Episodic obsessive-compulsive disorder and bipolar spectrum disorder: new evidence from a large Italian OCD sample.

OBJECTIVES: Obsessive-Compulsive Disorder (OCD) has been considered to be a chronic illness; however, some authors described a subtype of OCD characterised by symptom-free periods of time: Episodic-OCD (E-OCD). Only few studies focussed on this subtype of the disorder. The objectives of this research were to study the association between the episodic course of the disorder and lifetime psychiatric comorbidities and to investigate socio-demographic and other clinical features correlated to the episodic course. METHODS: The sample is composed of adult OCD patients. The course was defined episodic when at least one circumscribed symptom-free interval of at least 6 months was present. The sample was divided into two subgroups: Episodic-OCD and Chronic-OCD. Differences between groups were analysed with Student's t-test, χ2 tests, Fisher test and multivariate logistic regression. RESULTS: Data regarding 585 individuals were collected. 14.2% (N = 83) of our sample had an episodic course. Bipolar I comorbid disorder, abrupt onset, lower severity of illness and lower rates of repeating compulsions were associated with the likelihood of having an E-OCD. CONCLUSIONS: Our findings confirm that a significant proportion of OCD patients have an episodic course and that E-OCD could represent a specific endophenotype.

A significant proportion of OCD patients has an episodic course;Episodic OCD was related to comorbid Bipolar I Disorder;Episodic course was associated with an abrupt onset of OCD;Lower rates of repeating compulsions were associated with Episodic OCD.

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach

Objectives: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. Methods: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. Results: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Conclusions: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

Which patients benefit from adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression? A systematic review and meta-analysis of individual participant data.

BACKGROUND: Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression. METHODS: For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level. RESULTS: Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = -0.49, 95% confidence interval (CI) -0.61 to -0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = -0.68, 95% CI -1.31 to -0.05, p = 0.03) and than 1-2 years (B = -0.86, 95% CI -1.66 to -0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias. CONCLUSIONS: To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach.

OBJECTIVES: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. METHODS: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. RESULTS: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. CONCLUSIONS: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

First vs second wave of COVID-19 pandemic in patients with obsessive compulsive disorder: A multicentre report from tertiary clinics in Northern Italy.

INTRODUCTION: Among patients with mental illness, those with obsessive compulsive disorder (OCD) showed a significant clinical worsening by the COVID-19 pandemic. The effects of the COVID-19 pandemic on OCD have been shown to worsen symptoms severity, with serious clinical consequences. However, the persistence of COVID-19 pandemic in OCD patients has been poorly investigated. The purpose of the present study was to assess the impact of the second wave of the COVID-19 pandemic in a sample of OCD patients and to compare the results with those obtained during the first wave on the same OCD sample. METHODS: 116 OCD outpatients attending three OCD tertiary clinics in Northern Italy and previously included in a report on the impact of COVID-19, were followed-up in order to investigate sociodemographic and clinical features. Appropriate statistical analyses for categorical and continuous variables were conducted. RESULTS: The 43 OCD patients with a clinical worsening (OW) reported a significant development of new obsessions/compulsions and the recurrence of past OC symptoms, higher rates of psychiatric comorbidities and sleep disturbances compared to patients without symptom worsening. Moreover, an increase in avoidance behaviors, suicidal ideation, Internet checking for reassurance, and job difficulties emerged in OW patients. Also, lower rates of pharmacological stability, and higher rates of therapy adjustment were observed. In terms of sex differences, males showed higher rates of past obsessions occurrence, while females showed a rise in Internet checking behaviors. When comparing OW patients between the first and the second wave, the latter showed significantly higher rates of past obsession occurrence and lower rates of pharmacological stability. Moreover, patients with OW showed a significantly older age during the second wave. CONCLUSION: The persistence of the COVID-19 pandemic showed a globally impaired clinical picture in the analyzed OCD sample. A further worsening between the two waves timepoints emerged, mainly involving older patients with OCD. The concordance between our results and those existing in literature highlights the importance of an accurate long-term monitoring of OCD patients in light of COVID-19 pandemic persistence.

Assessing response, remission, and treatment resistance in patients with obsessive-compulsive disorder with and without tic disorders: results from a multicenter study.

