Kinematical analysis of emotionally induced facial expressions in patients with obsessive–compulsive disorder

Background: Motor function is deficient in many patients with obsessive–compulsive disorder (OCD), especially in the face. To investigate subtle motor dysfunction, kinematical analysis of emotional facial expressions can be used. Our aim was to investigate facial movements in response to humorous film stimuli in OCD patients.; Method: Kinematical analysis of facial movements was performed. Ultrasound markers at defined points of the face provided exact measurement of facial movements, while subjects watched a humorous movie (‘Mr Bean’). Thirty-four OCD patients (19 male, 15 female; mean (S.D.) age: 35·8 (11·5) years; mean (S.D.) total Y-BOCS score: 25·5 (5·9)) were studied in unmedicated state and after a 10-week treatment with the SSRI sertraline. Thirty-four healthy controls (19 male, 15 female; mean (S.D.) age: 37·5 (13·1) years) were also investigated.; Results: At baseline, OCD patients showed significantly slower velocity at the beginning of laughing than healthy controls and a reduced laughing frequency. There was a significant negative correlation between laughing frequency and severity of OCD symptoms. Ten weeks later a significant increase of laughing frequency and initial velocity during laughing was found.; Conclusions: Execution of adequate facial reactions to humour is abnormally slow in OCD patients. Susceptibility of OCD patients with regard to emotional stimuli is less pronounced than in healthy subjects. This phenomenon is closely correlated to OCD symptoms and is state-dependent.Peer Reviewe

Real-Time-Monitoring in der Behandlung von Zwangsstörungen: Technologie und Fallbeispiel

Background: New methods of internet-based real-time monitoring of psychotherapy processes allow for the documentation, analysis, and data-driven control of behaviour therapy. Daily ratings of the patient result in highly resolved time series of the change dynamics. Method and Patient: The Synergetic Navigation System was used in the treatment setting of a day hospital. This method is specialized in the representation of critical instabilities and pattern transitions of the process. The patient of this case report had the combined diagnosis of obsessive-compulsive disorder and depressive episodes. Result: Quantitative time-series and qualitative data from the internet-assisted diaries mirror important features of the change process. Conclusion: The method could help optimise treatment effects of behavioural interventions by using the feedback on necessary conditions, appropriate timing, and short-term effects of these interventions. Patients' motivation for change can be enhanced and the navigation system realises the continuous documentation of treatment processes and effects

Prediction of Treatment Outcome in Patients with Obsessive-Compulsive Disorder with Low-Resolution Brain Electromagnetic Tomography: A Prospective EEG Study

The issue of predicting treatment response and identifying, in advance, which patient will profit from treating obsessive-compulsive disorder (OCD) seems to be an elusive goal. This prospective study investigated brain electric activity [using Low-Resolution Brain Electromagnetic Tomography (LORETA)] for the purpose of predicting response to treatment. Forty-one unmedicated patients with a DSM-IV diagnosis of OCD were included. A resting 32-channel EEG was obtained from each participant before and after 10 weeks of standardized treatment with sertraline and behavioral therapy. LORETA was used to localize the sources of brain electrical activity. At week 10, patients were divided into responders and non-responders (according to a reduction of symptom severity > 50% on the Y-BOCS). LORETA analysis revealed that at baseline responders showed compared to non-responders a significantly lower brain electric activity within the beta 1 (t = 2.86, p < 0.05), 2 (t = 2.81, p < 0.05), and 3 (t = 2.76, p < 0.05) frequency bands and ROI analysis confirmed a reduced activity in alpha 2 (t = 2.06, p < 0.05) in the anterior cingulate cortex (ACC). When baseline LORETA data were compared to follow-up data, the analysis showed in the responder group a significantly lower brain electrical resting activity in the beta 1 (t = 3.17. p < 0.05) and beta 3 (t = 3.11. p < 0.05) frequency bands and equally for the ROI analysis of the orbitofrontal cortex (OFC) in the alpha 2 (t = 2.15. p < 0.05) frequency band. In the group of non responders the opposite results were found. In addition, a positive correlation between frequency alpha 2 (rho = 0.40, p = 0.010), beta 3 (rho = 0.42, p = 0.006), delta (rho = 0.33, p = 0.038), theta (rho = 0.34, p = 0.031), alpha 1 (rho = 0.38, p = 0.015), and betal (rho = 0.34, p = 0.028) of the OFC and the bands delta (rho = 0.33, p = 0.035), alpha 1 (rho = 0.36, p = 0.019), alpha 2 (rho = 0.34, p = 0.031), and beta 3 (rho = 0.38, p = 0.015) of the ACC with a reduction of the Y-BOGS scores was identified. Our results suggest that measuring brain activity with LORETA could be an efficient and applicable technique to prospectively identify treatment responders in OCD

Functional and structural connectivity of the amygdala in obsessive-compulsive disorder

