Understanding the support needs of parents of children with obsessive-compulsive disorder: a qualitative descriptive study in the UK.

INTRODUCTION: Caring for a child with obsessive-compulsive disorder (OCD) can be extremely difficult, yet evidence-based support strategies for parents/carers are limited. A detailed understanding of parent support needs is an important first step in intervention development and qualitative research with this focus is currently lacking. In this study, the viewpoints of parents and professionals were used to understand support needs and preferences when caring for a child with OCD. This qualitative descriptive study formed part of a wider UK-based project aimed at developing better support for parents of children with OCD. METHOD: Individual semi-structured interviews (and an optional one-week journal) with a purposive sample of parents of children and young people (CYP) with OCD, aged 8-18, and focus groups (or individual interviews where preferred) with a purposive sample of professionals supporting CYP with OCD. Data comprised transcripts of audio-recorded interviews and focus groups, and text from journals. Analysis was informed by the Framework approach involving inductive and deductive coding, supported by NVivo 12.0 software. Co-production methods were adopted throughout the research process, including the involvement of a parent co-researcher and charity collaborators. RESULTS: Interviews were undertaken with 20 parents, of which 16 completed a journal. Twenty-five professionals took part in a focus group or interview. Five key themes relating to parent support challenges and support needs/preferences were identified (1) Coping with the impact of OCD; (2) Getting help for my child; (3) Understanding parents' role; (4) Making sense of OCD; (5) Joined-up care. CONCLUSION: Parents caring for children with OCD have clear caregiver support needs which are currently not being met. Through triangulation of parent and professional accounts, this study has identified parent support challenges (e.g., emotional impact of OCD, visibility of caring role, misunderstanding about OCD) and support needs/ preferences (e.g., headspace/respite, compassion/sensitivity, guidance on accommodation) to lay the vital foundations for the development of effective parent support interventions. There is now an urgent need to develop and test an intervention to support parents in their caregiving role, with the aim of preventing and/or reducing their levels of burden and distress and ultimately, improving their quality of life.

Feasibility, acceptability and practicality of transcranial stimulation in obsessive compulsive symptoms (FEATSOCS): A randomised controlled crossover trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to be the left orbitofrontal cortex (L-OFC) and the supplementary motor area (SMA). We report the first study to test these targets head-to-head within a randomised sham-controlled trial. Our aim was to inform the design of future clinical research studies, by focussing on the acceptability and safety of the intervention, feasibility of recruitment, adherence to and tolerability of tDCS, and the size of any treatment-effect. METHODS: FEATSOCS was a randomised, double-blind, sham-controlled, cross-over, multicentre study. Twenty adults with DSM-5-defined OCD were randomised to treatment, comprising three courses of clinic-based tDCS (SMA, L-OFC, Sham), randomly allocated and delivered in counterbalanced order. Each course comprised four 20-min 2 mA stimulations, delivered over two consecutive days, separated by a 'washout' period of at least four weeks. Assessments were carried out by raters who were blind to stimulation-type. Clinical outcomes were assessed before, during, and up to four weeks after stimulation. Patient representatives with lived experience of OCD were actively involved at all stages. RESULTS: Clinicians showed willingness to recruit participants and recruitment to target was achieved. Adherence to treatment and study interventions was generally good, with only two dropouts. There were no serious adverse events, and adverse effects which did occur were transient and mostly mild in intensity. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were numerically improved from baseline to 24 h after the final stimulation across all intervention groups but tended to worsen thereafter. The greatest effect size was seen in the L-OFC arm, (Cohen's d = -0.5 [95% CI -1.2 to 0.2] versus Sham), suggesting this stimulation site should be pursued in further studies. Additional significant sham referenced improvements in secondary outcomes occurred in the L-OFC arm, and to a lesser extent with SMA stimulation. CONCLUSIONS: tDCS was acceptable, practicable to apply, well-tolerated and appears a promising potential treatment for OCD. The L-OFC represents the most promising target based on clinical changes, though the effects on OCD symptoms were not statistically significant compared to sham. SMA stimulation showed lesser signs of promise. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol (current, frequency, duration), longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, consideration of home-based approaches represents a rational next step. TRIAL REGISTRATION: ISRCTN17937049. https://doi.org/10.1186/ISRCTN17937049.

COVID-19 Vaccines and Potential Implications for COVID-19-Specific Obsessive-Compulsive Disorder Presentations.