BACKGROUND: Highlighting the relationship between obsessive-compulsive disorder (OCD) and tic disorder (TD), two highly disabling, comorbid, and difficult-to-treat conditions, Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) acknowledged a new "tic-related" specifier for OCD, ie, obsessive-compulsive tic-related disorder (OCTD). As patients with OCTD may frequently show poor treatment response, the aim of this multicenter study was to investigate rates and clinical correlates of response, remission, and treatment resistance in a large multicenter sample of OCD patients with versus without tics. METHODS: A sample of 398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from 10 different psychiatric departments across Italy. For the purpose of the study, treatment response profiles in the whole sample were analyzed comparing the rates of response, remission, and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to identify possible factors associated with treatment response. RESULTS: The remission group was associated with later ages of onset of TD and OCD. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts emerged in the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement. CONCLUSIONS: Although remission was associated with later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response with a significant impairment in quality of life for both patients and their caregivers, suggesting a worse profile of treatment response for patients with OCTD.

Adverse Events of Antipsychotics and Cytochrome Polymorphisms: A Case Series on 31 Patients.

BACKGROUND: Adverse events (AEs) contribute to poor outcome in patients affected by mental disorders. The aim of this case series is to describe how many antipsychotics-associated serious AEs could have been prevented if we had known in advance the genetic profile of the patient. SUBJECTS AND METHODS: Data of patients who required the prescription of an antipsychotic drug, with a history of a documented antipsychotics-associated serious AE and who underwent Neuropharmagen® test were retrospectively collected. RESULTS: Thirty-three subjects were selected for eligibility; two of them were excluded. Twelve subjects (38.7%) showed genetic polymorphisms most likely associated to an increased risk of AE, with pharmacokinetic variations being the most prevalent. Moreover, the 35.5% of the total sample revealed drug-drug interactions (pharmacodynamic/pharmacokinetic) associated with increased risk of AE. CONCLUSIONS: This case series highlights how pharmacogenetics testing with decision support tools, if applied earlier during the treatment with antipsychotics, could have led to identifying individuals at risk for serious AEs.

Suicidal ideation and suicidal attempts in patients with obsessive-compulsive tic-related disorder vs obsessive-compulsive disorder: results of a multicenter Italian study.

BACKGROUND: Obsessive-compulsive disorder (OCD) and tic disorder (TD) represent highly disabling, chronic and often comorbid psychiatric conditions. While recent studies showed a high risk of suicide for patients with OCD, little is known about those patients with comorbid TD (OCTD). Aim of this study was to characterize suicidal behaviors among patients with OCD and OCTD. METHODS: Three hundred and thirteen outpatients with OCD (n = 157) and OCTD (n = 156) were recruited from nine different psychiatric Italian departments and assessed using an ad-hoc developed questionnaire investigating, among other domains, suicide attempt (SA) and ideation (SI). The sample was divided into four subgroups: OCD with SA (OCD-SA), OCD without SA (OCD-noSA), OCTD with SA (OCTD-SA), and OCTD without SA (OCTD-noSA). RESULTS: No differences between groups were found in terms of SI, while SA rates were significantly higher in patients with OCTD compared to patients with OCD. OCTD-SA group showed a significant male prevalence and higher unemployment rates compared to OCD-SA and OCD-noSA sample. Both OCTD-groups showed an earlier age of psychiatric comorbidity onset (other than TD) compared to the OCD-SA sample. Moreover, patients with OCTD-SA showed higher rates of other psychiatric comorbidities and positive psychiatric family history compared to the OCD-SA group and to the OCD-noSA groups. OCTD-SA and OCD-SA samples showed higher rates of antipsychotics therapies and treatment resistance compared to OCD-noSA groups. CONCLUSIONS: Patients with OCTD vs with OCD showed a significantly higher rate of SA with no differences in SI. In particular, OCTD-SA group showed different unfavorable epidemiological and clinical features which need to be confirmed in future prospective studies.

What Happened to Patients With Obsessive Compulsive Disorder During the COVID-19 Pandemic? A Multicentre Report From Tertiary Clinics in Northern Italy.

After the outbreak of Coronavirus disease was declared a pandemic by the World Health Organization, this resulted in extraordinary public health measures to control the infection, such as entire countries being placed under quarantine. The psychopathological consequences of the pandemic and quarantine were anticipated to be of particular relevance, especially in patients with psychiatric disorders such as Obsessive Compulsive Disorder (OCD). Aim of the present report was to describe the impact of COVID-19 pandemics within a sample of Italian patients affected by OCD. Sociodemographic and clinical variables of a sample of 123 OCD outpatients, currently attending three OCD tertiary clinics in Northern Italy, were assessed through telephone and in-person interviews. Patients showing a clinical worsening of OCD represented more than one third of the sample and reported a significant emergence of new obsessions and compulsions phenotypes along with a significant exacerbation of past ones. Moreover, they were more frequently found to experience suicidal ideation, increased Internet checking, sleep disturbances, avoidance behaviors, and work difficulties. A significantly increased need of therapy adjustment and family accommodation was also observed. Further research is warranted to clarify the potential risk and related consequences of the current COVID-19 pandemic on OCD patients.