Background: The amygdala is known to be involved in anxiety processing, but its role in the psychopathology of obsessive-compulsive disorder (OCD) is still unclear. Aims: In this MRI study we investigated potential alterations in structural and functional connectivity of the amygdala in 42 adult patients with OCD and 37 healthy subjects. Method: Psychophysiological interaction analysis was used to explore amygdala functional connectivity during a negative affective task. Probabilistic tractography was then employed to study structural connectivity and integrity of underlying white matter fiber tracts. Results: Compared to controls, OCD patients showed a significantly increased functional connectivity of the left amygdala with mostly parieto-occipital regions during task. No structural connectivity differences could be found between the groups. In addition, only patients showed a significant association between functional and structural connectivity of these regions. Moreover, symptom severity was negatively associated with structural integrity of the underlying white matter tracts. Conclusions: Present results emphasize the relevance of the amygdala for OCD and may reflect that neuronal alterations in structural connectivity could be associated with functional connectivity alterations in broader networks. (C) 2016 The Authors. Published by Elsevier Inc

Der frühe Beginn der Zwangsstörung

Einleitung: Die vorliegende Untersuchung geht der Fragestellung nach, ob sich eine Zwangsstörung, die bereits im Kindes- bzw. Jugendalter beginnt, von einer Zwangsstörung, die erst im Erwachsenenalter beginnt, hinsichtlich Schweregrad und Symptomatik unterscheidet. Patienten und Methoden: Eine Stichprobe von 370 Patienten mit Zwangsstörung (ICD-10 F42), die sich zwischen 1998 und 2002 stationär in der Psychosomatischen Klinik Windach befanden, wurde in eine Early-Onset-Gruppe (Störungsbeginn ≤15 Jahre) und in eine Late-Onset-Gruppe (Störungsbeginn ≥16 Jahre) aufgeteilt. Die Gruppen wurden über ICD-10-Diagnosen und Y-BOCSWerte verglichen. Ergebnisse: Beim Schweregrad zeigte sich, dass 20,5% der Early-Onset-Gruppe, aber lediglich 8,7% der Late-Onset-Gruppe unter einer «massiven Zwangsstörung» leiden. Bei der Symptomatik zeigte sich, dass die Early-Onset-Gruppe häufiger die Diagnose «Zwangsgedanken und -handlungen gemischt» (76,9%)erhält als die Late-Onset-Gruppe (61,8%). Außerdem nennt die Early-Onset-Gruppe sowohl für die Gegenwart als auch für die Vergangenheit mehr Symptome als die Late-Onset-Gruppe (Gegenwart 8,2 vs. 7,0; Vergangenheit 5,5 vs. 3,9 Symptomgruppen). Weiter ergaben sich inhaltliche Unterschiede der Zwangsgedanken und Zwangshandlungen. Schlussfolgerungen: Early-Onset-Patienten scheinen häufiger von einer massiven Form der Zwangsstörung und einer größeren Symptomvielfalt betroffen zu sein als Late-Onset-Patienten. Ob es sich bei der Zwangsstörung mit Beginn im Kindes- und Jugendalter um einen abgrenzbaren Subtypus handelt, konnte jedoch in dieser Untersuchung nicht eindeutig geklärt werden und bedarf weiterer Forschungen.Introduction: This study investigates if obsessive compulsive disorder with early onset differs in severity and symptomatology from that with late onset. Patients and Methods: A sample of 370 patients with obsessive compulsive disorder (OCD; ICD 10 F42) who received in-patient treatment at the psychosomatic clinic of Windach between 1998 and 2002 were divided into an early-onset group (onset ≤15 years) and a late-onset group (onset ≥16 years). Groups were compared regarding ICD-10 diagnosis and Y-BOCS scores. Results: Considering severity of the disorder 20.5% of the early-onset group but merely 8.7% of the late-onset group suffered from an extreme form of OCD. With respect to symptomatology, the early-onset group was diagnosed with ‘obsessions and compulsions, mixed’ (76.9%) more often than the lateonset group (61.8%). Also, the early-onset group reported a wider variety of symptoms both for the present and for the past than the late-onset group (present 8,2 vs 7.0; past 5.5 vs 3.9 types of symptoms). There were also differences in the content of rumination and types of compulsive rituals. Conclusions: Patients with early-onset OCD seem to be more frequently affected by an extreme form of OCD and to experience a higher variety of symptoms than patients with late-onset OCD. If early-onset OCD can be considered a distinct subtype could not be answered unequivocally by the results of this study. This question needs additional research

Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa

Background: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study. Methods: 15 patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing interoceptive accuracy (IAcc) under two conditions either enhancing (Self) or decreasing (Other) self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder Inventory 2. Results: Patients with AN scored higher in IAcc when watching others’ faces as compared to one’s own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the Self condition. Conclusions: Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease interoceptive accuracy. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN

Prediction of Dementia in Primary Care Patients

BACKGROUND: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. METHODOLOGY/PRINCIPAL FINDINGS: We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe). After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort). Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV) and 97.8% negative predictive value of (NPV) for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort) the PPV for AD was 39.1% (52% for any dementia) in the test cohort. CONCLUSIONS: The prediction score has useful prediction accuracy. It can define individuals (1) sensitively for low cost-low risk interventions, or (2) more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs