Higher order compulsivity versus grooming dimensions as treatment targets for the DSM-5 obsessive-compulsive and related disorders.

BACKGROUND: Transdiagnostic definitions of obsessive-compulsive and related disorders (OCRDs) may represent useful treatment targets. The current study sought to characterize higher order dimensions underpinning the OCRDs in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, and examine their course during treatment. METHODS: Adult patients (N = 407) completed measures of OCRDs, depression, and worry before and after intensive/residential treatment for OCRDs. Structural equation modeling was used to examine the comorbidity structure and temporal course of the symptoms. RESULTS: Covariation of the symptoms was best represented by three dimensions: distress (depression and worry), compulsivity (obsessive-compulsive disorder, hoarding, and body dysmorphia), and grooming (hair pulling and skin picking). Latent change score modeling revealed significant reduction in the means of all three dimensions across treatment (Cohen's ds = -1.04, -0.62, and -0.23 for distress, compulsivity, and grooming, respectively). There was a strong correlation between change in compulsivity and grooming (r = .67) and change in compulsivity and distress (r = .80), but a small correlation between change in grooming and distress (r = .35). CONCLUSIONS: The results indicate that OCRDs are underpinned by higher order compulsivity and grooming dimensions that differ in their association with distress. The results further suggest that the two dimensions may reflect promising intervention targets suitable for transdiagnostic treatment protocols.

Family Accommodation in Intensive/Residential Treatment for Adults With OCD: A Cross-Lagged Panel Analysis.

Many adults with OCD experience residual symptoms following CBT, with or without medication. A potential target for enhancing treatment effectiveness is family accommodation (FA). This study examined (1) possible sociodemographic and clinical correlates of FA in adults presenting for intensive/residential treatment, and (2) temporal relationships between FA and OCD symptom severity during acute treatment and follow-up phases. Adult patients (N = 315) completed baseline measures of FA and OCD symptom severity at admission to IRT. Follow-up data were collected from a subset of participants (n = 111) at discharge, 1-month, and 6-month follow-up. Cross-lagged panel analysis showed that changes in OCD symptom severity from admission to discharge predicted changes in FA from discharge to 1-month follow-up. Increases in FA from discharge to 1-month follow-up predicted increases in OCD symptom severity from 1-month to 6-month follow-up. Female patients reported greater baseline FA from their family members than did males, and there were no significant differences in FA by relationship type or marital status. Contamination, Responsibility for Harm, and Symmetry/Incompleteness symptoms were each found to uniquely predict FA at admission. Results from this study provide support for the temporal precedence of FA reduction in OCD symptom improvement as adults transition home following residential treatment.

Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders.

Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.

Feasibility and Acceptability of Cognitive Bias Modification for Interpretation as an Adjunctive Treatment for OCD and Related Disorders: A Pilot Randomized Controlled Trial.

Cognitive models implicate interpretation bias in the development and maintenance of obsessive compulsive and related disorders (OCRDs), and research supports Cognitive Bias Modification for Interpretation (CBM-I) in targeting this mechanism. However, prior studies in OCRDs have been limited to nonclinical populations, adolescents, and adults in a laboratory setting. This study evaluated the feasibility and acceptability of CBM-I as an adjunctive intervention during intensive/residential treatment (IRT) for adults with OCRDs. We modified a lab-based CBM-I training for adults seeking IRT for OCRDs, and conducted a feasibility trial (N = 4) and subsequent pilot RCT; participants (N = 31) were randomized to receive CBM-I or psychoeducation. Benchmarks were met for feasibility, acceptability, and target engagement. From pre- to post-intervention, the CBM-I group showed a large effect for change in interpretation bias (d = .90), whereas this effect was trivial (d = .06) for psychoeducation. This was the first study to evaluate CBM-I in naturalistic treatment for adults seeking IRT for OCRDs. Findings support the feasibility and acceptability of CBM-I in this novel sample and setting. A larger scale RCT is needed to determine whether CBM-I can enhance OCRD treatment response.

Evaluation of efficacy and human health risk of aerial ultra-low volume applications of pyrethrins and piperonyl butoxide for adult mosquito management in response to West Nile virus activity in Sacramento County, California.

The Sacramento and Yolo Mosquito and Vector Control District (SYMVCD, also referred to as "the District") conducts surveillance and management of mosquitoes in Sacramento and Yolo counties in California. Following an increase in numbers and West Nile virus (WNV) infection rates of Culex tarsalis and Culex pipiens, the District decided on July 26, 2007, to conduct aerial applications of Evergreen EC 60-6 (60% pyrethrins: 6% piperonyl butoxide) over approximately 215 km2 in the north area of Sacramento County on the nights of July 30, July 31, and August 1, 2007. At the same time, the District received notification of the first human WNV case in the area. To evaluate the efficacy of the applications in decreasing mosquito abundance and infection rates, we conducted pre- and post-trapping inside and outside the spray zone and assessed human health risks from exposure to the insecticide applications. Results showed a significant decrease in abundance of both Cx. tarsalis and Cx. pipiens, and in the minimum infection rate of Cx. tarsalis. Human-health risks from exposure to the insecticide were below thresholds set by the US Environmental Protection Agency.

