Psychic euosmia among obsessive-compulsive personality disorder patients:A case control study

BACKGROUND Psychic euosmia(PE)has been described as a supposed psychological predisposition for which pleasant smells elicit an immediate sense of pleasure,order and calmness in obsessive-compulsive personality disorder(OCPD).In this study we tried to verify the interpretation that PE is the counterpart of disgust that has been associated to contamination and moral purity.Disgust and morality are significantly associated in people with obsessive-compulsive personality traits.We expected that OCPD patients would experience higher levels of PE.AIM To investigate the PE frequency in OCPD patients and healthy controls(HC)and to evaluate the relationship between PE and disgust.METHODS A single-center,case-control study was conducted in an outpatient service for obsessive-compulsive and related disorders.The sample consisted of 129 subjects:45 OCPD patients and 84 HC.In both groups we submitted the Disgust Scale Revised(DS-R)and the self-report Structured Clinical Interview for DSM-5 Screening Personality Questionnaire to which we added an additional yes or no question to investigate the presence of PE.In order to verify differences between groups,t-test was employed for continuous variables and 2 test for categorical variable;odds ratio was employed to analyze group differences in the PE survey.Correlation was explored with Pearson r correlations.RESULTS No differences were observed between groups in gender composition or education.A slight significant difference was found in mean age(t=1.988;P=0.049).The present study revealed significantly higher proportions of PE among OCPD patients when compared to HC(OR:5.3,2.28-12.46).Patients with OCPD were more likely to report PE(n=36;80%)whereas a much lower proportion endorsed PE in the HC group(n=36;42.9%).Interestingly,no differences were observed between groups in mean score for the Disgust Scale.There was also no difference between the two groups in any of the Disgust Scale Revised subscales.Moreover,no significant correlations were observed in the OCPD group between PE and Disgust Scale Revised subscales.CONCLUSION Results suggested that PE might be part of the clinical spectrum of OCPD,and it does not reflect the counterpart of disgust.This could also indicate that this phenomenon is a manifestation of orderliness or incompleteness.Further studies will need to be undertaken to better understand PE and its significance in OCPD.

Cognitive impairment in patients with bipolar disorder alone versus those with bipolar disorder comorbid with borderline personality disorder

BACKGROUND Bipolar disorder(BD)is a severe mental illness.BD often coexists with borderline personality disorders,making the condition more complex.AIM To explore the differences in cognitive impairment between patients with BD and those with BD comorbid with borderline personality disorder.METHODS Eighty patients with BD and comorbid borderline personality disorder and 80 patients with BD alone were included in groups A and B,respectively,and 80 healthy volunteers were included as controls.Cognitive function in each group was evaluated using the Chinese version of the repeatable battery for the assess-ment of neuropsychological status(RBANS),the Stroop color-word test,and the Wechsler intelligence scale-revised(WAIS-RC).RESULTS The indices of the RBANS,Stroop color-word test,and WAIS-RC in groups A and B were significantly lower than those of the control group(P<0.05).Group A had significantly longer Stroop color-word test times for single-character,single-color,double-character,and double-color,lower scores of immediate memory,visual breadth,verbal function dimensions and total score of the RBANS,as well as lower scores of verbal IQ,performance IQ,and overall IQ of the WAIS-RC compared with group B(P<0.05).Compared to group B,group A exhibited significantly longer single-character time,single-color time,double-character time,and double-color time in the Stroop color-word test(P<0.05).CONCLUSION The cognitive function of patients with BD complicated with borderline personality disorder is lower than that of patients with BD.

Understanding Behavioral Manifestations of Obsessive-Compulsive Disorder in People with Intellectual Disabilities—A Qualitative Study

Background: There is limited knowledge about obsessive-compulsive disorder (OCD) in people with intellectual disabilities (IDs). This paper describes the manifestation of compulsive behaviors associated with OCD at the behavioral level in people with ID in institutionalized settings. The aim was to gain nuanced insight into appropriate understanding and classification in this specific context, and derive implications for research and practice. Methods: Individual cases of people with ID (n = 7) were studied to assess compulsive symptoms through two days of on-site observation of the person with ID within the institution, guided group discussions (n = 28), and semi-structured interviews with key informants and caregivers of the person with ID (n = 20). Caregiver ratings of the compulsive behavior checklist were compiled. Data were analyzed using qualitative content analysis. Results: All forms of OCD were present. Characteristics of compulsive behaviors in people with ID at the behavioral level included less complex and more obvious compulsive acts, immediate responses, signs of tension, motor restlessness, facial expression changes, repetition, need for predictability, time-consuming behaviors, and aggressive reactions when these acts were interrupted. Some of the compulsive behaviors corresponded to the ICD-11 OCD code 6B20, and others to compulsions as a psychological symptom (MB23.4). Conclusions: OCD may manifest atypically at the behavioral level in people with ID, posing significant challenges for accurate classification due to symptom ambiguity. Follow-up differential diagnostic studies are needed to more accurately identify and differentiate OCD symptoms in people with ID. Further, disorder-specific guidelines for recognizing OCD in people with ID are needed for institutionalized settings without psychiatric-psychotherapeutic expertise.

Personalized medicine and opioid use disorder

Opioid use disorder(OUD)is a major public health problem affecting millions of people worldwide.Although OUD is a chronic and relapsing disorder,a variety of pharmacological and non-pharmacological interventions are available.Medication-assisted treatment of OUD generally relies on competition for opioid receptors against the addictive substance.The mechanisms of this competition are to block or inactivate the opioid receptor or activate the receptor with a substance that is intermittent or long acting.Methadone and buprenorphine are two United States Food and Drug Administration-approved medications that have long-term positive effects on the health of opioid-dependent individuals.Although clinical studies of drugs generally demonstrate efficacy in thousands of people and toxicity is excluded,it cannot be predicted whether the given drug will cause side effects in one of the patients at the treatment dose.Individual differences can be explained by many biological and environmental factors.Variations in genes encoding drug metabolism or cellular drug targets significantly explain the variability in drug response between individuals.Therefore,for the effects of candidate genes to be accepted and included in individual treatment protocols,it is important to repeat studies on individuals of different ethnic backgrounds and prove a similar effect.

Attribution retraining group therapy for outpatients with major depression disorder,generalized anxiety disorder,and obsessive-compulsive disorder:a pilot study

The aim of this present study is to examine the efficacy of attribution retraining group therapy （ARGT） and to compare the responses of outpatients with major depression disorder （MDD）, generalized anxiety disorder （GAD） and obsessive-compulsive disorder （OCD）. We carried out a prospective uncontrolled intervention study with a 8-weeks of ARGT on sixty three outpatients with MDD, GAD or OCD. Hamilton rating scale for depression, Hamilton rating scale for anxiety, Yale-Brown obsessive-compulsive scale, attribution style questionnaire, self-esteem scale, index of well-being, and social disability screening schedule were administered before and after treatment. Significant improvement in symptoms and psychological and social functions from pre- to posttreatment occurred for all participants. The changes favored MDD patients. Our study suggested that ARGT may improve the symptoms and psychological-social functions of MDD, GAD, and OCD patients. MDD patients showed the best response.

Anterior limb lesions in bilateral internal capsules and memory function in patients with refractory obsessive-compulsive disorder

BACKGROUND： Previous studies have shown that lesions in the anterior limb of the internal capsule contribute to obsessive-compulsive symptoms in patients with refractory obsessive-compulsive disorder （OCD）. However, few reports have addressed the effects of lesions in the anterior limb of the internal capsule on cognition, learning, and memory functions in patients with refractory OCD. OBJECTIVE： To investigate the degree of damage to memory tasks in refractory OCD patients following lesions to the anterior limb of the internal capsule. DESIGN, TIME AND SETTING： A case-controlled, observational study was performed at the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008. PARTICIPANTS： A total of 10 refractory OCD patients were admitted to the Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao-Tong University, China from May 2007 to March 2008 and were recruited for this study. The OCD patients were of equal gender, with an average age of （25.1 ± 9.6） years. An additional 10 healthy volunteers were enrolled from a community of Shanghai City as controls; they were of equal gender and aged （25.1 ± 8.6） years. METHODS： A total of 10 refractory OCD patients were subjected to lesions in the anterior limbs of the bilateral internal capsules. Wechsler Memory Scale-Chinese Revision （WMS-CR, as a task of explicit memory） and the Nissen Version （serial reaction time task） software （SRTT, as a task of implicit memory） were applied to determine memory functions and learning performance in pre- and post-operative OCD patients and controls. MAIN OUTCOME MEASURES： WMS scores, reaction time in SRTT, and Yale-Brown obsessive compulsive scale scores were measured in pre- and post-operative OCD patients and controls. RESULTS： Compared to controls, the pre-operative OCD patients exhibited reduced memory task scores （P = 0.005）, whereas scores for reciting numbers of backwards digits were greater （P = 0.000）. Figure recall and associative memory were less in OCD patients at 1 week following surgery than in the pre-operative OCD patients （P = 0.042, P = 0.002, respectively）. Reaction time in implicit SRTT was significantly longer in pre-operative OCD patients compared with controls and post-operative OCD patients （P = 0.01, P = 0.03, respectively）. These results suggested ameliorated SRTT following neurosurgery. Yale-Brown Obsessive Compulsive Scale results revealed significantly improved OCD following lesions in the internal capsule （P = 0.04）. Some post-operative OCD patients suffered from deficits in short-term memory and implicit memory. CONCLUSION： Lesions in anterior limbs of bilateral internal capsules improve obsessive- compulsive symptoms and implicit memory in OCD patients, but result in aggravated short-term memory deficits.

