Transcranial direct current stimulation as early augmentation in adolescent obsessive compulsive disorder:A pilot proof-of-concept randomized control trial

BACKGROUND Transcranial direct current stimulation(tDCS)is proven to be safe in treating various neurological conditions in children and adolescents.It is also an effective method in the treatment of OCD in adults.AIM To assess the safety and efficacy of tDCS as an add-on therapy in drug-naive adolescents with OCD.METHODS We studied drug-naïve adolescents with OCD,using a Children’s Yale-Brown obsessive-compulsive scale(CY-BOCS)scale to assess their condition.Both active and sham groups were given fluoxetine,and we applied cathode and anode over the supplementary motor area and deltoid for 20 min in 10 sessions.Reassessment occurred at 2,6,and 12 wk using CY-BOCS.RESULTS Eighteen adolescents completed the study(10-active,8-sham group).CY-BOCS scores from baseline to 12 wk reduced significantly in both groups but change at baseline to 2 wk was significant in the active group only.The mean change at 2 wk was more in the active group(11.8±7.77 vs 5.25±2.22,P=0.056).Adverse effects between the groups were comparable.CONCLUSION tDCS is safe and well tolerated for the treatment of OCD in adolescents.However,there is a need for further studies with a larger sample population to confirm the effectiveness of tDCS as early augmentation in OCD in this population.

Characterization of event-related potentials in obsessive compulsive disorder patients: Comparison with depression and generalized anxiety disorder patients

BACKGROUND： Study results of event-refated potential in obsessive compulsive disorder （OCD） remain controversial, potentially as a result of different instruments utilized and their differing technical characteristics. OBJECTIVE： To investigate the differences in several common event-related potentials, Le. contingent negative variations, P300, and mismatch negativity （MMN）, in OCD patients, depression patients, generalized anxiety disorder （GAD） patients, and healthy controls. DESIGN, TIME AND SETTING： A case-control study was performed in the Department of Electrophysiology, Shanghai Mental Health Center from May 2002 to December 2005. PARTICIPANTS： A total of 38 OCD patients, 20 depression patients, and 18 GAD patients, who were diagnosed according to the criteria of Chinese Classification of Mental Disorders （Version 3）, formulated by the Chinese Psychiatry Association, were selected from the Outpatient Department of Shanghai Mental Health Center. Patients with two or more the above diseases were excluded. In addition, 28 healthy people, gender and age matched, were selected as controls. METHODS： Contingent negative variations, P300, and MMN were recorded by a Nicolet Spirit Instrument. All electrodes were attached at Cz according to the Intemationa11020 system, with the mastoid leads as reference and Fpz as ground. MAIN OUTCOME MEASURES： Amplitude and latency of contingent negative variations, P300, and MMN. RESULTS： The contingent negative variations, P300, and MMN were different （P 〈 0.01）. OCD patients showed an increased MI amplitude compared with controls, depression, and GAD patients （P 〈 0.01）. Target P300 amplitudes were significantly lower in OCD, depression, and GAD patients compared with controls （P 〈 0.01）. Moreover, N2 latency and latency of MMN were prolonged in OCD and depression groups compared with controls （P 〈 0.05）. CONCLUSION： Event-related potentials were different in depression, GAD, and OCD patients and healthy controls. In particular, OCD patients exhibited unique characteristics.

Validation of Symptom Dimensions and Sub-Type Responses in Cognitive Behavioral Therapy in Obsessive Compulsive Disorder: A Systemic Review and Meta-Analysis

Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition without a conclusivesubtype dimension. This study will focus on the meta-analysis of the clinical responses of OCD subtypes to cognitivebehavioral therapy (CBT), which might clarify this issue. Methods: We performed a systematic search and ameta-analysis for the studies of OCD subtypes and the response to CBT in PubMed, ScienceDirect, Embase, Webof Science, and Scopus databases. The selective criteria were the OCD without significant medical or psychiatricco-morbidities and pre-and post-treatment changes in scores of OCD dimension. In addition, different subtypesof OCD in symptom dimensions, such as symmetry, contamination, unacceptable thoughts, and hoarding, werecompared to find the most significant subtype using the treatment response parameters by CBT. After limitedselection, four studies and 479 OCD subjects were enrolled. The meta-analysis was performed by Review Manager5.4, and only significant results were reported. Results: Among the OCD subtypes, the meta-analysis favors thehoarding subtype with poorer responses to CBT than symmetry, contamination, and unacceptable thoughts.The meta-analysis results were negative mean differences, significant tests for overall effect, and limited heterogeneitiesin the random effects model. In addition, the results were more significant when the hoarding subtypewas compared with non-hoarding subtypes. Conclusion: The hoarding subtype might be the most significantrepresentative subtype of OCD symptom dimension under the impression of unfavorable clinical response toCBT. However, future studies with more treatment parameters will be warranted to confirm this finding.