Public health crises, including the ongoing COVID-19 pandemic, have wide reaching implications on mental health, and have resulted in unique OCD presentations specific to respective crises. The distribution of highly efficacious and effective vaccines for COVID-19 present a crossroads for the COVID-19-specific OCD presentation, including the potential for COVID-19 presentation perpetuation or remission in the face of vaccinations. Individual differences may play a unique role in who does and does not see a reduction of OCD symptoms specific to this virus as a function of vaccination status. Here, we discuss prior health crises that have resulted in unique OCD presentations, review relevant assessment and intervention guidelines, discuss potential implications that vaccines may have on this COVID-19-specifc presentation, and provide case presentations and future recommendations for treatment providers and researchers.

Obsessive beliefs prospectively predict adherence to safety behaviours related to COVID-19 through obsessive-compulsive symptoms and COVID-19 distress: A serial multiple mediator analysis.

Obsessive-compulsive tendencies may render individuals vulnerable to elevated distress and over-adherence to safety behaviours during illness outbreaks. The present study investigated obsessive beliefs as a predictor of obsessive-compulsive symptoms, COVID-19 distress and the exercise of safety behaviours related to COVID-19 in a community sample. Four hundred seventy-nine participants responded to a questionnaire battery in March 2020 and 218 individuals participated in a follow-up assessment in September 2020. Results indicated that baseline obsessive beliefs predicted the exercise of baseline safety behaviours through obsessive-compulsive symptoms and COVID-19 distress. In addition, the relationship between baseline obsessive beliefs and safety behaviour adoption 6 months later was mediated by later obsessive-compulsive symptoms and COVID-19 distress. Findings extended prior research on the association between obsessive-compulsive phenomena and psychological changes related to illness outbreaks. The implications for prevention and treatment strategies are discussed.

Cognitive Training via a Mobile Application to Reduce Obsessive-Compulsive-Related Distress and Cognitions During the COVID-19 Outbreaks: A Randomized Controlled Trial Using a Subclinical Cohort.

Obsessive-compulsive disorder (OCD) is a persistent psychiatric disorder causing significant impairment in functioning. The COVID-19 pandemic has exacerbated OCD-related symptoms and interrupted access to treatment. Recent research suggests mHealth apps are promising tools for coping with OCD symptoms. This randomized controlled trial evaluated the effects of a CBT-based mobile application designed to reduce OCD symptoms and cognitions in community participants considered at high risk of developing OCD symptoms. Following initial screening (n = 924), fifty-five community participants scoring 2 standard deviations above the OCI-R mean were randomized into two groups. In the immediate-app use group (iApp; n = 25), participants started using the application at baseline (T0), 4 min a day, for 12 days (T0-T1). Participants in the delayed-app group (dApp; n = 20) started using the mobile application at T1 (crossover) and used the app for the following 12 consecutive days (T1-T2). Intention to treat analyses indicated that using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from .87 to 2.73) in OCD symptoms and maladaptive cognitions in the iApp group (from T0 to T1) and dApp group (from T1 to T2). These reductions were maintained at follow-up. Our findings underscore the usefulness of brief, low-intensity, portable interventions in reducing OCD symptoms and cognitions during the pandemic.

[Ward-Equivalent Psychiatric Treatment (StäB) for Patients with Severe Obsessive Compulsive Disorder in Times of COVID-19 - A Case Report]. / Stationsäquivalente psychiatrische Behandlung für Patienten mit schweren Zwangserkrankungen in Zeiten von COVID-19 ­ ein Fallbericht.

The ward-equivalent psychiatric treatment (StäB) is an intensive form of treatment and offers patients with severe and/or chronic illnesses the opportunity to take advantage of guideline-oriented treatment.This case description is intended to show the extent to which this form of community-based care - with psychiatric as well as psychotherapeutic treatment in the familiar home context - should be considered as a treatment option for patients with severe obsessive-compulsive disorders, not only in times of the COVID-19-Pandemic.

COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder.

BACKGROUND: The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated. AIM: This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year. METHOD: 1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment. RESULTS: During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65-0.68) and depression symptom severity (g = 0.56-0.65), medium to large reductions in psychological distress (g = 0.77-0.83) and small reductions in disability (g = 0.35-.50). CONCLUSION: Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.

Obsessive Compulsive Disorder During Coronavirus Disease 2019 (COVID-19): 2- and 6-Month Follow-Ups in a Clinical Trial.

BACKGROUND: Psychiatric patients are perceived to be especially vulnerable during a pandemic, as it increases stress and uncertainty. Several current publications have considered obsessive-compulsive disorder (OCD) patients to be particularly vulnerable during the coronavirus disease 2019 (COVID-19), and clinicians were advised to adjust treatments accordingly. The purpose of this study was to evaluate the 2- and 6-month impacts of COVID-19 on the symptom severity of OCD patients. METHODS: A cohort of OCD patients actively treated with Exposure and Response Prevention (ERP) combined with pharmacological treatment was evaluated as part of their regular psychiatric assessment twice: 113 patients were evaluated at their 2-month follow-up and 90 patients (from that cohort) were evaluated at their 6-month follow up. RESULTS: Obsessive-compulsive symptom deterioration was not present in 84% of the patients at the 2-month follow-up and 96% of the patients at the 6-month follow-up. The results were also replicated in the OCD subgroup that included patients with contamination (washers) and illness obsessions, who were believed to be particularly vulnerable considering their obsessional content. CONCLUSIONS: OCD patients (including those with obsessions related to contamination and health) who were under active ERP and pharmacological treatment did not experience exacerbated symptoms during COVID-19 at their 2- and 6-month follow-ups.

A Systematic Review on TeleMental Health in Youth Mental Health: Focus on Anxiety, Depression and Obsessive-Compulsive Disorder.

Background and Objectives: The Internet is widely used and disseminated amongst youngsters and many web-based applications may serve to improve mental health care access, particularly in remote and distant sites or in settings where there is a shortage of mental health practitioners. However, in recent years, specific digital psychiatry interventions have been developed and implemented for special populations such as children and adolescents. Materials and Methods: Hereby, we describe the current state-of-the-art in the field of TMH application for young mental health, focusing on recent studies concerning anxiety, obsessive-compulsive disorder and affective disorders. Results: After screening and selection process, a total of 56 studies focusing on TMH applied to youth depression (n = 29), to only youth anxiety (n = 12) or mixed youth anxiety/depression (n = 7) and youth OCD (n = 8) were selected and retrieved. Conclusions: Telemental Health (TMH; i.e., the use of telecommunications and information technology to provide access to mental health assessment, diagnosis, intervention, consultation, supervision across distance) may offer an effective and efficacious tool to overcome many of the barriers encountering in the delivery of young mental health care.

The impact of COVID-19 on the treatment of obsessive-compulsive disorder.

The COVID-19 pandemic has led to challenges in providing cognitive-behavioral therapy for patients with obsessive-compulsive disorder (OCD). Despite the presence of the pandemic and the risk of contracting illness, therapists can continue to utilize exposure with response prevention (ERP), which is the gold standard psychotherapy treatment for OCD. Therapists can ethically implement ERP by focusing on core treatment tenets while incorporating guidelines recommended by the Centers for Disease Control and Prevention to mitigate risk for COVID-19 exposure. The pandemic has also provided an opportunity to more widely implement ERP through virtual telehealth appointments, which have notable benefits as well as some drawbacks.

Variation in Obsessive-Compulsive Disorder Symptoms and Treatments: A Side Effect of COVID-19.

The Coronavirus Disease 2019 (COVID-19) exerts variable impact on patients with obsessive compulsive disorders (OCD). There remains a challenge to determine the extent to which OCD is exacerbated due to the pandemic. Therefore, our aim is to explicate the latest researching progress of OCD under COVID-19 based on a review of 15 existing articles. Our review confirms the prevalence of OCD exacerbation in different age groups and particular symptoms. However, it also reveals nonconformity among research, lack of investigation in OCD treatment, and imbalance in OCD symptoms research. Further, we discuss the probable reasons of the exacerbation and current situation of OCD treatments. Finally, based on our discussion, we offer suggestions on how to manage OCD under the new circumstance, including the introduction of new policies, the use of communications technology, the improvement of researching methods, and possible angles for further research.

Management of Obsessive-Compulsive Disorder before Bariatric Surgery with Cognitive Behavioral Therapy During COVID-19.

This is a report about a 44-year-old woman, with morbid obesity (BMI = 43) who was a candidate for bariatric surgery (BS) in Mother and Child Hospital in Shiraz, Iran. She had obsessive-compulsive disorder (OCD), so she refused surgery because she was afraid of getting the coronavirus. Psychiatric diagnostic interview and EyleBrown questionnaire that consists of 10 items were performed by a psychiatrist for the patient. After diagnosis of OCD, the patient underwent cognitive behavioral therapy (CBT) for 8 sessions. Results show that CBT is effective in reducing symptoms of OCD during COVID-19. Therefore, preoperative psychological interventions help increase patients' readiness for BS during COVID-19.

How is COVID-19 affecting patients with obsessive-compulsive disorder? A longitudinal study on the initial phase of the pandemic in a Spanish cohort.