Obsessive-compulsive disorder:Evidence-based treatments and future directions for research

Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments(which appears to be only a portion of the overall population) are not effectively treated.Suggestions for future avenues of research are also presented. These are primarily focused on(1) increased dissemination of effective therapies;(2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and(3) the impact of comorbid disorders on treatment outcome.

White matter abnormalities in young males with antisocial personality disorder Evidence from voxel-based morphometry-diffeomorphic anatomical registration using exponentiated lie algebra analysis

Voxel-based morphometry-diffeomorphic anatomical registration using exponentiated lie algebra analysis was used to investigate the structural characteristics of white matter in young males with antisocial personality disorder （APD） and healthy controls without APD. The results revealed that APD subjects, relative to healthy subjects, exhibited increased white matter volume in the bilateral prefrontal lobe, right insula, precentral gyrus, bilateral superior temporal gyrus, right postcentral gyrus, right inferior parietal Iobule, right precuneus, right middle occipital lobe, right parahippocampal gyrus and bilateral cingulate, and decreased volume in the middle temporal cortex and right cerebellum. The white matter volume in the medial frontal gyrus was significantly correlated with antisocial type scores on the Personality Diagnostic Questionnaire in APD subjects. These experimental findings indicate that white matter abnormalities in several brain areas may contribute to antisocial behaviors in APD subjects.

Psychic euosmia and obsessive compulsive personality disorder

Patients with obsessive compulsive personality disorder(OCPD) often refer to a prompt mood improvement upon encountering good scents in general, or fresh laundry borax on their clothes, pillows or home settings. The Authors propose the new term psychic euosmia in the mean of an overstated psychological predisposition for a real pleasant smell that elicits an immediate sense of pleasure, order and calm. The prompt reactions to a pleasant odor might be explained by the involvement of rhinencephalon and its proximity to mood-related limbic circuits, which bypass the cognitive awareness. Cleanliness may not preclude a subject to enjoy a good smell, even if we are representing smells that resemble freshness, in other words order. A potentially even more important argument is given by the continuum of personality disorders and their variability. Not all personality characteristics led to disturbed behaviors. In evolutionary perspectives having the ability to differentiate between unpleasant and pleasant odors should have made the difference in surviving. On the other hand, psychic euosmia could be considered a normal reaction, but in our clinical experience it is over-represented among OCPD subjects with marked orderliness and disgust. Therefore, detecting psychic euosmia might vicariously confirm the relevance of disgust as a cognitive driver of OCPD. Hereby we support research to characterize psychic euosmia as a feature of orderliness and cleanliness for OCPD.

Deep brain stimulation for obsessive-compulsive disorder:A systematic review of worldwide experience after 20 years

BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According to the results,the response in the first year predicts the extent to which an OCD patient will benefit from DBS,since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation.Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients;but it is still controversial whether this improvement persists,increases or decreases in the long term.Three different patterns of LT response emerged from the analysis:49.5% of patients had good and sustained response to DBS,26.6% were non responders,and 22.5% were partial responders,who might improve at some point but experience relapses during follow-up.A significant improvement in depressive symptoms and global functionality was observed in most studies,usually(although not always)in parallel with an improvement in obsessive symptoms.Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters;however,some severe adverse events including intracranial hemorrhages and infections were also described.Hypomania was the most frequently reported psychiatric side effect.The relationship between DBS and suicide risk is still controversial and requires further study.Finally,to date,no clear clinical or biological predictors of response can be established,probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD,providing both ST and LT evidence of efficacy.

Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis

BACKGROUND Differential diagnosis,comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder(ASD),but clinical assessments often omit screening for personality disorders(PD),which are especially common in individuals with high-functioning ASD where there is less need for support.AIM To summarize the research findings on PD in adults with ASD and without intellectual disability,focusing on comorbidity and differential diagnosis.METHODS PubMed searches were performed using the key words“Asperger’s Syndrome”,“Autism”,“Personality”,“Personality disorder”and“comorbidity”in order to identify relevant articles published in English.Grey literature was identified through searching Google Scholar.The literature reviews and reference sections of selected papers were also examined for additional potential studies.The search was restricted to studies published up to April 2020.This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria:16 evaluated personality profiles or PD in ASD(comorbidity),five compared ASD and PD(differential diagnosis)and one performed both tasks.There were significant differences in the methodological Cluster A and cluster C PD are the most frequent co-occurring PD,but overlapping features should be considered.Data on differential diagnosis were only found with cluster A and cluster B PD.CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists.Further studies are needed to explore the complex relationship between ASD and PD.

