A trans-diagnostic perspective on obsessive-compulsive disorder

© Cambridge University Press 2017. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.Peer reviewedFinal Published versio

The analytic hierarchy process to support decision-making processes in infrastructure projects with social impact

There is an increasing awareness among all kinds of organisations (in business,government and civil society) about the benefits of jointly working with stakeholders to satisfy both their goals and the social demands placed upon them. This is particularly the case within corporate social responsibility (CSR) frameworks. In this regard, multi-criteria tools for decision-making like the analytic hierarchy process (AHP) described in the paper can be useful for the building relationships with stakeholders. Since these tools can reveal decision-maker’s preferences, the integration of opinions from various stakeholders in the decision-making process may result in better and more innovative solutions with significant shared value. This paper is based on ongoing research to assess the feasibility of an AHP-based model to support CSR decisions in large infrastructure projects carried out by Red Electrica de España, the sole transmission agent and operator of the Spanishelectricity system

Fidelity of delivery and contextual factors influencing children’s level of engagement: Process evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) Trial (Preprint)

BACKGROUND: The Online Remote Behavioural Intervention for Tics (ORBIT) study was a multicentre randomized controlled trial of a complex intervention that consisted of an online behavioural intervention for children and young people (CYP) with tic disorders. In this first part of a two-stage process evaluation, we conducted a mixed-methods study exploring reach, dose, and fidelity of the intervention and contextual factors influencing engagement with the intervention. OBJECTIVE: This study aims to explore the fidelity of delivery and the contextual factors underpinning the ORBIT intervention. METHODS: Baseline study data and intervention usage metrics from participants in the intervention arm were used as quantitative implementation data (n=112). The experiences of being in the intervention were explored by semi-structured interviews with children (n=20) and parent (n=20) participants, therapists (n=4), and referring clinicians (n=6). A principal components analysis was used to create a comprehensive, composite measure of CYP’s engagement with the intervention. Engagement factor scores reflected relative uptake as assessed by a range of usage indices including chapters accessed, number of pages visited and number of logins. RESULTS: The intervention was implemented with high fidelity, and participants deemed the intervention acceptable and satisfactory. Engagement and adherence were high with child participants completing an average of 7.5/10 chapters and 100/112 (89.3%) participants completed a minimum of 4 chapters: the pre-defined threshold for effective dose. Compared to the total population of children with tic disorders, the sample tended to have more educated parents and live in more economically advantaged areas but socioeconomic factors were not related to engagement factor scores. Factors associated with higher engagement factor scores included participants enrolled at the London site vs. the Nottingham site (P=.011), self-referred vs. clinic-referred (P=.041), higher parental engagement as evidenced by number of parental chapters completed (ρ=0.73, n=111, P<.001) and more therapist time for parent (ρ=0.46, n=111, P<.001). A multiple linear regression indicated that parents’ chapter completion (β=.69, t110=10.18, P<.001) and therapist time for parent (β=.19, t110=2.95, P=.004) were the only significant independent predictors of engagement factor scores. CONCLUSIONS: Overall, the intervention had high fidelity of delivery and was evaluated positively by participants, although reach may have been constrained by the nature of the randomized controlled trial. Parental engagement and therapist time for parent were strong predictors of intervention implementation which has important implications for the design and implementation of digital therapeutic interventions into Child and Adolescent Mental Health Services. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN) 70758207; https://doi.org/10.1186/ISRCTN70758207 and ClinicalTrials.gov NCT03483493; https://clinicaltrials.gov/ct2/show/NCT0348349

Factors influencing the efficacy of an online behavioural intervention for children and young people with tics: Process evaluation of a randomised controlled trial

The Online Remote Behavioural Intervention for Tics (ORBIT) trial found that an internet-delivered, therapist-supported, and parent-assisted Exposure and Response Prevention (ERP) intervention reduced tic severity and improved clinical outcomes. This process evaluation aimed to explore mechanisms of impact and factors influencing efficacy. Participants were 112 children with a tic disorder and their parents randomised to the active intervention arm of the ORBIT trial. Child engagement was assessed by usage metrics and parent engagement by chapter completion. Experiences of the digital intervention were explored by semi-structured interviews. Outcomes (3-months post randomisation) were change in tic severity and overall clinical improvement. Tic severity reduced from baseline to 3-month follow-up and 36% were rated as much improved clinically. Greater tic severity at baseline predicted reduction in tic severity. Parental engagement was the only independent predictor of clinical improvement. There were no statistically significant mediators or moderators of the relationship between level of child engagement and outcome. From the qualitative findings, child participants appreciated working together with parents on the intervention and participants found the intervention engaging. ORBIT may be an effective and acceptable intervention for children and young people with tic disorders, with parental engagement being a key factor in successful outcomes

