Neurological soft signs in obsessive-compulsive disorder: two empirical studies and meta-analysis

Neurological soft signs (NSS) have been inconsistently reported in obsessive-compulsive disorder (OCD) but may make an impact on treatment response. Method: The current study examined the presence of NSS in two independent European samples of OCD patients (combined 85 patients and 88 matched healthy controls) using a standardized instrument and conducted a meta-analysis of all published studies identified in the literature with the aim to provide a more definitive answer to the question of whether OCD patients are characterized by increased NSS. Results Both empirical studies found elevated NSS scores in patients compared with matched controls. The results of the meta-analysis, which included 15 studies (combined 498 patients and 520 controls) showed large effect sizes (Hedges' g=1.27, 95% confidence interval 0.80-1.75), indicating that OCD patients have significantly higher rates of NSS than matched controls on both sides of the body and in multiple domains (motor coordination, sensory integration and primitive reflexes). The results were robust and remained largely unchanged in our reliability analyses, which controlled for possible outliers. Meta-regression was employed to examine the role of potential variables of interest including sociodemographic variables, symptom severity, medication effects and the use of different instruments, but none of these variables was clearly associated with NSS. Conclusions: As a group, OCD patients are characterized by increased rates of NSS, compared with healthy controls. However, their origins and potential clinical importance remain to be clarified. Future directions for research are discussed

Evaluation of minerals policy statements

The Planning White Paper: Planning for a Sustainable Future published in 2007, set out proposals for streamlining planning policy. In this context research was commissioned by the Department for Communities and Local Government in January 2010, to undertake an evaluation of the implementation of mineral policy statements for England in order to inform any possible future review. The objectives were to: 1. Separate the ‘policy’ and ‘guidance’ components for specific Minerals Policy Statements (MPSs) / Minerals Planning Guidance Notes (MPGs) in order to assess the relative proportions of each. The documents assessed were MPS1, MPS2, MPG3, MPG5, MPG7, MPG10, MPG13 and MPG15. 2. Determine the uptake of national minerals policies in Regional Strategies (RSs) and local planning documents, and their application through development (management) control. 3. Identify any barriers to the effective implementation of national minerals policy. 4. Identify any policies which require review, clarification or amendment in the light of legislation, local practice or interpretation. 5. Identify partners’ preferred style and format for national minerals policy which will allow Government to most effectively deliver its objectives for minerals planning. 6. Undertake a strategic level review of legislation, policy and strategies that have been introduced since November 2006, when MPS1: Planning and Minerals was published, in order to identify those that may have an impact on existing minerals policy. The research was informed by extensive document analysis accompanied by two focus group workshops, a questionnaire and interviews

Longitudinal course of symptom severity and fluctuation in patients with treatment-resistant unipolar and bipolar depression.

Little is currently known about the long-term course of symptom severity and fluctuation in patients with treatment-resistant depression (TRD). We assessed this using the longitudinal interval follow-up evaluation in 115 patients with TRD (84 unipolar, 31 bipolar) with 1-7 years (median 36 months) of follow-up. Of the follow-up months, 39.2% were spent asymptomatic and 21.1% at sub-threshold symptom level, while 15.8% were spent at mild, 13.9% at moderate, and 10.0% at severe depressive episode level. Significantly more unipolar than bipolar patients were continuously symptomatic during follow-up (43% vs. 29%). Patients had a mean of 1.0 (S.D.=1.2) symptom severity level fluctuations per year. High fluctuating patients had significantly poorer global functioning and quality of life. Although most patients with TRD achieve an asymptomatic state, they continue to fluctuate and experience depressive symptoms in the majority of months, mostly at subclinical or mild severity. However, there are important differences between unipolar and bipolar TRD, with unipolar patients more likely to experience an unremitting depressive state. Additionally, a more fluctuating longitudinal illness course is associated with poorer function and quality of life, and with a bipolar diagnosis. We suggest that the longitudinal illness course is an important outcome to be considered in future TRD research

The Maudsley Obsessive-Compulsive Stimuli Set: Validation of a standardized paradigm for symptom-specific provocation in obsessive-compulsive disorder

This article describes and further validates a standardized symptom-provocation procedure that combines symptom-specific audio instructions and pictures to reliably provoke different kinds of symptom-specific anxiety in obsessive–compulsive disorder, corresponding to its four major symptom dimensions: contamination/washing, obsessions/checking, hoarding and symmetry/order. The Maudsley Obsessive–Compulsive Stimuli Set has excellent convergent and discriminant validity, and it will be a useful resource for OCD researchers

Decision making and set shifting impairments are associated with distinct symptom dimensions in obsessive-compulsive disorder.

Contains fulltext : 50390.pdf (publisher's version ) (Closed access)Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The authors examined how specific OCD symptom dimensions were related to neuropsychological functions using multiple regression analyses. A total of 39 OCD patients and 40 controls completed the Iowa Gambling Task (IGT; A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994), which is a test of decision making, and the Wisconsin Card Sorting Test (R. K. Heaton, 1981), which is a test of set shifting. OCD patients and controls showed comparable decision making. However, patients with prominent hoarding symptoms showed impaired decision making on the IGT as well as reduced skin conductance responses. OCD patients had poorer set shifting abilities than controls, and symmetry/ordering symptoms were negatively associated with set shifting. These results help explain previous inconsistent findings in neuropsychological research in OCD and support recent neuroimaging data showing dissociable neural mechanisms involved in mediating the different OCD symptom dimensions