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.

A manic episode after bilateral subthalamic stimulation in a patient with advanced Parkinson's disease.

Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory symptoms in the advanced stages of Parkinson's disease. However, different psychiatric and cognitive problems may occur after DBS. We report a case of a manic episode after DBS of the subthalamic nucleus in a patient with advanced Parkinson's disease. After slow and gradually restart of the neurostimulation using the lowest effective intensity, the motor symptoms remained sufficiently under control without causing any psychiatric problems.

Cognitive behavioral based group psychotherapy focusing on repetitive negative thinking: Decreased uncontrollability of rumination is related to brain perfusion increases in the left dorsolateral prefrontal cortex.

Repetitive negative thinking (RNT) is a core process underlying various psychiatric disorders. 'Uncontrollability of rumination (UOR)' is one the most maladaptive factors of rumination, but little is known on how cognitive behavioral focused RNT psychotherapy may alter brain activity. In a subsample of 47 patients suffering from RNT who also underwent brain imaging (registered RCT trial NCT01983033), we evaluated the effect of cognitive behavioral based group psychotherapy (CBGP) (n = 25) as compared to a delayed treatment control group (DTCG) (n = 22) on frontolimbic brain perfusion with a focus on UOR. This RNT construct was measured using the subscale 'uncontrollability' of the Dutch version of the Rumination on Sadness Scale (LARSS-U). Brain perfusion was assessed with arterial spin labeling (ASL)-fMRI. LARSS-U scale scores significantly decreased in the CBGP cohort whereas no significant changes emerged in the DTCG group. Compared to the DTCG, this decrease on UOR in the CBGP group was related to significant perfusion increases in the left (dorsolateral) prefrontal cortex, part of the executive network. Besides the fact that CBGP significantly reduced RNT, this attenuation of uncontrollable ruminative thoughts was related to brain perfusion increases areas documented to be involved in the top down control of adaptive emotion regulation and the inhibition of ruminative processes.