such that younger age and being female predicted classification in the High-but Remitting group, greater anxiety sensitivity predicted classification in both the High-but-Remitting and Moderate-but Escalating groups, and greater distress tolerance predicted a lower likelihood of classification in the High-but-Remitting and Moderate-but-Escalating groups. Taken together, these trajectories have illustrated the temporal course and development of OCS across key developmental years. Moreover, the trajectories and their corresponding predictors may help identify adolescents who are particularly vulnerable to developing OCD.

Disgust as a primary emotional system and its clinical relevance.

This paper advocates for considering disgust as a primary emotional system within Panksepp's Affective Neuroscience framework, which has the potential to improve the efficacy of psychotherapy with obsessive-compulsive disorder, hypochondriasis, and emetophobia. In 2007, Toronchuk and Ellis provided comprehensive evidence that DISGUST system, as they defined it, matched all Panksepp's criteria for a primary emotional system. A debate ensued and was not unambiguously resolved. This paper is an attempt to resume this discussion and supplement it with the data that accumulated since then on DISGUST's relationship with the immune system and the role of DISGUST dysregulation in psychopathology. We hope that renewed research interest in DISGUST has the potential to improve clinical efficacy with hard-to-treat conditions.