Delayed Bedtimes Are Associated With More Severe Obsessive-Compulsive Symptoms in Intensive Residential Treatment.

Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment-however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.

Risk factors associated with human infection during the 2006 West Nile virus outbreak in Davis, a residential community in northern California.

We collected a total of 15,329 mosquitoes during weekly sampling in Davis, CA, from April through mid-October 2006 at 21 trap sites uniformly spaced 1.5 km apart over an area of approximately 26 km(2). Of these mosquitoes, 1,355 pools of Culex spp. were tested by multiplex reverse transcriptase-polymerase chain reaction, of which 16 pools (1.2%) were positive for West Nile virus (WNV). A degree-day model with a developmental threshold of 14.3 degrees C accurately predicted episodic WNV transmission after three extrinsic incubation periods after initial detection. Kriging interpolation delineated that Culex tarsalis were most abundant at traps near surrounding agriculture, whereas Cx. pipiens clustered within residential areas and greenbelt systems in the old portion of Davis. Spatial-temporal analyses were performed to test for clustering of locations of WNV-infected dead birds and traps with WNV-positive Cx. tarsalis and Cx. pipiens; human case incidence was mapped by census blocks. Significant multivariate spatial-temporal clustering was detected among WNV-infected dead birds and WNV-positive Cx. tarsalis, and a WNV-positive Cx. pipiens cluster overlapped areas with high incidences of confirmed human cases. Spatial analyses of WNV surveillance data may be an effective method to identify areas with an increased risk for human infection and to target control efforts to reduce the incidence of human disease.

Impact of aerial spraying of pyrethrin insecticide on Culex pipiens and Culex tarsalis (Diptera: Culicidae) abundance and West Nile virus infection rates in an urban/suburban area of Sacramento County, California.

In response to an epidemic amplification of West Nile virus (family Flaviviridae, genus Flavivirus, WNV), the Sacramento and Yolo Mosquito and Vector Control District (SYMVCD) sprayed ultralow-volume (ULV) formulations of pyrethrin insecticide (Evergreen EC 60-6: 6% pyrethrin insecticide, 60% piperonylbutoxide; MGK, Minneapolis, MN, applied as 0.003 kg/ha [0.0025 lb/acre] ) over 218 km2 in north Sacramento and 243.5 km2 in south Sacramento on three consecutive evenings in August 2005. We evaluated the impact of this intervention in north Sacramento on the abundance and WNV infection rates of Culex pipiens L. and Culex tarsalis Coquillett. Mortality rates of caged Cx. tarsalis sentinels ranged from 0% under dense canopy to 100% in open fields. A comparison of weekly geometric mean mosquito abundance in CO2-baited traps in sprayed and unsprayed areas before and after treatment indicated a 75.0 and 48.7% reduction in the abundance of Cx. pipiens and Cx. tarsalis, respectively. This reduction was statistically significant for Cx. pipiens, the primary vector of WNV, with highest abundance in this urban area, but not for Cx. tarsalis, which is more associated with rural areas. The infection rates of WNV in Cx. pipiens and Cx. tarsalis collected from the spray zone were 8.2 and 4.3 per 1,000 female mosquitoes in the 2 wk before and the 2 wk after applications of insecticide, respectively. In comparison, WNV infection rates in Cx. pipiens and Cx. tarsalis collected at same time interval in the unsprayed zone were 2.0 and 8.7 per 1,000, respectively. Based on the reduction in vector abundance and its effects on number of infective bites received by human population, we concluded that the aerial application ofpyrethrin insecticide reduced the transmission intensity of WNV and decreased the risk of human infection.

Role of communally nesting ardeid birds in the epidemiology of West Nile virus revisited.

Although herons and egrets in the family Ardeidae frequently have been associated with viruses in the Japanese encephalitis virus serocomplex, communal nesting colonies do not appear to be a focus of early season and rapid amplification of West Nile virus (WNV) in California. Evidence for repeated WNV infection was found by testing living and dead nestlings collected under trees with mixed species ardeid colonies nesting above in an oak grove near the University of California arboretum in Davis and in a Eucalyptus grove at a rural farmstead. However, mosquito infection rates at both nesting sites were low and positive pools did not occur earlier than at comparison sites within the City of Davis or at the Yolo Bypass wetlands managed for rice production and waterfowl habitat. Black-crowned night herons (Nycticorax nycticorax) were the most abundant and frequently infected ardeid species, indicating that WNV may be an important cause of mortality among nestlings of this species.