ØCD: protocol for the development and evaluation of a cognitive-behavioral prevention program for obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) imposes significant burdens on individuals, families, and healthcare systems and the COVID-19 pandemic appears to have exacerbated OCD symptoms. Currently, there are no validated prevention programs for OCD, highlighting a critical gap in mental health services. This study aims to develop and validate the first ØCD prevention program, for at-risk adults, utilizing cognitive-behavioral therapy (CBT) and exposure response prevention (ERP) techniques. METHODS: A single-blind, randomized controlled trial comparing the ØCD prevention program to a waitlist control group will be conducted. Participants, at-risk adults (18-65 years) with subclinical OCD symptoms (OCI-R score ≥ 12), will be recruited for the study. The ØCD prevention program compresise of six online group sessions incorporating CBT and ERP techniques over three modules. The primary outcomes are OCD symptom severity (measured by the Obsessive-Compulsive Inventory- revised form; OCI-R), depression symptoms (measured by the Patient Health Questionnaire; PHQ-9), and anxiety symptoms (measured by the Generalised Anxiety Disorder 7-item; GAD-7). Secondary outcomes include OCD-related beliefs, experiential avoidance, resilience, quality of life, uncertainty intolerance, automatic thoughts, and distress. Outcome measures will be collected at baseline, at completion of the intervention, and one year later (follow-up). At follow-up, we will also analyze the OCD diagnostic incidence, using the Structured Clinical Interview for DSM-5. We will employ a multivariate analysis of variance (MANOVA) to explore whether significant differences exist between groups across dependent variables. To compare the OCD incidence levels from the pre-test to the follow-up we will use the chi-squared test. DISCUSION: The present study may contribute novel data on the efficacy of OCD prevention approaches, leading to the development of an evidence-based OCD prevention program that could alleviate individual and societal burdens associated with OCD. TRIAL REGISTRATION: This trial was approved by the University Ethical Review Authority (937/ 28.11.2023) at Babeș-Bolyai University and is registered on clinicaltrials.gov (ID: NCT06262464).

Pedophilia-Themed Obsessive-Compulsive Disorder: Assessment, Differential Diagnosis, and Treatment with Exposure and Response Prevention.

Fears of sexually harming children are fairly common among clients suffering from obsessive-compulsive disorder (OCD), yet these symptoms are largely unrecognized and frequently misdiagnosed by mental health professionals. Specifically, clients with pedophilia-themed OCD (P-OCD) experience excessive worries and distressing intrusive thoughts about being sexually attracted to, and sexually violating, children. Expressing these concerns may provoke misjudgments from uninformed mental health professionals that a client is presenting instead with pedophilic disorder. This misdiagnosis and subsequent improper interventions can then contribute to increased fear, anxiety, and in many cases, depression, in affected clients. Therefore, it is imperative that mental health professionals first possess a good understanding of this common manifestation of OCD. As such, in this article, we described obsessions and compulsions typical of P-OCD, in order to inform the reader of the distinctive differences between P-OCD and pedophilic disorder. Information about how to assess for P-OCD symptoms is then provided, followed by suggestions on how to tailor aspects of exposure and response prevention to treat this specific form of OCD.

The Relationship between Obsessive Compulsive Personality and Obsessive Compulsive Disorder Treatment Outcomes: Predictive Utility and Clinically Significant Change.

BACKGROUND: The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. AIMS: We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. METHOD: The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. RESULTS: OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. CONCLUSION: This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.

Long-term efficacy of Internet-based cognitive behavior therapy for obsessive-compulsive disorder with or without booster: a randomized controlled trial.

BACKGROUND: As relapse after completed cognitive behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is common, many treatment protocols include booster programs to improve the long-term effects. However, the effects of booster programs are not well studied. In this study, we investigated the long-term efficacy of Internet-based CBT (ICBT) with therapist support for OCD with or without an Internet-based booster program. METHOD: A total of 101 participants were included in the long-term follow-up analysis of ICBT. Of these, 93 were randomized to a booster program or no booster program. Outcome assessments were collected at 4, 7, 12 and 24 months after receiving ICBT. RESULTS: The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments, with large within-group effect sizes (Cohen's d = 1.58-2.09). The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline (4 months) to 7 months, but not at 12 or 24 months. Participants in the booster group improved significantly in terms of general functioning at 7, 12 and 24 months, and had fewer relapses. Kaplan-Meier analysis also indicated a significantly slower relapse rate in the booster group. CONCLUSIONS: The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients.

Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial.

Many patients with obsessive-compulsive disorder (OCD) do not receive cognitive behavioral therapy with exposure and response prevention (first line treatment for OCD), for example, due to patients' fear of the exposure and reservations of the therapists. Technology-supported exposure (e.g., exposure therapy with response prevention in mixed reality [MERP]) for patients with OCD may help to overcome this obstacle. Building upon findings of our pilot study objectives of this study are to evaluate the efficacy, expectations of treatment success, feasibility, and acceptance of MERP as well as to identify possible limitations. In total, 64 outpatients with contamination-related OCD will be recruited and randomized to one of two conditions: MERP (six sessions in six weeks) and self-guided exposure therapy (six exercises in six weeks). Participants will be assessed before (baseline), after the six-week intervention period (post), as well as three months after post assessment (follow-up) regarding symptomatology (Yale-Brown Obsessive Compulsive Scale; Y-BOCS), their subjective evaluation of MERP (acceptance) and sense of presence. The planned study is the first to investigate MERP in patients with OCD.

Retrospective reports of the development of obsessive compulsive disorder: extending knowledge of the protracted symptom phase.

BACKGROUND: In contrast to a wealth of research on the treatment of Obsessive Compulsive Disorder (OCD), there is a relative paucity of work examining how OCD begins. Available data suggest that there is often a slow progression from the onset of symptoms to meeting criteria for a diagnosis of OCD. AIMS: The current study sought to add to existing data documenting the slow-development of OCD, and to extend previous findings by examining potential moderators of this symptom phase and to examine patients' explanations for the transition from symptoms to disorder. METHOD: One hundred and ninety-nine individuals with OCD reported on the start of their symptoms and the disorder via an internet-based survey. RESULTS: Over two-thirds of respondents reported that the development of their OCD was gradual. Further, participants reported having experienced obsessions and/or compulsions for an average of 5 years before experiencing full-blown OCD. This extended symptom phase was observed in individuals with early- and late-onset OCD, with an even more protracted symptom phase in the later group. Female gender and onset of compulsions prior to obsessions were also associated with slower progression to full-blown OCD. Finally, explanations for the transition from symptoms to disorder suggest that changes in daily routines and general stress may be particularly important in this transition for individuals that develop clinical OCD at age 18 or later. CONCLUSIONS: Existence of a protracted symptom phase may present opportunities for elucidating risk factors for OCD disease progression and a window of opportunity for indicated prevention programs.

Combination of aripiprazole and ethanol attenuates marble-burying behavior in mice.

Obsessive-Compulsive Disorder (OCD) is characterized by absurd, recurrent thoughts (obsessions) followed by certain stereotyped actions (compulsions). 5-Hydroxytryptamine (5-HT) abnormalities may be involved in OCD, and further, cause changes in serotonergic transmission that may have direct or indirect effects on the neuronal firing of other neuromodulators affecting thoughts, feelings and behaviors. Serotonin-related genes that are found in OCD include those coding for the 5-HT transporter (5-HTT) and receptors (5-HT(2A), 5-HT(2B), 5-HT(2C) and 5-HT(1B)) as well the 5-HT enzyme tryptophan hydroxylase. OCD can impair all areas of brain functioning and produce devastating effects on patients and their families. Marble-burying behavior of mice has been employed to study anxiety disorders, including the OCD. The aim of this study was to test the efficacy of aripiprazole and alcohol per se and in combination on marble-burying behavior of mice. A total of 114 male Swiss mice divided in 19 groups were studied. Aripiprazole (0.1 mg/kg, i.p.) per se as well as ethanol (0.1% w/v) per se did not show any anti-compulsive activity. But the combination comprising of ineffective doses of aripiprazole (0.1 mg/kg, i.p.) and ethanol (0.1% w/v) showed significant anti-compulsive activity as reflected by inhibition of marble-burying behavior.

Resisting the ritual.

People with obsessive compulsive disorder are plagued with repetitive, intrusive thoughts. But with increasing access to cognitive behavioural therapy, treatment is more available.

[Classification of OCD in terms of response to behavior therapy, manner of onset, and course of symptoms].

Obsessive-compulsive disorder (OCD) is a heterogeneous disease in terms of manner of onset, dimension of symptoms, and responses to psychological or pharmacological treatments. This paper groups cases of OCD into "effective" and "ineffective" types, based on their responses to exposure and response prevention (ERP). In the next phase, cases in the "effective" category were further broken down into Type A, characterized as readily responding to ERP, and Type B, characterized as not readily responding to ERP. Factors associated with Type B include: 1) below-average intelligence, 2) co-morbidity of other mental disorders, 3) insufficient recognition of irrationality of OCD symptoms, 4) significant difficulties in daily life, 5) insufficient motivation to follow through with ERP, and 6) other personal problems. This paper discusses possible strategies for addressing these factors, and thereby increasing the potential effectiveness of ERP. Next, this paper describes the characteristics and treatment of obsessional slowness as a typical type for which ERP is ineffective. Finally, this paper examines the process of distinguishing between OCD and other mental disorders that do not respond to ERP in spite of showing OC symptoms.

[Problem and pathological gambling. Epidemiology and prevention]. / Problematisches und pathologisches Spielverhalten bei Glücksspielen. Epidemiologie und Prävention.

With the expansion of the German gambling market, questions emerge concerning the magnitude of gambling-related problems in the general population and the effectiveness of preventive measures. Current prevalence rates of problem and pathological gambling range from 0.29-0.64% and 0.19-0.56%, respectively. In an international comparison, which is complicated by different methodological approaches of the primary studies, the rates fall at the lower end of the spectrum. In general, an increasing availability of gambling is connected with rising consumption among the population as well as--at least temporarily--with a growing number of gambling addicts. Whether the prevalence rate stabilizes at a certain level or even leads to a decrease after a gradual social adaption needs to be empirically evaluated. From the public health perspective, a gambling market that is strictly regulated by a state monopoly should be established to prevent targeted stimulation of demand and to implement effective safeguards. A preliminary evaluation of prevention measures can only be based on limited findings and, therefore, also has to focus on evidence on other harmful products such as alcohol and tobacco. For the sector of amusement with prize machines, direct interventions into structural characteristics and availability are recommended.

[Pathological gambling and computergame-addiction. Current state of research regarding two subtypes of behavioural addiction]. / Pathologisches Glücksspiel und Computerspielabhängigkeit. Wissenschaftlicher Kenntnisstand zu zwei Varianten substanzungebundener Abhängigkeitserkrankungen.

Behavioral addictions, like pathological gambling and computer game addiction (or internet addiction), have become a growing concern in research and public interest. Currently similarities between behavioral addictions and substance dependency are controversially discussed in the scientific community. Unfortunately a mismatch exists between the large number of people seeking treatment and the small number of scientific studies on pathological gambling and computer game addiction. Prevalence of pathological gambling among the German population is estimated to be 0.2-0.5%. These estimations are comparable to prevalence rates reported for drug dependency. Latest research states that about 3% of German adolescents and young adults are believed to suffer from computer game addiction. Therefore, it is important to enhance investigations regarding the clinical and neuroscientific basis of computer game addiction. This review offers a summary of current results of research regarding pathological gambling and internet addiction. The phenomenological description of these two disorders is meant to allow a deeper understanding of behavioral addictions.

COVID-19 and OCD: Potential impact of exposure and response prevention therapy.

This brief clinical review critically assesses the use of exposure and response prevention therapy (ERP) for patients with obsessive-compulsive disorder (OCD) in light of the COVID-19 pandemic. We discuss the ethical and practical considerations that clinicians employed in past infectious disease outbreaks, as well as general safety measures routinely practiced in the conduct of exposure therapy. During this time, concerns regarding the feasibility of ERP have emerged, especially with strict guidelines on social distancing and on following other preventative behaviors. While ERP may have to be modified to follow public health guidelines, this review outlines a) how ERP has been adapted in the context of other infectious triggers; b) the potential impacts on OCD patients of attenuated ERP, and c) minimizing concerns related to litigation. A case report is provided detailing ERP personalized given COVID-19 related considerations. In all, we advise against modifying therapies in ways that may jeopardize the efficacy of patient care or progress.

Treatment of monozygotic twins with obsessive compulsive disorder using cognitive therapy and exposure with ritual prevention.

BACKGROUND: Assessment and treatment of cohabiting monozygotic (MZ) twins with obsessive compulsive disorder (OCD) is a possible challenge for clinical psychologists. AIMS: This study aims to present a detailed history of two sets of cohabiting MZ twins with OCD, and describe the adaption of cognitive behavior therapy in their treatments. METHOD: Two sets of cohabiting MZ twins completed a structured intake and the Yale Brown Obsessive Compulsive Scale as well as measures of depression, anxiety, a measure of obsessive beliefs, and thought action fusion. One set received cognitive behavior therapy and exposure with ritual prevention (ERP) simultaneously and the other received ERP separately. Pre-, post-treatment and follow-up assessments occurred for both sets of twins. RESULTS: All four individuals showed notable decreases in OCD, and results were maintained for three of the four participants at follow-up points. CONCLUSIONS: This study highlights the developmental course of OCD that can occur in cohabiting twins, and the clinical adaption that may be necessary.