BACKGROUND: Although the consequences of the COVID-19 pandemic on emotional health are evident, little is known about its impact on patients with obsessive-compulsive disorder (OCD). METHODS: One hundred and twenty-seven patients with OCD who attended a specialist OCD Clinic in Barcelona, Spain, were assessed by phone from April 27 to May 25, 2020, during the early phase of the pandemic, using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and a structured interview that collected clinical and sociodemographic information. Results were compared with those for 237 healthy controls from the same geographic area who completed an online survey. RESULTS: Although 65.3% of the patients with OCD described a worsening of their symptoms, only 31.4% had Y-BOCS scores that increased >25%. The risk of getting infected by SARS-CoV2 was reported as a new obsession by 44.8%, but this only became the main obsessive concern in approximately 10% of the patients. Suicide-related thoughts were more frequent among the OCD cohort than among healthy controls. The presence of prepandemic depression, higher Y-BOCS scores, contamination/washing symptoms, and lower perceived social support all predicted a significantly increased risk of OCD worsening. CONCLUSIONS: Most patients with OCD appear to be capable of coping with the emotional stress of the COVID-19 outbreak and its consequences during the initial phase of the pandemic. Nevertheless, the current crisis constitutes a risk factor for a significant worsening of symptoms and suicidal ideation. Action is needed to ensure effective and individualized follow-up care for patients with OCD in the COVID-19 era.

How are OCD Patients and Family Members Dealing with the Waxing and Waning Pattern of the COVID-19 Pandemic? Results of a Longitudinal Observational Study.

The current study aimed to investigate the impact of the COVID-19 pandemic on the mental health of people with OCD and the degree of family accommodation (FA) by live-in family members across phases of the lockdown measures imposed by the Belgian government. Forty-nine OCD patients and 26 live-in family members participated in the study. We assessed OCD symptom severity and FA of the live-in family members, as well as depressive symptoms, anxiety and stress levels and COVID-19 related psychological distress of patients and family members at four different timepoints: one month after the start of the lockdown (T1), during the gradual relaxation (T2), between the two waves (T3) and during the second wave (T4). Results showed that although COVID-19 related stress increased and decreased in accordance with the waxing and waning pattern of the pandemic, OCD symptoms showed an initial slight increase followed by a decrease at T3 and again at T4. Changes in family members' accommodation of symptoms followed the same course as the OCD symptoms. Furthermore, OCD symptoms correlated with depressive symptoms, anxiety and stress levels and COVID-19 related distress at all timepoints. It is important to involve family members in the treatment of OCD even during a pandemic. Clinicians should also pay attention to symptoms of depression, anxiety and stress during OCD treatment. Further research is necessary to entangle the causal relationship between OCD symptoms, FA and symptoms of depression, anxiety and stress.

Defining and Addressing Gaps in Care for Obsessive-Compulsive Disorder in the United States.

OBJECTIVE: Obsessive-compulsive disorder (OCD) can be a chronic and disabling illness with a lifetime prevalence of 2%, twice that of schizophrenia. Although effective treatments exist, OCD often remains underdetected and undertreated. METHODS: The authors performed a scoping review of the literature (of articles in PubMed and PsycINFO published from January 1, 2000, to February 1, 2020) to define gaps in OCD diagnosis and treatment among U.S. adults. Interventions at the patient, clinician, and health care system levels used to address these gaps are described, and promising approaches from around the world are highlighted. RESULTS: Of 102 potential studies identified in the search, 27 (including five non-U.S. studies) were included. The studies revealed that lack of clinician and patient knowledge about OCD and misdiagnosis contributes to its underdetection. Suboptimal prescribing of selective serotonin reuptake inhibitor medications and limited use of exposure and response prevention, as a first-line psychotherapy, contribute to OCD undertreatment. Digital health technologies show promise in increasing OCD detection and delivery of evidence-based care and in ensuring continuity of care (including during the COVID-19 pandemic). CONCLUSIONS: Given the significant rates of disability, morbidity, and mortality associated with OCD, addressing gaps in OCD care will reduce the U.S. burden of mental illness. Further research is needed to determine how the use of digital health technologies can increase the detection and management of OCD.

Uncontrolled experiments: Treatment of contamination OCD during a pandemic.

Patients suffering from obsessive-compulsive disorder are vulnerable to exacerbation of symptoms related to contamination and illness during the current pandemic. A cognitive-behavioral psychotherapy group for adolescent females with obsessive-compulsive disorder made effective adaptations to promote resilience to stressors and social isolation during the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of the COVID-19 Pandemic on the Short-Term Course of Obsessive-Compulsive Disorder.

ABSTRACT: There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic ("pandemic" cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41-1.59; p = 0.535). Preexisting contamination symptoms and COVID-19-related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19-themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.

Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic.

The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized - rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts.