Paediatric obsessive-compulsive disorder and depressive symptoms: clinical correlates and CBT treatment outcomes.

Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms

When Too Much Is Not Enough: Obsessive-Compulsive Disorder as a Pathology of Stopping, Rather than Starting

Background: In obsessive-compulsive disorder (OCD), individuals feel compelled to repeatedly perform security-related behaviors, even though these behaviours seem excessive and unwarranted to them. The present research investigated two alternative ways of explaining such behavior: (1) a dysfunction of activation—a starting problem—in which the level of excitation in response to stimuli suggesting potential danger is abnormally strong; versus (2) a dysfunction of termination— a stopping problem—in which the satiety-like process for shutting down security-related thoughts and actions is abnormally weak. Method: In two experiments, 70 patients with OCD (57 with washing compulsions, 13 with checking compulsions) and 72 controls were exposed to contamination cues—immersing a hand in wet diapers —and later allowed to wash their hands, first limited to 30 s and then for as long as desired. The intensity of activation of security motivation was measured objectively by change in respiratory sinus arrythmia. Subjective ratings (e.g., contamination) and behavioral measures (e.g., duration of hand washing) were also collected. Results: Compared to controls, OCD patients with washing compulsions did not differ significantly in their levels of initial activation to the threat of contamination; however, they were significantly less able to reduce this activation by engaging in the corrective behavior of hand-washing. Further, the deactivating effect of hand-washing in OCD patients with checkin

Association of erectile dysfunction and urolithiasis

Objectives: In recent years, it has been shown that there is association between metabolic syndrome and urinary stone disease. Stone disease and erectile dysfunction (ED) are considered as systemic diseases which are associated with hormonal and metabolic disorders. Therefore we investigated the relationship between ED and urinary tract calculi.Material and methods: 98 male patients with urolithiasis and 59 randomly selected male patients without stone disease were included in the study. Serum testosterone (T) levels were measured and International Index of Erectile Function (IIEF)-15 questionnaire forms were used to assess ED.Results: The prevalence of ED was found 29% (29 patients) in the urolithiasis group. Sixty-nine patients (71%) had no ED; 16 (16.3%) had mild, 5 (5.1%) had moderate and 8 (8.2%) had severe ED. None of the patients in the control group had severe or modarete ED, six patients (10.2%) had mild ED. Serum T levels were detected at the level of biochemical hypogonadism on 13 patients with stones (13.3%) and T levels were detected at the lower limit in 18 (18.3%) patients.Conclusion: In our study we have shown that ED and low T levels are significantly associated with urolithiasis. We propose that the patients with urolitiasis should be evaluated for ED and hypogonadism

White matter microstructure and connectivity in patients with obsessive-compulsive disorder and their unaffected siblings

OBJECTIVE: We aimed to examine white matter microstructure and connectivity in individuals with obsessive-compulsive disorder (OCD) and their unaffected siblings, relative to healthy controls. METHODS: Diffusion-weighted magnetic resonance imaging (dMRI) scans were acquired in 30 patients with OCD, 21 unaffected siblings, and 31 controls. We examined white matter microstructure using measures of fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). Structural networks were examined using network-based statistic (NBS). RESULTS: Compared to controls, OCD patients showed significantly reduced FA and increased RD in clusters traversing the left forceps minor, inferior fronto-occipital fasciculus, anterior thalamic radiation, and cingulum. Furthermore, the OCD group displayed significantly weaker connectivity (quantified by the streamline count) compared to controls in the right hemisphere, most notably in edges connecting subcortical structures to temporo-occipital cortical regions. The sibling group showed intermediate streamline counts, FA and RD values between OCD and healthy control groups in connections found to be abnormal in patients with OCD. However, these reductions did not significantly differ compared to controls. CONCLUSION: Therefore, siblings of OCD patients display intermediate levels in dMRI measures of microstructure and connectivity, suggesting white matter abnormalities might be related to the familial predisposition for OCD

Abnormal white matter integrity in synthetic cannabinoid users

Synthetic cannabinoids have become increasingly popular in the last few years especially among adolescents and young adults. However, no previous studies have assessed the effects of synthetic cannabinoids on the structure of the human brain. Understanding the harms of synthetic cannabinoid use on brain structure is therefore crucial given its increasing use. Diffusion tensor imaging (DTI) was performed in 22 patients who used synthetic cannabinoids more than five times a week for at least 1 year and 18 healthy controls. Fractional anisotropy (FA) was significantly reduced in the cannabinoid group compared to controls in a cluster of white matter voxels spanning the left temporal lobe, subcortical structures and brainstem. This cluster was predominantly traversed by the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, fornix, cingulum-hippocampus and corticospinal tracts. Long-term use of synthetic cannabinoids is associated with white matter abnormalities in adolescents and young adults. Disturbed brain connectivity in synthetic cannabinoid users may underlie cognitive impairment and vulnerability to psychosis

A randomized controlled trial of a novel self-help technique for impulse control disorders: a study on nail-biting

Nail-biting is currently classified as an impulse control disorder not otherwise specified. Although seldom targeted as a primary symptom, nail-biting is often associated with somatic complications and decreased quality of life. The present study assessed the effectiveness of an innovative self-help technique, titled decoupling (DC). DC aims at attenuating pathological nail-biting by performing motor sequences that decouple and rearrange the behavioral elements involved in the habit. A total of 72 participants with excessive nail-biting were recruited via specialized self-help forums and were randomized to either DC or progressive muscle relaxation (PMR) groups after baseline assessment. Four weeks later, participants underwent a similar assessment as before and were asked to rate the effectiveness of the intervention. The primary outcome parameter was the Massachusetts General Hospital Scale (MGH) adapted. Relative to the PMR group, the DC group showed significant progress in withstanding the urge to bite their nails. Furthermore, they appraised the appearance of their nails as considerably less compromised at the end of the treatment relative to participants undergoing PMR. At statistical trend level, the DC group showed a significantly greater decline on the adapted MGH relative to PMR. Despite methodological limitations, the present study asserts that the effectiveness of DC, previously shown for trichotillomania, extends to nail-biting