Neuronal degeneration in the hippocampus and dorsolateral prefrontal cortex in depressive disorder Correlation between ~1H-MRS and Minnesota Multiphasic Personality Inventory

Previous studies using magnetic resonance imaging（MRI）and functional MRI to study depression have primarily focused on proton magnetic resonance spectroscopy（1H-MRS）appearance in various areas of the brain and volume measurements in the limbic system.However,results have not been consistent.To the best of our knowledge,very little is known about the relationship between 1H-MRS appearance and depression inventory.In the present study,the relationship between 1H-MRS appearance in depressive patients and Minnesota Multiphasic Personality Inventory-2 scale was analyzed.MRI and 1H-MRS exhibited widened sulci and cisterns,as well as an absence of abnormal signals in depressive patients.In addition,N-acetyl aspartate/total creatine ratios in bilateral hippocampi and dorsolateral prefrontal cortex were significantly less in depressive patients than in control subjects（P 〈 0.01）.In contrast,choline-containing compounds/total creatine ratios in the dorsolateral prefrontal cortex were significantly greater in depressive patients than in control subjects（P 〈 0.01）.These ratios significantly and positively correlated with patient total depression scores as assessed using the Minnesota Multiphasic Personality Inventory-2 scale（r=0.934 7,0.878 7,P 〈 0.01）.These results suggested that 1H-MRS could be used to reveal a reduced number of neurons in the hippocampus and dorsolateral prefrontal cortex,as well as altered membrane phospholipid metabolism in the dorsolateral prefrontal cortex,in patients with depressive disorder.Abnormal mechanisms partially reflected severity of depressive disorder.

Integrative therapy for personality disorders: Experiences in developing integrative approaches for treatment-refractory personality-disordered clients

Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as anxiety and depression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presentations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client’s distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent application of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical patterns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in recidivism and quality of life for each client, as measured by a significant reduction in presentation of symptoms and hypervigilance. Discussion: By understanding the maladaptive cognitive-behavioural processes of PD clients, they can be modified to reduce the client’s self-defeating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strategy must first be formulated that looks at the clients past use of mental health services to detect underlying PD.

WNT/β-catenin pathway and circadian rhythms in obsessive-compulsive disorder

The neuropsychiatric disease named obsessive-compulsive disorder is composed by obsessions and/or compulsions.Obsessive-compulsive disorder etiologies are undefined.However,numerous mechanisms in several localizations are implicated.Some studies showed that both glutamate,inflammatory factors and oxidative stress could have main functions in obsessive-compulsive disorder.Glycogen synthase kinase-3β,the major negative controller of the WNT/β-catenin pathway is upregulated in obsessive-compulsive disorder.In obsessive-compulsive disorder,some studies presented the actions of the different circadian clock genes.WNT/β-catenin pathway and circadian clock genes appear to be intricate.Thus,this review focuses on the interaction between circadian clock genes and the WNT/β-catenin pathway in obsessive-compulsive disorder.

Woman diagnosed with obsessive-compulsive disorder became delusional after childbirth:A case report

BACKGROUND Obsessive-compulsive disorder(OCD)is a common mental disorder that varies greatly in manifestation and causes much distress to individuals.We describe a case in which a Chinese woman with OCD became delusional after childbirth,and discuss the possible phenomenological and psychological alterations.CASE SUMMARY A 27-year-old woman presented to the Psychiatry Department of our hospital with obsessions and compulsions.After taking medication,her symptoms were alleviated.Three years later,during her pregnancy,the obsessions returned and even progressed into paranoid delusions after childbirth.After multiple adjustments of treatment along with several fluctuations,she finally achieved remission and gained reasonable insight.CONCLUSION This case suggests that the patient with OCD appeared to move along a continuum of beliefs,and highlights the importance of effective intervention during pregnancy,which would exert a significant impact on postpartum exacerbation outcomes.

Modern Health Worries and the Personality Disorders: Two Studies Using Different Measures

This paper reports on two studies using different measures of both Modern Health Worries (MHW) and the Personality Disorders (PDs) to establish the relationship between the two concepts. Study 1 used the PID-5 which is a measure of maladaptive personality traits and the extended 40 item MHW scale. Study 2 used the original 28 item measure of MHW and PDs as measured by the Coolidge Axis-II Inventory—Short Form: SCATI. In study 1 a regression on the total MHW scale accounted for 14% of the variance: those who scored higher on Antagonism and Negative Affect had higher MHW scores. In the study 2 regressions showed four variables consistently related to MHW: sex (females with higher scores), optimism, political beliefs (left wing liberals with higher scores) and those with Cluster B personality disorders (dramatic, overly emotional, erratic). There was enough overlap in the two studies to conclude that various PDs mainly from Cluster B (Moving Against others) were modestly related to MHW as predicted. Limitations and implications are considered.

Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.

Review of source-monitoring processes in obsessive-compulsive disorder

Obsessive-compulsive disorder(OCD)is a severe mental illness characterized by persistent,intrusive and distressing obsessions and/or compulsions.Such symptoms have been conceptualized as resulting from a failure in sourcemonitoring processes,suggesting that patients with OCD fail to distinguish actions they perform from those they just imagine doing.In this study,we aimed to provide an updated and exhaustive review of the literature examining the relationship between source-monitoring and OCD.A systematic search in the literature through January 2019 allowed us to identify 13 relevant publications investigating source-monitoring abilities in patients with OCD or participants with subclinical compulsive symptoms.Most of the retrieved studies did not report any source-monitoring deficits in clinical and subclinical subjects compared with healthy volunteers.However,most of the studies reported that patients with OCD and subclinical subjects displayed reduced confidence in source-monitoring judgments or global cognitive confidence compared to controls.The present review highlighted some methodological and statistical limitations.Consequently,further studies are needed to explore source monitoring with regard to the subcategories of OCD symptoms(i.e.,symmetryordering,contamination-washing,hoarding,aggressive obsession-checking,sexual-religious thoughts)and to clarify the relationship between sourcemonitoring subtypes(i.e.,reality or internal source-monitoring)and confidence in these populations.

Validation of a Classification System for Obsessive-Compulsive and Related Disorders Based on DSM-5

The purpose of this study was to examine whether a broad?obsessive-compulsive and related disorders model, which consisted of obsessive-compulsive, hoarding disorder, body dysmorphic, trichotillomania and pathological skin picking, displayed sufficient data fit. On the other hand, we examined whether a reduced obsessive-compulsive and related disorders symptoms model consisting of above mentioned disorders demonstrated superior fit or not. To test the factor structure validity of the classification system of obsessive-compulsive spectrum disorders, we used Confirmatory Factor Analyses (CFA). Result of factor structure analysis revealed and supported an OCSD symptoms dimension that included obsessive-compulsive, hoarding disorder, body dysmorphic, trichotillomania, and pathological skin picking symptoms. Also, results of this study supported?the DSM-5 changes.

Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic

BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment.Moreover,the pandemic forced a global switch to telemental health(TMH)services to maintain the standards and continuity of care.Consequently,clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD.However,several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic.AIM To describe the formulation,implementation,feasibility,and usefulness of videoconferencing-based ERP(VC-ERP)treatment for OCD during the coronavirus disease 2019 pandemic.METHODS This prospective,observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo(July 2020-June 2021).All patients with OCD were assessed using the home-based TMH services of the department.The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment.After a systematic evaluation of the available treatment options,an initial protocol for delivering VC-ERP was developed.Guidelines for clinicians and educational materials for patients and their families were prepared.The protocol was implemented among patients with OCD attending the TMH services,and their progress was monitored.The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders.Feasibility and efficacy outcomes were examined.RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases,10th version criteria.Out of 115 patients who attended the services during the study period,37 were excluded from the final analysis.Of the remaining 78 patients,VC-ERP was initiated in 43 patients.Six patients dropped out,and three were hospitalized for inpatient ERP.Eleven patients have completed the full VC-ERP treatment.One patient completed the psychoeducation part of the protocol.VC-ERP is ongoing in 22 patients.The protocol for VC-ERP treatment was developed and upgraded online.A large proportion of the eligible patients(n=34/43;79%)actively engaged in the VC-ERP treatment.Drop-out rates were low(n=6/43;14%).Satisfaction with the treatment was adequate among patients,caregivers,and clinicians.Apart from hospitalization in 3 patients,there were no other adverse events.Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol.Therefore,the feasibility of VC-ERP treatment in terms of operational viability,service utilization,service engagement,need for additional in-person services,frequency of adverse events,and user satisfaction was adequate.The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment.Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed.CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD.The results suggest that VC-ERP can be a useful option in resource-constrained settings.