Early intervention for obsessive compulsive disorder: An expert consensus statement.

Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.

Compulsive Digital Gaming: An Emerging Mental Health Disorder in Children.

Excessive digital gaming is emerging as a mental health disorder because youngsters are losing control of their lives by wasting their time by indulging in online multiplayer games. The popularity of the games can be gauged by the fact that India's online gaming market of US $360 million is expected to grow to $ 1 billion by 2021. Video gaming is an obsessive compulsive disorder. The players enjoy creating and building relationships with other online characters, which provides a virtual community feeling at the expense of one-to-one social interactions and real life bonding. In due course of time, the players are preoccupied or "hooked" to the games and display mood swings like irritability, restlessness, and aggressive behavior when they are denied the playing gadgets. Realizing the multifarious health hazards of digital gaming, WHO has recently classified it as a mental health disorder in the 11th revision of its International Classification of Diseases (ICD-11) so that it is accorded the state health benefits for its prevention and treatment. The technology is both a boon as well as a bane, the option is with us. It is important to avoid all obsessions or compulsions in life in order to follow the philosophy of "middle path".

[Othorexia: A new type of Eating Disorder?] / L'orthorexie : une nouvelle forme de trouble des conduites alimentaires ?

Othorexia Nevrosa is defined as an obsessive though regarding healthy food consumption, food properties and cooking tools. Orthorexia Nevrosa is not mentioned in the psychiatric nosography and is not considered as a disorder. While no formal diagnostic criteria currently exist, screening tools have been developed to explore characteristics of Orthorexia Nevrosa. While Orthorexia Nevrosa has specific characteristics, an overlapping exists with Eating Disorders (ED) and Obsessive Compulsive Disorder (OCD) symptoms.

Brief report: exposure and response prevention for obsessive compulsive disorder in a 12-year-old with autism.

Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2% of children with ASD are also diagnosed with OCD. Although there is extensive research demonstrating the effectiveness of behavioral interventions for pediatric OCD, little is known about how effective these treatments are for children who have a dual diagnosis of OCD and ASD. This report describes a 12-year-old male with Autism who was treated successfully with cognitive behavioral therapy with exposure and response prevention. This case study provides initial support that cognitive-behavioral therapy is effective in symptom reduction for children with comorbid autism and OCD.

[Obsessive-compulsive disorder]. / Obsessieve-compulsieve stoornis.

Obsessive-compulsive disorder is a complex psychiatric disorder characterised by obsessions and/or compulsions. Obsessive-compulsive disorder has a relatively high prevalence and is a highly disabling disease. The disorder is associated with shame, which causes long delays in accessing treatment. Obsessive-compulsive disorder is caused by a complex interplay between genetic and environmental factors. Effective treatments exist in the form of either pharmacotherapy--clomipramine or selective serotonin reuptake inhibitors--or cognitive behaviour therapy.

A call for prevention and early intervention in obsessive-compulsive disorder.

BACKGROUND: Evidence suggests that many people with obsessive-compulsive disorder (OCD) have subclinical symptoms years before the development of their disorder and that early treatment may reduce its severity. AIM: To explore prevention and early intervention strategies for OCD. METHODS: A narrative literature review was conducted. RESULTS: The literature in relation to the prevention of OCD is sparse. Genetic and environmental factors appear to be relevant to the aetiology of OCD, for example, the observation that hoarding symptoms and contamination/cleaning symptoms are more likely to also be present in first-degree relatives. Psychoeducation and the reduction of family accommodation, that is the act of parents, siblings or partners accommodating to the high-risk individual's requests to comply with their compulsions, are promising areas for prevention and early intervention in high-risk groups. Tertiary prevention has also been limited by an inadequate number of trained clinicians to deliver evidence-based treatments. CONCLUSIONS: Much more research is needed in relation to the prevention of OCD. There is limited scope for primary prevention with respect to biological aetiological factors, but there is potential for strategies addressing environmental factors (eg, family factors). The effectiveness of psychoeducation for parents with OCD as a primary prevention strategy for OCD in their children requires scientific evaluation. Improving access to effective treatments for OCD would also improve tertiary prevention.