Exploratory analysis of obsessive compulsive symptom dimensions in children and adolescents: a Prospective follow-up study

BACKGROUND: Recent statistical approaches based on factor analysis of obsessive compulsive (OC) symptoms in adult patients have identified dimensions that seem more effective in symptom-based taxonomies and appear to be more stable over time. Although a phenotypic continuum from childhood to adulthood has been hypothesized, no factor analytic studies have been performed in juvenile patients, and the stability of OC dimensions in children and adolescents has not been assessed. METHODS: This study was designed to perform an exploratory factor analysis of OC symptoms in a sample of children and adolescents with OC disorder (OCD) and to investigate the course of factors over time (mean follow-up period: four years). RESULTS: We report for the first time that four symptom dimensions, remarkably similar to those previously described in adults, underlined the heterogeneity of OC symptoms in children and adolescents. Moreover, after follow-up, the symptom dimensions identified remained essentially unmodified. The changes observed concerned the intensity of dimensions rather than shifts from one dimension to another. CONCLUSION: These findings reinforce the hypothesis of a phenotypic continuum of OC symptoms from childhood to adulthood. They also strengthen the interest for investigating the clinical, neurobiological and genetic heterogeneity of OCD using a dimension-based approach

The interdisciplinary nature of SOIL

The holistic study of soils requires an interdisciplinary approach involving biologists, chemists, geologists, and physicists, amongst others, something that has been true from the earliest days of the field. In more recent years this list has grown to include anthropologists, economists, engineers, medical professionals, military professionals, sociologists, and even artists. This approach has been strengthened and reinforced as current research continues to use experts trained in both soil science and related fields and by the wide array of issues impacting the world that require an in-depth understanding of soils. Of fundamental importance amongst these issues are biodiversity, biofuels/energy security, climate change, ecosystem services, food security, human health, land degradation, and water security, each representing a critical challenge for research. In order to establish a benchmark for the type of research that we seek to publish in each issue of SOIL, we have outlined the interdisciplinary nature of soil science research we are looking for. This includes a focus on the myriad ways soil science can be used to expand investigation into a more holistic and therefore richer approach to soil research. In addition, a selection of invited review papers are published in this first issue of SOIL that address the study of soils and the ways in which soil investigations are essential to other related fields. We hope that both this editorial and the papers in the first issue will serve as examples of the kinds of topics we would like to see published in SOIL and will stimulate excitement among our readers and authors to participate in this new venture

Protocol for the Process Evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) randomized controlled trial for children and young people

BackgroundProcess evaluations are an important component in the interpretation and understanding of outcomes in trials. The Online Remote Behavioural Intervention for Tics (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an Internet-delivered behavioural intervention (called BIP TIC) compared to an Internet-delivered education programme aimed at children and young people with tics. A process evaluation will be undertaken alongside the main trial to determine precisely how the behavioural intervention works and ascertain whether, and if so, how, the intervention could be successfully implemented in standard clinical practice. This protocol paper describes the rationale, aims, and methodology of the ORBIT trial process evaluation.MethodsThe process evaluation will have a mixed-methods design following the UK Medical Research Council 2015 guidelines, comprising both quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arm; purposively sampled, semi-structured interviews of parents and children, therapists and supervisors, and referring clinicians of the ORBIT trial, as well as analysis of qualitative comments put into the online therapy platform by participants at the end of treatment. Qualitative data will be analysed thematically. Quantitative and qualitative data will be integrated in a triangulation approach, to provide an understanding of how the intervention works, and what resources are needed for effective implementation, uptake and use in routine clinical care.DiscussionThis process evaluation will explore the experiences of participants, therapists and supervisors and referring clinicians of a complex online intervention. By contextualising trial efficacy results, this will help understand how and if the intervention worked and what may be required to sustain the implementation of the treatment long term. The findings will also aid in our understanding of factors that can affect the success of complex interventions. This will enable future researchers developing online behavioural interventions for children and young people with mental health and neurological disorders to gain invaluable information from this process evaluation.Trial registrationInternational Standard Randomised Controlled Trials Number, ISRCTN70758207. Registered on 20 March 2018.ClinicalTrials.gov, NCT03483493. Registered on 30 March 2018