Dissociative symptoms and dissociative disorders comorbidity in obsessive compulsive disorder: Symptom screening, diagnostic tools and reflections on treatment

Borderline personality disorder, conversion disorder and obsessive compulsive disorder frequently have dissociative symptoms. The literature has demonstrated that the level of dissociation might be correlated with the severity of obsessive compulsive disorder(OCD) and that those not responding to treatment had high dissociative symptoms. The structured clinical interview for DSM-IV dissociative disorders, dissociation questionnaire, somatoform dissociation questionnaire and dissociative experiences scale can be used for screening dissociative symptoms and detecting dissociative disorders in patients with OCD. However, a history of neglect and abuse during childhood is linked to a risk factor in the pathogenesis of dissociative psychopathology in adults. The childhood trauma questionnaire-53 and childhood trauma questionnaire-40 can be used for this purpose. Clinicians should not fail to notice the hidden dissociative symptoms and childhood traumatic experiences in OCD cases with severe symptoms that are resistant to treatment. Symptom screening and diagnostic tools used for this purpose should be known. Knowing how to treat these pathologies in patients who are diagnosed with OCD can be crucial.

NO ASSOCIATION BETWEEN TUMOR NECROSIS FACTOR ALPHA AND OBSESSIVE COMPULSIVE DISORDER IN CHINESE HAN POPULATION

Objective To investigate association between tumor necrosis factor alpha (TNF-α) and obsessive compulsive disorder (OCD) in Chinese Han population.Methods Plasma concentrations of TNF-α were measured in 61 drug-free patients who fulfilled DSM-Ⅳ criteria for OCD and 93 healthy controls.TNF-α concentrations in blood were determined by enzyme-linked immunosorbent assay (ELISA).Two polymorphisms of TNF-α gene were investigated in the same patients and healthy controls:-308 G/A and-238 G/A.The allelic and genotypic frequencies of these polymorphisms were examined by using DNA sequencing method.Results Plasma levels of TNF-α did not differ between patients and controls (P=0.292).No significant results were observed for any of the alleles at the-308 G/A or-238 G/A polymorphism of the TNF-α gene.Finally a haplotype consisting of genotypes of these two markers was also examined.No association was observed for any haplotype (P=0.108).Conclusion No significant differences were observed between patients and controls in plasma levels of TNF-α.There is no association between the-308 G/A and-238 G/A TNF-α gene polymorphisms and OCD in our Chinese samples.However,the results need to be replicated in larger samples.

Psychosurgery:A History from Prefrontal Lobotomy to Deep Brain Stimulation

Neurosurgical treatment for psychiatric disorders features a long and controversial history.This article explores a“spectrum of psychosurgery”,describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day,mainstream scientific deep brain stimulation(DBS).We focus on the rise,fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy,which evoked stern criticism from both public and professionals,through to the development of modern day DBS-performed for patients suffering from severe,treatment resistant symptoms of obsessive-compulsive disorder(OCD),epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities,whilst simultaneously challenging any public/professional preconceptions of psychosurgery,which may indirectly be obstructing patient care.Additionally,we carried out a qualitative survey displayed in WordCloud Format,capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust,on“psychosurgery”,“prefrontal lobotomy”and“DBS”,which may well reflect wider public opinion.In summary,the article provides a brief,yet comprehensive overview of the controversial history of psychosurgery,present-day practice,and future trends of neurosurgery for psychiatric disorders.

Updated Review on the Clinical Use of Repetitive Transcranial Magnetic Stimulation in Psychiatric Disorders

With the ability to modulate cortical activity,repetitive transcranial magnetic stimulation（r TMS） is becoming increasingly important in clinical applications for psychiatric disorders. Previous studies have demonstrated its promising efficacy in depression and schizophrenia, and emerging evidence has also been found in patients with anxiety disorder, obsessive–compulsive disorder, and substance or food craving. However, the overall literature features some conflicting results, varied quality of studies,and a lack of consensus on optimal r TMS parameters.Besides, the efficacy of r TMS in patients with medicationresistant symptoms has drawn most attention from clinicians. Here we review multi-site studies and double-blind randomized controlled trials（RCTs） in single sites, as well as meta-analyses of RCTs in the last three years, in order to update evidence on efficacy and the optimal protocol of r TMS in psychiatric disorders, especially for medicationresistant symptoms.

Deep brain stimulation for psychiatric disorders: roleof imaging in identifying/confirming DBS targets,predicting, and optimizing outcome and unravellingmechanisms of action

Following the established application of deep brain stimulation(DBS)in the treatment of movement disorders,new non-neurological indications have emerged,such as for obsessive–compulsive disorders,major depressive disorder,dementia,Gilles de la Tourette Syndrome,anorexia nervosa,and addictions.As DBS is a network mod-ulation surgical treatment,the development of DBS for both neurological and psychiatric disorders has been partly driven by advances in neuroimaging,which has helped explain the brain networks implicated.Advances in magnetic resonance imaging connectivity and electrophysiology have led to the development of the con-cept of modulating widely distributed,complex brain networks.Moreover,the increasing number of targets for treating psychiatric disorders have indicated that there may be a convergence of the effect of stimulating dif-ferent targets for the same disorder,and the effect of stimulating the same target for different disorders.The aim of this paper is to review the imaging studies of DBS for psychiatric disorders.Imaging,and particularly connectivity analysis,offers exceptional opportunities to better understand and even predict the clinical out-comes of DBS,especially where there is a lack of objective biomarkers that are essential to properly guide DBS pre-and post-operatively.In future,imaging might also prove useful to individualize DBS treatment.Finally,one of the most important aspects of imaging in DBS is that it allows us to better understand the brain through observing the changes of the functional connectome under neuromodulation,which may in turn help explain the mechanisms of action of DBS that remain elusive.