The efficacy of adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression: A systematic review and meta-analysis of individual participant data.

PURPOSE: We examined the efficacy of adding short-term psychodynamic psychotherapy (STPP) to antidepressants in the treatment of depression by means of a systematic review and meta-analysis of individual participant data, which is currently considered the most reliable method for evidence synthesis. RESULTS: A thorough systematic literature search resulted in 7 studies comparing combined treatment of antidepressants and STPP versus antidepressant mono-therapy (n = 3) or versus antidepressants and brief supportive psychotherapy (n = 4). Individual participant data were obtained for all these studies and totaled 482 participants. Across the total sample of studies, combined treatment of antidepressants and STPP was found significantly more efficacious in terms of depressive symptom levels at both post-treatment (Cohen's d = 0.26, SE = 0.10, p = .01) and follow-up (d = 0.50, SE = 0.10, p < .001). This effect was most apparent at follow-up and in studies examining STPP's specific treatment efficacy. Effects were still apparent in analyses that controlled for risk of bias and STPP quality in the primary studies. CONCLUSIONS: These findings support the evidence-base of adding STPP to antidepressants in the treatment of depression. However, further studies are needed, particularly assessing outcome measures other than depression and cost-effectiveness, as well as examining the relative merits of STPP versus other psychotherapies as added to antidepressants.

General medical conditions are associated with delay to treatment in patients with bipolar disorder.

BACKGROUND: Bipolar disorder (BPD) is associated with worse physical health. Indeed patients with BPD more frequently suffer from medical conditions such as cardiovascular illness, hypertension, diabetes, hypothyroidism, respiratory disease, liver disease, peptic ulcer, and arthritis. Since some clinical characteristics have been associated with worse course and outcome of BPD, it is possible that they might also bring to an increased medical burden in patients with BPD. The aim of the present report is to assess the prevalence of medical conditions in patients with BPD, and to determine the clinical variables associated with the presence of a medical condition. METHODS: Charts of patients with BPD I and II were reviewed: socio-demographic and clinical information were collected. Medical conditions were classified by the ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The associations between the presence of medical conditions and demographic/clinical variables of BPD were then analyzed. RESULTS: Charts of 309 patients were included in the study. 170 (55%) patients had at least one medical condition. The most common were endocrine/metabolic disease (23%), and vascular disease (21%). Having a medical condition was associated with longer duration of untreated illness and female gender. CONCLUSIONS: Patients with BPD have high rates of medical conditions, especially hypertension and metabolic disorders. A longer duration of untreated illness is associated with having a medical condition, probably due to the long-lasting adoption on unhealthy lifestyles not counterbalanced by treatment and psychoeducation.

No effect of adding brief dynamic therapy to pharmacotherapy in the treatment of obsessive-compulsive disorder with concurrent major depression.

BACKGROUND: Until now no studies have investigated the benefits of adding brief dynamic therapy (BDT) to medication in obsessive-compulsive disorder (OCD), while a number of recent investigations have demonstrated the efficacy of supplemental BDT among patients with major depressive disorders (MDD). The objective of the present study was to explore the efficacy of BDT combined with pharmacotherapy in comparison with pharmacotherapy alone in the treatment of OCD with concurrent MDD. METHODS: A 12-month randomized clinical trial compared a standard selective serotonin reuptake inhibitor treatment with (n = 27) or without (n = 30) supplemental BDT in patients with OCD and concurrent MDD. Supplemental BDT was added during the first 16-week trial; all patients continued to be treated with only pharmacotherapy in the following continuation phase. The primary efficacy assessments were the Yale-Brown Obsessive Compulsive Scale and the 17-item Hamilton Rating Scale for Depression; the secondary efficacy measures included the Clinical Global Impression scale and the Global Assessment of Functioning. The data analysis was conducted on the 'intent-to-treat (ITT) efficacy patient sample'. RESULTS: Fifty patients completed the study. No difference between the 2 treatment groups was found at any point by any assessment method in the ITT study sample. CONCLUSIONS: Supplemental BDT in the treatment of patients with OCD with concurrent MDD who are receiving effective medication has no significant clinical effect on both obsessive and depressive symptoms.