Consumo de bebidas alcohólicas y rendimiento escolar de los adolescentes de Granada

A group comprising 300 adolescents rancing in age from 15 yo 18 years old inclusive, all pupils at secondary schools in Granada, Was studied in order to examine the relationship between alcohol consumpition and academic performance. A questionnaire including items such as the knowledge of alcoholic drinks and their effect on health, the frequency of daily and weekend consumption, and the effect alcohol ingestion has on academic performance was used. The results obtained reveal that the adolescent interviewd know very little about nutrition and more sepecifically, about the effects of alcohol consumption. They show a high frequency of consumption with 29.5% drinking beer on a daily basis and 48.9% on Saturdays. 77.5% say their academic performance is poorer after the ingestion of alcohol and 76.5% of those who consume alcohol on a daily basis (44.1%) do not pass their exams.Se ha estudiado en una población constituida por 300 adolescentes escolarizados en centros públicos de Enseñanza Media de Granada, de edades comprendidas entre los 15 y 18 años la relación entre el consumo de bebidas alcohólicas y el rendimiento escolar. Para ello se ha utilizado un cuestionario que incluía "items" de conocimientos sobre bebidas alcohólicas y su efecto sobre la salud, frecuencia de consumo diaria y durante el fm de semana, y efecto de su ingesta sobre el rendimiento escolar. Los resultados obtenidos ponen de manifiesto que los adolescentes encuestados poseen un bajo nivel de conocimientos en nutrición y en concreto sobre el efecto del consumo de bebidas alcohólicas. Presentan una alta frecuencia de consumo y así el 29.6% toman cerveza diariamente y el 48.9% los sábados. El 77.5% afirman tener menores rendimientos intelectuales tras la ingesta de alcohol y un 76.5% de los que ingieren diariamente alcohol (44.1%) no superan los exámenes

Consumo de bebidas alcohólicas y rendimiento escolar de los adolescentes de Granada

Se ha estudiado en una población constituida por 300 adolescentes escolarizados en centros públicos de Enseñanza Media de Granada, de edades comprendidas entre los 15 y 18 años la relación entre el consumo de bebidas alcohólicas y el rendimiento escolar. Para ello se ha utilizado un cuestionario que incluía "items" de conocimientos sobre bebidas alcohólicas y su efecto sobre la salud, frecuencia de consumo diaria y durante el fm de semana, y efecto de su ingesta sobre el rendimiento escolar. Los resultados obtenidos ponen de manifiesto que los adolescentes encuestados poseen un bajo nivel de conocimientos en nutrición y en concreto sobre el efecto del consumo de bebidas alcohólicas. Presentan una alta frecuencia de consumo y así el 29.6% toman cerveza diariamente y el 48.9% los sábados. El 77.5% afirman tener menores rendimientos intelectuales tras la ingesta de alCohol y un 76.5% de los que ingieren diariamente alcohol (44.1 %) no superan los exámenes.A group comprising 300 adolescents rancing in age from 15 yo 18 years old inclusive, all pupils at secondary schools in Granada, Was studied in order to examine the relationship between alcohol consumpition and academic performance. A questionnaire including items such as the knowledge of alcoholic drinks and their effect on health, the frequency of daily and weekend consumption, and the effect alcohol ingestión has on academic performance was used. The results obtained reveal that the adolescent interviewd know very littIe about nutrition and more sepecifically, about the effects of alcohol consumption. They show a high frequency of consumption with 29.5/ drinking beer on a daily basis and 48.9% on Saturdays. 77.5% say their academic performance is poorer after the ingestión of alcohol and 76.5% of those who consume alcohol on a daily basis (44.1 %) do not pass their exams